An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.     

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.     

Intersectional Approach to Top Executive White‐Collar Offenders’ Discourses: A Case Study of the Martha Stewart and Sam Waksal Insider Trading Scandal

Employing a feminist intersectional approach, the current study analyzes how the intersected social identities of homemaker extraordinaire Martha Stewart and Sam Waksal, the former CEO of ImClone, manifest in their gendered discursive strategies during the insider trading scandal. Findings indicate gendered performance could be better understood from a social learning process perspective, which dictates that individuals learn from public reactions to their past acts and adjust their presentations of self to achieve their career goals. Our findings also highlight gender transgression includes not only the demeanors associated with acts but also the role individuals take against the socially constructed gendered expectations.     

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.     

The challenge of the medical setting for the clinical specialist in psychiatric nursing

The purpose of sharing these ideas about the role of the psychiatric clinical specialist in the medical setting has been threefold: first, to stimulate the interest of others by communicating the needs for and the value of such a role in improving health care; secondly, to convey the variety of potential opportunities available in the role; and third, to share some ideas about specific activities which can be pursued in such a role. The clinical specialist who chooses to work in the medical setting will discover opportunities to develop creativeness, to explore innovative ideas, and to utilize the variety of one's personal resources and past learning experiences. It affords one with opportunities to serve as a change agent, to influence the quality of patient care, and to stimulate the growth of other nurses. It allows for on-going contact and exchange with other professional groups comprising the health care team, and finally, it provides the nurses with a high level of autonomy and challenge in defining their own roles.     

Not <Emphasis Type="Italic">Merely</Emphasis> TLC: Nurses’ Caring Revisited

The profession and practice of nursing has been studied from quite diverse scholarly perspectives in the United States and abroad. Feminist critiques focus on the gendering of caring and its knowledge/skill features, while professionalization advocates view emotive caring as secondary to other critical activities necessary for the occupational advancement of nursing. Based on ethnographic observations 30 in-depth, semi-structured interviews with nurses across different units working at a large urban hospital, this paper examines how nurses define caring as knowledge-based, skilled work. Specifically, nurses described four types of skills—observational, analytical, interactional, and comforting—that they deploy in the accomplishment of caring work at the bedside. My findings go beyond previous literature in this area by showing how nurses think of caring work in line with occupational strategies that emphasize their biomedical knowledge and diagnostic skills and uphold an advocacy or intermediary role in health care. I argue that while this ideological work may reassure nurses of their professional identity and critical role in health care, it may also reinforce the dilemma of nurse professionalization by obscuring the organizational nature of caring, as it remains an unsupported dimension of their work.     

The psychiatric technician: trespasser or welcomed ally?

1. The increasing shortage of nurses, higher patient acuity levels, and greater demands placed on nursing to meet standards of care have contributed to the use of psychiatric technicians to alleviate the burden on nursing and ensure the delivery of quality patient care. 2. Psychiatric technicians provide care for a select group of patients under the supervision of the primary nurse. The patients assigned to psychiatric technicians require minimal direct nursing intervention. 3. Psychiatric technicians reported increased self-confidence and self-esteem; the nurses were able to perform more professional nursing activities, increasing their job satisfaction and promoting staff retention; and the patients received high-quality care.     

Gender differences in the roles and functions of inpatient psychiatric nurses

This study explored the difference between male and female psychiatric nurses' job performance and job satisfaction levels on an acute care inpatient unit. The amount of time male (n = 28) and female (n = 45) nurses spent on 10 specific functions and roles during a shift were observed and recorded. The nurses also self-rated the amount of time they spent on these specific functions and roles. The observed and self-rated functions were then correlated with job satisfaction. Female nurses were observed and self-rated as spending significantly more time on patient care activities, and these activities were significantly correlated with higher job satisfaction levels. Male nurses who self-rated spending more time on patient care activities had significantly lower job satisfaction scores. Findings confirm the concepts from social role theory that gender identity and expectations influence job performance in psychiatric nursing. The results offer insight for increasing job satisfaction and recruitment/retention efforts.     

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

Empowering part-time nurses in the treatment of depressed inpatients.

1. With the consistent number of part-time nurses in the workforce, hospitals would benefit by more actively integrating them into professional nursing practice. 2. Empowering part-time nurses by affording them the opportunity to provide primary care has the potential to effectively use part-time personnel, decrease the workload for full-time staff, offer more flexibility in scheduling, and result in savings for hospitals in terms of nursing recruitment and retention. 3. This program has successfully developed and implemented a model of primary nursing that places three part-time nurses on a team capable of handling two to three primary patients. The success of this model has been attributed to excellent communication, trust in one another's professional skills, and nursing expertise.     

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.     

Top 10 reasons to take your graduate program in psychiatric nursing online

1. Removing barriers to graduate psychiatric nursing education is possible by delivering courses via the Internet. 2. The Internet is full of valuable resources for graduate psychiatric nursing education. 3. Successful online learning environments involve a paradigm shift on the part of faculty from traditional teaching to facilitating the learning of adult students. 4. Increasing the number of advanced practice psychiatric nurses through Web-based education will transform the delivery of mental health care.     

Role conflicts & coping strategies in caregiving. A symbolic interactionist view

Institutional health care delivery is characterized by interdependency among caregivers and between caregivers and care receivers, which leads to role conflicts. This article examines role conflicts and coping strategies of health care aides who are faced with differing expectations of RNs and residents. Guided by a symbolic interactionist perspective, ethnographic data from 12 RNs, 15 health care aides, and 32 nursing home residents of Italian-Catholic and Anglo-Saxon descent in Toronto, Ontario, Canada, was gathered. Results showed that health care aides differed in how they handled role conflict and their elderly clients' concerns. Health care aides were more likely to reject conflicting role expectations from residents than from RNs.     

Reflections on International Certified Nursing Assistants

The author, a former university faculty member who taught English to speakers of other languages and now a nursing home resident, shares her observations about how English language proficiency, culture, and religious differences affect her care. She provides examples of communication challenges that can be annoying or cause harm, her coping strategies, and reasons many certified nursing assistants might never be fully fluent in English. She explains how international certified nursing assistants can benefit residents because of skills developed by family-centered care in their countries of origin. She also discusses related issues—the importance of being culturally competent about U.S. culture. She points out how religiousness not only affects residents but is a buffer for staff against the stress of physically and emotionally demanding low-wage work. Overall, the author likes receiving care from individuals from other countries, finding reward in comparing how her personal struggle with illness and paralysis resonates with the trauma of migration and how learning firsthand about varying beliefs and attitudes clarifies her identity and place in world history.     

Highlights from a Study of Abuse of Patients in Nursing Homes

This article reports some major findings from a random sample survey of nurses and nurses aides in 32 long-term care facilities. After defining key terms, we review the literature in an attempt to establish what is currently known about patient maltreatment in nursing homes. Next, data from the survey are presented to profile the staff and to describe difficulties in nursing home work. Findings on the extent and correlates of physical and psychological abuse of patients are then reported. The article concludes with recommendations to reduce abuse of patients.     

Multiple Perspectives of Teams’ Experiences of a New Zealand Wraparound Process

Since it was first introduced in the 1980s, Wraparound has been defined as ‘a philosophy,’ ‘an approach,’ and ‘a service’ which is designed to work with youth and families with high and complex needs. Wraparound is most commonly understood as an intensive, individualised care planning process. It aims to achieve positive outcomes through a structured, creative, and individualised team planning process, which results in effective and more relevant plans for the youth and family. The purpose of this qualitative study was to explore the experiences of Wraparound facilitators, caregivers, youths, and team members to gain a multi‐perspective insight into the process. Sixteen families and Wraparound teams participated in the study which resulted in 56 semi‐structured interviews being conducted involving 16 Wraparound facilitators (some facilitators were interviewed more than once because they served multiple families who participated in the study), 16 caregivers, eight youth, and 16 team members (one person from the team, i.e., teacher, social worker, or mentor). Thematic analysis gave seven themes organised into three broad domains: (1) key elements of the Wraparound process including the Wraparound facilitator, Wraparound's philosophies and principles, and the supportive nature of the process; (2) the outcomes achieved throughout the process including family empowerment and hope, improved family dynamics and relationships as well as individual parent and youth change; and (3) the challenges and feedback respondents identified through the process, which included personal and systemic challenges, improved transition, and continuity of care, role clarity, and accessibility of the service. Overall, the findings from this study support Wraparound as an effective process for youth and their families, identify the importance of key aspects of the process, and suggest some improvements to increase the efficacy of and accessibility to the process.     

Biopsychosocial nursing assessment: a way to enhance care plans

1. A psychiatric nursing assessment tool reinforces the primary nursing care model; re-establishes nursing's input at comprehensive treatment plan meeting; reorients the staff to the total nursing needs of the client; and provides a tool for establishing nursing diagnoses. 2. Implementation of the nursing assessment form has educated other staff about professional nursing practice, as well as promoted a greater understanding of the nursing process and reinforced accountability for the nurses. 3. The form enables clients to be viewed from a holistic biopsychosocial nursing context, and nursing care plan recommendations are more individualized and inclusive of the total aspects of patient needs.     

Making it real: using standardized patients to bring case studies to life

With increases in the overall number of individuals with posttraumatic stress disorder (PTSD), nurse educators must provide experiences that help nursing students learn how to better communicate and care for individuals with this disorder. This article describes how two learning strategies-case studies and standardized patients-were combined to facilitate the development of therapeutic communication and assessment skills. Two case studies on PTSD were written, and actors were trained to portray the individuals in the case studies. Fourteen baccalaureate nursing students enrolled in a senior-level psychiatric nursing clinical course participated in this pilot alternative learning activity. This article describes the learning activity and presents student evaluations of the assignment.