Showing papers in "Journal of Psychosocial Nursing and Mental Health Services in 2003"

The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment

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Workplace stress among psychiatric nurses. Prevalence, distribution, correlates, & predictors.

Abstract: Vicarious trauma and burnout are serious manifestations of workplace stress. Both can have substantial consequences for health care professionals, health services, and consumers. This article reports results of a study examining the prevalence, distribution, correlates, and predictors of vicarious trauma and burnout among registered psychiatric nurses (RPNs). A survey was distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The survey contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief Scale (i.e., a measure of vicarious trauma), and a section on symptoms of posttraumatic stress disorder (PTSD). The RPNs were found to be experiencing high levels of emotional exhaustion (i.e., high burnout) and even higher levels of personal accomplishment (i.e., low burnout). No significant differences were found between respondents' total scores on the Traumatic Stress Institute Belief Scale and instrument norms for mental health care professionals. Predictors of burnout and vicarious trauma also are presented in this article. Stress experienced by RPNs, as well as strengths on which to build, clearly are evident in the study results. Strategies for reduction in workplace stress may benefit psychiatric nurses, clients, and health services.

Cultural perspectives of death, grief, and bereavement.

Abstract: The cultural makeup of the United States continues to change rapidly, and as minority groups continue to grow, these groups' beliefs and customs must be taken into account when examining death, grief, and bereavement. This article discusses the beliefs, customs, and rituals of Latino, African American, Navajo, Jewish, and Hindu groups to raise awareness of the differences health care professionals may encounter among their grieving clients. Discussion of this small sample of minority groups in the United States is not intended to cover all of the degrees of acculturation within each group. Cultural groups are not homogeneous, and individual variation must always be considered in situations of death, grief, and bereavement. However, because the customs, rituals, and beliefs of the groups to which they belong affect individuals' experiences of death, grief, and bereavement, health care professionals need to be open to learning about them to better understand and help.

Positive Attitude: An Essential Element for Effective Care of People with Mental Illnesses

Abstract: It is well known that attitudes influence behavior, and attitudes toward people with mental illnesses have been described as negative, stigmatizing, uninformed, and fearful. The general public view people with mental illnesses as dangerous, prone to violence, unpredictable, and in some measure responsible for their illnesses. Health care professionals share these attitudes to a surprising extent, which compromises their ability to deliver competent, compassionate care. Nursing students' perceptions of people with mental illnesses are reflective of those held by the general public. The purpose of this descriptive study was to determine whether a curriculum that embeds psychiatric nursing principles in a course focused on care of people with chronic illnesses and uses specific fear-reduction teaching strategies, would have a positive effect on students' attitudes toward people with mental illnesses. Using an adaptation of Yucker's attitude scale, a test of nursing students' (n = 38) attitudes before and after completion of the course was conducted. Students' attitudes were significantly more positive at the completion of the course. The findings suggest that exposure to factual information about mental illnesses, the opportunity to interact with people with mental illnesses, emphasis on treatment options, and use of fear-reduction strategies positively affected students' attitudes toward people with mental illnesses.

Loss by suicide. A risk factor for suicidal behavior.

Abstract: 1. Data show suicidal behavior often is precipitated by individuals' experience of loss by suicide. This article focuses on three potential links between the two phenomena (i.e., grief experienced by suicide survivors and familial risk factors for suicide; suicide clusters and pacts; consequences of mass media portrayals of suicide). 2. Suicide bereavement has certain typical characteristics that comprise the "suicide survivor syndrome" and may be linked with increased risk of suicidal ideation and behavior. 3. Individuals' suicidal behavior and ideation can lead to suicide clusters (i.e., a group of suicides or attempts occurring close together in time and space) and pacts (i.e., mutual agreements between two people who promise to kill themselves at the same time, often in the same place). 4. Mass media portrayals of suicide may lead to imitative suicides (i.e., the "Werther effect").

Women's adjustment to widowhood. Theory, research, and interventions.

Abstract: 1. People respond differently to loss and grieve in their own time. 2. Frequently, the hardest time for new widows is after the funeral. 3. Young widows often have no peer group and generally are less prepared emotionally and practically than older widows to cope with the loss. 4. Widowhood often causes financial stress because a major income source is lost with the death of a husband.

Effects of suicidal behavior on a psychiatric unit nursing team.

Abstract: 1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.

Child and adolescent homicide survivors. Complicated grief and altered worldviews.

Abstract: The act of homicide may influence the worldviews of children and adolescents. Problematic beliefs of uncertainty, inadequacy, perceiving the world as dangerous, self-denial, and lack of control can contribute to complicated grief in children and adolescents, and can potentially disrupt their normal psychosocial growth and development. Mental health professionals' understanding of grief after the homicide of a family member enhances their ability to intervene with and support young people struggling to cope with and adapt to a sudden loss.

Psychological effects of violence on forensic nurses.

Abstract: 1. Forensic nurses frequently work in violent settings without regard for self-preservation to save the lives of injured individuals or investigate the deaths of deceased individuals. 2. Cases involving children and victims with disfiguring injuries, and incidents when their personal safety was compromised are most disturbing to forensic nurses. 3. Providing means for health care professionals to cope appropriately encourages healthy healing. 4. Forensic nurses must learn to self-assess and recognize the signs and symptoms associated with unhealthy coping, depression, or posttraumatic stress disorder.

Benefits of community meetings in the corporate setting after the suicide of a coworker.

Abstract: When an employee commits suicide, his or her coworkers are confronted unexpectedly with issues related to the sudden traumatic death. Being inundated with questions, grappling with acceptance of the loss, and exploring how this could have happened are factors that can complicate the bereavement process and delay a return to workplace homeostasis. Understanding the dynamics and issues related to grief and bereavement after sudden traumatic death potentially can accelerate the recovery process and promote restoration of workforce normalcy for employees and organizations. This can be significantly important to corporate managers and administrators who must maintain ongoing productivity despite such disruption, while promoting adaptive coping for their employees.

Mental health literacy beliefs. A comparison of psychiatric trained nurses and enrolled nurses in Singapore.

Abstract: The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.

Effectiveness of a training program for ECT nurses.

Abstract: Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.

Psychiatric nursing & medication adherence.

Abstract: A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenge imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).

PRN medication use in inpatient psychiatry.

Abstract: 1. Administration of p.r.n. medications occurs frequently for staff nurses in inpatient psychiatry. 2. The appropriate use of p.r.n. medications is not well addressed in nursing textbooks or hospital policies and procedures. 3. Thorough assessment of patients is an essential step in the safe administration of p.r.n. medications. 4. Concise, accurate clinical evaluations may be the most successful way to determine the best dose of medication for each patient.

SSRI-related hyponatremia among aging adults.

Abstract: A frail, 90-year-old nursing home resident it was demonstrating symptoms of depression. Her symptoms included lethargy, social withdrawal, and depressedmood and affect. To treat these symptoms, fluoxetine (10 mgper day) was initiated. Fourteen days later, tthepatient's depressive symptoms became worse, and she unexpectedly fell while ambulating. Her serum electrolyte levels were evaluated, and hyponatremia (129 mEq/L) was noted. As, a precaution, fluoxetine was discontinued, andfluid restrictions were instituted. Two weeks later, her serum sodium level was within normal range (135 to 145 mEq/L), she could safely ambulate by herself, and her depressive symptoms had diminished.

Users' involvement in their care: A follow-up study

Abstract: 1. User involvement in both care planning and staff development helped staff and residents at a community rehabilitation unit in terms of attitudes and care delivery. 2. Undertaking follow-up work shows progress in care management for staff and in social skills development for residents. 3. The results of this study provide clear indications of positive progress and identify a few areas where work still need to be done to improve care.

NURSING INTERVENTIONS FOR Parasuicidal Behaviors IN FEMALE OFFENDERS

Abstract: Parasuicide refers to the nonfatal, intentional, self-injurious behaviors frequently exhibited by individuals with features of a borderline personality disorder. In correctional systems, the rate of parasuicidal behavior among incarcerated female offenders can be high and intertwined with complex behavioral and social issues. Nursing interventions in the management and treatment of parasuicidal behaviors incorporating the principles of dialectical behavior therapy have been developed and implemented at the authors' institution. This treatment approach provides practical, effective nursing interventions including pretreatment orientation, strategies for use with threats to self-harm and during self-harming episodes, and follow-up treatment.

The Four S Model in action for de-escalation. An innovative state hospital-university collaborative endeavor.

Abstract: In this article, the Four S Model is presented as a working clinical framework for generating structured nursing interventions and treatment plans. The de-escalation process, formalized by the De-escalation/Alternative to Restraint Flowsheet, is one way in which the model is being operationalized to reduce seclusion and restraints. As shown by the flowsheet, the model allows for integration of mental health and mental illness. It spans the scope of nursing practice at all levels, from para-professional to advanced practice nurse, by integrating the mental health concepts of communication, leadership, clinical judgement, critical thinking, and caring within its framework. Most important, the flexibility to individualize treatment that is built into the model allows for generalization to all psychiatric presentations.

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals.

Abstract: The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.