A process-oriented approach. Selecting a nursing model for psychiatric nursing.

The nursing literature is replete with articles and books that describe nursing conceptual frameworks and models and encourage their use in clinical, education, and research activities. Although much information exists on the content of nursing models, less has been written about how a model is to be chosen and the process that may facilitate the choice of a model. This article reviews potential benefits and limitations of nursing models and conceptual frameworks and describes a three-phase process for selecting a model for psychiatric nursing practice.     

Caring in forensic nursing. Expanding the holistic model

Nurses have practiced forensic nursing for many years without formal recognition of the domain as a discipline for specialized study. Forensic nursing expands the traditional concept of holism to include the medical-legal aspects of potential or actual client problems. The American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) recently have designated forensic nursing as a unique specialty. Recognition of forensic nursing as a specialty area of practice within nursing mandates that the specialty define and explicate its major conceptual base. A concept germane to the practice of forensic nursing is that of caring. Caring as a central concept to the role of this specialty is discussed, and the implications for its inclusion in a curriculum preparing forensic nurses are explored.     

Girl Scouts Beyond Bars: a unique opportunity for forensic psychiatric nursing.

The interplay of victim and perpetrator roles experienced between daughters and their mothers provides for intricately complex interactions within a family and the community. Unique opportunities exist for forensic psychiatric nurses to articulate their nursing roles against health promotion and illness prevention programs for incarcerated women and their families. Participation in community-based projects allows forensic psychiatric nurses to observe and respond to the total environment of offenders and their families.     

Relational ethics in forensic psychiatric settings

1. The pressure of the competing demands of custody and caring shapes the moral climate of forensic settings. 2. A relational approach to health care ethics, requiring the opening of dialogue, consideration of multiple perspectives, and attention to context, can guide nurses as they strive to engage and respect even their most estranged patients. 3. The core elements of relational ethics include mutual respect, engagement, and attention to the environment.     

Recruitment and retention issues in rural labour markets

This paper aims to provide insights into the recruitment and retention issues faced by employers in rural areas. To this end, information gathered through interviews with employers and labour market intermediaries in the predominantly rural county of Lincolnshire, UK was used as a source of data and focal point to discuss the demand side of the labour market. A distinction is made between circumstances in which there are hard-to-fill vacancies on the one hand, and the effects of an abundant labour supply on the other. The factors that affect labour retention are also discussed, including situations in which staff retention is a non-issue. Recognising the fact that economic life exists within, and is affected by the social context, the views of employers and labour market intermediaries are also analysed in the light of data from other sources. The paper concludes by suggesting that employers’ recruitment and retention issues cannot be studied in isolation; the supply side as well as the demographic, economic, and political context need to be considered as well.     

A gender-based incidence study of workplace violence in psychiatric and forensic settings

Limited data exist analyzing the role of gender in workplace violence in health care settings. This study examined whether different types of threatening incidents with patients (physical, verbal, sexual, or posturing) were salient to male versus female staff across psychiatric settings (inpatient forensic, inpatient acute/chronic psychiatric, and outpatient psychiatric). Results indicated that although women disproportionately experienced sexualized threats, they were not more likely to report such incidents as salient and threatening. The study also assessed the extent to which situational variables contributed to staff's feelings of threat. Results showed that rapport with the patient, quality of relationships with coworkers, and presence of coworkers in the area were not significantly related to how threatened staff felt in a recent threatening incident. Findings are discussed within the context of staff training and organizational benefits.     

Re-visioning nurses' punitive attitudes within forensic psychiatric and correctional nursing: the significance of ethical sophistication

1. Development is an essential lifelong process if we are to compassionately care for patients in forensic and correctional nursing. 2. Many of us are blocked in our ability to understand and to care; we will need to grow to meet the challenges and to bear the shocks of forensic and correctional nursing. 3. Concepts that correspond to Kegan's levels of consciousness imply a progression from punitive attitudes toward more positive attitudes.     

Scope of practice issues in forensic nursing

1. There is significant role variation, across the Western world, in relation to how forensic nurses practice. 2. The authors conducted a pilot survey of forensic nurses in Australia, New Zealand, the United States, and the United Kingdom to examine forensic nursing practice, role definition, and role boundaries. 3. Issues arising from the data include the visibility of forensic nurses, the client group, forensic-specific education, and role development.     

Mental health promotion in forensic & correctional environments

I hope this brief glimpse into the concept of mental health promotion within forensic and correctional environments will challenge nurses to explore creative ways in which a mental health agenda can be formulated and actualized in practice.     

A collaborative model: ambulatory pharmacotherapy for chronic psychiatric patients.

1. Increases in patient acuity and diagnosis related groups limiting hospital lengths of stay have contributed to the heightened demand for structured outpatient programs. 2. The Medication Clinic and Medication Group, a daily functioning outpatient program, is designed to shift the responsibility for medication management from the health-care provider to the patient and family through education and participation. 3. Within the framework of a collaborative practice model, the patient, clinical nurse specialist, and psychiatrist share equal power and responsibility. A phenomenologically oriented approach whereby the health-care provider attempts to understand the patient's illness from the patient's perspective is a crucial component. 4. The Medication Program combines the expertise of nursing and medicine in a complementary fashion, conducive to both revenue-generating activity and cost-effective role use.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Forensic psychiatric nursing. Discursive practices and the emergence of a specialty

1. While some authors argue that specialization is a threat to holistic nursing practice, others suggest that specialization is not only desirable and inevitable but should follow a rigorous process, including specific educational curriculum and examination procedures. 2. Two opposing views regarding forensic nursing are found in contemporary nursing literature. Some authors resist the discourse of specialization in nursing, while the discursive practices of others (e.g., leaders in forensic psychiatric nursing) could reflect a desire for power. 3. Using a poststructuralist approach, the controversy that has accompanied the development of forensic nursing through discursive practices is analyzed.     

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.     

Philosophical basis and practice of self-awareness in psychiatric nursing

1. Reflection on one's reasoning and judgments to become cognizant of what is in the unconscious mind, not what should be there according to a belief system, theory, or teachings, is necessary for the development of self-awareness. 2. The process of self-awareness compels nurses to examine their own value positions so these biases and prejudices are not projected onto others, and so nurses do not reject others who do not share similar values. 3. Seeking answers to the questions generated through self-awareness can make interpersonal work with clients dynamic, living experiences, which can bring a sense of satisfaction and meaning to nurses' work.