Ombudsman: A New Role for Advanced Practice Nurses in Psychiatric-Mental Health Nursing

topic . The role of ombudsman for advanced practice nurses in psychiatric mental health nursing.
purpose . To describe the role of ombudsman and its fit with nursing as seen in the Price Spratlen Ombudsing Model.
source . The author's own experiences as both an advanced practice nurse and an ombudsman.
conclusion . Because of downsizing, reorganization, and a general trend toward mutual distrust in large organizations, being an ombudsman has been named one of the "25 hottest careers." Advanced practice nurses in psychiatric mental health nursing, by virtue of their knowledge of interpersonal, preventive, and systems theories, are in a unique position to fill this role.     

A longitudinal investigation of peer sexual harassment victimization in adolescence

The current study describes longitudinal trends in sexual harassment by adolescent peers and highlights gender, pubertal status, attractiveness, and power as predictors of harassment victimization. At the end of 5th, 7th, and 9th grades, 242 adolescents completed questionnaires about sexual harassment victimization, pubertal status, and perceived power. Results indicate an increase in sexual harassment from 5th to 9th grade, with boys more likely to report harassment than girls in each grade. An analysis of harassment type indicated no gender difference in 9th grade cross-gender harassment, but boys received more same-gender harassment than girls. Pubertal status predicted concurrent sexual harassment victimization in each grade. Boys and girls with advanced pubertal status at all grades were more likely to be victims of 9th grade same-gender harassment. Adolescents with greater power at all grades were more likely to be victims of 9th grade cross-gender sexual harassment.     

THE IMPACT OF SEXUAL HARASSMENT ON DEPRESSIVE SYMPTOMS DURING THE EARLY OCCUPATIONAL CAREER

Sexual harassment has been theorized as a stressor with consequences for the physical and mental health of its targets. Though social scientists have documented a negative association between sexual harassment and mental health, few longitudinal studies have investigated the association between sexual harassment and depressive symptoms. Using longitudinal survey data from the Youth Development Study, combined with in-depth interviews, this article draws on Louise Fitzgerald's theoretical framework, stress theory, and the life course perspective to assess the impact of sexual harassment on depressive affect during the early occupational career. In support of Fitzgerald's model, our findings confirm that sexual harassment is a stressor that is associated with increased depressive symptoms. Our quantitative results show that women and men who experience more frequent sexual harassment at work have significantly higher levels of depressed mood than non-harassed workers, even after controlling for prior harassment and depressive symptoms. Moreover, we find evidence that sexual harassment early in the career has long-term effects on depressive symptoms in adulthood. Interviews with a subset of our survey respondents point to a variety of coping strategies and reveal further links between harassment and other aspects of mental health, such as anger and self-doubt.     

Measurement of the bystander intervention model for bullying and sexual harassment

Although peer bystanders can exacerbate or prevent bullying and sexual harassment, research has been hindered by the absence of a validated assessment tool to measure the process and sequential steps of the bystander intervention model. A measure was developed based on the five steps of Latané and Darley’s (1970) bystander intervention model applied to bullying and sexual harassment. Confirmatory factor analysis with a sample of 562 secondary school students confirmed the five-factor structure of the measure. Structural equation modeling revealed that all the steps were influenced by the previous step in the model, as the theory proposed. In addition, the bystander intervention measure was positively correlated with empathy, attitudes toward bullying and sexual harassment, and awareness of bullying and sexual harassment facts. This measure can be used for future research and to inform intervention efforts related to the process of bystander intervention for bullying and sexual harassment.     

Sexual harassment on the job: psychological, social and economic repercussions

This article is an effort to shed new light on what has been commonly termed sexual harassment, to identify its forms and, most importantly, to explore its effect upon those who have been subjected to it. The author's hypothesis is that sexual harassment in the workplace is more a social phenomenon than a personal problem, and that it is the cause of lasting psychological, social and economic after-effects among its victims. Combatting sexual harassment is only part of the solution; we must look beyond its legal aspects to find ways of changing male-female occupational relationships, and we must provide support to victims of sexual harassment.     

Psychoanalytic Developmental Ego Psychology: A Framework for Advanced Psychiatric Nursing Practice

topic : The use of psychoanalytic developmental ego psychology (PDEP) as a theoretical framework for understanding clinical material.
methods : Thirty-four students in advanced practice psychiatric mental health nursing provided data for analysis. Interview data were organized into case studies and analyzed.
findings : PDEP provides a framework that is suitable for education and practice of advanced psychiatric nurses.
conclusion : PDEP can provide a framework that is theory-derived, outcome oriented, and suitable for a variety of clients.     

It isn't all just fun and games: Collegiate participation in extracurricular activities and risk for generalized and sexual harassment,psychological distress,and alcohol use

Collegiate extracurricular activities, despite their benefits, may place students at an increased risk for experiencing harassment. This study utilizes multiple waves of data from an online longitudinal survey to examine how participation in college activities (intramural sports, fraternities/sororities, school clubs) relates to experiences of sexual and generalized harassment and outcomes (psychological distress, heavy alcohol use) among undergraduates (N = 1852, 58.6% female, 57.4% White) in the Midwestern United States. Activity participation was related to harassment, but the pattern depended on the activity, harassment type, and sex. Fraternity/sorority involvement was associated with generalized harassment, whereas school club involvement was linked to both generalized and sexual harassment. Female intramural athletes were at an increased risk to experience both harassment types. In addition to direct relations, activity participation was indirectly linked to future psychological distress (depression, anxiety) and heavy alcohol use via harassment. Implications for intervention with this college student population are discussed.     

Online or off-line victimisation and psychological well-being: a comparison of sexual-minority and heterosexual youth

The purpose of this study was to compare sexual-minority and heterosexual youths' exposure to sexual abuse off-line, problematic sexual meetings off-line with person/s met online and online harassment with regard to prevalence, psychological well-being and support seeking. A nationally representative sample of 3,432 Swedish high school seniors completed an anonymous school-based survey about sexuality, health, sexual abuse and online-related sexual victimisation or harassment. Sexual-minority adolescents reported a greater rate of sexual abuse, problematic sexual meetings off-line with person/s met online and online harassment, compared to heterosexual youth. When compared to non-victimised heterosexual adolescents, victimised heterosexual adolescents and non-victimised and victimised sexual-minority adolescents reported more psychiatric symptoms, lower self-esteem and a weaker sense of coherence. Same-sex sexual orientation was related to more psychiatric symptoms, lower self-esteem and a weaker sense of coherence even when controlled for victimisation and gender. Compared to victimised heterosexual adolescents, victimised sexual-minority adolescents were more likely to seek support because of sexual abuse (females) or Internet-related problems (males and females). Results for sexual-minority youth were basically the same whether sexual orientation was assessed as sexual identity or as sexual or emotional attraction. Health care providers are challenged to not only provide the same care to sexual-minority youth who seek counselling or psychiatric treatment for mental health problems or problems related to victimisation that all adolescents should receive but also to find ways to address topics like prevention of sexual abuse and risk-taking behaviour online or off-line.     

The Psychodynamics of Factitious Sexual Harassment Claims

False allegations of sexual harassment in the workplace can be made for a variety of reasons, some of which may fall into the realm of ‘factitious’ claims. Factitious sexual harassment claims are those in which the plaintiff's wish for victim designation is a major driving force behind the claim. Being aware of potential internal and external incentives in these evaluations may be of assistance to the mental health expert when considering alternative explanations for the plaintiff's perception of events. This article proposes the use of psychodynamic principles to aid the forensic evaluator in considering the conscious and unconscious factors that may be operating to contribute to the development of a false sexual harassment claim. The concepts of repetition compulsion, displacement, denial, misattribution and reaction formation will be used as a framework to explore potential internal incentives operating in a plaintiff to bring about such claims.     

Forensic aspects of sexual harassment.

Sexual harassment law presents a complex set of issues not only for lawyers but also for psychiatrists in their roles both as evaluators and clinicians. Judge Reinhardt of the US Court of Appeals for the 9th Circuit, summed up these complexities: "We tend these days, far more than in earlier times, to find our friends, lovers, and even mates in the workplace. We ... often discover that our interests and values are closer to those of our colleagues or fellow employees than to those of people we meet in connection with other activities. In short, increased proximity breeds increased volitional sexual activity." On the other hand, he notes that Title VII "entitles individuals to a workplace that is free from the evil of sexual intimidation or repression. It is frequently difficult to reconcile the two competing values." He goes on to ask, "When does a healthy constructive interest in romance become sexual harassment? To what extent is pursuit of a co-worker proper but of a subordinate forbidden? Is wooing or courting a thing of the past? Must a suitor cease his attentions at the first sign of disinterest or resistance? Must there be an express agreement before the person seeking romance may even hold the hand of the subject of his affection? Is it now verboten to steal a kiss? In the workplace? Everywhere? Under all circumstances or only some? Has the art of romantic persuasion lost its charm? Questions relating to love and sex are among the most difficult for society to answer." The US Supreme Court has stressed the need for common sense in evaluating cases of sexual harassment. Perhaps psychiatrists can play a sobering role in developing answers to these questions.     

Impact of combat and sexual harassment on the severity of posttraumatic stress disorder among men and women peacekeepers in Somalia

The impact of combat and sexual harassment on the severity of posttraumatic stress disorder (PTSD) is compared for 1,307 men and 197 women peacekeepers who served in the same military units. A theoretical model was proposed to express the nature of the impact. Structural equation modeling was used to evaluate the model separately for men and women. Good-fitting, parsimonious models were developed that showed substantial similarity for men and women. For men, severity of PTSD symptoms was impacted by exposure to combat directly and indirectly through fear and sexual harassment. For women, severity of PTSD symptoms was impacted by combat indirectly through the same two influences, although the mechanisms involving fear and sexual harassment were somewhat different. For both genders, moreover, PTSD severity was impacted directly by exposure to the dying of the Somali people. These similarities suggest that in modern stressful overseas military missions, both genders may be susceptible to the same types of risk for the development of PTSD. The incidence and impact of sexual harassment is particularly noteworthy in the case of men and calls for more detailed investigation in future studies.     

Persons with developmental disability exposed to interpersonal violence and crime: approaches for intervention

PURPOSE.  Psychoeducational and psychotherapeutic interventions, by psychiatric advanced practice registered nurses and caregivers working with people with developmental disabilities exposed to interpersonal violence and crime, are recommended to help the individual resolve the intrapsychic trauma .
CONCLUSIONS.  Persons with developmental disabilities experience the full affective range of the effects of trauma and may benefit from a variety of interventions. What may be different in comparison to other survivors are the ways psychotherapeutic and psychoeducational interventions are adapted so that emotions, resultant actions, and ongoing concerns can be effectively expressed and addressed .
PRACTICE IMPLICATIONS.  Advanced practice registered nurses have an important role in addressing the sequelae of trauma by employing flexible, creative, and direct therapy with individuals. Additionally significant is provision of educational and supportive measures for the caregivers, who have the potential to generate an ongoing socially therapeutic environment .     

Prospective associations among relationship abuse,sexual harassment and bullying in a community sample of sexual minority and exclusively heterosexual youth

IntroductionSexual minority youth (SMY) are at significantly greater risk for experiencing adolescent relationship abuse (ARA) than exclusively heterosexual youth, yet little is known about the factors that elevate their risks for such abuse. Peer victimization (i.e., bullying, sexual harassment) has been associated with ARA among heterosexual youth. SMY experience higher rates of peer victimization than heterosexual youth, suggesting that it may be a risk factor for ARA among these youth. Using longitudinal data from a community sample of adolescents recruited from the northeastern US, we examined whether sexual identity was associated prospectively with ARA, and whether that relationship would be indirect, and mediated via bullying and sexual harassment at a 12-month follow-up. We expected to find higher rates of peer victimization and ARA among SMY than heterosexual youth, and we expected that sexual harassment and bullying would predict subsequent relationship abuse.MethodsAdolescents (N = 800; 58% female; 81% European-American; 19% SMY) between 13 and 15 years (M = 14.45, SD = 0.85) completed a web survey at baseline, 6-months and 12-months.ResultsConsistent with prior studies, SMY reported higher rates of bullying, sexual harassment, and relationship abuse than heterosexual youth. SMY who reported sexual harassment at baseline were more likely to report relationship abuse over time. Contrary to our expectations, however, bully victimization did not predict subsequent relationship abuse.ConclusionsSexual harassment can be particularly harmful for SMY because it targets gender and sexual identity at a formative developmental period and puts youth at risk for relationship abuse.     

Experiences of sexual harassment are associated with high self-esteem and social anxiety among adolescent girls

Abstract

Introduction: Subjection to sexual harassment among adolescents have been associated with negative mental health outcomes, such as depression and social anxiety. Self-esteem and social support may modify these associations.

Methods: The Adolescent Mental Health Cohort 10-year replication data were used. It is a cross-sectional classroom survey involving 656 girls and 636 boys aged (mean (sd)) 15.6 (0.4) years and 15.7 (0.4) years, respectively. Subjection to sexual harassment was elicited with five questions. Depression was measured by the Beck’s 13-item Depression Inventory, social anxiety by the SPIN-Fin Inventory, self-esteem by Rosenberg’s Self-Esteem Scale and social support by the PSSS-R scale. The data were analysed using cross-tabulations with chi-square statistics and logistic regressions.

Resutls: Among girls, social anxiety and higher self-esteem were positively associated with experiencing subjection to sexual harassment in multivariate models. No statistically significant associations were detected among boys between experiences of sexual harassment and any of the four variables.

Conclusion: Experiences of being sexually harassed correlate among adolescents with high social anxiety but also with high self-esteem. Sexual harassment among adolescents may partly be explained as inept ways of showing interest, but it may nevertheless have detrimental effects on the well-being of the those subjected to it.     

Sexual minority status, peer harassment, and adolescent depression

The well-documented higher rates of depression among sexual minority youth are increasingly viewed by developmentalists as a byproduct of the stigmatization of sexual minority status in American society and of the negative impact this stigma has on the processes associated with depression. This study attempted to spur future research by testing Hatzenbuehler's (2009) psychological mediation framework to investigate the ways in which peer harassment related to sexuality puts young people at risk by influencing the cognitive, social, and regulatory factors associated with depression. Analyses of 15 year olds in the NICHD Study of Early Child Care and Youth Development revealed that sexual minority status was largely associated with depressive outcomes via harassment, which was subsequently associated with depression via cognitive and social factors. Results point to various avenues for exploring the importance of the social world and self-concept for the outcomes of sexual minority adolescents in the future.     

Is this Injury Reasonable? Do Psychological Injury Expectations Affect Mock Jurors' Legal Decisions in a Sexual Harassment Case?

The experiments examined the viability of a proposed decision-making process to explain how jurors' expectations for a sexual harassment complainant's psychological injury affect their legal decisions. Two experiments provided undergraduate mock jurors with a sexual harassment allegation that manipulated their range of expectations for reasonable psychological injuries (mild vs. mild to severe) and the severity of the complainant's alleged psychological injury (from minimal to extreme). Experiment 1 (N = 295) found that participants expecting mild injuries found the complainant's psychological injury allegations to be less reasonable and credible than participants expecting mild to severe injuries. Experiment 2 (N = 202) investigated whether these expectations influenced liability and compensatory damage decisions. As the injury increased from minimal to moderate severity, participants expecting mild injuries found less liability, whereas participants expecting mild to severe injuries found significantly more liability. Both expectations and injury severity independently impacted damage decisions, but not in an interactive fashion. We discuss the applicability of the proposed decision-making process to explain legal decisions in sexual harassment cases.     

Asses Making Passes: Making Meaning of Unwanted Sexual Advances

Abstract

The author believes there may be no way to discuss possible meanings of unwanted sexual overtures that does not arouse strong, uncomfortable feelings. Despite a sense of justice being served when victims of sexual harassment come forward and start naming names, the author asks, should we not distinguish between legitimate concern for people who have been sexually abused from the experiences of those claiming abuse but who were probably just offended or disappointed? This article discusses how interpersonal and relational analysts listen to patient accounts of sexual harassment and abuse. This is followed by a discussion of permissive sexual attitudes and mores of the 20^th century. The author recounts some personal accounts of unwanted sexual advances in professional settings. A clinical vignette of a dream and its associations illustrates the psychoanalytic complexity of teasing apart problems in living from problems in survival. The author concludes with a call for increased efforts to achieve justice for actual victims without creating a social environment in which everyone presents him- or herself as a potential victim.     

La représentation cinématographique du harcèlement

This study tries to show the way to represent harassment through 33 examples of films. Eight different types of motivations of harassment are described: professional and sexual ones, of course, but also by revenge, mediatic goal, racism motivation, ludo-sadism, delirium, and even therapeutic harassment.