Using Margaret A. Newman's Theory of Health With Elderly Nursing Home Residents

TOPIC. The use of Margaret A. Newman's theory by psychiatric nursing students with elderly nursing home residents.
SOURCE. The author's work with baccalaureate nursing students.
CONCLUSIONS. Nurses who form relationships with elderly nursing home residents can help their clients identify problematic patterns, move to a choice point, then to a higher level of consciousness, resulting in a reduction in problematic patterns of behavior.     

Parkinson's disease and nursing home placement: the economic impact of the need for care

Background and Purpose:  To examine the relative risk (RR) for living in nursing homes for patients with Parkinson's disease (PD) compared with the general population and to ascertain society's costs related to nursing home placement for this patient group.
Methods:  We evaluated the frequency of admission to nursing homes in a cross-sectional study and during a 12-year follow-up study of 108 patients with PD and 864 controls who were matched for age and sex. The RR for living in a nursing home was calculated at baseline and during follow-up. On the basis of 2007 prices, we estimated the costs per person year of survival for patients with PD and controls.
Results:  The RR for living in a nursing home at baseline was 5.0 for patients with PD and 4.8 during follow-up. Patients with PD caused 4.8 times higher costs for nursing home placement with euro 18 875 versus euro 3978 per individual and year. The annual costs for institutional care of patients with PD in Norway were euro 132 million.
Conclusion:  Patients with PD have a substantially higher risk for living in nursing homes than the general population. This causes high costs to society. Therapeutic interventions to prevent or delay nursing home admissions are therefore important.     

The Psychiatric Advanced Practice Nurse's Role as Sexual Harassment Ombudsman

topic . The psychiatric advanced practice nurse's role as sexual harassment ombudsman.
source . The author's own experiences as both an advanced practice nurse and an ombudsman for sexual harassment.
goal . To describe the role of ombudsman for sexual harassment and its fit with nursing as seen in the Price Spratlen Ombudsing Model.
conclusion . An ombudsman for sexual harassment can play a significant role in the continuing problem of sexual harassment in the workplace. Managing grievances requires a client-centered approach, environmental assessment and sensitivity, flexibility in programs, and cost-efectiveness. Elements include education, consultation, counseling, planned interventions. refeyval, follow-up, evaluation, and institutional recommendations.     

Milieu Therapy: A Therapeutic Loophole

topic . The confusion over, and ultimate demise of, milieu therapy
source . Literature review
goal . To chronicle the conceptual problems and other events leading to the decline in the use of milieu therapy.
conclusion . Inpatient nurses would do best to leave the concept of milieu therapy behind and focus on clarifying how specific nursing interventions are operationalized and tied to patient outcomes.     

The Nurse-Client Alliance Model

topic . A nursing model for psychiatric nursing.
source . Author's clinical work, review of literature.
goal . To describe this model and its use with psychiatric clients.
conclusion . This model complements the biomedical model by helping clients gain insight and access to their subjective experience.     

Custody and Caring: Clinical Placement of Student: Nurses in a Forensic Setting

topic . Clinical placement of student nurses in a forensic setting during their psychiatric nursing course.
source . Curriculum at the College of Nursing, University of Saskatchewan.
goal . To describe a unique setting for learning psychiatric nursing.
conclusion . Forensic settings provide an opportunity for student nurses, educators, and clinicians t work together to learn and to provide excellent care     

Family-focused treatment of the suicidal bipolar patient

Objectives:  Bipolar patients are at high risk for suicidal ideation and attempts. Suicidal behavior is correlated with poor family communication and/or high levels of intrafamilial conflict, particularly among adolescent bipolar patients. This article describes the application of family-focused therapy (FFT) as an adjunct to pharmacotherapy in the management of suicidal ideation and behavior among bipolar patients.
Methods:  We describe the empirical basis of FFT in studies of adult and adolescent patients. We then describe the manner by which the three modules of FFT – psychoeducation, communication skills training and problem solving – are adapted to address the clinical issues presented by suicidal bipolar adults or adolescents and their families.
Results:  Key objectives of the treatment are to help the family recognize that suicidal behavior is a part of the pathophysiology of bipolar disorder but that it is also to some extent under environmental control. Thus, the family is in a unique position to develop and help assure the success of a suicide prevention contract. A case study of an adolescent with suicidal behavior is presented.
Conclusions:  Future research should include a focus on: (i) cross-cultural issues in suicide and bipolar disorder; and (ii) the adaptation of interventions shown to be effective in reducing suicidal behaviors in non-bipolar populations.     

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.     

Impaired Personal Boundaries: A Proposed Nursing Diagnosis

topic . How impaired personal boundaries play a significant role in mental illnesses and co-dependency.
purpose . To demonstrate the value of having a formal nursing diagnosis of "impaired personal boundaries."
source . A concept analysis of personal boundaries, which describes the physical, emotional, intellectual, and spiritual dimensions of personal boundaries.
conclusion . The author recommends a new nursing diagnosis of "impaired personal boundaries," which provides a basis for the plan of care for clients with this difficulty.     

Solution Focused Therapy: An Alternative Approach to Addictions Nursing

topic : The application of solution-focused therapy as an alternative approach to addictions nursing.
purpose : To acquaint nurses with solution-focused therapy as a treatment modality that uses specific techniques to focus on clients'strengths and resources, rather than on pathology.
source : Traditional method of addictions treatment as a way of confronting a client's denial are contrasted with solution-focused therapy approaches, which provides a positive framework that uses clients'competencies to create necessary solutions.
conclusions : Solution-focused therapy represents a caring and humanistic approach to the practice of addictions nursing.     

Book Reviews

Books Reviewed in this Article:
Psychopathology of Children and Youth: A Cross-Cultural Perspective. Edited by E lizabeth P urcell
Personality: Theory, Measurement and Research. Edited by F ay F ransella .
The Special Child. By B arbara F urneaux .
Towards a Full Life: Provisions for Mentally Handicapped Adults. By E ileen B aranyay
Genetic Counselling in Mental Handicap. By B rian K irman .     

Book Reviews

Book reviewed in this article:
They can make Music . By P hilip B ailey .
Theories of Cognitive Development . Edited by R. M. A llen , A. D. C ortazzo and R. P. T oister .
Toward an Educational Theory for the Mentally Handicapped . By J. M. M c M aster .
Perception and Cognition . By B arbara B. L loyd
The Working Brain: an Introduction to Nenropsychology . By A. R. L uria .
The Pathology of Mental Retardation . By L. C. C rome and J. S tern .
Learning and Perceptuo-Motor Disabilities in Children . By K. W edell .
The Principle of Normalization in Human Services . By W. W olfensberger .
Educating mentally handicapped children . Edited by A lice F. L aing .     

Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study

Objective:  This study determined the clinical predictors of suicidal behavior during a 2-year follow-up of patients with bipolar disorder presenting with a major depressive episode (MDE).
Method:  Sixty four patients with DSM-III-R bipolar disorder were assessed at presentation for treatment of an MDE. Correlates of past suicidal behavior were determined by comparing patients with and without a history of suicide attempts using a t -test, Wilcoxon test or chi-squared test of independence on individual explanatory variables. Putative predictors of attempts during the follow-up period were tested separately using Cox proportional hazards regression analysis.
Results:  Twelve of 64 patients had at least one suicide attempt in the follow-up period, five of them attempted in the first 2 months and seven around or shortly after the 1-year follow-up visit. All attempters had a history of past suicide attempts. Most predictors of future suicidal behavior were correlates of past suicidal behavior. Family history of suicide acts and comorbid borderline personality disorder predicted early attempts, while younger age, high hostility scores, number of past attempts, subjective pessimism as reflected in depression and suicidal ideation, and few reported reasons for living predicted suicidal acts during the whole period.
Conclusion:  In this data set of bipolar patients we noted an intriguing picture of two clusters of suicide attempts. Hostility was the strongest risk factor. These findings may have implications in both the identification of at-risk patients and the timing of clinical interventions including aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptomatology.     

Psychiatric symptoms in adolescents with Internet addiction: Comparison with substance use

Aims:  The aim of the present study was to compare psychiatric symptoms between adolescents with and without Internet addiction, as well as between analogs with and without substance use.
Methods:  A total of 3662 students (2328 male and 1334 female) were recruited for the study. Self-report scales were utilized to assess psychiatric symptoms, Internet addiction, and substance use.
Results:  It was found that Internet addiction or substance use in adolescents was associated with more severe psychiatric symptoms. Hostility and depression were associated with Internet addiction and substance use after controlling for other symptoms.
Conclusions:  This result partially supports the hypothesis that Internet addiction should be included in the organization of problem behavior theory, and it is suggested that prevention and intervention can best be carried out when grouped with other problem behaviors. Moreover, more attention should be devoted to hostile and depressed adolescents in the design of preventive strategies and the related therapeutic interventions for Internet addiction.     

From Fragmentation to Wholeness: An Integrative Approach With Clients Who Dissociate

topic . Three domains of treatment with the client who dissociates.
source . Author's clinical work, review of literature.
goal . To describe the use of building ego strength, modulating affect, and supporting abreaction to decrease fragmentation.
conclusion . The nurse psychotherapist can use these interventions to decrease fragmentation with clients who dissociate.     

Differences between clinical and nursing inpatient staff: Implications for training in behavioral rehabilitation

Line-level staff have been trained in behavioral rehabilitation strategies by program developers who believe that this training may lead to better quality of inpatient care. The effects of staff training, however, may be mitigated by characteristics of the various disciplines that constitute the staff. Differences in nursing versus clinical staff may be particularly relevant to inpatient staff training in behavioral rehabilitation. To identify these differences, 80 clinical and 210 nursing staff members at a state hospital completed measures of work-related stress, knowledge of behavior therapy, and impressions of behavioral interventions. Results showed that clinical staff had significantly more formal education and knowledge of behavioral treatment. Nursing staff reported greater work-related stress. Despite these differences, the two samples did not differ in terms of commitment to social learning ideology or perceptions of barriers to behavior therapy. Moreover, the pattern of staff variables that predict social learning ideology or perceptions of barriers to behavior therapy was similar across samples. The impact of differences in clinical and nursing staff on staff training is discussed.     

Book Reviews

Book reviewed in this article:
Human Chromosomes . By E. H. R. F ord .
Genetic Studies in Mental Subnormality. I. Familial idiopathic severe subnormality . By B. C. C lare D avison . II. The application of genetic principles in screening for metabolic disorders . By P. N. S wift , P. F. B enson and J. D. S tuddy .
Inquiring Man. The Theory of Personal Constructs . By D. B annister and F ay F ransella .
A Milieu Therapy Program for Behaviorally Disturbed Children . By M arjorie M c Q. M onkman .
Guide to Films on Mental Handicap . By T homas A. P ilkington .
Consumer's Guide to the British Social Services . By P hyllis W illmott .     

Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique.

Inappropriate behaviors are very common in dementia and impose an enormous toll both emotionally and financially. Three main psychosocial theoretical models have generally been utilized to explain inappropriate behaviors in dementia: the "unmet needs" model, a behavioral/learning model, and an environmental vulnerability/reduced stress-threshold model. A literature search yielded 83 nonpharmacological intervention studies, which utilized the following categories of interventions: sensory, social contact (real or simulated), behavior therapy, staff training, structured activities, environmental interventions, medical/nursing care interventions, and combination therapies. The majority are reported to have a positive, albeit not always significant, impact. Better matching of the available interventions to patients' needs and capabilities may result in greater benefits to patients and their caregivers.