The ten commitments: a value base for mental health recovery

The concept of recovery is an important part of contemporary mental health services. During the past 5 years, Tidal Model projects, focused on developing the recovery attitude within nursing practice, have been established in several different countries. The Tidal model emphasizes 10 philosophical assumptions the "Ten Commitments," that are central to recovery-focused practice.     

The experience of divorce for the psychotherapy patient—A developmental perspective

In this article the dynamics of divorce are discussed from the perspective of psychoanalytic developmental psychology. This theoretical framework is used to highlight and to explain some typical internal and external responses of psychotherapy patients for whom divorce is an issue. A therapeutic stance is suggested that enables the patient to understand the connection between his or her marital situation, early life experience, and past developmental problems. The patient's preoccupation with the unsatisfactory marital relationship can serve as a catalyst for the strengthening of the patient's overall ego functioning. This article demonstrates Kris' (1951) concept that the material at the psychic surface-in this case divorce-needs to be explored in such a way that the patient's ego is enlisted in his or her total growth.     

The Use Of Shame and Dread in the Countertransference

Much has been written about paranoid anxieties as these occur in the patient. Less, however, has been written about primitive experiences as these occur in the therapist during the session. This paper recounts a patient's correct articulation of the therapist's self-perception, which, because of its accuracy, initially flooded the therapist with shame and dread. Nonetheless, the patient's perception was able to be used in a way that clarified, in the countertransferance, a piece of the patient's early experience in relation to her mother and strengthened the therapeutic relationship.     

The mystical hue in clinical practice

The notion of the mystical hue in clinical practice, viewed essentially as therapist tendency to formulate understandings and interventions from a known frame of reference, is considered from the dimensions of theoretical commitment, technical style, and similarity to psychic processes. Consideration is given to reification, the projective fallacy, and the developmental tilt, for their potential reverberations in practice. Emphasis is placed on the need to formulate experience-near interventions related to the patient's subjective state consistent with the reality that existing well reasoned theory is continually subject to revision. A case is presented in which the patient's subjective experience, imbued with a mystical flavor, was best approached from a mystical perspective familiar to both patient and therapist.     

The Four S Model in action for de-escalation. An innovative state hospital-university collaborative endeavor

In this article, the Four S Model is presented as a working clinical framework for generating structured nursing interventions and treatment plans. The de-escalation process, formalized by the De-escalation/Alternative to Restraint Flowsheet, is one way in which the model is being operationalized to reduce seclusion and restraints. As shown by the flowsheet, the model allows for integration of mental health and mental illness. It spans the scope of nursing practice at all levels, from para-professional to advanced practice nurse, by integrating the mental health concepts of communication, leadership, clinical judgement, critical thinking, and caring within its framework. Most important, the flexibility to individualize treatment that is built into the model allows for generalization to all psychiatric presentations.     

Supporting the scholar role in intensive care nursing

This study investigates how future informatics applications can support and challenge intensive care nurses (ICU nurses) to grow and learn continuously. To this end a research-and-design tool is introduced which is based on a model of the nursing process that starts from the idea that a nurse fulfills three different roles: the role of practitioner (using information immediately to base actions upon), the role of scholar (using information later on to learn from) and the role of human (coping with stress and dealing with emotions). In this paper the focus is on the scholar role. Twenty-eight intensive care staff members from six different hospitals were asked to recount an imposing experience from the perspective of each role. Regarding the scholar role, the participants mentioned 77 learning strategies they adopt for individual as well as organizational learning. Individual learning concerned reflection on former patient cases, reflection on current patient cases to anticipate a change in the patient's condition and reflection on personal behavior and decisions. Organizational learning concerned reflection on former patient cases. Examples of specific strategies were formal team evaluations focused on procedure and understanding the perspective of team members, being present at autopsies, and giving feedback on the nursing skills of colleagues. Based on these strategies design implications are defined for future nursing informatics applications, which will be presented.     

Listening for the patient's story. The psychosocial story of a patient with end-stage heart disease

1. The way patients make sense of their lives can be heard in the stories they tell. 2. Nurses should address the patient's experience as well as the patient's disease. 3. Listening carefully to patients gives nurses valuable tools for intervening in their lives. 4. Medical illnesses extend far beyond the biological processes.     

The underreporting gap in aggressive incidents from geriatric patients against certified nursing assistants

Staff in the health care industry experience workplace aggression at a much higher rate than the general workforce. However, a large proportion of aggressive incidents go unreported, and the source of many of these incidents is patients. This study investigates aggressive incidents from patients against certified nursing assistants (CNAs; n = 76) in a sample of six geriatric care facilities. The results indicate that CNAs experienced a median of 26 aggressive incidents over the course of the 2-week study and that approximately 95% of these incidents were not reported to the facility. The present study also empirically examines reasons why nursing staff decide to report incidents. Finally, this study reveals that the experience of aggression from patients is related to subsequent organizational commitment, job satisfaction, and intent to leave the job.     

Austerity and the Demise of Social Europe: The Baltic Model versus the European Social Model

This article draws on the experience of the imposition of radical austerity measures in the Baltic states. It challenges the myth that austerity can be achieved in a socially and economically ‘costless’ manner. Baltic-style austerity has now become a template of ‘successful adjustment’ and a recipe for recovery of the Eurozone. The authors argue contra such ‘myth-making’ that austerity is compromising the longer run sustainability of societies that follow this path, while simultaneously ending prospects of the adhesion of a European ‘Social Model’ in the post-communist periphery. The article is a contribution to an emerging debate in academic and policy circles concerning the viability and future of Europe's ‘Social Model’ in an age of austerity.     

Continuous quality improvement to an electroconvulsive therapy delivery system

1. ECT is known to be highly effective in relieving severe depression; however, there are few published articles focusing on nursing care of patients receiving ECT. 2. Education is an important component of nursing care. Lack of information about ECT can cause a high level of anxiety and reluctance to consent to ECT. 3. Using the Continuous Quality Improvement Model, nurses can improve the quality of a whole system of care delivery.     

Experimental study of assistant aids and new nursing method in nursing care work

This study seeks to evaluate the effect of regular and new nursing methods in nursing care work. Nursing care work often causes low back pain in nursing care worker. The principle of not lifting when transferring patients has been proposed as one way to prevent low back pain. This principle incorporates the use of the patient's strength and assistant aids. A sliding seats and transfer boards have been proposed as assistant aids for the transferring patients. It is necessary to evaluate the effectiveness of these assistant aids in preventing low back pain. Ten subjects performed two tasks in this experiment. Five were nursing experienced persons and five were the inexperienced. EMG results indicated that the new nursing method was less stressful than the methods. A questionnaire revealed that the new method was evaluated more highly than the regular method. Based on these results, we propose that a sliding seats and transfer boards be used in nursing care work.     

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.     

The latex allergic psychiatric patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.     

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.     

Psychiatric nursing recruitment. Roles for educators and nursing staff

Recruiting new nurses to a relatively unpopular specialty in the midst of a nursing shortage is challenging. However, the literature offers educators and clinical nursing staff important insight regarding the promotion of student interest in psychiatric nursing. Clearly, a collaborative effort is needed. Educators and clinicians should work together to provide students with a satisfying psychiatric nursing experience. Through a combination of effective, intellectually stimulating classroom instruction and positive, welcoming clinical experiences, educators and clinical nursing staff may increase the number of nursing graduates who pursue this rewarding specialty.     

Depletion states and selfobject disorders

The subjective experience of depression is reviewed. The dynamics of that experience are then explicated from the perspective of self psychology. It is proposed that some depressions may best be understood as reflective of the patient's feeling of depletion. This feeling may be related to the loss of a selfobject, or may be reflective of a deficit in the self, which gives rise to unsatisfiable yearnings.     

The Reflective Learning Model: Supervision of Social Work Students

A key task for the field education supervisor is to facilitate reflection in beginning practice, and to promote in the student a sense of ownership, mastery and understanding of his or her clinical process. At the same time the supervisor is charged to instruct and guide the student. A major challenge for the supervisor is to balance these two dimensions of supervision and maintain a focus on the student's experience rather than the supervisor's expertise. The authors present a Reflective Learning Model which identifies the importance of both facilitative and didactic interventions within effective supervision. A case study is provided to demonstrate the model in action.     

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.     

Test-taking anxiety among nursing & general college students

This study examined whether nursing students experience an unusual amount of debilitative anxiety in academic achievement, compared to general university students and provided senior psychiatric nursing students with a hands-on experience in research. A nonprobability convenience sample of 225 students was drawn from a university in the eastern United States. Alpert and Haber's Achievement Anxiety Test was administered to 94 nursing students and 131 general university students. Results indicated that nursing students do not have a statistically significantly higher debilitative anxiety than the general student population. However, all students experienced significantly higher levels of debilitative anxiety than were found by Alpert and Haber. Implications for academic nursing are discussed.