Revising a medication education program on an inpatient child and adolescent psychiatric unit

Adherence to a medication regimen can be challenging for children and adolescents with mental health disorders. Medication education can be a beneficial tool for nurses to help promote adherence to psychotropic medications. This article describes an initiative to improve medication education offered to children and adolescents and their families on an acute child and adolescent inpatient unit in a mental health facility. Strategies included adding a game to medication education groups, creating and distributing medication education handouts, and developing and implementing medication education sessions for parents. When used by the patients and families, the interventions were appreciated. Having successful interventions in place may help meet the diverse educational needs of this population as nurses seek to improve medication adherence.     

Beyond the prescription pad: psychosocial treatments for individuals with schizophrenia

Individuals with schizophrenia face multiple barriers to the achievement of optimal health, including apathy and poor concentration, sedative effects of medication, and poverty and lack of access to health education and treatment programs. In addition, the symptoms of the disease negatively affect their social functioning, which may result in isolation and lack of social support. In addition to providing psychiatric care and monitoring, both generalist nurses and advanced practice psychiatric nurses may assess physical and psychological risk factors, monitor medication responses, and provide health promotion to these individuals. Health promotion for individuals with schizophrenia includes psychosocial treatments to prevent relapse (e.g., education on the importance of treatment adherence) and to promote recovery (e.g., involving family members in treatment when possible). This article describes the key elements of recommended psychosocial treatments, briefly reviews the evidence for these treatments, and discusses clinical implications for all psychiatric nurses.     

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.     

Caring for older adults with bipolar disorder

Bipolar disorder is a recurrent, chronic mental illness that has a profound impact on the lives of patients and their families and may require extensive use of mental health services. Although bipolar disorder is often considered an illness of young people, the disorder is being recognized as more common in older adults than previously thought. Much more research needs to be done to understand the impact of aging on the course and treatment of bipolar disorder. Evidence-based interventions for treatment of this disorder in older adults must be developed. Mental health nurses can play a key role in enhancing medication adherence, implementing structured psychosocial interventions, and carrying out research to enhance diagnosis and treatment of older adults with bipolar disorder.     

Intimacy boundaries: between mental health nurses & psychiatric patients

This was the first research study in Canada to explore intimacy boundary violations and sexual misconduct between nurses (both RNs and registered psychiatric nurses) and patients. Using a researcher-generated survey, a total of 923 mental health nurses commented on their sexual attraction to patients, and dating and sexual intercourse patterns with patients. The findings indicated that very few nurses had dated or engaged in sexual intercourse with discharged patients, and the few nurses who had done so tended to be younger men prepared at the registered psychiatric nursing diploma level. A small number of nurses believed it was permissible to have a sexual relationship with a patient while the patient was hospitalized, but none reported having a current relationship. Given the severity of this intimacy boundary violation, nurses need to be educated regarding the serious and dangerous psychiatric effects that can result for patients from engaging in a sexual relationship with nurses. The Code of Ethics of the Canadian Nurses Association and nurses' obligation to follow it needs to be reinforced. Nurses engaging in intimacy boundary violations are vulnerable to patient-initiated lawsuits.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Emerging adult identity following adolescent experiences with psychotropic medications: A retrospective study

This study examines the perceptions of mental illness identity among a group of emerging adults based on their retrospective experiences with diagnoses and psychotropic medication use during their earlier formative adolescent years. A short questionnaire was administered via online social media platforms to volunteers between the ages of 19 and 30 and who self-identified as having taken psychotropic medication between the ages of 12 and 18 (N = 46). Correlation analysis revealed that several variables were associated with a stronger illness identity, including participant’s happiness with their medication experiences, the belief that medication made them more like their “true” selves, and the belief that their diagnosis was accurate. Content analysis of participant narratives suggested themes related to discontinuation and barriers to adherence. These results contribute to the growing knowledge base around lived experiences of psychiatric medication use and suggest further study on how to advance more informed and compassionate mental health care.     

How to work with elderly patients on a general psychiatric unit

Currently, there are specialized geropsychiatric units being used for elderly psychiatric inpatients. However, these units are not always available to the growing elderly population. The general inpatient psychiatric unit seems to be well suited for treating the medical and mental illness of elderly psychiatric patients (Billig, 1989; Conwell, 1989; Liptzin, 1987). As identified earlier, nurses may not be enthusiastic about adding this population to their unit. Our society is youth-oriented and the elderly tend to be viewed as slow, needy, and sick. It is essential for nurses to explore their own feelings regarding aging and what it means to be old. If the nurse has not dealt with issues such as her own mortality and that of her parents and close friends, it may be difficult for her to understand and work with the elderly. The ability to understand the feelings of another and to communicate this understanding has been identified as a crucial variable related to positive therapeutic outcome (Kirk, 1982). Inservice programs and groups that give the staff opportunities to explore their attitudes and feelings toward the elderly may result in more effective therapeutic interventions (Farley, 1983). To many elderly patients, nurses are seen as supportive figures, interpreters of the unknown, and potential allies who have an empathic regard for them (Davis, 1968). The nurse can use these impressions to initiate interventions. This, along with coming to terms with one's own feelings about aging, can result in a greater understanding of these patients. This article has given a very brief overview of the many issues related to the care of the elderly psychiatric inpatient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cytochrome P450 testing for better psychiatric care

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.     

Japanese expert public health nurses empower clients with schizophrenia living in the community

1. Home visiting psychiatric public health nurses are integral to expanding community-based mental health services for Japanese citizens living with schizophrenia and other mental illnesses. 2. Interviews with experienced psychiatric public health nurses revealed empowerment as the basic social process that guides their practice. Five empowering practice domains foster client autonomy. 3. Psychiatric public health nurses work with families, neighbors, educators, and employers to enable their clients' healthy living in the community.     

Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

Ancient Greek psychotherapy for contemporary nurses

Ancient Greek physicians as well as philosophers were fully cognizant of a human being's psychological function and used their particular art to influence individual or social behavior in accordance with their pursuit. This art or technique favorably compares with several of the methods currently called supportive psychotherapy. This psychotherapy was the first form of care for people with mental health problems. Nurses who base their practice on ancient Greek psychotherapy see the patient as a whole, a person who creates meaning in life. Applying the philosophical principles of ancient Greeks helps nurses understand the behavior of people with mental health problems and recognize and facilitate adaptive satisfaction of these psychological needs. In addition, psychiatric nurses are able to help distressed individuals understand their fears and anxieties, so they are freed from the causes of their symptoms that led them to seek therapy in the first place. Consequently, this understanding can make psychiatric nurses' work a living experience and add meaning to their work.     

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.     

The Provider’s Voice: Patient Satisfaction and the Content-filtered Speech of Nurses and Physicians in Primary Medical Care

Two studies examined vocal affect in medical providers’ and patients’ content-filtered (CF) speech. A digital methodology for content-filtering and a set of reliable global affect rating scales for CF voice were developed. In Study 1, ratings of affect in physicians’ CF voice correlated with patients’ satisfaction, perceptions of choice/control, medication adherence, mental and physical health, and physicians’ satisfaction. In Study 2, ratings of affect in the CF voices of physicians and nurses correlated with their patients’ satisfaction, and the CF voices of nurses and patients reflected their satisfaction. Voice tone ratings of providers and patients were intercorrelated, suggesting reciprocity in their vocal affective communication.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Widows and widowers in today's society

With the increasing life span in our society, the number of widowed individuals has increased dramatically. The loss of a spouse is one of the most stressful life events for both women and men, yet there is little nursing research on the physical and psychosocial needs of older adults who are experiencing this loss. Some studies suggest that widowed women and men develop significant physical and mental health problems and complicated grief. Thus, it is important for nurses to recognize the diversity of grieving experiences and the increased vulnerability of widowed individuals to psychiatric illnesses that may result in suffering and impairment of daily functioning. With a better understanding of these needs, nurses can provide interventions that help these individuals maintain their health and independence.     

Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.