The pros and cons of physical restraints & behavior controls.

1. Nurses are often the victims of abuse in psychiatric settings. Employing physical and chemical restraints or behavior controls on violent or potentially violent clients has strong arguments supporting and refuting it. 2. There is a concern that restraints and behavior control techniques are morally unacceptable because their use is incompatible with respect for an individual's autonomy. 3. Those who support the use of physical restraints and behavior controls base their arguments on patient and staff safety. 4. By nature of the profession, nurses accept the responsibility of total patient care, including the well-being of abusive patients as well as others on the ward.     

Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.     

Aggression exhibited by older dementia clients toward staff in Japanese long-term care

This study examined the experiences of staff members from seven Japanese hospitals who had been treated aggressively by older dementia clients. Altogether, 170 questionnaires were analyzed. In the past year, 75.3% and 63.5% of staff members had experienced physical and verbal aggression, respectively. Working numerous night shifts, working shifts other than 3-shifts, and being allotted assignments with clients who had a lower average level of physical capacity were the factors associated with recurrent client aggression. Those staff members who spent adequate time caring for their clients, who gained client consent before providing care, and who tried to build a trusting relationship with their clients were found to have experienced less aggression. Burnout, which is likely to enhance the risk of the staff mistreatment and neglect of older clients, was found to be higher among those who experienced aggression.     

Women from the Middle East and North Africa in Europe: understanding their marriage and family dynamics

The aim of this article is to assist the understanding of social workers in Europe of marriage and family dynamics among women from Middle East and North African countries who have moved to Europe. The focus of this article is on husband selection processes and family dynamics after marriage in Egypt, which is used as a case study reflecting culture and norms surrounding marriage in this region. This article reports on the findings of doctoral studies which examined marriage patterns and family dynamics in North Africa and in particular in Egypt where more in-depth data were available. The authors reflect issues surrounding values and process of marriage not only in terms of the implications for practice with social work clients or service users, but also in relation to the potential of women from this region who may join the social care workforce.     

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.     

Placing Clinical Social Workers “Between a Legal Rock and a Practice Hard Place”: Reactions to Madden and Parody

The debate about the veracity of incest memories uncovered in therapy is often impassioned and acrimonious. Recent statements by various professional organizations, advising that corroboration of recovered memories is the only method for determining their accuracy, have not decreased the intensity of this debate. This response to Madden and Parody's paper discusses the importance of corroboration of recovered memories of sexual abuse and details the clinical, scientific, and legal foundations for this approach. A point of confusion in Madden and Parody's paper and an important aspect of this response is the difference between clients who uncover completely new memories of childhood sexual abuse and clients who enter therapy with a history of sexual abuse. Those clients with new memories are the focus of this debate and the standard of care proposed in this paper.     

Career Development With Lesbian and Gay Clients

Trends in career counseling with lesbian and gay clients are reviewed along with discussions on considering lesbian women and gay men a different cultural minority. The role and direction of career development with lesbian and gay clients is presented based on current information regarding employment discrimination, the decision to pass as heterosexual on the job, counselor and student training issues, age-related factors, and differences between gay men and lesbian women with respect to careers. Concrete suggestions are made to career counselors who wish to prepare themselves to work with this group or to extend their effectiveness, and suggestions for services are also presented.     

How Effective are Interventions to Enhance Adherence to Psychiatric Medications? Practice Implications for Social Workers Working With Adults Diagnosed With Severe Mental Illness

This study integrates eight systematic reviews of adherence enhancement interventions to develop practice guidelines for social workers who work with adults who do not adhere to prescribed psychiatric medications. Findings indicate that existing investigations are disparate in their adherence definitions, methodologies employed, and sampling strategies, rendering it difficult to construct overall guidelines for social work practice. However, themes associated consistently with increased adherence are collaboration between clients and providers regarding medication decisions, consistent follow-up care, and a comprehensive network of professionals and caregivers who support clients in their use of medication to facilitate stabilization of mental health symptoms.     

Managed care. The effect of case management on state psychiatric clients.

This study examined whether case management services, mandated under the managed care contract for adult clients in a medium-sized state psychiatric hospital in Tennessee between July 1996 and June 1997, were offered as specified, and the impact these services had on recidivism for individuals who were identified as having a severe or persistent mental illness. Although all of the clients were offered case management, 47% refused the service. Of the 14 who had one or more readmissions, six (43%) had case management. These findings demonstrate that health care providers must offer sufficient information to their clients so that they can use the managed care system more effectively.     

Disability pension among adult former child welfare clients: A Swedish national cohort study

Using longitudinal register data on all persons born in Sweden 1973–1978, we report on prevalence of disability pension among young adults who were child welfare clients during their formative years, and explore risk factors for this long-term outcome. For most child welfare subgroups, prevalence approached or exceeded ten percent. Multivariate logistic regression analyses found high crude odds ratios of disability pension among child welfare alumni. These were substantially reduced – but not obliterated – after adjustments for a host of background factors. Decomposition analyses revealed that child welfare alumni’s poor school performance and low educational attainment accounted for most of the confounding effects. We also found that child welfare clients with a disability pension had far higher rates of psychosocial problems in their adult lives than other peers with a disability pension.Child welfare alumni should be regarded as a high risk group for future disability pension and for permanent exclusion from the labor market. Rates of suicidal behavior in adult age were extreme among some subgroups of child welfare alumni with a disability pension, which should be communicated to agencies who are likely to meet these groups (eg. primary health care).     

Patterning in Citations: An Analysis of References to George Herbert Mead

Abstract

Family work in dual-earner families has been studied extensively, but the focus has been primarily on household tasks and child care, neglecting the component of health care behavior. In this paper, I introduce scales to study the performance of family health care behaviors in dual-earner families. The items assess topics such as who arranged and accompanied family members to health care appointments, who left work early or took time off from work for health care, and who handled the paperwork of medical expenses. The sample consisted of 174 married women employed in health care and education. The study results indicate that the health care scales are reliable. They are also not highly correlated with demographic variables that might affect the utility of the scales to examine how health care behaviors are linked to other family work.     

A Survey of AIDS Knowledge and Attitudes Among Prostitutes in an International Border Community

Prostitutes are a high risk population engaged in high risk behavior for the transmission of HIV Disease (AIDS). This paper presents the results of a survey to evaluate the knowledge, attitudes and behaviors of prostitutes about HIV Disease (AIDS). This survey was conducted in an International Border Community. A total of sixty women participated in this survey. The sources of information on AIDS and its accuracy were explored. The impact of this knowledge on behavior was identified. The most important finding is that the prostitutes are not utilizing risk reduction behaviors while having sexual relationships with their clients. The survey found that fifty-four percent of the participants did not use condoms on a regular basis. And an alarming ten percent did not use condoms at all. The results of this survey have implications for social workers and public health workers who must develop strategies to work effectively with this high risk population.     

Staff burnout from a social perspective

Physical distress, emotional distress, and cognitive fatigue are common symptons of burnout. The consequences of burnout affect the effectiveness of the care giver, the client, and the agency employing the burned out worker. The authors emphasize the societal context in which we all work and the changes in this context that have led to changes in the attitudes, behaviors, and roles of care givers and recipients. The change of role perception and the role behavior has occurred in a wide variety of public agencies. The authors suggest establishing agency guidelines for personal and system limitations concerning assistance to clients. Care givers can also work on an individual basis with clients and outline limits of assistance. As more people seek assistance when resources are limited, the need to build realistic expectations for the care giver, client, and agencies increase.     

The healing power of dogs: Cocoa's story

Animals bring a sense of "at homeness" and even normalcy to people who are hospitalized or live in health care facilities. Illnesses, separation from family, fear, loneliness, and even depression may be lessened for those who receive a therapy dog visit by providing a welcome change in routine and something to look forward to. Individuals are often more active and responsive during and after a visit. Just stroking and petting a dog requires the use of hands and arms, as well as the motions of stretching and turning. Dogs are also unconcerned with age or physical ability; they accept people as they are. This alone causes many to reach out and interact with dogs. Animals provide a focus for conversation and a common interest. As Cocoa's human partner can attest, a pet also makes it easier for strangers to talk. Cocoa is known by so many people at the facilities she visits that residents' family members often stop to talk with "Cocoa's mom" when they meet her in the community, asking questions about how Cocoa is doing. When Cocoa is no longer able to perform her services, many in her community will mourn. Cocoa's story, as well as the limited research literature, supports the positive physical and psychological effects of animals, but continued research on the effect of therapy animals on health outcomes is needed. As advocates for clients, nurses are in key positions to facilitate the inclusion of animals in clients' care. Although not for everyone, including those who react negatively to animals or who are allergic, pet therapy offers important possibilities for providing holistic care that extends not only to clients, but also to family members and staff, and to the pets themselves.     

Repairing the nest: A psychodynamic developmental approach to clients with severe behavior disorders

In this article, the authors explicate concepts from psychodynamic developmental theory that can foster affirmative assessment and intervention with clients who have developmental disabilities and present severe behavior disorders. A case example illustrates how making bonding the primary goal of intervention appears to facilitate positive behavior change in these clients while reducing feelings of helplessness and discouragement in their caregivers.     

Understanding the role of Australian Aboriginal maternal infant care workers: bringing a cultural dimension to a critique of the ideal worker concept

Models of care that include a prominent role for Aboriginal workers are fundamental to improving the health of Aboriginal Australians. However, tension arises when these models co-exist with mainstream models, contributing to difficulties sustaining an Aboriginal workforce. The ‘ideal worker’ theory is drawn on to explore whether historical workplace norms undermine the roles of Aboriginal workers in an Australian hospital setting. In-depth interviews were conducted with 30 staff and clients of an innovative maternity service, featuring Aboriginal Maternal Infant Care (AMIC) workers caring for Aboriginal women in partnership with midwives. A phenomenological methodology highlighted that unrealistic and inappropriate assumptions embedded in the ideal worker notion underpin many challenges facing AMIC workers. These workers have deep ties to their communities, with extensive responsibilities beyond the workplace. Although the hospital system relies on these ties to engage clients, this time commitment and the unbounded ways in which AMIC workers provide care are not acknowledged. Findings illustrate how the ideal worker concept has a cultural and gender dimension, which undermines AMIC workers and does not value culturally relevant care. This work has implications for ingraining cultural competence into health care, suggesting the wide-ranging contributions of Aboriginal workers must be recognised to achieve sustainable reform.     

Tracking the Sexual Behavior-Specific Effects of a Foster Family Treatment Program for Children with Serious Sexual Behavior Problems

Few treatment programs exist for very young children with serious sexual behavior problems. Fewer still have produced data relating to their effectiveness, and the sparse data that have emerged have focused on global social adjustment or improvement rather than on sexual behavior- specific changes. This study tracked both frequency of problem sexual behaviors and care giver estimates of the propensity to re-offend of six initial clients referred to a treatment-intensive foster care program for sexually reactive children and pre-adolescent sexual offenders. A simple pre-post (basepoint-treatment) design was used, and in-treatment data gathered over a two-year interval are presented. Initial results indicate that the problem sexual behaviors of most of these youthful clients were effectively and immediately suppressed in the context of their treatment intensive foster placements, but that the program's impact on the clients' propensity to re-offend given the opportunity—a crude measure of treatment internalization—was much less immediate, less pronounced, and less predictable across clients. Recommendations based on these data are offered concerning the viability of foster care intervention for sexualized and offending children, as well as optimal durations for such treatments. The strengths and weaknesses of the novel progress tracking method are discussed.