Showing papers in "Journal of Psychosocial Nursing and Mental Health Services in 1994"

Examining the sexual assault victim: a new model for nursing care

Abstract: 1. A sexual assault nurse clinician or examiner is a registered nurse who has been specially trained to provide comprehensive care to sexual assault survivors. She usually is certified by her local institution after completing a training program of approximately 40 hours. Demonstrated competence in conducting a comprehensive evidential examination also is required. 2. All forensic examinations of the sexual assault survivor in the emergency department should include treatment and documentation of injuries, treatment and evaluation of sexually transmitted diseases, pregnancy risk evaluation and prevention, crisis intervention and arrangements for follow-up counseling, and collection of medicolegal evidence while maintaining the proper chain of evidence. 3. The role of the nurse examiner involves providing comprehensive care for the survivor and working cooperatively with other individuals in the legal system.

Depression in African-American women.

Abstract: Depression is an increasing problem for African-American women. These women are experiencing role changes and additional stressors. Depressed African-American women may perceive themselves as being devalued within American society and may have fewer support systems to buffer stressful conditions (Carrington, 1980). Depressive symptoms may escalate into clinical depression, which can erode quality of life for African-American women. Psychiatric mental health nurses can be instrumental in developing protocols and individualized interventions that respond to the psychological and physical needs of their depressed clients and promote an improved quality of life.

A Health Profile of Spousal Alzheimer's Caregivers: Depression and Physical Health Characteristics

Abstract: 1. For caregivers of persons with Alzheimer's disease (AD), each day holds unexpected challenges and losses of personal control. Both physical and emotional health are at risk for caregivers of persons with AD. 2. Depression is a problem for caregivers, whether the spouse with AD remains in the home or has been transferred to a nursing home. 3. It is important for clinicians to advise caregivers that depression is a treatable disorder. When a caregiver complains of sleep problems, a red flag for depression should go up.

Telephone counseling interventions with caregivers of elders.

Abstract: 1. The use of the telephone in therapy has been documented in the care of disabled persons and persons with cancer and can be used with other populations. Telephone counseling is a feasible addition to the repertoire of assistance programs available. 2. The use of telephone counseling as an in-home intervention addresses some of the major limitations of out-of-home interventions, such as travel, making arrangements for an alternate caregiver, and worry due to absence from the care recipient. Telephone counseling also provides a means of reaching isolated or rural caregivers who have few or no available services. Telephone care can be a cost-effective, time efficient, and culturally acceptable intervention. 3. Telephone counseling has a potential value with caregivers comparable to the outcomes derived from pioneer mental health services, such as crisis intervention, suicide hot lines, and information and referral services. Nurses and other health care workers are encouraged to respond to the opportunities and challenges, as well as the promises, of telephone counseling intervention.

The importance of relationships in fostering hope.

Abstract: 1. A person with mental illness, such as schizophrenia, can be mobilized to maintain hope. 2. A relationship seems to be the catalyst that allows hope to develop exponentially. 3. A belief in the client's abilities can be a powerful motivator for change.

Inspiring hope in the oncology patient.

Abstract: 1. Cancer is a life-threatening disease that creates an uncertain and foreboding future, yet it is because of this uncertain future that hopes can be accommodated. 2. Inspiring hope is an intervention that can be used with many nursing diagnoses, especially when feelings of helplessness, hopelessness, powerlessness, and depression are present. 3. Most individuals are "hoping" ones, but at times the hoping process must be assisted. 4. The nurse can inspire hope by understanding the hoping process; offering nursing encouragement; and incorporating such skills as presence, touch, active listening, reality surveillance, and values clarification.

Cost-effectiveness and quality of care provided by clinical nurse specialists

Abstract: Clinical nurse specialists in psychiatric-mental health nursing provide primary mental health services to prevent and treat minor mental illnesses and collaborate with physicians to provide mental health services to those with complex mental and/or physical illnesses CNSs practice in a wide range of settings and in rural and urban areas Eliminating bureaucratic, attitudinal, legal, and insurance barriers to the services of CNSs in psychiatric mental health nursing can improve access, lower costs, and enhance the quality of mental health delivery systems Nurses can eliminate some of these barriers Within bureaucratic organizations, such as hospitals and clinics, nurses can document problems and experiment with collaborative models of practice that make full use of their skills Nurses must be active participants, including taking on leadership roles, in committees that address changes in patient and health care policies in their organizations Changing attitudes by educating the public--as well as other health care providers and politicians--about the roles and credentials of nurses is instrumental to removing barriers Brochures about the roles and credentials of nurses can be prepared and disseminated to patients, civic organizations, other health care providers, and politicians Nurses should never miss an opportunity to address one of these groups! Demonstrating excellence in nursing practice leaves a lasting impression on patients and other health team members Implementing innovative approaches to care based on current literature in nursing and related areas is an advanced practice expectation Further documentation of the impact on cost and quality of care by nurse providers is necessary Legal and insurance barriers are the most resistant to change(ABSTRACT TRUNCATED AT 250 WORDS)

Interventions to improve the AMA-discharge rate for opiate-addicted patients.

Abstract: 1. The nursing staff of a chemical dependency unit were troubled by the unit's high against medical advice (AMA) discharge rate. Almost half (46%) the hospital's total AMA discharges (0.9%) were occurring on this 14-bed unit. 2. It was discovered that opiate-addicted patients comprised 26.5% of the unit's AMAs, while representing only 15% of total admissions. At one point, as high as 50% of the opiate-addicted patients were discharged AMA. 3. Many treatment issues and ethical dilemmas are encountered with AMA discharges, such as staff demoralization and debate over who should pay for AMA discharges. 4. Use of the Endicott-Watson Subjective/Objective Opiate Withdrawal Scale yielded a 60% improvement in the AMA discharge rate. When a community resource link was put into place, there was an additional 1% improvement, making the overall improvement rate 61%.

Adult survivors of childhood sexual abuse: survivor's disclosure and nurse therapist's response

Abstract: Recent literature pertinent to adult survivors suggests that childhood sexual abuse is a serious problem, and that disclosure is on the rise. The aftereffects of childhood sexual abuse can cause dysfunction in various aspects of the survivor's physical and mental health. Understanding the traumagenic dynamics of childhood sexual abuse and its aftereffects provides direction for the nurse therapist during both the client's disclosure and intervention planning. This knowledge assists the therapist in promoting mental health and healing, as well as providing comfort for the therapist. The nurse therapist's reactions to the client's disclosure can affect the way the client feels about disclosure and the therapeutic relationship. If a negative message is conveyed to the survivor at the time of disclosure, the feelings of betrayal, stigmatization, and powerlessness that the survivor experienced as a child will be replicated. This can damage the therapeutic relationship and delay the healing process. When disclosure is received and acted upon in a sensitive, therapeutic manner, the survivor is empowered and can enter with the nurse therapist into an effective therapeutic alliance. Nurse therapists should gain awareness of the types of emotional responses that can be engendered in the health professional during disclosure. Awareness of these emotional reactions can lead to the identification of coping strategies useful to both the therapist and the adult survivor. Coping strategies useful to the therapist include maintaining adequate boundaries, understanding oneself and one's responses to sexual-abuse issues, utilizing ongoing consultation or supervision, and preventing burnout.(ABSTRACT TRUNCATED AT 250 WORDS)

Methadone Anonymous: A 12-Step Program: Reducing the Stigma of Methadone Use

Abstract: 1 Methadone is a synthetic narcotic that relieves the craving for heroin Methadone enables the former heroin addict to feel well and unimpaired by side effects, and be free of heroin hunger 2 Methadone Anonymous (MA) is a 12-step program (similar to Alcoholics Anonymous and Narcotics Anonymous) for individuals with addictions who are in methadone treatment programs 3 The MA program at our facility in New York has been extremely successful Patients carry the message to new sites and leave information for potential groups Requests for information are received weekly, both from neighboring states and even abroad

Tacrine: A Pharmacological Approach to Alzheimer's Disease

Abstract: Overall, studies of the effect of tacrine on the cognitive symptoms of AD are inconclusive. Small (1992) gave some insight into this variability of results by stressing that different research methods can generate different outcomes. Small also pointed out that there is an inherent weakness in the Mini Mental State Examination (MMSE)--a tool used in most, if not all, AD studies. The MMSE is not sensitive to subtle and real changes in mental function. Regardless of the inconclusiveness of these studies, research must continue in order to tease out the variables contributing to clinically significant gains found in some studies. Anecdotal observations, combined with the previously summarized clinical trials, indicate that a subgroup of AD patients may hope to benefit from tacrine. At a geriatric clinic with which the author is associated, prospective patients and their families are told that tacrine helps about 10% to 20% of those who take it. Further, they are instructed that tacrine seems to be most helpful if given early in the disease process and that it is relatively expensive. Treatment with tacrine costs about $1,000 to $1,500 per year (Anderson, 1993). The maximum dose of tacrine is 120 mg per day, and there is a relatively high incidence of side effects. The most serious side effect of tacrine is liver toxicity, which occurs in up to 30% of the patients taking this drug. Elevations in serum aminotransferase levels occur with the same frequency and therefore must be closely monitored. Additionally, 20% of patients taking tacrine develop nausea and vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Magazine Photo Collage: A Multicultural Assessment and Treatment Technique

Abstract: Bring home now the book enPDFd magazine photo collage a multicultural assessment and treatment technique to be your sources when going to read. It can be your new collection to not only display in your racks but also be the one that can help you fining the best sources. As in common, book is the window to get in the world and you can open the world easily. These wise words are really familiar with you, isn't it?

As-needed psychotropic medications: prevalence, indications, and results.

Abstract: 1. Approximately 50% of inpatients are receiving p.r.n. psychotropic medications. 2. The most prevalent reasons reported in the literature for giving p.r.n. medications were to prevent/contain agitation, physical aggression, disruptive behavior in children, and aggressive behavior in children. 3. Nurses are responsible for providing a safe milieu; nurses must have the option of giving p.r.n. medications to protect patients and staff members.

A critique: Watson's caring ideology. The proper focus of psychiatric nursing?

Abstract: 1. Watson's (1989) conceptualization of care possesses limited clinical utility in psychosocial contexts, given that there already exists an extensive lineage of human concepts of helping, within various psychotherapeutic traditions. 2. Watson's (1989) use of language delimits any utility that the "caring" construct might possess, Watson's conceptualization of caring is an inappropriate focus for psychiatric nursing, and historical precedents exist for many of the propositions upon which the science of caring is based. 3. Four decades of psychiatric nursing practice research and education render Watson's notion of a "science of caring" redundant.

Beyond discharge: telephone follow-up and aftercare.

Abstract: 1. Decreased length of stay, inadequate aftercare service, and insufficient attention on the part of professionals to the immediate difficulties of postdischarge adjustment have made the transition from psychiatric hospital back to the community more difficult. 2. Telephone follow-up and aftercare groups ease the patient's transition from hospital to community, help to prevent rapid readmission, and provide a feedback loop to the staff on discharge planning. 3. Little is known about the immediate postdischarge experience for patients and its effects on long-term adjustment. Extended contact with the discharged patient is an ideal way to begin to collect such data.

A report on staff injuries and ambulatory restraints: dealing with patient aggression

Abstract: 1. During a 6 1/2-year period on a unit designed for repetitively aggressive male patients, nursing staff members were the recipients of 95% of aggressions and 97% of serious injuries. 2. Two-point ambulatory restraints, called Preventive Aggression Devices (PADS) help liberate the patient from prolonged seclusion, but in a safe manner. 3. Patient aggression is underreported; there is a need for a standardized aggression reporting system across facilities. Language: en

An ethical dilemma: risk versus responsibility.

Abstract: 1. In the psychiatric community, two highly profitable diagnoses currently are filling psychiatric hospitals: dissociative disorder and multiple personality disorder. Certainly these patients need help, and psychiatric nurses are well-qualified to plan their scope of care. However, when the hospital reported on in this article exploited these diagnoses by encouraging practices that extended lengths of stay and restricted patient's rights, the nurses were forced to speak out as advocates for the patients. 2. The dissociative disorder unit housed 10 patients billed at an intensive care unit rate of $1,200 per day. One patient's average fee per day was $1,560; multiply this by 10 patients, and the hospital received $15,600 per day from this unit alone. 3. Financial calculation is not what nurses are used to thinking about; indeed, it somehow seems unbefitting to link nursing care with any mention of monetary gain. Yet, this is exactly the sort of information that nurses must have in order to understand how hospital politics may influence their situation.

The Healing Process for the Multidisciplinary Team: Recovering Post-Inpatient Suicide

Abstract: 1. With an inpatient suicide, the staff may experience grief for a variety of reasons. The staff member's perception of self as a competent mental health care provider may be destroyed. The caregiver may grieve the loss of an ideal. Some inpatient staff members mistakenly believe that suicide can always be prevented and that the multidisciplinary team can accurately assess all patients. 2. To successfully mourn a loss, Worden (1982) identified four tasks of grieving that must be completed: accept the reality of the loss; experience the pain of grief; adjust to an environment in which the deceased or lost object is missing; and withdraw emotional energy and reinvest it in another relationship. 3. Interventions to promote healing post-inpatient suicide must be aimed at individual caregivers and the multidisciplinary team. Individual caregivers will differ in their responses based on experiences, beliefs, values, and culture. Language: en

Examining violence in the workplace. A look at work-related fatalities.

Abstract: This study identified only 6 out of a possible 33 homicide classifications for workplace violent crime. As expected, the largest number of offenders represented authority killings. Half that number, however, had the largest number of victims and were classified as nonspecific homicide. Interestingly, there is a high number of domestic homicides occurring in the workplace. One could speculate that as families break up, addresses and telephone numbers easily can be changed--but not necessarily employment. Victims are sought out at their places of employment and killed there. Argument/conflict homicides, which were expected to be high, accounted for only 7 homicides. Another important finding was the large number of suicides in this offender group. An important implication of this study for nurses is that violence in the workplace sometimes can be anticipated and possibly deterred. Hospitals and other facilities--with proper preparation and training of employees, and implementation of strict protocols--can become safer workplaces. In the event that workplace violence does occur, however, the nurse can be prepared--and perhaps save his or her life.

Clients' perceptions of involuntary hospitalization.

Abstract: Because involuntary hospitalization involves the restricting of an individual's autonomy and choice, the challenge in nursing practice is to listen to the client's perceptions and then to set "limits in a humane and least restrictive manner to assure the safety of the client and others" (American Nurses' Association, 1982). However, the danger is that limits may be used to enforce socially desired behavior beyond what is necessary for safety (Garritson, 1983). Study results indicate that clients can clearly offer many specific ideas about their health care experience and needs. These perceptions offer an experiential grounding in the process of offering sensitive, relevant, quality care. Because nursing is a client-centered process, studies on clients' perceptions of care experiences are an area in which nurses can make a major research contribution. Implementation of care based on these client-centered studies could offer significant administrative and practice contributions. The client wants to be heard; nurses have an opportunity to take an active role.

Bibliotherapy: a valid treatment modality. Research-based practice.

Abstract: Clients seem already to be reading on their own for help with difficult life situations. As nurses we can further help clients by referring them to appropriate literary resources.

Anticholinergic syndrome. Avoiding misdiagnosis.

Abstract: Anticholinergic syndrome can develop in multiple clinical situations. The disturbance of the central nervous system muscarinic transmission by acetylcholine antagonists or lack of acetylcholine can result in this unpredictable behavioral syndrome. Health care professionals should do the following: Be familiar with common drugs or drug combinations that may induce this condition; Be aware of patients who may be at greatest risk; Be able to identify the cluster of signs and symptoms of anticholinergic toxicity; and Implement appropriate nursing treatment interventions for patients with anticholinergic syndrome. Because this condition is constantly changing, it often is misdiagnosed. Much remains to be studied and understood about the neurophysiology of this condition. Central cholinergic transmission is blocked with the use of many anticholinergic drugs in numerous patient settings. Because acetylcholine plays a significant role in modulating the interactions among most other central transmitters, excessive blockage of this neurotransmitter may result in the unpredictable behavioral condition known as anticholinergic syndrome.

The Developmentally Disabled, Psychiatrically Impaired Client: Proper Treatment of Dual Diagnosis

Abstract: 1. As many as 30% to 35% of all developmentally disabled persons have a psychiatric impairment. Nurses must be aware that in a developmentally disabled client, psychiatric impairments are frequently exhibited as negative behaviors. 2. Nursing interventions are the same as those used in general mental health settings, but are adapted to the client's needs. If needed, nurses should encourage the full range of psychiatric medications. 3. Care of these patients requires undertaking much investigative work and review of old files, interviewing persons who know the client well, and doing some guess work.

Psychosocial assessment for treatment planning and evaluation.

Abstract: 1. Use of standardized measures to document a client's psychosocial status and circumstances yields readily interpretable data. These data can provide a basis for treatment selection and make possible reliable documentation of change. 2. Identification of the best measure(s) for a particular purpose requires consideration of the reason for the assessment, intended use of the data, characteristics of instruments, capabilities of respondents, and available resources. 3. Increased use of measures can advance efforts to obtain rigorous and comparative data in psychosocial nursing research and practice. Such information advances science, develops clinical acumen, and documents the results of interventions.

Schizophrenia family work: mental health nurses delivering an innovative service.

Abstract: 1. Mental Health Nurses (MHNs) have an unique role in providing care to the mentally ill. The Thorn Nurse Initiative designed to prepare and evaluate the work of MHNs has been successful in providing nurses with the skills of Family Work for Schizophrenia. 2. The effectiveness of family work in improving MHNs' knowledge of and attitudes about schizophrenia has been demonstrated, and there is increasing evidence of the efficacy of MNHs in delivering family work. 3. The impact of schizophrenia on families tends to go unrecognized, and there is an urgent need to train nurses in family work to help families cope with this illness. 4. Families are extremely valuable and a positive resource for clients. The emphasis of family work is to promote and support all families in improving their knowledge of schizophrenia, and its effects, and in developing their coping skills.