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.     

A proposal for change to achieve competence in long-term psychosocial nursing care

Psychiatric nursing in a large institutional setting presents challenges to the nursing staff, who must remain competent in the specialized areas of psychiatric and medical nursing. Chronically mentally ill individuals present complex and continuing nursing care needs that must be addressed using a holistic approach to nursing assessment and care. The complex needs of nursing staff and patients in an institutional setting have been described. Methods of assisting the nurse to achieve competence using education and experience have been implemented and described with the goal of improving holistic nursing care to chronically institutionalized individuals.     

Promoting public/academic linkage.

1. Collaborative linkages between public mental health/mental retardation service systems and academic institutions have evolved in response to several problems: increasing numbers of individuals requiring long-term mental health care; the nursing shortage; and a decline in enrollment and students graduating from psychiatric mental health nursing programs. 2. Evidence suggests that a public/academic linkage in the form of a multidisciplinary training course in the care of seriously mentally ill patients promotes a recruitment of mental health professionals to work with these patients. 3. The establishment of academic/health care system linkages can enhance client care, expand and improve clinical experiences and education for students, and provide opportunities for collaborative research among clinical staff, faculty members, and graduate students.     

Strategies for improving education

1. An extensive curriculum is required to prepare mental health professionals to adequately assess, plan, and implement the necessary comprehensive treatment plan and to sufficiently develop relevant social policy. 2. A majority of professionals believe they were not adequately trained in the care of the chronically mentally ill; this may be a result of the trend of integrating the teaching of mental health nursing concepts into the baccalaureate curriculum. 3. Frequently there is a lack of mental health professional role models. Nursing faculty are in an excellent position to implement innovative practice models. 4. Learning from a multidisciplinary team may increase the likelihood that students will apply these approaches to the chronically mentally ill.     

Caring for Persons with Serious Mental Illness

Abstract

This article places evidenced-based knowledge of practice within the social context of care and proposes five policy objectives and specific policy and program changes to address care needs of people with serious mental illness. In spite of demonstration programs that provide the basis for proposed policy initiatives throughout the United States, treatment provision for this population remains inadequate and their safety and well-being continues to be at risk. The authors suggest that treatment initiatives need to be tied to stable policies protecting the mentally ill from adverse social context changes. The authors conclude that policies are needed that will enhance housing assistance, independent social functioning, personal empowerment, and treatment engagement. In addition, efforts are needed to make better use of inpatient hospital care, to better understand the role of assisted treatment, and to better develop consistent long-term fiscal support for the seriously mentally ill. They offer specific policy recommendations for changes in HUD programs, Medicaid and Medicare funding, and treatment programming that address these needs.     

Independent living for the chronically mentally ill

1. Many of the systems problems faced by the chronically mentally ill and their caregivers could be ameliorated by applying the principles of primary nursing. 2. Psychiatric nurses as primary caregivers of the chronically mentally ill can intervene at the client level (assessment, education, medication monitoring, family counseling) and at the systems level (networking, boundary-spanning, advocacy). 3. Psychiatric nurses are a natural and largely untapped resource for improving the care of the chronically mentally ill in the community.     

Why research doesn't yield treatment

This article has presented examples from nursing research with chronically mentally ill clients that illustrate problems with utilization of nursing research in this field. Obstacles to utilizing research in clinical practice include (a) difficulty in identification of treatment goals; (b) difficulty in measurement of treatment outcomes; (c) diversity of psychotherapeutic interventions; (d) attrition of clients over a relatively short period of time; and (e) variation among clients with regard to degree of impairment, response to medication, and social support. These problems were examined using the criteria described by Fawcett (1982) for utilization of research findings: scientific merit, clinical relevance, and clinical evaluation. Limitations for utilizing findings from research with the chronically mentally ill were illustrated in the areas of scientific merit and clinical evaluation. However, studies of the chronically mentally ill and their treatment showed definite clinical relevance, indicating the need for further research with the chronically mentally ill.     

Physical health problems of the psychiatric client

The psychiatric nurse can make significant contributions to the client's overall state of health by attending to the physical health care needs of clients in psychiatric settings. Psychiatric clients die at a younger age than the general population and their incidence of physical health problems tends to be higher. As major providers of psychiatric care, especially to the chronically mentally ill, nursing skills are crucial to the physical and mental health of vulnerable clients. The case reports provide examples of how the interaction between physical and psychological states influence care.     

Deinstitutionalization: a public policy perspective

1. Deinstitutionalization was initiated in an era of social reform to protect the rights of the mentally ill; however, a strong research base was absent and led to major flaws in the policy's implementation. 2. The chronically mentally ill are frequently poor advocates for themselves and, without even the most simple needs fulfilled, end up homeless. 3. The homeless mentally ill require comprehensive support systems with assured continuity of care. An emerging concept to deal with this issue is that of case management. 4. The mental health professional can strive to influence future public policy as patient advocate and nonpartisan educator.     

Guiding the way: acting as a preceptor for graduate students

This article has conceptualized and discussed clinical preceptorship of graduate students in psychiatric nursing, an area poorly represented in the literature. While grounded firmly in the nursing process, it is flexible to accommodate other frameworks as the student participates in various learning activities to meet her course objectives. Many issues have been addressed to guide the preceptor in helping the student approach her new role with realistic expectations, increased confidence, and visions of a future filled with promise.     

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.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

A discharge group for chronically mentally ill. Easing the way.

1. Chronically mentally ill clients have unique needs for discharge planning due to their lack of resources and poor social skills. 2. A weekly group focused on discharge needs can assist patients in planning and solving problems. 3. A psychoeducational approach is used, including video tapes, role playing, group discussion, and guest speakers. 4. Topics for discussion include medication compliance, employment, housing, loneliness, aftercare, and fear of failure.     

The social support. Social dissupport continuum

A person's network embodies "the good, the bad, and the ugly" of all social relationships. The nature of these relationships may be conceptualized as a continuum between social support and social dissupport. Social support, as a product of relationships that facilitate growth, generates self-esteem and assists in assuming appropriate societal roles. Social dissupport represents those relationships that hinder growth and/or promote disintegration. Clinically, nurses either formally or informally assess the degree of social support, but neglect the overall social support/dissupport ratio. The MSNI profiles the person's perception of social support/dissupport on four levels of social relationships and is an efficient instrument in assessing who is in the social network, what is provided, perceived helpfulness, and expectations. Preliminary use of the instrument with parents of the long-term mentally ill, acutely and long-term mentally ill clients, students, and a variety of clients of graduate students enrolled in a crisis intervention course are promising. Thus, nurses must be prepared to confront their clients' perceptions of the professional's role and to modify and adapt those interactions to facilitate goal achievement.     

Factor structure of quality of life: The Lehman interview

This study of 67 chronically mentally ill outpatients with psychotic disorders examined subjective quality of life scores from Lehman's Quality of Life (QOL) interview. Factor analyses identified ‘Affiliative’ and ‘Instrumental’ dimensions which accounted for 67% of the variance in subjective satisfaction ratings. The results suggest a model in which instrumental and affiliative needs comprise significant portions of subjective life satisfaction and that global QOL satisfaction is related more to instrumental than affiliative needs. These findings further clarify the concept of life satisfaction in this population of severely mentally ill individuals and suggest modifications in how quality of life information is evaluated.     

The experiences of youth serving as caregivers for mentally ill parents: a background review of the literature

Young caregivers of mentally ill parents are a vulnerable population. These vulnerabilities include risks for developmental issues, poor socialization, and poor school performance. The purpose of this background review of the literature is to explore the experiences of young caregivers of mentally ill parents and detect the gaps in the literature. The guiding research questions were: What is the experience of young caregivers of mentally ill parents? and What is the experience for those who witness or must assist their parent during a crisis? The majority of research has been conducted outside the United States, primarily in the United Kingdom, and studies have focused mostly on young caregivers of parents with physical rather than mental illness. No studies focused on young caregivers who witnessed or assisted their mentally ill parent in crisis. Information gained through this review will add to the body of knowledge for child mental health and build a case for additional research.     

Nurse entrepreneurs

1. Supervised Environmental Living Facility (SELF) is a nurse-developed, non-profit, community-based, supervised apartment program for the chronically mentally ill. It provides comprehensive supportive and rehabilitative services to the chronically mentally ill, allowing them to re-establish themselves as part of the community. 2. SELF is based on the philosophy that a person needs assistance according to the extent that the illness affects the individual's ability to live safely and optimally. 3. Nurses can be entrepreneurs by seeking and creating innovative models for the delivery of services to specialized populations.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Conceptualizing psychosocial nursing in the jail setting

1. The deinstitutionalization movement led to the release of thousands of mentally ill patients, many of whom were incarcerated as a way of dealing with their disturbed behavior. More restrictive civil commitment laws have also contributed to the number of mentally ill who are incarcerated. 2. Health care and security can be perceived as competing interests in the correctional institution. These competing interests may also be perceived as sources of conflict because each interest aims towards divergent goals that interfere with the other. 3. A problem central to the inadequate services for the mentally ill offender is that few people are aware of the poor conditions for this population. Correctional and mental health organizations must educate the public about the plight of the mentally ill offender.