Do you feel powerless when a patient refuses medication?

1. Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication. 2. Overall, nurses were more apt to identify with indirect indicators than they were to identify words that address the concept directly (control and powerlessness). 3. The most common hazard identified in a medication refusal event was the potential for injury, and the individuals most at risk were the nurse giving the medication and other personnel on the unit. 4. The most prominent nursing response to medication refusal was counseling. Nearly all the nurse subjects believed that the medication refusal event negatively influenced nursing care, the patient/nurse interaction, and patient teaching.     

Interpersonal communications task group

Primary nurses can use their theoretical, pragmatic and creative efforts by being involved in groups such as the one mentioned in this article. For those unfamiliar with group work, course and seminars are available through colleges, universities and inservice departments of major hospitals. Even with this knowledge base, adequate supervision by a clinical expert is essential in providing this type of care to patients. Taking on a leadership role, the nurse becomes accountable for presenting effective interpersonal techniques with the hope that the patient would adapt and integrate such skills when he returns to the outside community.     

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)     

Medication management, antidepressant drugs, and the elderly: an overview.

1. Several factors may affect an elderly client's use of medications: polypharmacy, potentially leading to interactions; over-the-counter drugs taken without a physician's knowledge; noncompliance or poor compliance with medication regimens; and ageist beliefs. 2. Psychiatric nurses must be aware that the signs and symptoms they observe may be the result of normal physical or biological aging, psychosocial changes, disease-related changes, medication side effects, or a drug interaction. 3. Nurses must ask two questions when psychotropic drugs are used with elderly clients: What will be the onset, duration, magnitude, and characteristic action of a specific drug in an individual; and What are the characteristics of an "ideal" medication?     

Revising a medication education program on an inpatient child and adolescent psychiatric unit

Adherence to a medication regimen can be challenging for children and adolescents with mental health disorders. Medication education can be a beneficial tool for nurses to help promote adherence to psychotropic medications. This article describes an initiative to improve medication education offered to children and adolescents and their families on an acute child and adolescent inpatient unit in a mental health facility. Strategies included adding a game to medication education groups, creating and distributing medication education handouts, and developing and implementing medication education sessions for parents. When used by the patients and families, the interventions were appreciated. Having successful interventions in place may help meet the diverse educational needs of this population as nurses seek to improve medication adherence.     

Sex differences in observers' reactions to a nurse's use of touch

We tested the notion that male and female observers would have different reactions to the use of touch by a nurse towards a patient in a hospital situation. If males are socialized to favor autonomy and independence and females to favor nurturance and caring, it was assumed that male subjects would rate a nurse as less supportive and competent if a nurse touched a patient. The results (based on reactions to photographs manipulating the level of physical contact that occurred between a nurse and a patient) were generally consistent with these predictions. While the subjects' sex moderated reactions to the nurse-initiated touch, there was an overall pattern for observers to react more favorably to the nurse who used touch compared to no touch in interacting with a patient. The results suggest that nurses and health professionals who use touch in interacting with patients may be judged in part by the attitudes of males and females about the use of touch.     

Psychiatric nursing & medication adherence

A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenge imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).     

The Influence of Agency Staffing on Quality of Care in Nursing Homes

ABSTRACT

Data from a large sample of nursing homes were used to examine the cross-sectional association between use of agency staff, regular staff, and quality. Agency use data came from a survey conducted in 2003 (N?=?1071 nursing homes). The agency and regular staff measures were for nurse aides, licensed practical nurses, and registered nurses. We used a single quality factor constructed from the 14 quality measures in Nursing Home Compare. More agency nurse aides resulted in a smaller increase in quality, compared to the use of an equivalent number of regular nurse aides. Agency registered nurse staff were associated with better quality factor scores, especially in the presence of high levels of regular licensed practical nurses. Our results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.     

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.     

Transnational spaces of care: migrant nurses in Norway

This article argues that international nurse recruitment from Latvia to Norway is not a win–win situation. The gains and losses of nurse migration are unevenly distributed between sender and receiver countries. On the basis of empirical research and interviews with Latvian nurses and families they left behind, this article argues that nurse migration transforms families and communities and that national health services now become global workplaces. Some decades ago feminist research pointed to the fact that the welfare state was based on a male breadwinner family and women’s unpaid production of care work at home. Today this production of unpaid care is “outsourced” from richer to poorer countries and is related to an emergence of transnational spaces of care. International nurse recruitment and global nurse care chains in Norway increasingly provide the labor that prevents the new adult worker model and gender equality politics from being disrupted in times where families are overloaded with elder care loads.     

Coordinating psychosocial nursing care across treatment settings

A criticism sometimes made of nurse practitioners is that they want to be or think they are doctors. Who has not heard a nurse administrator accused of having lost her nursing identity, or of a faculty person who no longer knows nursing? Before BSN degrees were common, there were stories of 4-year nurses who believed they were above providing direct care and identified only with the administrative roles on the unit. These criticisms have been made by nurses. It is only recently that nurses are recognizing that fragmentation of the profession along these and other lines disempowers us and may result in non-nurses delineating what our practice will be. Perhaps stimulated by the nursing shortage and an increased awareness of our collective power, nurses are more vocal and we are owning our identity as nurses. Psychosocial nurses, perhaps because of conflicts related to professional territory with psychiatry, psychology, and social work, or because of the ramifications of third party payments, are less likely to assume the generic title of "therapist" than in the past. More often, there seems to be a coming together of psychosocial nurses with each other and with the nursing community as a whole. This coming together enhances the potential for nurse-to-nurse communication and sets the stage to allow nursing to become the bridge needed by consumers of mental health services. I am hopeful that psychosocial nursing will meet this challenge.     

Medication education: increasing patient compliance.

The medication education program described is based on group discussion and individual counseling in a partial hospital setting. It is one model for promoting medication compliance. The important issues are those presented by the patients themselves. Nurses can and must help patients understand the influences on patient decision-making processes and encourage them to make sense of the wealth of information regarding health care and medications now available to them as consumers. Nurses should also introduce patients to the successful methods invented and refined by others to manage medication difficulties. We can also support the patient in the lifelong processes of developing a clearer understanding of their relationships with health-care providers and of promoting sound health practices.     

Clinical supervision for psychiatric nurses

Supervision does not represent merely the acquisition of facts. It is an emotionally charged process that touches on therapists' affective problems, interpersonal conflicts, problems in being helped, and problems in helping (Ekstein). As such, it is a process similar to, but not the same as, psychotherapy. Supervision is necessary for continued professional growth, no matter how skilled the nurse may be. Other mental health disciplines have long accepted supervision as an essential component of professional work. A number of methods can be used to review the therapist's work, including case material discussion, conjoint interviewing, direct observation, and review of mechanical recordings. This can be done individually, in groups, or among peers. A supervisor can be a senior clinician from any of the mental health disciplines. The nurse should not be limited to receiving supervision only from other nurses. Periodic evaluations of the supervisory relationship as well as the therapist's skills are recommended. Supervision is a valuable tool that the nurse therapist should use fully to develop the professional self.     

Spouse-aided Therapy and Psychiatric Nursing: A Preliminary Report

The training of psychiatric nurses as behavioural nurse therapists has been successfully established in the U.K. by Marks et al. However, their approach has a number of theoretical and practical limitations, such as a rigid adherence to an illness model of psychiatric disorder. This paper describes and evaluates an approach to the training of psychiatric nurses based on systems theory. Four nurses were trained in the use of Spouse-aided Therapy, a time-limited, goal-orientated outpatient approach to the treatment of married psychiatric patients with persisting psychological disorders. Patients' spouses are involved throughout therapy, with the aim of making full use of resources within marriage which may facilitate patients' recovery. Questionnaire and anecdotal data from 12 patients showed a mean fall of 30% in patients' symptoms and a mean fall of 20% in marital dissatisfaction after therapy. The pattern of results supported a systems theory interpretation of outcome.     

Caring for older adults with bipolar disorder

Bipolar disorder is a recurrent, chronic mental illness that has a profound impact on the lives of patients and their families and may require extensive use of mental health services. Although bipolar disorder is often considered an illness of young people, the disorder is being recognized as more common in older adults than previously thought. Much more research needs to be done to understand the impact of aging on the course and treatment of bipolar disorder. Evidence-based interventions for treatment of this disorder in older adults must be developed. Mental health nurses can play a key role in enhancing medication adherence, implementing structured psychosocial interventions, and carrying out research to enhance diagnosis and treatment of older adults with bipolar disorder.     

Longitudinal Prevalence and Correlates of Elder Mistreatment Among Older Adults Receiving Home Visiting Nursing

The objectives of this study were to identify elder mistreatment (EM) prevalence among a cohort of older adults receiving visiting nurse care in their homes, determine EM subtypes, and identify factors associated with EM. EM data were collected by nurses during monthly home visits for up to 24 months. It took the nurses a mean of 10.5 visits to discern EM. Fifty-four (7.4%) of 724 patients were identified as mistreated, of which 33 had enough information to subtype the EM. Of these 33, 27 were victims of neglect, 16 of psychological abuse, and 10 of financial exploitation, and 17 suffered more than one type. Among the entire sample, 11 variables were positively correlated with EM presence. Nurses visiting older adults in their homes should be aware that their patients are, as a group, vulnerable to EM, and that the factors identified here may be specific markers of greater risk.