Showing papers in "Journal of Psychosocial Nursing and Mental Health Services in 2004"

Reducing Seclusion and Restraint Use in Mental Health Settings: Core Strategies for Prevention

Abstract: 1. The use of seclusion and restraint (S/R) is traumatizing to consumers and staff, interrupts the therapeutic process, and is not conducive to recovery. 2. Six effective strategies to reduce S/R use have been identified and are low cost, easily replicable, and publicly available. 3. Organizations that wish to reduce S/R use need to embrace a prevention approach, follow the tenets of continuous quality improvement, and develop a reduction plan individualized for that facility. 4. Highly visible, consistent, and effective organizational leadership appears to be the most significant and critical component in any successful S/R reduction initiative.

Sensory approaches in inpatient psychiatric settings: innovative alternatives to seclusion & restraint.

Abstract: The national initiative to decrease the use of seclusion and restraint in psychiatric inpatient settings requires innovative methods to facilitate the processes of consumer self-organization, self-care, and positive change. Sensory-based approaches and multisensory rooms are valuable resources as cultures of care shift to become more responsive and collaborative. This article explores the importance and efficacy of trauma-informed approaches that are sensory supportive, address the individual needs of the person, and strengthen the therapeutic relationship.

The family's role in person-centered care: practice considerations.

Abstract: Effective implementation of person-centered care requires a shared understanding and commitment to make it a reality by administrative personnel, direct care providers, and residents and their family members. Long-term care facilities must seek ways to engage residents' families in person-centered care through its training, policies, care planning, and documentation. Doing so may require revisions to policies and work practices, and ongoing leadership efforts to maintain this care framework within the realities of staff turnover and regulatory requirements. Developing protocols and procedures that facilitate family members' communication with staff and build consensus and shared values will result in a system that represents and honors the unique perspectives, values, and needs of each resident receiving care. It is important for facility leadership to set the tone for acknowledging the importance of family involvement in person-centered care by modeling acceptance of concerns and criticisms as valid and by acknowledging that direct care providers, residents, and their family members have a voice in care decisions. Such an approach has the greatest chance of success in promoting person-centered care and the shared values necessary to ensure its successful implementation.

Stigma and help seeking related to depression: a study of nursing students.

Abstract: The stigmatization of people with mental illnesses and its effect on help-seeking behaviors have been identified by the Surgeon General and the President's New Freedom Commission on Mental Health as significant issues on the nation's health care agenda. Negative perceptions regarding depression and its treatment contribute to the 30,000 suicides committed annually in the United States. Nurses have the potential to exert tremendous influence toward overcoming this problem, contingent on their attitudes toward depression and its treatment. As nurses and future nurses, students enrolled in both a basic and degree-completion baccalaureate program comprised a sample that represented the influence of the educational process. This descriptive, correlational study measured attitudes toward an individual with depression, described in a vignette, and personal help-seeking intention, and examined the effects of personal variables on help-seeking intention. Students who believed depression was not under personal control were more likely to endorse help seeking for themselves. Individuals who were women, older, upperclassmen, and Catholic reported greater acceptance of seeking psychological help. The role of the psychiatric-mental health nursing class and rotation were identified as improving stigmatizing attitudes and increasing help-seeking intention.

Mindfulness meditation: a path of transformation & healing.

Abstract: As nurses, we have the unique privilege of witnessing and nurturing the healing process of the whole person--mind, body, and spirit. Teaching mindfulness meditation is a nursing intervention that can foster healing. The consistent practice of mindfulness meditation has been shown to decrease the subjective experience of pain and stress in a variety of research settings. Formal and informal daily practice fosters development of a profound inner calmness and nonreactivity of the mind, allowing individuals to face, and even embrace, all aspects of daily life, regardless of circumstances. By emphasizing being, not doing, mindfulness meditation provides a way through suffering for patients, families, and staff. This practice allows individuals to become compassionate witnesses to their own experiences, to avoid making premature decisions, and to be open to new possibilities, transformation, and healing.

Relocation to a long-term care facility: working with patients and families before, during, and after.

Abstract: Permanent relocation of a dependent older adult to a long-term care facility can occur for a number of reasons, including the need for postacute care or a higher level of care than can be provided in a less-restrictive environment, and/or the inability of family members or others to care for the individual in a noninstitutional setting. Outcomes of institutional placement may be either negative, such as the older adult experiencing relocation stress syndrome, or positive, such as improved management of chronic illnesses and reversal of functional decline. This article offers a review of the factors that predict when and where older adults will relocate for institutional long-term care, an overview of individual transitions to institutional care, and suggestions for seamless transitions during the preinstitutionalization, transitional, and postinstitutionalization phases of relocation, which are guided by a transactionist approach to stress and coping.

Nurses' attitudes toward people with mental illnesses in a psychiatric hospital in Singapore.

Abstract: A positive attitude toward people with mental illnesses is a necessary dimension of psychiatric nursing practice. Although studies have been conducted in Israel and Australia to examine the attitudes of nurses toward people with mental illnesses, no such study had been conducted in Singapore. This study explored the factors influencing nurses' attitudes toward and their involvement in caring for people with mental illnesses, and sought to establish the relevance and effects of mental health training on enhancing the nurses' positive attitudes. The study used a descriptive, self-administered questionnaire, which contained 24 statements scored on a Likert scale. Factors related to attitudes toward people with mental illnesses included age, professional qualification, years of psychiatric nursing experience, type of ward, and designation (i.e., position within the institution). The questionnaires were given to all of the local nurses working in a psychiatric hospital in Singapore, and 96% returned the questionnaires. Results showed that nurses with any of the following characteristics had a more positive attitude: age group of 31 to 50; professional qualification of advanced diploma in mental health nursing, nursing degree, or post-basic certificate; or more than 10 years of psychiatric nursing experience. In addition, nursing officers had a more positive attitude than staff nurses or assistant nurses, and nurses working in the short-stay wards had more positive attitudes than those working in the long-stay wards.

Understanding the emotional aspects of infertility: implications for nursing practice

Abstract: Approximately 10% to 15% of childbearing-age couples experience infertility Infertility has multiple aspects, including physical, emotional, financial, social, and psychological effects Although most health care professionals are more aware of problems related to physical aspects of infertility, the difficulties and needs that arise from the emotional aspects are often more significant for couples Thus, it is crucial that health care professionals, particularly nurses, understand these needs This article provides some practical information to help nurses do just that

A chuckle a day keeps the doctor away: therapeutic humor and laughter.

Abstract: There are several beneficial efforts attributed to humor and laughter, including improved immune function, increased pain tolerance, and decreased stress response. Humor therapy, laughter therapy, laughter meditation,and laughter clubs all have unique implications as group programs and as self-management techniques. For practitioners to implement credible programs and effectively teach self-management techniques, further empirical research on the physical, psychosocial, debonafide, and the placebo effects of humor and laughter needs to be conducted.

Understanding those who self-mutilate.

Abstract: Self-mutilating behavior is a symptom seen in both men and women with various psychiatric disorders, but the majority of those who self-mutilate are women with borderline personality disorder. This complex, maladaptive behavior is used by clients as a means of self-preservation and emotion regulation, and is often associated with childhood trauma. Clients who self-mutilate perceive they receive poor care in hospital emergency departments and are retraumatized by these experiences. Clinicians who understand the complexity and purposes of self-mutilating behavior are better able to provide clients with supportive, empathetic care.

Stigma & Help Seeking Related to Depression: A Study of Nursing Students

Abstract: The stigmatization of people with mental illnesses and its effect on help-seeking behaviors have been identified by the Surgeon General and the President's New Freedom Commission on Mental Health as significant issues on the nation's health care agenda. Negative perceptions regarding depression and its treatment contribute to the 30,000 suicides committed annually in the United States. Nurses have the potential to exert tremendous influence toward overcoming this problem, contingent on their attitudes toward depression and its treatment. As nurses and future nurses, students enrolled in both a basic and degree-completion baccalaureate program comprised a sample that represented the influence of the educational process. This descriptive, correlational study measured attitudes toward an individual with depression, described in a vignette, and personal help-seeking intention, and examined the effects of personal variables on help-seeking intention. Students who believed depression was not under personal control were more likely to endorse help seeking for themselves. Individuals who were women, older, upperclassmen, and Catholic reported greater acceptance of seeking psychological help. The role of the psychiatric-mental health nursing class and rotation were identified as improving stigmatizing attitudes and increasing help-seeking intention.

Spirituality and mental health clients.

Abstract: Spirituality is an important part of human existence but is often overlooked in the conceptualization of the person as a biopsychosocial entity. This article examines spirituality as a concept, relates it to the experience of mental health clients, proposes spiritual assessments and interventions within the role of advanced practice mental health nurses, and discusses the necessity of including spiritual interventions to support healing and wholeness for mental health clients.

Long-term effects of teaching behavioral strategies for managing persistent auditory hallucinations in schizophrenia.

Abstract: 1. Attendance at a 10-week class designed to teach behavioral management strategies to people with schizophrenia was effective in reducing some of the negative characteristics of auditory hallucinations for 12 months and in reducing anxiety for 9 months after completion of the class. 2. The sustained improvement experienced by class participants was characterized by their voices being less frequent and more mumbled and the participants feeling more in control, less distractible, and less anxious. 3. Participants recommended that other mental health consumers take similar classes to learn how to better manage their voices. 4. Monthly support groups may help participants maintain gains lost during the follow-up period.

The emerging self in conceptualizing and treating mental illness.

Abstract: 1. The course of severe mental illnesses is more heterogeneous than previously thought and is influenced by many complex, interacting factors. 2. The experience of self and capacity to cope of people with mental illnesses contribute to the recovery process. 3. Changes in traditional treatment models and a focus on broader societal interventions are needed to facilitate recovery. 4. Psychiatric nurses play an important role in these new developments as evident, for example, in the 3R Program (relapse, recovery, and rehabilitation).

Serotonin syndrome and the use of SSRIs.

Abstract: Nurses need to become more aware of serotonin syndrome to avoid its development and to ensure a therapeutic response when early symptoms emerge. While polypharmacy tends to put individuals at greatest risk for the syndrome, use of a single serotonergic agent may also provoke an adverse response. Because the onset and progression of serotonin syndrome are rapid, prompt action may be needed to avoid potentially life-threatening consequences.

Redefining consumer roles: changing culture & practice in mental health care settings.

Abstract: The creation of positions for CSPs is a phenomenon with a promising future for the delivery of mental health services. People who have direct experiences are the ones who best know the possibility of recovery from mental illness. They are the only ones who can serve as role models for others, providing them with hope and inspiration. With courage and determination, CSPs will make good partners with non-consumer providers, each needing to listen and learn from the other to work together effectively and to keep the wishes of those they serve as their highest priority.

Homophobia: A Challenge for Psychosocial Nursing

Abstract: 1. In 1975, the American Psychological Association stated that homosexuality was not a disorder and that homophobia was a form of prejudice based on stereotypes. 2. Because homophobia, like racism or sexism, is learned, it can be unlearned. 3. People who feel homosexuality is a choice hold more negative attitudes toward individuals who are gay, lesbian, bisexual, or transgendered. 4. Homophobia not only damages individuals who are gay, lesbian, bisexual, or transgendered, but also limits heterosexuals by locking them into rigid gender-based roles.

Primary care update for mental health nurses: evidence-based guidelines for nursing assessment, intervention, and follow up.

Abstract: Physical health comorbidities are often undiagnosed or undertreated in individuals with severe and persistent mental illness. Mental health nurses are in an ideal position to identify, refer, and monitor treatment of these comorbidities. National evidence-based practice guidelines provide key information about common physical health comorbidities that mental health nurses can readily use in their everyday practice.

Using scrapbooks & portfolios in group work with women who are chemically dependent.

Abstract: This article provides a rationale and strategies for using scrapbooks and portfolios within the context of group work with minority women recovering from chemical dependence. An expanded model of recovery-based group work places the use of scrapbooks and portfolios within the context of a practice model that seeks to increase general and social self-efficacy in these women. Memory scrapbooks, lifecourse scrapbooks, and recovery portfolios are defined; their differential use in group work is described; and ways group members can use the tools to strengthen their sources of self-efficacy are explored.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Review of Treatment Techniques

Abstract: Obsessive-compulsive disorder (OCD) is a chronic, impairing condition with an estimated lifetime prevalence in adults of 2.5%. Controlled treatment trials have demonstrated that cognitive-behavioral therapy (CBT) is an effective intervention for OCD. However, many individuals diagnosed with OCD do not receive appropriate, empirically validated interventions, perhaps due to limited knowledge of CBT among mental health practitioners. This article provides a review of CBT for OCD. Issues related to treatment delivery and assessment are presented and highlighted by an individual example.

Dying patients' thoughts of ending their lives: a pilot study of rural New Mexico.

Abstract: Forty-nine hospice patients in rural New Mexico were directly interviewed concerning their thoughts about ending their lives Thirty-one patients (63%) did not have thoughts of ending their lives, whereas 18 patients (37%) reported having suicidal thoughts There were no differences between patients with and without thoughts of suicide related to gender; ethnicity; age; education; disease; religion; importance of religion; location of hospice agency; remaining financial, family, or spiritual issues; satisfaction with hospice care; sum of hospice personnel seen; or sum of medical equipment used There were significant differences between patients with and without thoughts of suicide related to the number of household members (p = 02); the symptoms of trouble sleeping (p = 04) and nervousness (p =03); and Medicare insurance coverage for hospice care (p =01) No other symptom, including pain and hopelessness, was significant Seven (39%) of the 18 patients who thought of ending their lives told someone about these thoughts There were no variable differences between patients who did and did not tell someone about these thoughts

Staff and Client Perceptions of Unit Quality: A Pilot Study

Abstract: This pilot study compared psychiatric health care team members' perceptions of unit quality with discharged clients' perceptions of quality of care received on the unit. The staff members were from four different service units in one acute care psychiatric facility. The study used the Perceptions of Unit Quality (PUQ) scale, a valid and reliable outcome measurement instrument, developed by Cronenwett. Most quality assurance instruments that exist have focused on individual caregivers' or service-specific views of quality, but the PUQ scale allows quality assurance data that represent team performance to be described through team perceptions of quality. Results of this pilot study suggest that use of the PUQ scale, in conjunction with clients' perceptions of unit quality, may be a legitimate approach in continuous quality improvement efforts in psychiatric-mental health care centers.

Shaken baby syndrome: assessment, intervention, & prevention.

Abstract: Child abuse and neglect continue to be parts of a disturbing reality in both the United States and the world. Despite significant advances in the identification and treatment of child abuse, health care professionals are still attempting to grasp the extent of the physiological and psychological effects of child maltreatment and injury. Child abuse, in all of its forms, is preventable, and more must be done to decrease its incidence. Shaken baby syndrome is one of the most deadly and devastating forms of child abuse and is characterized by a traumatic brain injury caused by the violent shaking of an infant. Recognition of high-risk families, combined with education of parents and other caregivers are key to prevention of shaken baby syndrome.

Relationships Between Incarcerated Women: Moving Beyond Stereotypes

Abstract: 1 Described as one of the "pains of imprisonment," separation may be particularly difficult for women in prison because most functioned in multiple relational roles, including mother, wife, girlfriend, daughter, sister, and friend, before incarceration 2 In the absence of consistent contact with family, friends, and other loved ones outside prison, incarcerated women may seek to develop connections with other inmates as a way to adapt to life in prison 3 Positive adaptation may allow incarcerated women to take advantage of educational/vocational, parenting, and drug treatment programs offered in prison, thus facilitating their adaptation after release

A different kind of caregiving support group.

Abstract: 1. Support groups are an important and frequent source of help for caregivers of older adults who experience a high degree of physical and emotional stress. However, not every participant feels comfortable speaking in a group setting. 2. Writing is a form of emotional expression that has been shown to produce both physiological and psychological benefits. Use of narrative writing as an adjunct to traditional group therapy methods has not been studied. 3. In this pilot project, use of writing within the support group format provided caregivers with an additional strategy for coping with the stressors of caregiving. Participants' physical and mental health improved significantly after participating in the group. 4. Therapeutic writing can be used independently or in a group to enable emotional expression. Nurses who work with caregivers can help develop interventions that use narrative writing as a method to improve coping.

Historical interpretations of alcohol use and misuse. implications for nursing curricula.

Abstract: Since the 1950's, nursing schools have been encouraged to include some formal content on alcoholism in their curricula. Yet there remains on immerse disparity between the prevalence of drug and alcohol problems in our society and the required number of hour on these topics in our nursing curricula. The International Nurses Society on Addictions calls on the nursing profession to promote healthy lifestyles for "at-risk" individuals. In a historical context, this article critiques the ambivalence related to alcohol use and misuse in the United States. Within that background, pedagogy to help nursing faculty and students meet current societal and professional demands and standards regarding intervention for alcohol-related problems will be explored. The constructivist educational and caring-educative models are highlighted. Language: en

Rational emotive behavior therapy: disputing irrational philosophies

Abstract: This article provides an overview of the concepts and techniques of rational emotive behavior therapy to distinguish it from cognitive-behavioral therapy. Rational emotive behavior therapy proposes that psychological disturbance is largely created and maintained through irrational philosophies consisting of internal absolutistic demands. This therapy strives to produce sustained and profound cognitive, emotive, and behavioral change through active, vigorous disputation of underlying irrational philosophies.