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.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Achieving spiritual wellness: using reflective questions.

Health care professionals are increasingly recognizing the importance of spiritual health as a precursor of physical health. As we emerge into the 21st century, we must place greater emphasis on promoting spiritual wellness so that clients do not develop spiritual distress. Assisting clients in developing their spiritual wellness is a rewarding experience for nurses. As health care providers, we have the opportunity to educate the public about spiritual wellness to prevent physical problems. Attentiveness to one's spirit is a key component to healing and becoming a whole person. With guidance, clients can initiate a plan to maintain their own spiritual needs.     

Managed care. The effect of case management on state psychiatric clients.

This study examined whether case management services, mandated under the managed care contract for adult clients in a medium-sized state psychiatric hospital in Tennessee between July 1996 and June 1997, were offered as specified, and the impact these services had on recidivism for individuals who were identified as having a severe or persistent mental illness. Although all of the clients were offered case management, 47% refused the service. Of the 14 who had one or more readmissions, six (43%) had case management. These findings demonstrate that health care providers must offer sufficient information to their clients so that they can use the managed care system more effectively.     

How Effective are Interventions to Enhance Adherence to Psychiatric Medications? Practice Implications for Social Workers Working With Adults Diagnosed With Severe Mental Illness

This study integrates eight systematic reviews of adherence enhancement interventions to develop practice guidelines for social workers who work with adults who do not adhere to prescribed psychiatric medications. Findings indicate that existing investigations are disparate in their adherence definitions, methodologies employed, and sampling strategies, rendering it difficult to construct overall guidelines for social work practice. However, themes associated consistently with increased adherence are collaboration between clients and providers regarding medication decisions, consistent follow-up care, and a comprehensive network of professionals and caregivers who support clients in their use of medication to facilitate stabilization of mental health symptoms.     

An empirically derived typology of mentally ill group home residents.

The classification of clients in terms of psychiatric diagnosis or level of functioning is a logical prerequisite to the conduct of quality of care assessments in mental health care. This article reports on efforts to create a typology of mentally ill group home residents based on a variety of measures of functioning. Subjects for the study come from a probability sample of 253 group home residents in Michigan. A three group typology, derived through cluster analytic procedures, is presented along with-evidence supporting its validity. Implications of the typology for program evaluators and service system planners are briefly addressed.     

Chronic care,integrated care,and mental health: Moving the needle now

Healthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.     

Evaluation of the Alumni Program. A shared-care model for psychosis

This article describes the results of a prospective, naturalistic evaluation of the Alumni Program, conducted by the Psychotic Disorders Clinic at the McMaster Site of Hamilton Health Sciences, Hamilton, Ontario, Canada. The Alumni Program is a form of continuing psychiatric support offered to individuals with psychosis. The program involves providing shared care by both the specialist psychiatric team and the family practitioner. This model has been in operation for more than 8 years. The clinical data have been reviewed to determine whether the program is beneficial in supporting clients with their health maintenance goals, thus reducing occurrences of relapse, hospital readmission, and crisis or emergency room visits. The results appear favorable and affirm the Alumni Program is one viable method of follow up within a comprehensive range of psychiatric services.     

Self-Care Practices and the Professional Self

ABSTRACT

Consistently and actively engaging in self-care has been shown to improve the performance of mental health practitioners by reducing burnout, vicarious trauma, compassion fatigue, and other stress-related psychological problems. Not only is this important to the individual practitioner’s well-being, but ethical standards also mandate the recognition and remediation of any physical, mental, or emotional self-impairment to maintain high standards of care for clients. Professionals in small communities, like the Deaf community, however, confront unique challenges in attending to their self-care. This article investigates these challenges—as well as the rewards—experienced by Deaf and hearing counselors working in mental health care with deaf clients.     

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

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.     

The pros and cons of physical restraints & behavior controls.

1. Nurses are often the victims of abuse in psychiatric settings. Employing physical and chemical restraints or behavior controls on violent or potentially violent clients has strong arguments supporting and refuting it. 2. There is a concern that restraints and behavior control techniques are morally unacceptable because their use is incompatible with respect for an individual's autonomy. 3. Those who support the use of physical restraints and behavior controls base their arguments on patient and staff safety. 4. By nature of the profession, nurses accept the responsibility of total patient care, including the well-being of abusive patients as well as others on the ward.     

Understanding Italian American cultural norms

The components of Italian American culture in many ways provide a striking contrast to current American beliefs, values, and living habits. The challenge to the psychiatric nurse lies in maximizing the strengths of this culture to enhance the individual's ability to be what he or she can and chooses to be within the Italian culture and within the broader context of contemporary American society. By being culturally well informed and sensitive, and sharing goals and expectations with clients (Louie), the psychiatric nurse will be accepted and trusted to provide the kind of high quality care that will ultimately have a positive impact on the mental health status of Italian Americans.     

Transition from the hospital to the community: small group program.

1. Clients in a psychiatric hospital often experience loss of control over their lives and dissatisfaction with their quality of living. A small group rehabilitation program can counteract the effects of institutionalization and restore a sense of mastery to chronic psychiatric clients. 2. The therapeutic nurse-client relationship provides consistency and stability for clients who must cope with the stress of the mental health system and the transition to a community setting. 3. The program strives to restore individuals' self-confidence and dignity, improve their quality of life, and decrease the frequency and length of hospitalization.     

Current treatment of generalized anxiety disorder

Generalized anxiety disorder is the most common anxiety disorder and is second only to depression as the most common disorder diagnosed in primary care. Because it is potentially disabling due to its high comorbidity with other psychiatric conditions, psychiatric nurses must accurately diagnose GAD and formulate individualized treatment plans that promote positive outcomes for clients with this disorder.     

Impact of the Most Frequently Reported Traumatic Events on Community Mental Health Clients

This survey of 354 community mental health clients examined the relative impact of client self-reported events that they deemed “most traumatic” for predicting posttraumatic stress syndrome (PTSD) symptom severity. Results of the voluntary survey revealed the most traumatic lifetime events to be (in descending order of frequency): sudden death of a loved one, sexual abuse, physical abuse, suicide attempt, and having been in a serious/life-threatening accident. These factors were then tested for gender differences, and regression models were developed to test the predictive power of traumatic events relative to primary diagnosis, psychosocial well-being, other key psychiatric indicators, and drinking to cope with negative emotions. Results demonstrated that sexual abuse was reported to be among the strongest predictors of PTSD symptom severity. Separate regression models also revealed important gender differences. Implications for social work assessment of seriously mentally ill clients are suggested.     

Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.     

Understanding those who self-mutilate

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.     

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.     

Practical ways psychotherapy can support physical healthcare experiences for male survivors of childhood sexual abuse

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2009), which is intended to help healthcare providers from all disciplines understand the effect of child sexual abuse on some survivors' abilities to access and benefit from health care. This paper discusses what psychotherapists can learn from the healthcare experiences of the male survivors who participated in this project. It also offers practical suggestions for supporting male clients who experience difficulty seeking treatment for physical health concerns.     

Pilot study results: the psychiatric RN case manager.

1. It is important to examine client and staff satisfaction with the RN case management (RNCM) model to enhance the quality of care in psychiatric settings. 2. Ninety-two percent of clients surveyed ranked the RNCM care as "excellent" or "above average." Clients valued most the humanistic role of the RNCM and repeatedly commented on the importance of the nurse being caring, genuine, and supportive. 3. RNCMs expressed high satisfaction with their role, which they described as collaborative with the psychiatrist, yet also professional and independent. Psychiatrists expressed a high degree of confidence that clients were receiving excellent care by competent nurse professionals.