Recruitment & retention. A successful model in forensic psychiatric nursing

1. The recruitment and retention of forensic psychiatric nurses in this highly competitive environment has been identified as a critical issue. 2. In response to the need to expand services, the development, implementation, and evaluation of an innovative model that has demonstrated success in the recruitment and retention of nurses for this highly specialized area of practice are described. 3. The successful recruitment and retention of forensic psychiatric nurses may be facilitated by developing and implementing strategies that integrate the goals and objectives of the organization with the needs of individual nurses.     

A process-oriented approach. Selecting a nursing model for psychiatric nursing.

The nursing literature is replete with articles and books that describe nursing conceptual frameworks and models and encourage their use in clinical, education, and research activities. Although much information exists on the content of nursing models, less has been written about how a model is to be chosen and the process that may facilitate the choice of a model. This article reviews potential benefits and limitations of nursing models and conceptual frameworks and describes a three-phase process for selecting a model for psychiatric nursing practice.     

Re-visioning nurses' punitive attitudes within forensic psychiatric and correctional nursing: the significance of ethical sophistication

1. Development is an essential lifelong process if we are to compassionately care for patients in forensic and correctional nursing. 2. Many of us are blocked in our ability to understand and to care; we will need to grow to meet the challenges and to bear the shocks of forensic and correctional nursing. 3. Concepts that correspond to Kegan's levels of consciousness imply a progression from punitive attitudes toward more positive attitudes.     

Framing nursing practice within a forensic outpatient service

The role of the outpatient forensic nurse is evolving as a specialized area of nursing practice in the community. Nurses must have comprehensive knowledge of the patients, keen intuition, and sound judgment in the continuous clinical assessment of the criminogenic factors that help determine the patients' level of risk. In addition, it is crucial to know and understand the court system, the process of the ORB, and the implications of the disposition order. The comprehensive, client-centered care provided by the Forensic Outpatient Service encompasses multifunctional and complex roles and responsibilities and clearly demonstrates the importance of the forensic outpatient nurse in working with this group of patients.     

Caring in forensic nursing. Expanding the holistic model

Nurses have practiced forensic nursing for many years without formal recognition of the domain as a discipline for specialized study. Forensic nursing expands the traditional concept of holism to include the medical-legal aspects of potential or actual client problems. The American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) recently have designated forensic nursing as a unique specialty. Recognition of forensic nursing as a specialty area of practice within nursing mandates that the specialty define and explicate its major conceptual base. A concept germane to the practice of forensic nursing is that of caring. Caring as a central concept to the role of this specialty is discussed, and the implications for its inclusion in a curriculum preparing forensic nurses are explored.     

Forensic psychiatric nursing. Discursive practices and the emergence of a specialty

1. While some authors argue that specialization is a threat to holistic nursing practice, others suggest that specialization is not only desirable and inevitable but should follow a rigorous process, including specific educational curriculum and examination procedures. 2. Two opposing views regarding forensic nursing are found in contemporary nursing literature. Some authors resist the discourse of specialization in nursing, while the discursive practices of others (e.g., leaders in forensic psychiatric nursing) could reflect a desire for power. 3. Using a poststructuralist approach, the controversy that has accompanied the development of forensic nursing through discursive practices is analyzed.     

Potential for violence toward psychiatric nursing students: risk reduction techniques

1. Nursing students could be vulnerable targets of violence in their psychiatric nursing clinical rotations by virtue of their predominant gender, and meek, insecure attitudes. 2. Nurses are taught to put the patients' needs first and students may blame themselves or minimize situations where they have been threatened or assaulted by a patient. Priority consideration must also be given to our own safety and that of our students, given the risk for occupational injury in the nursing workplace. 3. Affiliating agencies may restrict disabled students from patient care areas. Allowing a disabled student to participate in a clinical rotation on a psychiatric unit could put staff at unnecessary risk of violence if called on to protect the vulnerable student.     

Effects of suicidal behavior on a psychiatric unit nursing team

1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.     

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.     

Orthostatic hypotension: a potential side effect of psychiatric medications.

1. Orthostatic hypotension is a major underrecognized side effect of antipsychotic and antidepressant medications. It has been associated with falls, fractures, and lacerations, particularly in the elderly. 2. Orthostatic vital signs need to be routinely measured in patients susceptible to orthostasis. A standardized procedure should be available and must include a stable baseline measurement in the supine position at 30 seconds and 2 minutes in the sitting or standing position. 3. Measures to counteract orthostasis include nutrition/hydration assessment, environmental safety, and patient teaching.     

Homophobia: a challenge for psychosocial nursing

1. In 1975, the American Psychological Association stated that homosexuality was not a disorder and that homophobia was a form of prejudice based on stereotypes. 2. Because homophobia, like racism or sexism, is learned, it can be unlearned. 3. People who feel homosexuality is a choice hold more negative attitudes toward individuals who are gay, lesbian, bisexual, or transgendered. 4. Homophobia not only damages individuals who are gay, lesbian, bisexual, or transgendered, but also limits heterosexuals by locking them into rigid gender-based roles.     

The challenge of the medical setting for the clinical specialist in psychiatric nursing

The purpose of sharing these ideas about the role of the psychiatric clinical specialist in the medical setting has been threefold: first, to stimulate the interest of others by communicating the needs for and the value of such a role in improving health care; secondly, to convey the variety of potential opportunities available in the role; and third, to share some ideas about specific activities which can be pursued in such a role. The clinical specialist who chooses to work in the medical setting will discover opportunities to develop creativeness, to explore innovative ideas, and to utilize the variety of one's personal resources and past learning experiences. It affords one with opportunities to serve as a change agent, to influence the quality of patient care, and to stimulate the growth of other nurses. It allows for on-going contact and exchange with other professional groups comprising the health care team, and finally, it provides the nurses with a high level of autonomy and challenge in defining their own roles.     

Deliberate self-injury. Management in a psychiatric setting.

Self-injury is a significant clinical problem of psychiatric patients, although the prevalence of self-injury in specific disorders is unclear. Nurses can assess and intervene in the psychological causes and behavioral sequelae self-injury. Each patient's early history, dynamics, and motives for self-injury require evaluation. Behavioral techniques (eg, reinforcement) and psychodynamic techniques, such as exploring feelings and anxiety, can help patients understand their self-destructive tendencies. Patients can learn to anticipate anxiety-provoking situations, plan strategies to manage anxiety, cope with feelings, and reduce self-injury.     

A collaborative model: ambulatory pharmacotherapy for chronic psychiatric patients.

1. Increases in patient acuity and diagnosis related groups limiting hospital lengths of stay have contributed to the heightened demand for structured outpatient programs. 2. The Medication Clinic and Medication Group, a daily functioning outpatient program, is designed to shift the responsibility for medication management from the health-care provider to the patient and family through education and participation. 3. Within the framework of a collaborative practice model, the patient, clinical nurse specialist, and psychiatrist share equal power and responsibility. A phenomenologically oriented approach whereby the health-care provider attempts to understand the patient's illness from the patient's perspective is a crucial component. 4. The Medication Program combines the expertise of nursing and medicine in a complementary fashion, conducive to both revenue-generating activity and cost-effective role use.     

The measurement of opportunity inequality: a cardinality-based approach

We consider the problem of ranking distributions of opportunity sets on the basis of equality. First, conditional on a given ranking of individual opportunity sets, we define the notion of an equalizing transformation. Then, assuming that the opportunity sets are ranked according to the cardinality ordering, we formulate the analogues of the notions of the Lorenz partial ordering, equalizing (Dalton) transfers, and inequality averse social welfare functions – concepts which play a central role in the literature on income inequality. Our main result is a cardinality-based analogue of the fundamental theorem of inequality measurement: one distribution Lorenz dominates another if and only if the former can be obtained from the latter by a finite sequence of rank preserving equalizations, and if and only if the former is ranked higher than the latter by all inequality averse social welfare functions. In addition, we characterize the smallest monotonic and transitive extension of our cardinality-based Lorenz inequality ordering. Received: 2 May 1995 / Accepted: 11 October 1996