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.     

On public sector psychosocial nursing: a conceptual framework

1. Nursing practice is driven more by its environment than by knowledge provided by faculty or even strong relationships between faculty and staff. Because that environment is publicly supported, programs reflect changes in the ideological environment. 2. The psychosocial nursing specialty incorporates psychiatric/mental health nursing and social sciences to reduce the negative environmental influences while increasing the positive ones. 3. Public sector psychosocial nurses must be familiar with changing laws and regulations as well as the history of hospital and community programs for the mentally ill; understand the complexity of society and that the state hospital is only one component of a large system; and contribute to the development of their subspecialty.     

EBV. Managing the physiological and psychosocial implications of the Epstein-Barr virus

EBV has both physiological and psychological implications. Few medical/nursing interventions are available to alleviate the physical stressors and fatigue. The primary nursing intervention, therefore, becomes one of providing emotional support and psychosocial interventions. Providing measures to ensure adequate sleep will assist the patient in more positive feelings about self. Although causation and diagnosis of this syndrome may be debated in the medical literature, the nursing role is to provide support and guidance for these patients. Longitudinal studies could be done to facilitate the understanding of the long-term effects of EBV and the outcome measures of mental health interventions.     

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.     

Results of an Interdisciplinary Intervention to Improve the Psychosocial Well-Being and Physical Functioning of African American Grandmothers Raising Grandchildren

ABSTRACT

This paper describes the effects of an interdisciplinary intervention designed to enhance family adaptation toward stress of grandmothers raising grandchildren by improving their psychosocial well-being and physical functioning. Participants were predominantly low-income, African American grandmothers raising one or more grandchildren in parent-absent households in an urban area in the southeast. The intervention consisted of social work and nursing case management, participation in monthly support groups, and parenting classes, as well as legal service referrals for those seeking custody or adoption of their grandchildren.

Results indicated that there were statistically significant differences in the direction predicted for psychological distress, family resources, social support, and family coping, but not physical health. These findings suggest that the intervention positively affected the psychosocial well-being of grandmothers raising grandchildren. Implications for practice, policy, and research are discussed. doi:10.1300/J194v05n03_04     

A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence.

This study examines stress, coping, and regimen adherence as determinants of chronic and transient metabolic control in diabetes. We also examine the interaction of biologic vulnerability and psychosocial risk factors to see if Type 1 (insulin dependent diabetes mellitus) or Type 2 (noninsulin dependent diabetes mellitus) diabetes had greater responsiveness to psychosocial risk factors. Analyses of data from insulin-treated adults with Type 1 (N = 57) and Type 2 (N = 61) diabetes supported the biopsychosocial model. For Type 1 diabetes, self-controlling persons had better glycemic control and emotional persons had worse (because of differences in stress). All of these associations were mediated by regimen compliance. For Type 2 diabetes, self-controlling persons had better glycemic control for reasons other than regimen compliance. There was an interaction between biologic and psychosocial factors, with psychosocial factors accounting for more variance in glycemic control within Type 1 patients. Stable psychosocial resources (i.e., education, being married, and positive coping styles) were associated with better chronic glycemic control, while stress and regimen nonadherence were associated with worse transient glycemic control.     

Treatment of incarcerated, sexually-abused adolescent females: an outcome study

This study examined the psychosocial functioning of 100 adolescent females (ages 12-17) sentenced to secure care in a southeastern state and the impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of subjects who reported a history of sexual abuse. The Multidimensional Adolescent Assessment Scale (MAAS) was used to assess psychosocial functioning. Pre-test scores on the MAAS revealed significantly higher scores on 12 of 16 dimensions of psychosocial functioning and higher rates of serious criminal behavior for youth who subsequently disclosed sexual abuse histories as compared to those without such histories. At post-test, statistically significant improvements in psychosocial functioning were observed on 14 of 16 MAAS subscales for those who received the CBT intervention. Thus, incarcerated female adolescents who reported a history of sexual abuse demonstrated more impairment in their functioning as compared to those without a reported history of sexual abuse and responded positively to gender-specific, CBT-based intervention.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

Parents as caregivers: when a son has AIDS

1. Factors to consider in parental reactions to children with AIDS are the unique relationship of each family member to the affected individual; the difference of the parent's reaction compared with other family members; and the roles that the person with AIDS plays in each individual's life. 2. The debilitation caused by AIDS often leads to regression to earlier developmental stages; parents are confronted with a need to once again provide basic support as they work to attain completion of their own psychosocial tasks. 3. Caring for patients with AIDS presents profound challenges to nursing; nurses must carefully schedule breaks and vacations so that this does not become the focus of all their attention.     

Psychosocial distress,physical illness,and social behaviour of close relatives to people with substance use disorders

ABSTRACT

This study explores how a family member with substance use disorder (SUD) affects the psychosocial, behavioral, and physical states of other family members. Sixteen in-depth interviews with relatives of Icelandic individuals afflicted with SUD were performed. The interviewees were selected from a pool of Icelandic families whose members included one or more chronic SUD users. They represented different relations to the user (spouses, parents, children, and siblings) and both genders. All participants except for siblings expressed that SUD had negatively affected their mental health by inducing depression, anxiety, and stress-related physical illness. All had experienced physical violence, mental abuse and financial loss. Parents indicated that the SUD of the family member had isolating psychosocial impacts on their children and caused a loss of connection among their family members. All participants, except the siblings, regarded their workplace as a shelter. The study’s findings can help social professionals to better understand the effects of SUD on families, family systems, and public health in general.     

Services for the underserved. A nurse-managed center for the chronically mentally ill

1. A university-based, nurse-managed center for the chronically mentally ill enhanced the experiences of baccalaureate nursing students with this underserved population. 2. The course objectives included psychosocial rehabilitation for chronic illness and provided a good fit between client's needs, course objectives, and the behavioral-ecological model. 3. The project positively changed the attitudes of nursing students. Changing attitudes of professionals and motivating student interest toward the chronically mentally ill is an imperative for meeting their needs.     

Biopsychosocial nursing assessment: a way to enhance care plans

1. A psychiatric nursing assessment tool reinforces the primary nursing care model; re-establishes nursing's input at comprehensive treatment plan meeting; reorients the staff to the total nursing needs of the client; and provides a tool for establishing nursing diagnoses. 2. Implementation of the nursing assessment form has educated other staff about professional nursing practice, as well as promoted a greater understanding of the nursing process and reinforced accountability for the nurses. 3. The form enables clients to be viewed from a holistic biopsychosocial nursing context, and nursing care plan recommendations are more individualized and inclusive of the total aspects of patient needs.     

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.     

Psychosocial issues in end-of life care

Interest in aging and dying has increased substantially, in large part because of recent biomedical advances, the shift from a sacred to a secular conception of death, and the death awareness movement. The importance of mental health professionals in helping people through the aging and dying process is now more widely recognized. In addition, because societies are becoming increasingly multicultural, a greater need exists for appreciation of the cultural aspects involved. This article discusses the various psychosocial factors involved in aging and dying. It also touches on cultural factors that mental health and nursing professionals should be aware of to remain in tune with the changing times and better serve their patients.     

Sensitizing nursing home staff to residents' psychosocial needs

Most of the direct care of nursing home residents is provided by nursing aides. Aides generally have had limited training and experience working with the frail elderly and may not be attuned to residents' psychosocial needs. This can result in aides working at cross purposes with the social worker, producing a system that is counterproductive. This paper describes a situation where inservice training was utilized to help aides gain a greater understanding of the residents in their care. Advantages of using in-service are discussed, potential pitfalls are considered, and illustrations of in-service training techniques are presented.     

Domestic violence: a worldwide exploration

The concept of domestic violence is important to nursing because further knowledge of this phenomenon can help drive more effective intervention and prevention approaches. Domestic violence, also known as gender violence, interpersonal violence, and domestic abuse, is a daily and often a deadly fact of life for millions of women and girls around the world. Attacks are perpetrated in settings that include public streets, at places of employment, in the home, while serving in the military, and in prisons and jails. The costs of this violence, both monetary and in human lives, are tremendous. Although nurses are in a unique position to screen for domestic violence and provide assistance and advocacy for victims, barriers exist related to victim disclosure and staff training and comfort levels. Advanced practice nurses can address the issue directly through appropriate treatment facilitation, including both physical and psychosocial intervention.     

Homeward bound. Broadening student experience with home visits

1. Because of patients are rapidly discharged after medication stabilization or crisis resolution, tertiary care in the home is emerging as an integral part of current psychiatric care. Students miss a valuable opportunity to participate in psychosocial rehabilitation if the clinical rotation is limited to an inpatient setting. 2. Guiding the client toward mental stabilization is the process of psychiatric care; outcomes are most apparent in the home. 3. Nursing is moving into psychiatric case management and continues to provide home care as a traditional role. Student home visits promote awareness of nursing responsibilities to families beyond the institution.     

Skipped Generation Families: Sources of Psychological Distress Among Grandmothers of Grandchildren Who Live in Homes Where Neither Parent Is Present

Abstract

Today, more than at any period in U.S. history, more grandparents are raising their grandchildren. In many instances, the biological parents are absent from these grandparent-headed households for a variety of reasons. Although grandfathers and grandmothers both serve in the role of surrogate parents, grandparent caregiving can be seen as a “women's issue” when examined from the broader sociological context of gender. Using data from the National Survey of America's Families, this study examined factors associated with the frequency of feelings of psychosocial distress among grandmother caregivers of grandchildren in skipped generation families. Multivariate regression models indicate that for these grandmothers, being Black and living in the Midwest, having a family income below the poverty level, having Medicaid or SCHIP coverage, not receiving Welfare payments for childcare, and having a usual place for health care were all associated with more frequent feelings of psychosocial distress. On the other hand, being married, receiving social services help with childcare, grandmother's perception of less parenting burden, and living below poverty in the Midwest were associated with less frequent feelings of psychosocial distress.     

Perceived Need for Psychosocial Services in the Context of Political Violence: Psychological Distress Among Israeli Mothers with Young Children

The current study investigated the association between mothers’ perceived need for psychosocial services due to exposure to political violence, and theirs and their children’s psychological distress. A representative sample of 904 Israeli mothers of young children aged 2–6 were asked to fill out a questionnaire about exposure to war and other types of trauma, psychological distress, social support, and perceived need for help. The results showed that mothers who reported a need for psychosocial services due to exposure to political violence had higher levels of exposure to political violence, depressive symptoms and more emotional problems in their young children than mothers who reported no need for help. Those who reported a need for psychosocial services also had less social support even when all other variables are controlled. Furthermore, Arab mothers and mothers with low family income perceived a greater need for psychosocial services. The implications of this study are relevant for policies of outreach to vulnerable groups in situations of ongoing political violence.