Psychiatric nursing & medication adherence

A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenge imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).     

The Association of Couples’ Relationship Status and Quality With Breastfeeding Initiation

Using data from the Fragile Families and Child Wellbeing Survey (N= 3,567), we examine the links between relationship status, relationship quality, and race and ethnicity in breastfeeding initiation. We consider four relationship types: married, cohabiting, romantically involved but not cohabiting (termed visiting), and nonromantically involved mothers. We find that even after adjusting for a wide range of sociodemographic factors, married mothers were more likely to breastfeed than unmarried mothers and that racial and ethnic differences in breastfeeding do not result from differences in marriage rates. Among unwed mothers, paternal provision of money or other assistance during pregnancy decreases the likelihood of breastfeeding. We conclude that relationship status, above and beyond demographic characteristics, is an important correlate of breastfeeding.     

Changing American home life: trends in domestic leisure and storage among middle-class families

This study of middle-class American families draws on ethnography and urban economic history, focusing on patterns of leisure time and household consumption and clutter. We trace how residential life evolved historically from cramped urban quarters into contemporary middle-class residences and examine how busy working families use house spaces. Our ethnographic sample consists of 24 Los Angeles families in which both parents work full time, have young children, and own their homes. Formal datasets include systematically timed family uses of home spaces, a large digital archive of photographs, and family-narrated video home tours. This analysis highlights a salient home-storage crisis, a marked shift in the uses of yards and garages, and the dissolution of outdoor leisure for busy working parents. The UCLA Center on Everyday Lives of Families (CELF) is generously supported by the Alfred P. Sloan Foundation program on the Workplace, Workforce, and Working Families. Anthony Graesch assisted with the tables. Additional information about CELF can be found at www.celf.ucla.edu.     

Epidemiological Associations between Gambling Behavior, Substance Use & Mood and Anxiety Disorders

Objective To compare gambling behaviors in a random sample of community residents with and without mental disorders identified by the Composite International Diagnostic Interview (CIDI).Method A large national community survey conducted by Statistics Canada included questions about problems arising from gambling activities as per the Canadian Problem Gambling Index (CPGI). We compared respondents within three gambling severity categories (non-problem, low severity and moderate/high severity gambling) across three diagnostic groupings (mood/anxiety disorders, substance dependence/harmful alcohol use, no selected psychiatric disorder).Results Of the 14,934 respondents age 18–64 years who engaged in at least one type of gambling activity in the previous 12 months, 5.8% fell in the low severity gambling category while 2.9% fell in the moderate/high severity category. Females accounted for 51.7% of the sample. The risk of moderate/high severity gambling was 1.7 times higher in persons with mood or anxiety disorder compared to persons with no selected disorder. For persons with substance dependence or harmful alcohol use, the risk of moderate/high severity gambling was 2.9 times higher. Persons with both mood/anxiety and substance/alcohol disorders were five times more likely to be moderate/high severity gamblers. The odds ratio for females was 0.6 and for those with less than post-secondary education it was 1.52. Differences in age and personal income were not significant.Conclusions Individuals in the community suffering from mood/anxiety disorders and substance dependence/harmful alcohol, and especially those with both, experience a higher risk for gambling problems. The treatment of these comorbidities should be integrated into any problem gambling treatment program.Disclaimer: The data upon which of the analyses contained in this paper derive from surveys conducted by Statistics Canada. The opinions expressed in this paper do not represent the opinions of Statistics Canada.     

Development and Spanish translation of the Weinberg Center Risk and Abuse Prevention Screen (WC-RAPS)

Barriers for enhanced detection, identification, and reporting of elder abuse include the paucity of appropriate, valid, easily administered screening tools. This article describes the qualitative methods used in the development of the Weinberg Center Risk and Abuse Prevention Screen (WC-RAPS), and of its Spanish version. Focus groups and cognitive interviews were instrumental in identifying problematic items, underscoring potential response errors, and informing about putative causes for divergent interpretations of item-intent. Seven of the 11 original items were modified, a double-barreled item was segregated into two, one item deleted, and three additional items included to create the final 13 WC-RAPS items. The multi-step approach implemented for the Spanish conversion evidenced deviation from the original intended meaning for one item. The readability for English and Spanish versions was also assessed. Screening for elder abuse, if implemented systematically can be instrumental in identifying unrecognized abuse and preventing reoccurrence.     

Widows and widowers in today's society

With the increasing life span in our society, the number of widowed individuals has increased dramatically. The loss of a spouse is one of the most stressful life events for both women and men, yet there is little nursing research on the physical and psychosocial needs of older adults who are experiencing this loss. Some studies suggest that widowed women and men develop significant physical and mental health problems and complicated grief. Thus, it is important for nurses to recognize the diversity of grieving experiences and the increased vulnerability of widowed individuals to psychiatric illnesses that may result in suffering and impairment of daily functioning. With a better understanding of these needs, nurses can provide interventions that help these individuals maintain their health and independence.     

Collective efficacy, family attachment, and urban adolescent suicide attempts

The suicide rate among American adolescents between the ages of 14-25 has dramatically increased during the last 50 years, and this fact has been the focus of extensive social-scientific investigation. To date, however, research focusing on the joint effects of mental health, family, and contextual-level predictors on adolescents' suicidal behaviors is scarce. Drawing on Durkheim's classic macro-level approach to suicide and collective efficacy theory, we use data from the Project on Human Development in Chicago Neighborhoods (PHDCN) to examine the effect of informal social controls on adolescents' suicide attempts. Analyzing reports from 990 youth, we examine the hypothesis that neighborhood-level collective efficacy and family-level integration and social control independently affect suicide attempts. We also examine the extent to which they interact in their effects on suicidal behavior. Overall, results from multilevel logit models support the Durkheimian expectation that family attachment reduces the probability that adolescents will attempt suicide. The effect of collective efficacy is interactive in nature. Specifically, we find that collective efficacy significantly enhances the protective effect of family attachment and support on adolescent suicidal behaviors. We discuss findings within the context of social control theory.     

The neurobiology of PTSD: implications for nurses

Posttraumatic stress disorder (PTSD) is a disabling and prevalent psychiatric disorder. Researchers and scientists have developed a neurobiological basis, which provides a framework for understanding the complexities of PTSD, for many symtoms of the disorder. The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women twice as likely as men to have PTSD. Onset of symptoms can occur years after exposure to trauma, and the duration of the illness can last a lifetime. Patients with PTSD often encounter multiple psychosocial problems that result from the symptoms they experience, and their distorted perceptions can affect relationships within the family and the workplace. Nurses in various roles (e.g., educator, therapist, prescriber, case manager, staff nurse) may encounter individuals with PTSD. The nursing profession has traditionally sought to explain sophisticated language to patients in understandable terms, and nurses serve in encouraging, supporting, and evaluating roles, all of which will be increasingly important as science and technology discover more information about the neurobiological basis for mental illnesses.     

A Comparison of Depression and Styles of Coping in Male and Female GA Members and Controls

Depression and maladaptive coping styles are important components of theories of pathological gambling and are frequently foci of treatment with individuals with gambling problems. The present study aimed to improve understanding and treatment of pathological gambling by comparing levels of depression and styles of coping in male and female members of Gamblers Anonymous (GA) to a group of non-pathological gambling controls matched according to gender, age, education, and income. Pathological gambling was measured by the South Oaks Gambling Scale, depression by the Beck Depression Inventory, and coping styles by the Problem-Focused Styles of Coping inventory. Results showed that GA members reported significantly higher levels of depression and more maladaptive styles of coping than controls. Pathological gamblers' greater use of maladaptive coping was evident even when variance attributable to depression was removed, suggesting that their coping deficits may be pervasive. Female subjects reported significantly greater levels of depression and maladaptive coping thantheir male counterparts. Implications for treating depression and coping styles in pathological gamblers are discussed.     

A Note on Maritally-Disrupted Men’s Reports of Child Support in the June 1980 Current Population Survey

Data from the June 1980 Current Population Survey on fathers’ reported provision offinancial support to children from previous marriages living elsewhere is compared to previously published tabulations from the April 1979 CPS of women’s receipt of child support payments. The comparison indicates that the number of men with children from previous marriages living elsewhere is substantially underreported in the June 1980 CPS. Because of the apparent underreporting, the data on the provision of financial support should be interpreted with caution.