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.     

Community responsibility for the self-neglectful client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and informal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

Does the client have a gambling problem?

Representatives from 40 New York City social agencies were interviewed in order to determine the extent to which gambling is a problem among their clients. The findings indicate that (a) agency personnel rarely ask clients about gambling behavior either on intake or with continued agency contact; (b) rarely do clients spontaneously mention gambling as a problem; (c) problem gambling is usually brought to the attention of the agency by the wives of problem gamblers; and (d) gambling is a hidden family problem associated with marital discord and financial disarray. In order to have a better understanding of problem gambling and its vicissitudes it is recommended that agency personnel keep statistics on gambling and gambling related problems.This paper was revised after the untimely death of Leonard S. Kogan, Professor of Psychology and Director of the Center for Social Research, The Graduate School and University Center, The City University of New York.     

Preventing spiritual distress in the dying client.

1. Nurses want to provide holistic care to all clients. Viewing spiritual development as a part of human growth and development is appropriate and essential to nursing practice. 2. Nursing care that is effective in maintaining the spiritual integrity of clients nearing death can be effective if placed within a theoretical framework. 3. Levels of spiritual development coupled with the transitional phases of the dying process lead to accurate assessments of clients. In turn, nursing strategies that are selected as a result of such theoretically based assessments are likely to be effective in preventing spiritual distress.     

A multi-dimensional client satisfaction instrument

Development of a client satisfaction measure through successive factor analyses is described. Five factors, each defined by five items and accounting for at least 11% of the total variance, were identified and replicated. A single second order factor also emerged in both studies. Reliability of the second order factor, and of three of the first order factors is sufficient for most purposes. The second order factor, which is a linear combination of the first order factors, was not significantly correlated with sex, age, race, or number of attempts made before receiving a client response. The distribution of scores was highly skewed, with most respondents scoring near the upper (satisfied) end.     

Assessing client satisfaction among Hispanics

Data from two studies using community health center clients are analyzed to assess how a measure of client satisfaction operates when used with different ethnic populations. The eight-item version of the Client Satisfaction Questionnaire (CSQ-8) is a measure of general satisfaction with services that was developed to provide a brief, standard assessment procedure suitable for use in a wide variety of service settings. Based on the results of this survey, the CSQ-8 seems to operate about the same, whether administered to Anglos, blacks, persons of Mexican descent, or persons of other Hispanic origin, or whether in English or Spanish. There were essentially no differences among the various ethnic groups across statistical criteria of internal consistency reliability, central tendency, dispersion, item intercorrelation, or missing values. These results suggest that the CSQ-8 is a measure of general satisfaction with services suitable for use with a variety of client populations, including Hispanics.     

The trainee and the borderline client: Countertransference pitfalls

Acknowledging and overcoming hostile countertransference is a major problem in treating borderline personalities, especially for clinicians in training. Borderline personality dynamics and transference/countertransference phenomena are described, and a compendium of trainess' negative countertransference reactions is offered, following Maltsberger's and Buie's (1974) schema. Myths of omnipotence, seen as antecedents to countertransference reactions, are discussed briefly. A case example illustrates some of the ways that a trainee may inadvertently foster a negative transference/countertransference experience; it also discusses the roles of supervision and consultation in explicating the particular difficulties that the therapist and patient created. The necessity for and nature of limit-setting with borderline patients is noted.     

Accountability revisited: the arrival of client outcome evaluation

In the past few years, "accountability" for public mental health programs has become differentiated in the minds of not only program evaluators, but also program managers and funders, including state and local-level legislators. Increasingly, these officials are becoming concerned with more than just the numbers and targets of services delivered, and the cost involved, and are looking for evidence of positive outcome or impact on clients to justify program implementation and maintenance. This represents a significant move beyond the two accountability models that most recently seemed to be the focus of most formal accountability efforts--performance measurement and quality assurance. Pressures for implementing these two alternatives seem to have been reduced somewhat by the new federal Administration, but even prior to its advent there had been a rapid escalation in awareness of and concern for client outcome measurement among important audiences, including state and local mental health policy-makers and the U.S. Congress. This presents a major new opportunity and challenge for program evaluators at this new accountability focus continues to gather momentum.     

Successful transition: Therapeutic interventions with the transferred client

The author discusses working with transferred clients in an agency setting and suggests interventions that enhance the new therapeutic relationship. The article includes a review of the literature and case examples which emphasize work in the first session.     

Use of vehicles with client groups

Conclusion In analyzing the group's behavior in the vehicle one needs to determine whether the behavior is obstreperous and aggressive or whether it is excessive energy and enthusiasm stimulated by the anticipated activity. If the worker determines that the group's hyperactivity is due to enthusiasm and delight over the anticipated pleasure, he may interpret to the group his awareness of their delight and enthusiams and support it. At the same time that he indicates his awareness of their impatience in not getting into the activity soon enough, the worker needs to help the group realize the danger potentials in their behavior and the need to maintain safety. Group members often have persecutional interpretations of regulations and rules (Redl & Wineman, 1957, p. 117). However, group workers need to help members acquire more realism about behavior that is appropriate in a vehicle.     

The triangle: The worker,the client,the agency

The power of the agency and its ability to enhance or detract from therapeutic work is discussed in relation to therapeutic failures. Most commonly a triangle involving the worker, the client, and the agency confound the problem. The historical base of this problem and present day influences on worker and client are reviewed. Suggestions are made for system changes to increase the power of the worker and to improve therapeutic work.This article is a revised version of a paper presented at the annual meeting of the Illinois Society of Clinical Social Work, April 25, 1981.     

Treatment of the bipolar client: Clinical social work contributions

The medicalization of bipolar disorder during the past two decades has tended to obscure the fact that it remains a disorder of uncertain etiology. Research has continued to support hypotheses that there are psychological and social, as well as biological, components of the onset and course of the disorder. Comprehensive treatment of the bipolar clinet thus requires intervention at all three of these levels. Social workers, with theiry psychosocial perspective, are well qualified to coordinate an overall treatment plan. The social worker's role includes six general intervention strategies.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

A cross-national validation of the client satisfaction questionnaire: the Dutch experience

A Dutch translation of the eight-term version of the Client Satisfaction Questionnaire (CSQ-8) was administered to community mental health outpatients in the Netherlands (n = 110). Data analyses indicate that the Dutch CSQ-8 has highly similar operating characteristics and psychometric properties compared with the English language version. Results also indicate that one general satisfaction factor was found in the Dutch CSQ-8 data. All eight of the scale items loaded heavily on this general factor, strong inter-item correlations were found, and the scale demonstrated high internal consistency. On these grounds, we can conclude that the Dutch CSQ-8 has the same properties as the original questionnaire and can be used as such in Holland. It was also found that those clients who decided to stop therapy on their own were less satisfied than other clients. Clients who made a common decision with their therapist or let him/her make that decision were more satisfied than clients who stopped by themselves. Additional research is planned to investigate whether clients who complete treatment goals are indeed more satisfied and whether this line of research could be a means of studying the external validity of the scale.