Working with children with obsessive compulsive disorder

1. Children with OCD are a special challenge for nursing staff. 2. Children with OCD often are unable to comply with preexisting behavior management programs at child psychiatric units. 3. Each child who enters an inpatient unit must be viewed as an individual, separate from his or her diagnosis, and what works for one patient with a particular diagnosis may not work for another patient with the same diagnosis. 4. A special plan devised with input from the entire nursing team is the best way to ensure that continuity of care is carried out among all staff on the unit.     

The contribution of a cultural perspective in understanding and evaluating client satisfaction

Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.     

Ready or Not: Transitioning from Institutional Care to Community Care

Federal legislation has moved toward the support and expansion of home- and community-based alternatives to nursing home placement. Despite the seemingly positive nature of these efforts, the question remains as to whether individuals, families, and communities are prepared for this shift in long-term care. Furthermore, there has been a lack of attention to the impact of nursing home transition programs on family caregivers, community resources, and the availability of appropriate housing alternatives. Although nursing home transition programs offer a promising alternative to institutional care, the authors suggest a closer examination of the policies and practicality of these transitions is needed.     

The changing world of long-term care: a state perspective

Based on data from an eight year longitudinal study of Ohio's long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despite an increasing disabled older population, nursing home occupancy rates have fallen from 92.5% to 83.5%. At the same time, in-home service and assisted living use has increased. The paper concludes by describing how such changes are likely to impact the system of the future.     

Biopsychosocial nursing assessment: a way to enhance care plans

1. A psychiatric nursing assessment tool reinforces the primary nursing care model; re-establishes nursing's input at comprehensive treatment plan meeting; reorients the staff to the total nursing needs of the client; and provides a tool for establishing nursing diagnoses. 2. Implementation of the nursing assessment form has educated other staff about professional nursing practice, as well as promoted a greater understanding of the nursing process and reinforced accountability for the nurses. 3. The form enables clients to be viewed from a holistic biopsychosocial nursing context, and nursing care plan recommendations are more individualized and inclusive of the total aspects of patient needs.     

Homeward bound. Broadening student experience with home visits

1. Because of patients are rapidly discharged after medication stabilization or crisis resolution, tertiary care in the home is emerging as an integral part of current psychiatric care. Students miss a valuable opportunity to participate in psychosocial rehabilitation if the clinical rotation is limited to an inpatient setting. 2. Guiding the client toward mental stabilization is the process of psychiatric care; outcomes are most apparent in the home. 3. Nursing is moving into psychiatric case management and continues to provide home care as a traditional role. Student home visits promote awareness of nursing responsibilities to families beyond the institution.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

Intersections of care: an analysis of culturally competent care, client centered care, and the feminist ethic of care

Many of us work within a healthcare field, but do we think about the meaning of the care that we provide? This paper examines three approaches to practices in the caring professions; culturally competent care, client centered care, and the feminist ethic of care, in an effort to discover if and where the three intersect. Although philosophically similar, the essence of caring practice discovered in this examination resulted in the simple equation: Provider knowledge and skills + client respect = client empowerment. An examination of the meaning of this formula and its implication for practice is included.     

Health Care Providers' Experiences with Problem Gamblers

The purpose of this study was to document health care providers' awareness of problem gambling and frequency of recognition and treatment. An exploratory survey was designed to collect data on awareness and knowledge of problem gambling. A structured questionnaire was completed anonymously by 180 health care providers (nurses, physicians, social workers, and other allied health professionals). Almost all respondents (96%) reported knowledge of problem gambling, and 30% reported asking clients about gambling problems when they presented with stress related symptoms. A third of the respondents reported identifying and treating clients for a gambling problem. The most frequently reported intervention was referral to counseling and other gambling resources. Respondents were generally interested in learning more about gambling problems, particularly those providers who have had a client discuss gambling related concerns. There were no significant differences in findings between provider groups.     

Textual accounts,ruling action: the intersection of knowledge and power in the routine conduct of community nursing work

This paper reflects critically on nursing knowledge-based action, its increasingly scientific and text-based manifestations, and the relevance of these practices for power and powerlessness in nursing. Smith's concept of text-mediated relations of ruling (1990. 1999) provides the analytic frame to investigate how nursing case managers articulate public health services and home support for people with disabilities to specific policies, including fiscal policy. An institutional ethnography shows how a nurse's routine text-mediated assessment and exercise of professional judgement establishes a ruling relation with a client (against her intention), as he is “written up” in organizational texts. The analysis of assessment texts spells out how a local perspective is subdued to the ruling discourse. A general argument is made on the basis of this analysis: nurses participate in ruling through the textualization of their knowledge and in the process it dominates their knowing and acting. An ideological construction of nursing knowledge results. The paper suggests what this means for the profession, nurses themselves, and their clients.     

Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

The United States Department of Veterans Affairs (VA) is facing pressures to rebalance its long-term care system. Using VA administrative data from 2004–2011, we describe changes in the VA’s nursing homes (called Community Living Centers [CLCs]) following enactment of directives intended to shift CLCs’ focus from providing long-term custodial care to short-term rehabilitative and post-acute care, with safe and timely discharge to the community. However, a concurrent VA hospice and palliative care expansion resulted in an increase in hospice stays, the most notable change in type of stay during this time period. Nevertheless, outcomes for Veterans with non-hospice short and long stays, such as successful discharge to the community, improved. We discuss the implications of our results for simultaneous implementation of two initiatives in VA CLCs.     

Cognitive-behavioral therapy for obsessive-compulsive disorder: review of treatment techniques

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.     

Geropsychiatric education programs. Providing skills and understanding

1. The treatment of mental health problems is a growing concern in long-term care facilities; up to 80% of nursing home residents suffer from some type of mental illness, but most receive no active treatment. 2. Nursing home staff do not receive sufficient training on mental health issues, the aging process, and assessment and management of psychiatric symptoms in the elderly. 3. Psychiatric nurses can provide a number of quality geriatric mental health programs to increase staff knowledge and promote quality of care.     

Obsessive-compulsive disorder: suffering in silence

Obsessions and compulsions vary in frequency and intensity. Many individuals have habits that cause minimal or no disruption of their lives. OCD, however, causes significant distress and interference with daily life. The problem may go unnoticed by anyone except the involved individual, or it may involve family, friends, and acquaintances. The disorder can be disabling, adversely affecting a student personally, socially, and occupationally. Those who are significantly affected by OC symptoms are encouraged to seek treatment. Behavior therapy and medications are extremely beneficial in helping to relieve symptoms of OCD. Clomipramine and fluoxetine (Prozac) are new drugs available in the US that appear to be effective for OCD symptoms. Several other anti-OCD medications may be available in the US within the next few years. It is important that students and others on campus be made aware that OCD is more common than previously recognized, that more persons with OCD are seeking help, and that effective treatment is available. This "secretive," often disabling disorder is more open now, and it is to be hoped that more individuals will take advantage of current, effective evaluation and treatment modalities.     

State commitment to home and community-based services: effects on independent living for older unmarried women

This study examines the impact of state variation in commitment to the provision of home and community-based services on the living arrangement outcomes of older unmarried females with functionallimitations. We combine data from the 1990 U.S. Census of Population (PUMS) with state-level information on long-term care home and community- based service expenditures, nursing home bed availability, and Medicaid nursing home costs from a special report that compares state variation in long-term care systems. Using multilevel logistic regression modeling techniques, we find that the risk of institutionalization compared to community living arrangements is reduced as spending for home and community-based services at the state level increases. We discuss these findings in light of policy changes during the 1990s.     

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.     

Effect of Brief Staff‐Assisted Career Service Delivery on Drop‐In Clients

Brief staff‐assisted career counseling services based on cognitive information processing theory were evaluated using 138 drop‐in clients who completed pre‐ and postintervention self‐report measures of knowledge about next steps, confidence in making next steps, and anxiety about career concerns. Significant changes occurred in each dimension and were significantly associated with the quality of career adviser interaction. Participants rated the experience as highly positive. Decreases in anxiety about career concerns were unrelated to the intervention. Implications include that a brief service delivery model yields positive outcomes for many clients but requires adjustments in organizational culture, physical environment, practitioner approaches, and client expectations. Future research should examine relational variables related to decreased anxiety with a brief service delivery model, the degree to which this approach works with specific career needs, and client attributes leading to successful versus unsuccessful outcomes with this model.     

Exposure to Client Trauma,Secondary Traumatic Stress,and the Health of Clinical Social Workers: A Mediation Analysis

While it is widely acknowledged that providing services to traumatized populations may negatively impact the mental health of clinicians, little is known about the impact of exposure to traumatized clients and secondary traumatic stress on the physical health status of clinicians. As such, the twofold purpose of this study was to: (1) document the prevalence of STS in a national (US) sample of clinical social workers, and (2) to examine the relationships between exposure to client trauma, STS, and perceived health of clinical social workers. Specifically, we sought to determine if STS mediates the relationship between exposure to client traumas and perceived health. Results indicate clinicians experience intrusion symptoms most frequently, and a significant portion report arousal and avoidance symptoms. Mediation analyses revealed that exposure to traumatized client populations indirectly influenced clinical social workers’ physical health perceptions by way of secondary traumatic stress. Findings call for increased attention toward prevention and amelioration of secondary traumatic stress symptomology among direct service providers, given both its prevalence and potential impact on physical health. Directions for future research are discussed.     

Elder Abuse:

Elder abuse in Québec has been defined as a social problem since the late 70s. Many changes in policies, social practices, and laws are proposed as scientific knowledge is still growing. Using research methodology in criminology, elder abuse is defined and the impact of violence and neglect towards elders in the community, family and nursing home settings investigated. This paper critically examines the current knowledge gained through research on elder abuse in Québec and offers suggestions for future progress on this issue.