A balancing act. Continuing education for staff nurses

Basic nursing education programs prepare nurses as generalists. Continuing education programs for psychiatric nurses are needed to provide additional knowledge and expertise in this specialty area. 2. This educational program was developed for psychiatric staff nurses who have completed their orientation but are new to their institution or to the psychiatric clinical area. 3. Content of the program includes an overview of theories, therapeutic relationships, psychiatric terminology, the nursing process as it relates to patients with psychiatric problems, psychotropic medications, electroconvulsive therapy, and DSM-III R. 4. A pretest based on the content of this program can help assess the learning needs of each new nurse. The nurse may then attend the entire program or only specific parts based on individualized needs.     

THE IMPACT OF INFORMATION AND RISK PERCEPTION ON THE HURRICANE EVACUATION DECISION-MAKING OF GREATER NEW ORLEANS RESIDENTS

This article contributes to the current discussion on how residents living in vulnerable areas make the decision to evacuate when they are in harms way. Key in this discussion is the question, what role does information and risk play in shaping evacuation behavior? This study used a sample of respondents from the greater New Orleans region (Orleans, Jefferson, and St. Bernard Parishes) of the Twelve Parish Survey (N = 1,207) conducted prior to Hurricane Katrina. The findings indicate that information sources are vitally important in the evacuation process. By examining the role of information from authorities, family, and friends; visual imagery; and the media we found that individuals use a variety of sources when they decide to evacuate. Further, the importance of visual imagery in the evacuation process is discussed. The article concludes with a discussion of the implications of information dissemination and its importance to members of the media and public policy makers.     

How to work with elderly patients on a general psychiatric unit

Currently, there are specialized geropsychiatric units being used for elderly psychiatric inpatients. However, these units are not always available to the growing elderly population. The general inpatient psychiatric unit seems to be well suited for treating the medical and mental illness of elderly psychiatric patients (Billig, 1989; Conwell, 1989; Liptzin, 1987). As identified earlier, nurses may not be enthusiastic about adding this population to their unit. Our society is youth-oriented and the elderly tend to be viewed as slow, needy, and sick. It is essential for nurses to explore their own feelings regarding aging and what it means to be old. If the nurse has not dealt with issues such as her own mortality and that of her parents and close friends, it may be difficult for her to understand and work with the elderly. The ability to understand the feelings of another and to communicate this understanding has been identified as a crucial variable related to positive therapeutic outcome (Kirk, 1982). Inservice programs and groups that give the staff opportunities to explore their attitudes and feelings toward the elderly may result in more effective therapeutic interventions (Farley, 1983). To many elderly patients, nurses are seen as supportive figures, interpreters of the unknown, and potential allies who have an empathic regard for them (Davis, 1968). The nurse can use these impressions to initiate interventions. This, along with coming to terms with one's own feelings about aging, can result in a greater understanding of these patients. This article has given a very brief overview of the many issues related to the care of the elderly psychiatric inpatient.(ABSTRACT TRUNCATED AT 250 WORDS)     

When disaster strikes. The concerns of staff nurses

1. This study determined how involvement with an earthquake affected patient care delivery and ascertained what nurses need to continue providing safe and efficient care in future disasters. 2. Although 60% of the staff had experienced a previous disaster, the literature described that learned coping does not automatically "transfer" to present loss experiences. 3. Providing staff with debriefing sessions and other support groups is helpful in the post-trauma period. At all levels, there is a need to communicate concerns and to be involved in disaster drills and other disaster preparedness sessions.     

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.     

What If Hurricane Ivan Had Not Missed New Orleans?*

Author's Note: As I was developing the hypothetical situation depicting a devastating hurricane striking New Orleans, Louisiana, the disaster waiting to happen threatened to become a reality: Hurricane Ivan, a Category 4 hurricane (140 mph winds) fluctuating to a Category 5 (up to 155 mph winds), was slowly moving directly toward New Orleans. Forecasters were predicting a one‐in‐four chance that Ivan would remain on this direct path and would be an “extreme storm” at landfall. In reality, the storm veered to the north and made landfall east of Mobile Bay, Alabama, causing devastation and destruction well into the central Gulf shoreline and throughout the Southeast and the mid‐Atlantic states.     

Break-up of New Orleans Households after Hurricane Katrina

Theory and evidence on disaster-induced population displacement have focused on individual and population-subgroup characteristics. Less is known about impacts on households. I estimate excess incidence of household break-up due to Hurricane Katrina by comparing a probability sample of pre-Katrina New Orleans resident adult household heads and non-household heads (N = 242), traced just over a year later, with a matched sample from a nationally representative survey over an equivalent period. One in three among all adult non-household heads, and one in two among adult children of household heads, had separated from the household head 1 year post-Katrina. These rates were, respectively, 2.2 and 2.7 times higher than national rates. A 50% higher prevalence of adult children living with parents in pre-Katrina New Orleans than nationally increased the hurricane's impact on household break-up. Attention to living arrangements as a dimension of social vulnerability in disaster recovery is suggested.     

Disaster mental health services: a personal perspective

1. Services that may be provided by psychiatric-mental health nurses following a disaster include education, intervention, problem solving, advocacy, and referral. 2. Nurses providing disaster mental health services must be flexible and creative. Strong observational skills and teamwork are also essential characteristics in disaster settings. 3. Psychiatric-mental health nurses who wish to receive training for disaster mental health volunteer opportunities should contact their local chapter of the American Red Cross.     

Challenges faced by inpatient child/adolescent psychiatric nurses

Inpatient nurses work to engineer an environment in which patients and staff are physically and psychologically safe. A recent research study on an adult psychiatric unit examined the dimensions involved in keeping the unit safe. The four dimensions included ideology, people (staff and patients), space, and time. In this article, we discuss how these dimensions apply to real-world efforts to keep child and adolescent inpatient units safe. We also discuss the challenges nurses face within each of these safety dimensions, including those arising from fluctuating acuity, staffing formulas, surveillance of physical space, and entrenched unit cultures.     

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.     

Simulation to enhance care of patients with psychiatric and behavioral issues: use in clinical settings

Nurses with a medical-surgical clinical focus often care for patients with psychiatric and behavioral issues in acute care hospitals. This article describes how hospital staff and nursing and theater department faculty joined forces to develop realistic simulated psychiatric scenarios for use by practicing nurses.     

Challenges in Counter‐disaster Measures for People with Functional Needs in Times of Disaster Following the Great East Japan Earthquake

This article describes the three major challenges that were identified and their possible solutions are proposed in counter‐disaster measures for “people with functional needs in times of disaster (PFND)” following the 2011 Great East Japan Earthquake. First, recent developments in preparedness measures for PFND in Japan have been uncritically relying on the assumption that hazard maps represent “correct” estimates of future hazardous events, which are based on the maximum probable event (MP_rE) framework. In reality, however, a maximum possible event (MP_oE) has occurred in the Tōhoku regions. This has tremendous implications for fundamentally re‐thinking the entire hazard estimation process from a MP_rE to MP_oE framework. Second, counter‐disaster measures for PFND have focused mainly on warning and neighborhood‐based evacuation assistance activities. Needs for shelters and temporary housing units that were specially designated for PFND arose following the earthquake. However, their provisions were neither systematic nor universal due to the lack of pre‐planning. More detailed guidelines for specially designated shelter and temporary housing operations need to be developed in order to address this issue. Third, people with disabilities (PWD) became invisible in shelters and communities or in the eyes of local government administrators. This was due to the fact that a majority of PWD did not ask for help in evacuation shelters because they felt general shelters were not “barrier free” and were unresponsive to their functional needs. Furthermore, many local government administrators felt hesitant to release their PFND registry to non‐governmental and self‐help organizations that were eager to check the whereabouts and current situations of PWD. This was due to the fear of breaking the Personal Information Protection Bylaw despite the fact that the bylaw provided exceptional conditions, where the onset of disaster was clearly one of these exceptional conditions. Further elaboration and education on the use of personal information of PFND during a disaster period is needed among public and local government administrators.     

“Gimme a Pigfoot and a Bottle of Beer”: Food as Cultural Performance in the Aftermath of Hurricane Katrina

In the aftermath of Hurricane Katrina and the federal levee failures, hundreds of thousands of volunteers went to New Orleans to help rebuild. Food was quickly used as a way to welcome volunteers, to compensate them for their hard work, to celebrate progress in rebuilding community, and to interact with others. In time, however, the giving and consuming of food was renegotiated. Volunteers coming to New Orleans expected meals representative of New Orleans's foodways. This article looks at the cultural performance of food in the aftermath of Hurricane Katrina. In particular, I analyze the symbolic exchanges of food in what I call performances of reciprocity and performances of solidarity. This study adds to the burgeoning work in symbolic interaction on food, especially as it pertains to progressive spaces of cultural politics.     

Evaluation of an experience-based program to understand the concept of recovery among hospital-based psychiatric nurses

This study aimed to implement an experience-based program to promote the understanding of the concept of recovery, which is defined as a meaningful life and valued sense of integrity based on subjective and individual viewpoints, among psychiatric nurses working in hospitals in Japan and to evaluate this program. Methods: We conducted a preliminary survey of nurses at six facilities with psychiatric wards. The experience-based program was conducted for 12 nurses who expressed a wish to participate. The program spanned three days and consisted of lectures, assertive community treatment (ACT) staff visits for recovery orientation, and group work. Results: The mean Recovery Knowledge Inventory of nine participants ultimately included was 3.41 points (SD, 0.28) before the program and 3.69 points (SD, 0.24) after the program, indicating a significant difference (p = .004). Categories obtained from ACT support experiences included the following: “Continuing to attend to the need to live in one’s community/home regardless of how bad psychiatric symptoms become without the use of medicines,” “Viewing the person living their life in a place where they belong and in their own individual style,” “Valuing the patient’s wishes is the slow but sure way to a fruitful relationship,” and “Become familiar to the patient and their family’s lifestyle by carefully listening to the family’s feelings”. Discussion: We believe that this program can help establish the concept of recovery in hospital, which tend to rely on the medical model, and enable daily nursing practice to be implemented from a strength-based viewpoint.     

The psychiatric technician: trespasser or welcomed ally?

1. The increasing shortage of nurses, higher patient acuity levels, and greater demands placed on nursing to meet standards of care have contributed to the use of psychiatric technicians to alleviate the burden on nursing and ensure the delivery of quality patient care. 2. Psychiatric technicians provide care for a select group of patients under the supervision of the primary nurse. The patients assigned to psychiatric technicians require minimal direct nursing intervention. 3. Psychiatric technicians reported increased self-confidence and self-esteem; the nurses were able to perform more professional nursing activities, increasing their job satisfaction and promoting staff retention; and the patients received high-quality care.     

Violence,Police and Riots in New Orleans Political Culture: 1854–18741

Abstract Through an analysis of four major riots in New Orleans between 1854 and 1874, this paper examines the central role of local police forces in the violent New Orleans political culture. Through this analysis, the paper questions the extent to which not just exclusion, but political violence, is embedded in American republicanism. From the re-integration of the city in 1852 well into the Jim Crow era, police forces served as party operatives in New Orleans, insuring through violence that their party won majority on the city council or losing their positions, en masse, if they did not. These patterns of mob violence highlight the remarkable extent to which majority approval figured over rule of law in mid-nineteenth century republicanism.     

ADJUSTING TO UNCERTAINTY: COPING STRATEGIES AMONG THE DISPLACED AFTER HURRICANE KATRINA

This study examined the coping strategies of individuals displaced after Hurricane Katrina. Following the evacuation of New Orleans, surveys were administered to those individuals displaced by Katrina and relocated to shelters or in Disaster Centers in Cape Cod, Massachusetts; Lansing, Michigan; different parts of Indiana and Kentucky; and federal aid distribution centers throughout Texas. Results indicated that talking, staying informed, and praying emerged as predictors of changes in psychological stress during relocation. Differences emerged in coping strategies based on gender, race, and income; however, age did not emerge as a factor. Recommendations are made to use these results for postcrisis response and coordination.     

On public sector psychosocial nursing: a conceptual framework

1. Nursing practice is driven more by its environment than by knowledge provided by faculty or even strong relationships between faculty and staff. Because that environment is publicly supported, programs reflect changes in the ideological environment. 2. The psychosocial nursing specialty incorporates psychiatric/mental health nursing and social sciences to reduce the negative environmental influences while increasing the positive ones. 3. Public sector psychosocial nurses must be familiar with changing laws and regulations as well as the history of hospital and community programs for the mentally ill; understand the complexity of society and that the state hospital is only one component of a large system; and contribute to the development of their subspecialty.