Bridging gaps between mind, body, & spirit. Healing the whole person.

Fifty percent of visits of primary care providers are for psychiatric problems making it desirable to screen for mental, addictive, or behavioral disorders at the level of primary care. Psychiatric/mental health nurses prepared at the master's level to practice in the blended clinical specialist/nurse practitioner role are well placed to treat or collaborate in the treatment of people who present with symptoms of physical or psychological problems. The role of the clinical specialist/nurse practitioner is evolving in response to changes in health demographics, epidemiology, scientific and technological advances, and changes in managed care. Advanced practice nursing education must continue to anticipate and meet on-going changes and challenges.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Integrating a professional apprenticeship model with psychiatric clinical simulation

In this article, we present a theory-based application of clinical simulation in psychiatric-mental health nursing education. As described by Benner, Sutphen, Leonard, and Day, a three-pronged apprenticeship that integrates intellectual, practical, and ethical aspects of the professional role is critical in the development of practical reasoning in nursing education and training. Clinical encounters are often fraught with ambiguity and uncertainty. Therefore, educating for a practice discipline requires experiential and situated learning. Using the three-pronged experiential model in simulated psychiatric-mental health nursing practice supports the development of critical nursing skills, ethics, and theoretical concepts. A clinical scenario is presented that demonstrates the application of this model of professional apprenticeship in psychiatric-mental health education. Applications of the concept presented may be used in training nurses new to the practice of psychiatric-mental health nursing.     

Anti-oppressive Practice in Mental Health

This article identifies the challenges to incorporating an anti-oppressive practice approach in the field of mental health, which has traditionally utilized a discourse and perspectives of a bio-medical model. Schools of Social Work often teach anti-oppressive and social justice approaches which make it difficult for students to link theory and practice in fields such as mental health. In this article, seven principles of practice are presented as a framework for working with people with disabling conditions of mental health. Specific strategies for implementing these principles are presented.     

The history, economics, and financing of mental health care. Part 2: The 20th century

1. To understand how mental health nursing practice was affected by the financing and policy changes occurring rapidly in the second part of the 20th century, sources can only be found in the literature in psychiatry, the social sciences, and economics. There was no psychiatric nursing journal until the 1950s, and no article by a nurse in the general nursing literature about finances. 2. Deinstitutionalization was really transinstitutionalization. Changes in regulations in Medicaid allowed the shifting of mentally ill people who were older than age 65 to nursing homes. 3. Community mental health centers never developed programs to serve people who were seriously mentally ill. Rather than serving clients who were psychotic, the community mental health centers marketed their treatment programs to people with anxieties, who were undergoing divorce, or who had mildly troubled children.     

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.     

Nursing Intervention on Sexual Health: A Multilevel Behavioral Survey of Senior Nursing Students in Clinical Practice

ABSTRACT. There are many diseases that may impact patients’ sexual health and psychological well-being. Despite the importance of sexual health care (SHC), insufficient SHC occurs across care settings and the patient population. Studies investigating the essential elements of SHC behaviors of nursing students in clinical practice have been scant. The aim of this study was to assess the frequency of senior nursing students’ multilevel interventions for patients’ SHC in primary clinical practice. An anonymous 19-item instrument entitled Nursing Intervention on Sexual Health was distributed among senior nursing students at two central Taiwan nursing schools. We analyzed overall nursing intervention in SHC in clinical practice by levels. The results of this study indicate that the frequency of nursing intervention in sexual health is low. Another important finding is that following the PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) model, from permission level to the specific-suggestion level, the behavioral frequency of nursing intervention shows a decrease along with the model. Nursing students omitted each level of SHC in clinical practice, even if they had sufficient time and extensive preceptor resource, in this study. The nursing students’ SHC on different levels would help educators to frame the sexuality education program.     

Learning opportunities through camping for mental health nursing

1. To equip nurses with the skills necessary for working with disturbed people, nurse educators need to be mindful of not watering down the essential skills necessary for nurses to deal with difficult behaviour in all branches of nursing. 2. These components of a mental health clinical experience should equip the graduate to deal with the pressures of dealing with disturbed people in any environment, as the skills learned generalize to any branch of nursing. 3. Universities can combine with traditional hospital services and community mental health services to provide services to clients with mental illness. An additional benefit is in providing students with an intensive clinical learning experience that reinforces the theory taught in the classroom.     

Beyond the limitations of best practices: how logic analysis helped reinterpret dual diagnosis guidelines

The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated teams in specific health-care contexts and the appropriateness of the proposed model for certain populations. Using logic analysis, we identify the key clinical and organizational factors that contribute to successful implementation. Building on both the professional and organizational literatures on integrated services, we propose a conceptual model that makes it possible to analyze integration processes and places integrated treatment within an interpretative framework. Using this model, it becomes possible to identify key factors necessary to support service integration, and suggest new models of practice adapted to particular contexts.     

Potential and Possibility: Psychodynamic Psychotherapy and Social Change with Incarcerated Patients

In the present paper, Pierre Bourdieu’s theory of symbolic power is used to illustrate how the practice of psychodynamic psychotherapy in a prison-based mental health treatment program constitutes both a psychological and sociological intervention, congruent with clinical needs of this particular population. The author draws from psychodynamic theory, Bourdieu’s framework and her experience as a clinical social worker with the California Department of Corrections and Rehabilitation.     

Providing nursing leadership in a community residential mental health setting

The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies.     

Strategies for improving education

1. An extensive curriculum is required to prepare mental health professionals to adequately assess, plan, and implement the necessary comprehensive treatment plan and to sufficiently develop relevant social policy. 2. A majority of professionals believe they were not adequately trained in the care of the chronically mentally ill; this may be a result of the trend of integrating the teaching of mental health nursing concepts into the baccalaureate curriculum. 3. Frequently there is a lack of mental health professional role models. Nursing faculty are in an excellent position to implement innovative practice models. 4. Learning from a multidisciplinary team may increase the likelihood that students will apply these approaches to the chronically mentally ill.     

When therapists do not acknowledge their moral values: Green's response as a case study

In this rejoinder to Green's (this issue) commentary on my article, I clarify several points of agreement and divergence with his critique. The failure of Green to be forthcoming about the sociopolitical and moral framework that infuses his response is unfortunately all too common in this literature. This places a limitation on the degree to which his comments can be contextually evaluated, though they remain didactically useful. Marriage and family therapists (MFTs) must realize that their underlying belief systems exact a profound influence on their conceptions about what constitutes mental health, valid treatment goals, and the best means to achieve these aims. These value frameworks may or may not be shared by religiously conservative and other clients who seek to develop their heterosexual potential. This has important, but often unrecognized, implications for clinical practice.     

The ten commitments: a value base for mental health recovery

The concept of recovery is an important part of contemporary mental health services. During the past 5 years, Tidal Model projects, focused on developing the recovery attitude within nursing practice, have been established in several different countries. The Tidal model emphasizes 10 philosophical assumptions the "Ten Commitments," that are central to recovery-focused practice.     

Promoting public/academic linkage.

1. Collaborative linkages between public mental health/mental retardation service systems and academic institutions have evolved in response to several problems: increasing numbers of individuals requiring long-term mental health care; the nursing shortage; and a decline in enrollment and students graduating from psychiatric mental health nursing programs. 2. Evidence suggests that a public/academic linkage in the form of a multidisciplinary training course in the care of seriously mentally ill patients promotes a recruitment of mental health professionals to work with these patients. 3. The establishment of academic/health care system linkages can enhance client care, expand and improve clinical experiences and education for students, and provide opportunities for collaborative research among clinical staff, faculty members, and graduate students.