Challenges faced by inpatient child/adolescent psychiatric nurses

Inpatient nurses work to engineer an environment in which patients and staff are physically and psychologically safe. A recent research study on an adult psychiatric unit examined the dimensions involved in keeping the unit safe. The four dimensions included ideology, people (staff and patients), space, and time. In this article, we discuss how these dimensions apply to real-world efforts to keep child and adolescent inpatient units safe. We also discuss the challenges nurses face within each of these safety dimensions, including those arising from fluctuating acuity, staffing formulas, surveillance of physical space, and entrenched unit cultures.     

Methodologic challenges of e-health research

In this article, research-based strategies used in a web-based study to assess the impact of participation in cancer-related mailing lists on cancer survivors and caregivers are highlighted. The paper presents alternative methods of measuring response rates in Internet surveys. Response rate estimation, based on American Association for Public Opinion Research guidelines, ranged between 15% and 24.9% for the study. Several strategies were implemented to increase survey participation and reduce item nonresponse. Few participants opted for a telephone survey as an alternative to a web-administered design (mixed-mode administration). Using time-stamp data to diagnose places in the questionnaire where respondents prematurely exited or broke off survey participation, we were able to decrease premature break offs. A lottery was also implemented to increase response rates. The experience of obtaining institutional review board approval for the lottery is also described. Preliminary data indicate slight increases in response rates subsequent to implementing the lottery.     

Domestic violence in veterans with posttraumatic stress disorder who seek couples therapy

Domestic violence rates among veterans with posttraumatic stress disorder (PTSD) are higher than those of the general population. Individuals who have been diagnosed with PTSD who seek couples therapy with their partners constitute an understudied population. Self-report measures of domestic violence, relationship satisfaction, and intimacy were administered at intake to 179 couples seeking relationship therapy at a Veterans Affairs clinic. Couples in which the veteran was diagnosed with combat-related PTSD were compared with two other groups based on the veteran's primary diagnosis (depression, adjustment disorder/V-code). Both the PTSD- and depression-diagnosed veterans perpetrated more violence than did those with adjustment/V-code diagnoses. Domestic violence rates among depressed and PTSD-diagnosed veterans were much higher than those found in previous research. Implications for assessment and treatment are discussed.     

Rates and correlates of recurrent psychiatric crisis episodes among children and adolescents in state custody

The purpose of this study was to determine the extent of and factors associated with recurrent psychiatric crisis episodes among children and adolescents in state custody. A total of 1362 children ages 3 to 16 years who were in custody of the child welfare agency and underwent a psychiatric crisis screening and services for the first time between 2001 and 2003 were followed for the same observation period of 24 months. Logistic regression was used to determine the clinical and non-clinical factors associated with a return to psychiatric crisis screening and services. Overall, 44.6% of the sample had another psychiatric crisis episode in the following two years. Nearly two thirds of those who returned did so within 6 months of their first crisis episode. A greater likelihood of recidivism was associated with severity of psychiatric illness, being female, white, in residential care placement, and having placement instability. Recurrent psychiatric crises appear to be predictable using readily available variables, which can inform interventions designed to reduce repeat episodes.