Delirium: a very common problem you may not recognize

Older adults with multiple pre-existing conditions are admitted to hospitals with acute illnesses and injuries every day. Delirium is not recognized by clinicians across health care settings. With awareness of risk factors and knowledge of delirium, nurses can play a pivotal role in the early identification, treatment, and, most important, prevention of delirium in older adults. Nurses often display a lack of knowledge related to delirium and the complex symptoms that appear differently in the presence of other complicating co-morbid conditions in aging adults. Nurses play a crucial role in keeping patients safe and ensuring optimal outcomes, regardless of the setting. With the growing population of older adults and the expected increases in chronic illness and dementia, delirium is a problem nurses are likely to experience in all practice settings. Knowing what to look for facilitates recognizing the risk and acting early to minimize (or even prevent) delirium.     

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.     

The incidence of metabolic risk factors in an inpatient psychiatric setting

Our study examines risk factors for metabolic syndrome on admission to an acute psychiatric facility and the incidence of medical referrals at discharge. Data on demographics, risk factors for metabolic syndrome, other health risk factors, medications, related diagnoses, and primary care providers and referrals were collected from 125 psychiatric patient charts. Comparison analysis was done for two groups: those with two or more risk factors for metabolic syndrome and those with less than two risk factors. Differences between groups were statistically significant for age, waist circumference, body mass index, high-density lipoprotein, triglycerides, and fasting glucose levels. Few patients were referred to their primary care provider for follow-up care. This study has clinical implications for improving assessment of psychiatric patients at risk for developing metabolic syndrome, for designing interventions to help patients adopt lifestyle changes to mitigate these risks, and for working toward fuller integration of psychiatric and primary care.     

Theory,practice and use of self in the open dialogues approach to family therapy: A simple complexity or a complex simplicity?

In the family therapy literature there is increasing interest in the dialogical approach, particularly as it becomes well‐grounded in psychotherapy research. One embodiment is ‘open dialogues’, which has developed over a 30‐year period in Western Lapland, Finland. This paper outlines my experience of visiting Keropudas Hospital in Tornio, Finland, the birthplace of open dialogues. It explores the seven theoretical principles of open dialogues, associated elements of clinical practice, and the therapist use of self. The author utilises these aspects to reflect on dialogical moments through words and images based on three conceptual themes, which illustrate the relevance of open dialogues for family therapy practitioners and their contexts.     

I'm Not a Bad Mother — Stories of Mothering‐on‐the‐Edge

This article is located in the field of custody and day‐to‐day care, with a focus on experiences of mothering where mothers no longer have everyday care of their children. At the time of writing, tens of thousands of mothers live separately from their children in Aotearoa, New Zealand. However, there is a general perception of rarity associated with non‐resident mothers, partly due to their reluctance to speak of loss of custody. In this article, we develop a theoretical discussion around the inside/outside relationships between non‐resident mothers and their children that informs therapeutic practice. We argue that mothers who live apart from their children are situated at the edge or periphery of their children's day‐to‐day lives and experience this as outside the lives of their children. Nevertheless, mothers' stories speak of qualities of (m)othering that have been born of and nurtured by longstanding and long‐term commitment to their children.     

Approaches used by employee assistance programs to address perpetration of intimate partner violence

Employee Assistance Programs (EAPs) are workplace resources available to employees with problems impacting work performance. EAPs are well-positioned to address intimate partner violence (IPV), a major public health problem with workplace impacts. A purposeful sample of 28 EAPs across the United States was surveyed to identify policies and programs to address IPV, including perpetration. Most EAPs did not report having standardized approaches for addressing IPV perpetration. EAPs also described significant barriers to identifying IPV perpetrators, with the majority relying on self-disclosure on the part of the perpetrator when contacting the EAP. These results suggest that many EAPs--even when interacting with employees who present with issues known to correlate with IPV--are missing a potential opportunity to assess and intervene with IPV perpetrators.     

The effects of tact training on stereotypic vocalizations in children with autism

This study was a systematic extension of Karmali, Greer, Nuzzulo-Gomez, Ross, and Rivera-Valdes (2005) and Ahearn, Clark, MacDonald, and Chung (2007). We investigated the effects of a tact correction procedure on stereotypic vocalizations in 4 children diagnosed with autism who ranged in age from 6 to 16 years. Participants had limited vocal verbal repertoires and were primarily dependent on prompts for the emission of appropriate vocalizations. A multiple-baseline design across participants was used. Data were collected on instances of stereotypic vocalizations and independent tacts during baseline conditions and on instances of stereotypic vocalizations, independent tacts, and echoic-tacts during intervention. Procedural integrity and social validity data were also obtained. The results indicated a decrease in stereotypic vocalizations for 3 of the 4 participants and a slight increase in appropriate vocal verbal behavior (i.e., tacting) for all participants. The study provides support for the use of tact correction procedures to decrease stereotypic vocalizations and increase appropriate vocalizations in children with autism.