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.     

Meeting spiritual needs on an inpatient unit

Two focus groups were held with patients who had experienced inpatient hospitalization and their families, to discuss spiritual needs during psychosis. Spirituality was described in terms of relationship and religion in terms of rules. Four themes emerged to describe spiritual needs during an inpatient hospitalization: comfort, companionship, conversation, and consolation. Eleven succinct interventions were identified within these themes. The number one need expressed by consumers of all denominations and religions who belonged to a church/temple/spiritual group was for their pastor/rabbi/spiritual advisor to not abandon them. For those who did not belong to a religious/spiritual group their number one need was to at least be asked for some type of religious/spiritual preference and for the nurse to somehow contact the person mentioned.     

Unlocking Hikikomori: an interdisciplinary approach

This article provides an interdisciplinary exploration of the ways in which social isolation is constructed in institutional and public imaginaries. It examines the discursive devices that produce hikikomori subjectivities, with a particular focus on the existence of an enduring deviant construct. Despite largely existing in the private sphere, hikikomori are positioned as residing outside of the prevailing system of social relationships and as such are perceived as a threat to social order. Persistent psycho-medical and idiosyncratic cultural depictions of hikikomori continue to obscure those who are doing the defining. Such portrayals also re-assert enduring normative expectations concerning the social, civil and economic participation of young people. Through an interdisciplinary approach that blends sociological and cultural critique, this paper challenges the dominant discourses framing hikikomori, at the same time underlining the ways in which these limiting discourses act upon the self by reinforcing an individualised subjectivity, masking the network of institutions and cultural discourses that mediate this process. We assert that there needs to be a broadening of the concept away from the atomised individual to one that situates hikikomori within a social and cultural context, having significant implications for identity and notions of personhood in contemporary, digital Japan and beyond.     

Military Deployment of an Adult Child: Ambiguous Loss and Boundary Ambiguity Reflected in the Experiences of Parents of Service Members

ABSTRACT

This study explored the experiences of parents of service members, military family members who are often overlooked even though they are likely a vital source of support for their military adult-children. Reflections on deployment of military adult-children were gathered from 21 parents in semistructured group interviews. A framework of ambiguous loss, boundary ambiguity, and ambivalence was used to analyze comments reflecting pre-deployment, deployment, and post-deployment experiences. Pre-deployment anticipation of leave-taking was associated with boundary ambiguity and ambivalence for parents, tempered by safety concerns. During deployment ambiguity in parental role expectations and parameters complicated parents’ attempts to manage physical absence and maintain psychological presence. Post-deployment challenged parents with ambiguous psychological presence and disruption of family boundaries, complicated by changes associated with the effects of war.     

The role of the interdisciplinary team in using psychotropic drugs.

1. The use of psychotropic medications to control unacceptable or maladaptive behaviors should be an integral part of the client's active treatment plan developed by the interdisciplinary team. 2. Ideally, psychotropic medication is used for behavioral management only after less restrictive programmatic alternatives have been exhausted, and then only in conjunction with a behaviorally based training program. 3. Attitudes and beliefs of individual team members will contribute to the success or failure of the interdisciplinary team process.     

Effects of suicidal behavior on a psychiatric unit nursing team

1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.     

A model for short-term group therapy on a children's inpatient unit

The paper describes the group therapy model which has evolved over the past two years on the Child Psychiatry Inpatient Unit of North Carolina Memorial Hospital. It begins with a brief review of the literature concerning group therapy with latency-aged children. The setting and patient population are described. Vignettes from group sessions are used to illustrate techniques which have evolved to deal with this particular setting and population. These include a leadership style characterized by much clarification, modeling, and limit setting; extensive focus on beginning and terminating; clearly defined behavioral limits; the use of time out; and use of play materials requiring little skill or attention as anxiety binders as well as projective media; and observation and supervisory discussions open to all members of the treatment team. The paper concludes with a discussion of the potentials and limitations of group therapy in such a setting. The thesis is that this model is effective in diagnosing developmental levels, in developing interpersonal skills, in substituting verbalization for action, and in mastering separation anxieties, though the setting limits the extent to which controlled regression, transference, and group pressures can develop and be used to produce change.     

Parents Forever: Evaluation of an Online Divorce Education Program

Divorce education programs are conducting increasingly rigorous impact evaluations to assess if their curriculum improves parenting practices, reduces conflict in the coparenting relationship, and improves outcomes for children. This article presents a 6-month follow-up evaluation of the online version of Parents Forever, an 8-hour divorce education course developed by the University of Minnesota Extension. At follow-up, parents (N = 232) reported significant improvements on several questions about postdivorce parenting and well-being, indicating that the online version of Parents Forever is effective in promoting positive behavioral change for parents.     

Enhancing knowledge of adolescent mental health among law enforcement: Implementing youth-focused crisis intervention team training

This study explores the feasibility, acceptability, fidelity, and outcomes of a youth version of the Crisis Intervention Team training (CIT-Y). This intervention is designed to keep youth with a mental health problem out of the criminal/legal system by equipping police officers with developmentally appropriate information and techniques. Whereas much is known about the adult-focused CIT training, little is known about the youth-focused training. This preliminary investigation uses multiple methods (training observations, officer interviews, and pre/post-tests) to assesses the implementation of CIT-Y in two Midwest counties. Multiple 8-hour training sessions were offered in both counties with 127 officers participating and completing the pre/post measure. The findings of this study confirmed that CIT-Y training was feasible in these counties and acceptable to the officers who participated. Outcomes from the pre/post-tests show that 86% of officers positively changed their knowledge and attitudes regarding youth with mental health problems. Interviews revealed a positive impact on officers’ reported behaviors. While this preliminary investigation of CIT-Y showed positive outcomes, recommendations for enhancing the curriculum and subsequent research are discussed.     

Outcomes of an interdisciplinary study abroad course: learning Spanish and multicultural education concurrently

This study reports the outcomes of undergraduate students completing a pilot Interdisciplinary Intensive Course Abroad (IICA) with a service learning component. The IICA model is comprised of a three-part sequence of study that includes a seven-week course on campus, followed by three weeks of study abroad, and a summative seven-week course back on campus. The additional summative component gives students the opportunity to bring together their newly acquired knowledge and skills, and to reflect on how to integrate these experiences in their future. The sequence integrates discipline-specific content studies with foreign language classes, and grounds them with a study abroad experience. A mixed-method design was used to measure students’ development of language skills, understanding of multicultural education concepts, and intercultural skills. Primary data sources were pre/post-assessments, student field notes and reflections, and a post-course survey. Results indicated that students gained confidence in their Spanish skills and were likely to enroll in further Spanish courses, their ability to define multicultural education concepts increased, and service learning, homestays abroad, and their time in an indigenous reservation contributed to development of intercultural skills.     

Treatment of an acting-out adolescent girl: An interpersonal experience

The current emphasis on psychotherapy as an interpersonal or intersubjective experience is highly relevant to clinical work with adolescents. This paper presentes and discusses the treatment of an acting out adolescent girl from the perspective of the two-person relationship, emphasizing the interaction between the patient's dynamics and the therapist's responses.     

The Impact of Childrens' Divorce on Parents:

Little has been written to date concerning the impact of an adult child's divorce on his or her parents-their anguish, grief, concern, humiliation or even occasional elation. The senior parent's reactions affect their own life cycle development. And within the context of a cybernetic circular systems model of conceptualization about family relations which we adhere to, it is posited that their reactions impact upon their childrens' (and grandchildrens') post divorce readjustment. This article is written to attempt to begin to address this issue and to fill this gap in the literature. It is primarily on the author's combined clinical observations with hundreds of clients and friends and their experiences living through their childrens' divorces. The next step is process and outcome research about this issue.     

Effectiveness of the Coral Tree Family Service family inpatient unit: a longitudinal study exploring change in family functioning

Child mental health disorders represent a major burden to public health in Australia due to high prevalence rates, the widespread impact across domains, and the potential for difficulties to persist into adolescence and adulthood. Extensive evidence exists for the use of parent management training and cognitive behavioural therapy to treat difficulties experienced by children; however, a proportion of children do not benefit as expected from these treatments. The use of complementary therapeutic approaches and variations to the mode and intensity of existing intervention is warranted; family inpatient units represent a unique example of this. The aim of this study is to evaluate the effectiveness of a well-established Australian inpatient unit that admits the whole family, for children aged 12 years and younger referred with mental health, behavioural, or emotional difficulties. This study's longitudinal within-subject study design utilised routinely collected outcome data from the systemic clinical outcome and routine evaluation, 15 item (SCORE-15)—a valid and reliable measure of family functioning—from a sample of 980 participants attending the Family Residential Program. This study reported significant improvement in family functioning across all outcome variables between baseline and post-intervention, with no variables returning to pre-intervention levels at follow-up. Clinically significant changes in overall family functioning showed that 37% of participant scores moved from the clinical range at baseline to the nonclinical range post-intervention. This study represents the first empirical evaluation of the Family Residential Program, and the reported results provide compelling evidence for the program to effect improvement in family functioning for families with long-standing and severe difficulties. Poor rates of questionnaire completion following intervention frequent the literature base of family inpatient units, with low post-intervention (56%) and follow-up (12%) rates evident in this study. This study uniquely contributes to the growing evidence base of family inpatient units using rigorous evaluation methods.     

When alcohol withdrawal has to be treated on an inpatient basis

Contrary to popular belief, alcohol withdrawal does not have to be treated on an inpatient basis. Two cardinal signs — a history of alcohol‐withdrawal delirium or alcohol‐withdrawal seizures — indicate hospitalization. So do certain comorbidities. Most cases can indeed be treated on an outpatient basis, according to two top experts: Lorenzo Leggio, M.D., Ph.D., senior investigator with the joint National Institute on Alcohol Abuse and Alcoholism (NIAAA)‐National Institute on Drug Abuse (NIDA) Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, and Mark Willenbring, M.D., founder and CEO of Alltyr in St. Paul, Minnesota and former director of the Division of Treatment and Recovery Research at NIAAA. However, even though it can be treated on an outpatient basis, it often isn't, and there's a good reason for that — better safe than sorry, to sum it up.     

Staff stress on an Alzheimer's unit.

Nurses working with the elderly encounter many complex and potentially stressful care situations. Nowhere is this more true than for nursing home staff who work in highly demanding, labor- and client-intensive jobs. A number of factors contribute to the high levels of stress found among nurses who work with the elderly, including continual exposure to physical and emotional pathology and death, and conflict with families, co-workers, supervisors, and representatives from other departments or professions (Goldin, 1985; Klus, 1980). When the stress level in a long-term care facility becomes overwhelming, role conflict, ambiguity, poor self-esteem, and burnout may ensue (Goldin, 1985; Heine, 1986; Klus, 1980; Morrow-Winn, 1985). The process of burnout is characterized by a progressive loss of idealism, energy, and purpose that eventually leads to emotional overextension and exhaustion (Price, 1984).