Teaching hospitalized patients with serious, persistent mental illness.

1. Although patient teaching is an important nursing function, minimal research was found related to education of patients with schizophrenia. Teaching psychiatric patients about illness, treatment, and rehabilitation has not received the same attention in psychiatric nursing as it has in other nursing specialties. 2. Eighty percent of the patients who participated in patient education classes would recommend the program to others. Treatment teams reported that some patients asked more questions about their treatment and became more active in ward groups following the classes. 3. The use of nurses as patient educators facilitates professional nursing practice and effectively ensures that patients' general physical health and psychiatric education needs are systematically addressed.     

The clinical practice of juvenile forensic psychiatric nurses

The differences in working with an adolescent population within the nonmedical structure of the juvenile justice system provides a basis for claiming forensic psychiatric nursing has a specialized knowledge and skill base for meeting the needs of this juvenile population. Future development of forensic psychiatric nursing depends on continued articulation of the role of forensic nurses in these highly specialized settings and development of empirically based forensic psychiatric nursing interventions. Juvenile forensic psychiatric nursing requires specific personal attributes and new competencies that extend beyond traditional psychiatric nursing skills. These nurses must be confident in their clinical skills, demonstrate strong leadership capabilities, and be tolerant of the uncertainties associated with these unique environments.     

Preceptorship: a shared journey between practice & education

Creative new approaches must be developed to attract new graduate and transitioning nurses to psychiatric-mental health nursing. In this article, we present a collaborative nurse preceptor program between a clinical practice agency and a university college of nursing faculty group. The preceptorship was designed to facilitate recruitment and retention of new graduate and transitioning nurses into a community-based, psychiatric-mental health agency. This process could be applied in any practice setting to address issues of recruitment and retention. Over the course of more than 2 years, the program has resulted in a 70% retention rate of new and transitioning nurses in the agency; of particular note is the 100% retention of new baccalaureate graduates. This program has positively affected the agency, the nurse preceptors, and the new graduate and transitioning nurse preceptees. We describe the collaborative development and implementation of the preceptor program designed to enhance recruitment and retention of new graduate nurses and nurses transitioning from other specialty areas into community-based psychiatric-mental health nursing practice.     

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.     

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.     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

The history of college health nursing

Almost from the beginning of formal college health programs in the second half of the 19th century, college health nurses were there to care for students in college and university settings. By the end of the 20th century, the role of college health nurses had evolved with the nursing field in general, but with enough unique features for the American Nurses' Credentialing Center to recognize college health nursing as a professional subspecialty and administer the first College Health Nurse Certification examinations. In addition, new nurse practitioner programs provided practicing nurses with more independence, and their duties continued to expand beyond care of the sick to include health promotion, administrative, and teaching activities. As a result of these changes, college health nurses now play a larger role in the life of students and promoting a healthy campus community than ever before in the history of college health.     

An historical view of right to treatment

The patient's right to treatment is a clear mandate from the Supreme Court that the providers of mental health care must provide treatment. Important Supreme Court decisions have influenced the way in which professional nurses determine what constitutes adequate treatment on an individualized basis. Individualized treatment planning is rooted in meeting legal, regulatory, and funding requirements. The professional nurse is in a unique position to assess the patient's needs and to plan with others how those needs can best be met. Paraprofessional staff may implement those parts of the plan that do not require the direct intervention of the professional nurse. The technicians provide the daily care under the supervision and direction of the professional nurse. However, it is the professional psychiatric nurse who plays a critical role in providing active psychiatric treatment, who determines the nursing component of the treatment plan on an individualized basis, and who monitors the patient's environment, thus safe-guarding the legal rights of the mentally ill.     

Addiction Social Work Fellowship Program in Canada

Substance use disorders (SUD) disproportionally contribute to the global social and economic cost of disease; however, their treatment has been inadequate in large part due to an enduring research to practice gap in which competencies for treating and preventing SUDs are often lacking from social work education curricula. Training social workers in managing SUDs has been separated from nurse and physician training, partly due to the long-standing divide between the behavioral health and medical care system. Recently, a new interdisciplinary fellowship in addiction social work, nursing and medicine has been established in Vancouver, Canada. We describe the novel fellowship program and outline initial impact of the training on knowledge and skills in addiction social work from our qualitative evaluation of the fellowship. We conclude that training social workers, and other allied health professionals alongside physicians and nurses may extend the reach of this type of training program even further.     

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)     

The History of College Health Nursing

Abstract

Almost from the beginning of formal college health programs in the second half of the 19th century, college health nurses were there to care for students in college and university settings. By the end of the 20th century, the role of college health nurses had evolved with the nursing field in general, but with enough unique features for the American Nurses’ Credentialing Center to recognize college health nursing as a professional subspecialty and administer the first College Health Nurse Certification examinations. In addition, new nurse practitioner programs provided practicing nurses with more independence, and their duties continued to expand beyond care of the sick to include health promotion, administrative, and teaching activities. As a result of these changes, college health nurses now play a larger role in the life of students and promoting a healthy campus community than ever before in the history of college health.     

Girl Scouts Beyond Bars: a unique opportunity for forensic psychiatric nursing.

The interplay of victim and perpetrator roles experienced between daughters and their mothers provides for intricately complex interactions within a family and the community. Unique opportunities exist for forensic psychiatric nurses to articulate their nursing roles against health promotion and illness prevention programs for incarcerated women and their families. Participation in community-based projects allows forensic psychiatric nurses to observe and respond to the total environment of offenders and their families.     

Chronic factitious disorders. Helping those who hurt themselves

A chronic factitious disorder is a complex psychiatric illness that generally manifests itself in the medical/surgical setting. The immediate need for psychiatric intervention is generally overshadowed by the need for intense medical treatment. The psychiatric liaison nurse is in a key position to manage emotional nursing care during acute hospitalization. Assisting staff to recognize behavioral manifestations can help to prevent further self-destruction and promote future psychiatric followup. The prevalence of factitious disorders is probably higher than misconceptions about the disorder. The potential to save health care cost as well as needless human misery makes this a professional nursing concern. The high incidence of factitious disorders in the nursing profession may make profession may make it a personal issue for nurses as well.     

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.     

Intimacy boundaries: between mental health nurses & psychiatric patients

This was the first research study in Canada to explore intimacy boundary violations and sexual misconduct between nurses (both RNs and registered psychiatric nurses) and patients. Using a researcher-generated survey, a total of 923 mental health nurses commented on their sexual attraction to patients, and dating and sexual intercourse patterns with patients. The findings indicated that very few nurses had dated or engaged in sexual intercourse with discharged patients, and the few nurses who had done so tended to be younger men prepared at the registered psychiatric nursing diploma level. A small number of nurses believed it was permissible to have a sexual relationship with a patient while the patient was hospitalized, but none reported having a current relationship. Given the severity of this intimacy boundary violation, nurses need to be educated regarding the serious and dangerous psychiatric effects that can result for patients from engaging in a sexual relationship with nurses. The Code of Ethics of the Canadian Nurses Association and nurses' obligation to follow it needs to be reinforced. Nurses engaging in intimacy boundary violations are vulnerable to patient-initiated lawsuits.     

The expanded role of nurse case managers

1. Effective nursing practice is responsive to the changing needs of clients. The community, rather than the hospital, has become the primary treatment setting in which the long-term mentally ill manage their daily activities. 2. The professional role of rehabilitative nurse case management can provide an opportunity for nurses to expand their roles and develop new career directions. 3. The primary nursing model provides an excellent foundation for acquiring the attitudes and skills necessary in the delivery of a comprehensive rehabilitative model of case management.     

Puberty Education in a Global Context: Knowledge Gaps,Opportunities, and Implications for Policy

Youth programs and policies provide opportunities for institutions and societies to support healthy adolescent development. Puberty education programs are universally important, as they provide crucial knowledge and skills to help youth and their caregivers navigate the physical, emotional, and interpersonal changes of puberty with positive outcomes. However, few puberty programs have been rigorously evaluated, resulting in a lack of evidence‐based knowledge and practice in this area. This review examines the status of research on puberty education and related programs and draws on the broader intervention literature and recent research findings on adolescence to identify program features that might improve program effectiveness. Implications for policy are also discussed. The need for rigorous program evaluation is emphasized throughout.     

Not <Emphasis Type="Italic">Merely</Emphasis> TLC: Nurses’ Caring Revisited

The profession and practice of nursing has been studied from quite diverse scholarly perspectives in the United States and abroad. Feminist critiques focus on the gendering of caring and its knowledge/skill features, while professionalization advocates view emotive caring as secondary to other critical activities necessary for the occupational advancement of nursing. Based on ethnographic observations 30 in-depth, semi-structured interviews with nurses across different units working at a large urban hospital, this paper examines how nurses define caring as knowledge-based, skilled work. Specifically, nurses described four types of skills—observational, analytical, interactional, and comforting—that they deploy in the accomplishment of caring work at the bedside. My findings go beyond previous literature in this area by showing how nurses think of caring work in line with occupational strategies that emphasize their biomedical knowledge and diagnostic skills and uphold an advocacy or intermediary role in health care. I argue that while this ideological work may reassure nurses of their professional identity and critical role in health care, it may also reinforce the dilemma of nurse professionalization by obscuring the organizational nature of caring, as it remains an unsupported dimension of their work.