The latex allergic psychiatric patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.     

More responsibility, less control: psychiatric survivors and Welfare State restructuring

This paper is concerned with the implications of recent Welfare State restructuring for psychiatric survivors' citizenship status. Using the Province of Ontario as a case study, the paper examines the extent to which recent change in mental health care and social assistance programs has worked to facilitate or constrain survivors' ability to exercise control over their lives. Despite recognition of the importance of survivors' participation in the mental health care system in the late 1980s, recent years have seen a return to a more traditional treatment paradigm characterized by professional control. Concurrently, restructuring of social assistance programs has led to a decline in the real value of income supports and growing pressure on informal support networks. As a result, psychiatric survivors are increasingly held responsible for their own material well-being and public conduct, but are less able to exercise control within everyday life.     

The impact of expert evidence on care proceedings

There has been an increased demand for expert child psychiatric opinion in child care cases where social services have instigated care proceedings under the Children Act 1989. However, there has been little evaluation of this work in terms of whether such a referral changes the care plan of the referring social work agency or the outcome for the child. This article examines the contribution to care proceedings of assessment reports completed by a child and adolescent forensic psychiatry team in respect of 37 consecutive child care cases. All of the assessments were presented to court and the information was collated once the proceedings were completed. Our findings indicated that the court followed the recommendations of the child psychiatric report entirely in 73% of cases. In addition, in 86% of cases the social service departments reported that they had gained confirmation of their professional opinion. In only 10% of cases did they change their care plan in response to the child psychiatric assessment. In conclusion, the results suggest that in most cases social service departments are using child psychiatry expert evidence merely to validate and/or lend support to their original care plans. Copyright © 1999 John Wiley & Sons, Ltd.     

School Reintegration and Perceived Needs: The Perspectives of Child and Adolescent Patients During Psychiatric Hospitalization

Youth hospitalized with psychiatric illness often experience disruption in their school attendance. Knowledge from the youths’ perspective of concerns for returning to school after hospitalization is very limited. Exploring youths’ concerns for school reintegration may inform transition practices for youth with psychiatric illness. The purpose for this study was to explore youths’ concerns for school reintegration and to report their perceived needs for support before leaving hospital. A questionnaire was developed to capture qualitative perceptions and quantitative self-reports of youths’ concerns for school reintegration. Child and adolescent patients accessing in-patient psychiatric care completed surveys containing open-ended questions about their concerns and service needs at discharge, and self-ratings of their concerns for their studies, friends, other students and emotions. One hundred and sixty-one youth (mean age 15.41, SD 1.4; 75% female; 57% with a primary diagnosis of major depression) reported considerable concerns about anticipated social situations at school, academic standing, feeling overwhelmed with school and great difficulty with managing their emotions. Youth identified a need for ongoing supports from mental health professionals and school personnel, social support from friends and family, and educational assistance or modifications. High rates of intense worries reported about school issues and school reintegration suggest this vulnerable population may benefit from increased attention to transition planning. Two important developmental domains, social development and educational outcomes, appear at-risk and this risk highlights the need for a greater emphasis on continuity of care.     

Brief admission program. An alliance of inpatient care and outpatient case management

1. Brief planned and crisis admissions to an inpatient psychiatric unit are presented as a component supportive of outpatient care and case management for chronically mentally ill patients. 2. Typical patients admitted to this inpatient short-term program are those experiencing a life stress or temporary crisis; chronically mentally ill patients who cycle and experience exacerbations of their illness; and those who need to make the transition from an acute inpatient unit to community living. 3. The Brief Admission Program treats the individual's response to and the consequences of a lifelong illness and enables the patient to return to his previous level of functioning and continue necessary outpatient treatment.     

Are nonprofit prisons an alternative? Some experiences in the Netherlands

Outsourcing of detention is complex due to quality risks from incomplete contracts, the public responsibility for sentencing and execution, and related social opinions. In the Netherlands, prison services are extensively outsourced—particularly for juvenile detention and internal forensic psychiatric care—to nonprofit organizations. In the Dutch experience, we have not found differences between public and nonprofit execution with respect to the type of contract, costs, performance indicators such as escapes and violence against personnel. The Dutch experience shows that outsourcing to nonprofit organizations can be an alternative to outsourcing to private entrepreneurs.     

Outcomes of a model care coordination program for adults with mental illness under guardianship/conservatorship

Adults with serious and persistent mental illnesses, such as schizophrenia, schizoaffective disorder, and bipolar disorder, who are under guardianship/conservatorship, may experience health care, social, financial, and housing concerns, which can be addressed by care coordination programs. In such programs, providers assist with communication across service sectors, assistance with monitoring of psychiatric care, and support with practical needs. Such programs are understudied in the context of guardianship/conservatorship. Through a review of electronic records for 217 consumers who were enrolled in a model program continuously for 3 years or more, we examined trends before and after enrollment in a model care coordination program for adults with serious and persistent mental illnesses under guardianship/conservatorship. We sought to describe the number of days and rates of hospitalization, emergency room visits, and arrests before and after receiving program services. Comparing utilization among consumers three years pre- to three years post-enrollment, we identified statistically significant reductions in hospitalizations and imprisonment, but no change in state hospitalizations. We also saw some (non-significant) reduction in emergency room visits. Findings provide preliminary evidence of effectiveness of the model program; future efforts could expand its reach to more adults with serious and persistent mental illnesses.     

A proposal for change to achieve competence in long-term psychosocial nursing care

Psychiatric nursing in a large institutional setting presents challenges to the nursing staff, who must remain competent in the specialized areas of psychiatric and medical nursing. Chronically mentally ill individuals present complex and continuing nursing care needs that must be addressed using a holistic approach to nursing assessment and care. The complex needs of nursing staff and patients in an institutional setting have been described. Methods of assisting the nurse to achieve competence using education and experience have been implemented and described with the goal of improving holistic nursing care to chronically institutionalized individuals.     

Don't get bugged: practical strategies for managing bedbug infestation in psychiatric rehabilitation programs

Bedbug infestation has become a major problem in the United States. Infestations can be frightening and expensive and appear to be more prevalent in urban settings and low-income housing such as homeless shelters, public housing, and single-room occupancy apartments. This exposes consumers and staff of psychiatric rehabilitation agencies to higher risk of infestation. This brief report outlines practical suggestions for managing bedbug infestation in such agencies. Drawing on resources readily available on the Internet and the experience of Thresholds, a large provider of psychiatric rehabilitation services based in Chicago, this report describes strategies for responding to infestation. Providers need to assume that bedbug infestation is a significant risk and prepare accordingly. Assertive, persistent, and calm response is recommended.     

Bridging gaps between mind, body, & spirit. Healing the whole person.

Fifty percent of visits of primary care providers are for psychiatric problems making it desirable to screen for mental, addictive, or behavioral disorders at the level of primary care. Psychiatric/mental health nurses prepared at the master's level to practice in the blended clinical specialist/nurse practitioner role are well placed to treat or collaborate in the treatment of people who present with symptoms of physical or psychological problems. The role of the clinical specialist/nurse practitioner is evolving in response to changes in health demographics, epidemiology, scientific and technological advances, and changes in managed care. Advanced practice nursing education must continue to anticipate and meet on-going changes and challenges.     

Can Anyone Here Know Who I Am? Co-constructing Meaningful Narratives With Combat Veterans

The discourse on psychosocial reintegration of combat veterans in the United States has largely been confined to discussions of the best treatment for those diagnosed with psychiatric disorders. Yet analysis of the data indicates that all combat veterans are changed by their experience. It also indicates that the current medical model of treatment is insufficient. The author suggests that another model is called for; one that benefits from psychoanalytic insights on war and violence. A model that supports veterans’ experience of changed consciousness might best help them form a coherent narrative that connects their past lives and combat experience to their lives going forward. She argues that this approach may not have been taken because the same mental processes that cause combat veterans to split off their experiences also cause society as a whole to distance itself from them. Clinicians can be most effective when they create a link to the veteran by acknowledging the veteran as part of society, not a split off aberration, and recognizing the universal role of aggression within and without in creating the war that the veterans fought, and shaping the social response to their return. Literature drawn from psychoanalysis, cognitive neuroscience, and clinicians from the global south is combined with that of military psychiatry and global relief and development to support these positions.     

A Child's Place in Society: New Challenges for the Family and Day Care

SUMMARY. Using the experience of a study of childhood in Denmark, Norway, Finland, Iceland and Sweden, this article explores the now common situation of children growing up in two settings: their families and day care centres. In Denmark, where almost all mothers work and where good quality care is widely available, the family and day care centres are seen as having important complementary roles in supporting children's social development. The child learns to both integrate and separate the experience of these two worlds, more or less successfully depending on how well he or she is developing at home, and the relationship between the home and the day care centre. Day care should be seen as a positive support for family life: dual-socialisation through family and day care is, and will remain, part of the lives of most children.     

Professional support for family caregivers of people with serious and persistent mental illnesses.

1. Professional support for family caregivers of people with serious and persistent mental illnesses is essential to ensuring the well-being of the caregivers and maximizing the functioning of the ill person. 2. Significant percentages of family caregivers had never received critical elements of instrumental and affective support from mental health care professionals. 3. The role of psychiatric nurses encompasses the responsibility to address these deficits, as well as multiple opportunities to do so.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Benefits of psychosocial rehabilitation programming in a treatment mall

Psychiatric patients need educational interventions that help them recover and increase their ability to live and work independently following discharge from the hospital. The psychosocial rehabilitation treatment mall model is designed to meet this educational need. Treatment malls are a new approach to psychosocial rehabilitaion for patients in state psychiatric hospitals. Treatment malls provide psychoeducation and skill-building activities in a centralized, school-like setting for participants from all patient care units. It differs from traditional strategies that use decentralized one-on-one or unit-based models. Treatment malls provide a self-directed learning experience that meets the person-centered needs of participants. Evidence is increasing that this psychosocial educational model can provide lasting benefits for psychiatric patients, including symptom management, reduced psychiatric hospital readmission rates, and improved quality of life.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Life after leaving care: Experiences of young Indian girls

Transition out of residential care to living independently in society is one of the most complex processes for young adults in India. The situation becomes more complicated for girls who are at the risk of gender discrimination in a male dominated society. A quantitative study was conducted to understand the experience of social reintegration of a hundred young girls who had left care in the past four years. The girls' responses on a series of questions regarding their experience of social reintegration in the areas of education, life skill, money management, etc., were computed as the Experience of Social Reintegration Index. Overall, the findings showed that about 50% girls were able to pursue higher education and had savings. In social support, organisational support was available to only one-third of the respondents. It was also revealed that the care-leavers' educational qualification, age of leaving care, preparation for social reintegration, availability of support network and self-esteem were some of the predictors of their nature of experience after leaving care.     

Women Attending High-Risk Substance Abuse Clinics Versus General Obstetrics Clinics

Substance-abusing women experience burdens making attending high-risk prenatal care critical for a healthy pregnancy. Many face barriers that compromise their health by reducing access to care, delaying their first prenatal appointment. One hundred forty-one women attending a high-risk prenatal clinic were compared to a matched group from the hospital’s general obstetrics clinic. Analyses revealed that substance-abusing women with a mental illness attended prenatal care earlier than those without a mental illness. This is important because psychiatric illnesses might precipitate poor reproductive behaviors. Women with HIV also entered prenatal care earlier, which improves reproductive health. Clinicians’ roles are discussed.     

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.