A new nursing medium: computer networks for group intervention.

The PLWAs and the caregivers of persons with AD were similar in their adaptation to this new technology as a communication medium with nurses. Both groups availed themselves of the resources, both technological and personal, on the computer network. Although different in demographics, they also were similar in their ability to form and work in a traditional group structure. Nurses have historically intervened with groups, and this article demonstrates that nurses can intervene on a computer network with groups. Yalom's therapeutic factors exist in both non-face-to-face groups and traditional groups. The benefits of this technology to nurses are numerous: they can access clients in an efficient yet supportive manner; they can respond to multiple levels of need in multiple clients; and they can attend to emotional as well as more concrete needs of clients. The benefits to clients are also numerous: they can use the system at a time, frequency, and duration of their choice; they have the opportunity to be supported in self-care efforts versus being in a more dependent role; and they can engage in a normalization of their experiences. Computer networks can enhance nursing's ability to intervene with clients experiencing clinical problems.     

Spouse-aided Therapy and Psychiatric Nursing: A Preliminary Report

The training of psychiatric nurses as behavioural nurse therapists has been successfully established in the U.K. by Marks et al. However, their approach has a number of theoretical and practical limitations, such as a rigid adherence to an illness model of psychiatric disorder. This paper describes and evaluates an approach to the training of psychiatric nurses based on systems theory. Four nurses were trained in the use of Spouse-aided Therapy, a time-limited, goal-orientated outpatient approach to the treatment of married psychiatric patients with persisting psychological disorders. Patients' spouses are involved throughout therapy, with the aim of making full use of resources within marriage which may facilitate patients' recovery. Questionnaire and anecdotal data from 12 patients showed a mean fall of 30% in patients' symptoms and a mean fall of 20% in marital dissatisfaction after therapy. The pattern of results supported a systems theory interpretation of outcome.     

Understanding Nurse Perceptions of a Newly Implemented Electronic Medical Record System

Nurses are the frontline of healthcare; however, there has been little theoretically-driven research on their acceptance of information technology use in care delivery. This research utilized the unified theory of acceptance and use of technology (UTAUT) model to understand how hospital nurses perceived the implementation of a new electronic medical record (EMR) system. This study used mix methods. The survey responses indicated that social influence and performance expectancy were significant factors in system adoption. Effort expectancy did not have a significant influence on the intention to use the EMR. The interviews were utilized to better understand these results. The UTAUT model highlighted factors that are important to nurses during an EMR deployment and can help in future implementations of technology in healthcare.     

Primary care update for mental health nurses: evidence-based guidelines for nursing assessment, intervention, and follow up

Physical health comorbidities are often undiagnosed or undertreated in individuals with severe and persistent mental illness. Mental health nurses are in an ideal position to identify, refer, and monitor treatment of these comorbidities. National evidence-based practice guidelines provide key information about common physical health comorbidities that mental health nurses can readily use in their everyday practice.     

Social support for victims of domestic violence.

Nurses in a variety of settings encounter people whose lives are affected by domestic violence. Case identification, crisis intervention, advocacy, psychoeducation, psychotherapy, case management, and referral networking are tasks that can be performed by nurses with various levels of education. A holistic approach is needed when caring for victims, perpetrators, and witnesses of physical and psychological violence. A variety of disciplines must work together to challenge this multifaceted social dilemma. Nurses can guide clients to useful resources to help battle the tide of violence existing in society today.     

Music listening: its effects in creating a healing environment

Older adults face challenges in function, cognition, and isolation as they age. Nurses are responsible for providing a healing environment to promote health and well-being. Music listening is an intervention that could be used to facilitate a healing environment. This article provides examples of evidence that music can improve the healing environment for older adults, both physiologically and psychologically. Music can connect individuals with their emotions and bring about a sense of self-awareness that improves the quality of life for older adults. Music is a safe, inexpensive, and easy-to-use intervention that nurses can implement independently to help older adults cope with pain, acute confusion, and functional deficits. Examples of ways nurses can use music to provide a healing environment are also included.     

Working on the front-line: risk culture and nursing in the new NHS

Nursing and midwifery are increasingly marked by risk and uncertainty under the dual impact of patient consumerism and organisational accountability. The omnipresent character of risk in health work means that it is particularly difficult to manage. Since the practice decisions of today may only be known as problems in the future, risk can never really be forestalled. This means that it is very difficult to close-off risk, but nonetheless imperative to try. Drawing on research conducted in two hospital trusts, this paper explores the strategies that nurses and midwives use in an attempt to colonise the future and protect themselves in the risk culture of the new NHS. It will suggest that although the self-protective strategies that emerge may enhance quality of patient care, they can also generate defensive practices which are in the interests of neither nurses and midwives nor patients.     

Elder abuse and neglect

Elder abuse and neglect is a critical health care issue that must be brought to the attention of health care providers and older adults' family members. Adults older than 65 who live at home or in long-term care facilities may be at risk for abuse. Nurses should be aware of the causes, screening questions, symptoms of abuse, and resources in the community. Armed with information and a better understanding about the issue, nurses can minimize the devastating effects of abuse on older adults and their families.     

Physical Restraints:

In spite of the increasing recognition of the physical and mental problems encountered as a result of using physical restraints, their use has markedly increased over the years. The ultimate form of abuse, restraint related deaths, has only recently come to light. The popular press began to investigate and report on deaths, but there has been little recognition of the potential lethal dangers of restraint use in the professional literature. Health professionals, particularly nurses, walk the thorny path of choosing ethical dilemmas, such as freedom vs. best interests, where safety and sanctity of life often become the overriding concerns when caring for confused elders. Faced with an increasingly litigious society, nurses feel they must tie down the elderly to prevent lawsuits. However, several reviews of lawsuits indicate that, rarely, are suits entered for a lack of restraining and when they are, other abridgements of care standards can be found to support the plaintiffs claim. The future should see an increasing number of legal cases brought for abridgement of human rights. A more informed public can be expected to seek redress when there is a lack of keeping with the spirit of the new OBRA regulations and incidents occur in the presence of restraint use.     

Facilitating communication: how to truly understand what patients mean

1. Patients experience greater satisfaction with nursing care when they are truly understood. 2. Being aware of taken-for-granted meanings and committing the time to seek clarification and explore meanings are two basic principles that can facilitate understanding. 3. Techniques nurses can use to facilitate understanding include restating what was heard to ensure understanding and to demonstrate active listening, asking open-ended questions, and checking for understanding.     

An international validation study of the care thermometer: a tool supporting the quality of ergonomic policies in health care

Occupational back pain among nurses leads to high costs and personal suffering for nurses. It is difficult to assess the success of such initiatives and to monitor results in a practical way. Such a practical monitoring and web-based instrument was developed. This Care Thermometer (CT) allows the users to assess the current situation in their facility today, and, with regular use, it can help to track progress over time. The Care Thermometer is a further step in the development of the TilThermometer, a validated assessment tool that is used on a large, national scale in The Netherlands. The claims of the newly developed Care Thermometer are ambitious and an international validation study was performed in four countries: the UK, USA, Germany and the Netherlands. The instrument appears to be sufficiently valid, useful and practical. There are however some points to keep in mind when interpreting the results of the CT. Especially a careful, punctual and stringent data collection phase is crucial for accurate and useful results. Some recommendations to further improve the practical use both for the design of the instrument and the process of data-collection and -entering are given.     

Mastering group leadership. An active learning experience

Leading therapeutic groups is an underused but viable treatment role for nurses in all specialty areas. A dynamic psychoeducational group model provides structure as nurses invest and collaboratively participate to actively learn the group leader role. this article highlights the sequencing of instruction of group theory and skills with examples from a baccalaureate nursing curriculum. Samples from student journals reveal their growing assimilation of the group leader role as learners actively participated in groups, collaborated, and reflected on their learning. Examples of creatively adapted group exercises, as well as selected nursing group leader interventions, demonstrate group leadership as a skill that can increase nurses' repertoire of therapeutic responses. Therapeutic groups are both exciting and cost-effective treatment strategies for use with mentally ill clients. The skills of an accomplished group leader are transferable from within the psychiatric population to working with families, bereavement groups, and other client populations, ranging from people with diabetes to survivors of catastrophic crises. Group leadership ability complements the management and negotiation skills needed in professional nursing roles. When students and staff nurses grow in group leadership expertise, clients in various settings will be better served with this currently underused treatment option.     

Concern, Caution, and Care: HIV Risk Perception among Hospital Nurses

Nurses routinely confront uncertainties surrounding the risk of occupationally transmitted HIV, particularly in the context of hospital AIDS care. Nurses respond to their perception of this HIV risk with a mixture of concern, caution, and care. This study empirically examines HIV risk perception based on a survey of hospital nurses in U.S. cities with high HIV seroprevalence rates. There is variation in the degree to which hospital nurses worry about HIV at work, despite widespread use of universal precautions. Occupational HIV risk perception is associated with knowledge of workplace transmission vectors, comfort with AIDS patients, AIDS care experience, and working conditions. Results show that nurses on AIDS care units are more habituated to HIV risk, whereas those with less AIDS care knowledge, tolerance, and experience are more concerned about HIV Consequently, nurses who worry less about being infected with HIV are more willing to perform AIDS care, predict plans to continue AIDS care in the future, and report more equal treatment of people with AIDS. Supportive workplaces which reduce stress and emotional exhaustion, together with enhanced and improved training for hospital nurses, may temper provider concerns and improve the continuity and quality of care.     

What is cyberbullying & how can psychiatric-mental health nurses recognize it?

Cyberbullying is an emerging issue within our society, particularly among adolescents. The phenomenon is similar to traditional bullying in that it is hurtful, repetitive behavior involving a power imbalance, often causing psychosocial issues. With the availability of cell phones, Internet, and video gaming systems, adolescents are constantly plugged into technology and therefore at risk of being a victim or a perpetrator of cyberbullying. Both physical and mental health problems can result from cyberbullying, which, in turn, can affect an adolescent's performance in school and other crucial areas of life. Legal action is an option, but many times the law is not clear. Psychiatric-mental health nurses are in a position to help educate children about resources to prevent or cope with cyberbullying in a way that will help not only the patients themselves but also parents, teachers, school administrators, and the community.     

Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.     

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.     

The Low Status of Female Part‐Time NHS Nurses: A Bed‐Pan Ceiling?

Despite increases in female participation rates into the paid working population of Britain women remain concentrated into particular sectors of the economy. Areas of the labour market where women predominate are also characterized by high levels of part‐time employment. The significance of part‐time work is that it is lower paid and offers fewer employment opportunities for women. This article examines the careers of 643 qualified female NHS nurses. It is found that respondents working part‐time are the least likely to occupy the upper echelons of NHS nursing. Explanations for this centre on the actions and strategies of managers who use negative gender role stereotypes regarding part‐time nurses to inform recruitment and promotion decisions. Managers, however, regard the low status of part‐time nurses as a reflection of their own choice strategies, thus failing to recognize the existence of gender‐based disadvantage. The resultant outcome is one where part‐time nurses are confined to the lowest qualified clinical grades, with little opportunity to progress to the higher grades. Critical labour shortages in nursing, however, may mean that the utilization of part‐timers is re‐examined as NHS management seek to retain more qualified nurses. For such a re‐examination to be successful management attitudes also need to change.     

Effects of government policies on the work of home care personnel and their occupational health and safety

The health sector in Québec (Canada) is dealing with profound macro-economic and macro-organizational changes. This article is interested in the impact of these changes on the work of home health aides (HHAs) and home care nurses and their occupational health and safety (OHS). The study was carried out in the home care services (HCS) of four local community service centres (CLSC) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 22 observed workdays and 35 observed multidisciplinary or professional meetings, as well as on administrative documents. HHAs are experiencing an erosion of their job because the relational and affective aspects of their work are disappearing. This may be due to an increase in their physical workload, leading to an increase in musculoskeletal problems and, to a lesser extent, in psychological health problems. Nurses are seeing an increase in the volume of invisible work that they have to do, which also has the effect of decreasing the relational aspects of their activity. The increasingly numerous psychological health problems are the consequence of this change in their profession. This study also shows that managers' decisions at the local level can reduce or increase the work constraints of HHAs and nurses. Examples of good practices for HHAs are the stabilization of clienteles and the possibility of organizing their itinerary, while for nurses, it is in how clientele follow-up tools are implemented. This article discusses the effects of government policies and decisions on the work and OHS of home care personnel. To address this subject, we use a specific analysis of the workload of home health aides (HHAs) and nurses. We will show the relationships between managers' organizational choices to respond to governmental constraints and the resulting work changes. We will also look at their consequences on occupational health and safety (OHS) and on the work of different personnel.     

Changing attitudes about self-injury prevention management: lessons learned

In the behavioral health environment, nurses often use continuous staff monitoring and, at times, physical restraints, to manage the severity of patients' self-injury. Both options put staff in control, are the most restrictive in nature, and can be financially draining on the hospital's budget. This can result in negative reactions by both patients and staff. It is important to develop a program that will empower patients to control their behavior and allow staff to be aware of their perceptions and attitudes toward patients who self-injure. This article describes the leadership initiative that drove the development, training, and implementation of a self-injury prevention project and the lessons learned by staff.     

The Effect of Economic Standing,Individual Preferences,and Co-ethnic Resources on Immigrant Residential Clustering 1

Our study examines how immigrants cluster in co-ethnic neighborhoods. We systematically explore the effects of three factors on the co-ethnic clustering of immigrants: economic resources, co-ethnic preferences, and the use of co-ethnic information sources. The study is based on a unique data set that provides rarely available rich information on housing search collected in Toronto in 2006. Focusing on Asian Indians and Chinese immigrants, the results clearly suggest that of all preferences, only co-ethnic preference is related to co-ethnic clustering of the two groups when income and use of co-ethnic resources are taken into consideration, and that levels of co-ethnic clustering are not related to the economic resources of immigrants. The findings also reveal that some effects are distinctive to specific groups. Although immigrants use various co-ethnic resources to obtain housing information, only the use of co-ethnic real estate agents is significant, and that only for the clustering of Chinese, not for Asian Indians.