Dual diagnosis,as described by those who experience the disorder: Using the Internet as a source of data

The complexity of providing treatment for people with dual diagnosis is well recognized. For the purpose of this paper, the World Health Organization definition of dual diagnosis was used; that is, a person diagnosed with an alcohol or drug use problem in addition to mental illness. This research explored the personal narratives of those who experience dual diagnosis using the Internet as a data source. An important consideration in using the Internet as a data source was that Web forums can offer a sense of anonymity, allowing people to share very detailed and personal information, and providing a rich source of qualitative data. The results produced five emergent themes: spiralling out of control – again!, getting help and giving support, treating both the addiction and mental illness, having meaning and being active, and being honest with self and others. The results indicate that individuals who experience dual diagnosis are often left to navigate their personal treatment requirements across two diverse systems, and were generally not satisfied with the conflictual advice received across these two systems (i.e. alcohol and other drug and mental health services). This study has produced valuable insights related to consumer‐perceived service barriers and enablers.     

Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care

The aim of the study was to explore nurses' experience of how their own vulnerability and suffering influence their ethical formation and their capacity to provide professional care when they are confronted with the patient's vulnerability and suffering. Care is shaped in the meeting between human beings. Professional care is informed by the patient's appeal for help as it is expressed in the meeting. Ethical formation is understood as a personal ethical and existential process, resulting in the capacity to provide professional care. A nurse must have the sense of being a complete human being with own personal attributes and sensitivity in order to be able to relate to other people. The study is based on qualitative interviews with 23 experienced nurses from Sweden, Finland and Denmark. The analyses and interpretation were carried out in line with Steinar Kvale's three levels of interpretation. The study clarifies that ethical formation is a union of the nurse's personal attributes and professional qualifications and that ethical formation is developed over time. Moreover, it also demonstrates that the nurse's personal and professional life experiences of vulnerability and suffering influence ethical formation. Vulnerability and suffering have proven to be sensitive issues for nurses, like a sore point that either serve as an eye-opener or cause the development of blind spots. Furthermore, vulnerability, suffering and the sore points are seen to shape the nurse's courage in relation to care. Courage appears to be a significant unifying phenomenon that manifests itself as the courage to help patients face their own vulnerability and suffering, to bear witness to patients' vulnerability and suffering and to have faith in oneself in arguing for and providing professional care. Courage thus seems to play a significant role in nurses' ability to engage in care. Nurses' own vulnerability, suffering and sore points seem to shape their courage.     

Lawyer and counselor as an interdisciplinary team serving the terminally ill

Mental health professionals consult with the terminally ill and provide therapy to the client, spouse, and family. Some clients have been forewarned and have a carefully drafted estate plan that incorporates all the nuances of property and personal planning. In addition, the client may have an interest in donating his or her body or its parts as an anatomical gift or may inquire concerning the right to die a natural death. He or she may further be concerned with the appropriateness of a power of attorney or a living trust. Whatever the inquiry, the mental health professional should be ready, willing, and able to offer informed data regarding questions in these areas and then to serve with the attorney as an interdisciplinary team to respond quickly and effectively to these legitimate personal concerns.     

Spiritual care, ethical choices, and patient advocacy

Each of the nurses in these examples demonstrates an understanding of patient advocacy. Patient advocacy may involve the nurse in political action or negotiation for change. Perhaps more frequently, however, it is a quiet, private function of support and intuition as patients (or clients) seek to come to a personal awareness of the meaning of illness. Advocacy exhibits a sensitivity to personal values, hopes, and even unspoken prayer that shape an atmosphere of caring. Patient advocacy enhances all that is life giving.     

Territoriality as a universal need 0

Three aspects of territoriality are important to consider when planning nursing care: a physical space of one's own, a personal space, and the territory of expertise or role. Territoriality serves four functions: it provides security, privacy, autonomy, and self-identity, all of which are important for well-being. Many factors, such as age, sex, culture, and health status, affect the way people relate spatially to one another. The nurse should assess territorial needs routinely by asking the patient questions and by observing him in his environment. If the patient is in his own home, she should avoid invading his territory without his permission and should help him maintain and protect his territory. If the patient must leave his own home to be hospitalized, she should help him establish a temporary territory elsewhere and help him adapt to the loss of his own physical space, personal space, and/or territory of expertise and role. Careful attention to territorial needs, particularly when the person is ill, at a vulnerable age, or is facing a move, can contribute a great deal to his health and well-being.     

Lawyer and counselor as an interdisciplinary team serving the terminally ill

Abstract

Mental health professionals consult with the terminally ill and provide therapy to the client, spouse, and family. Some clients have been forewarned and have a carefully drafted estate plan that incorporates all the nuances of property and personal planning. In addition, the client may have an interest in donating his or her body or its parts as an anatomical gift or may inquire concerning the right to die a natural death. He or she may further be concerned with the appropriateness of a power of attorney or a living trust. Whatever the inquiry, the mental health professional should be ready, willing, and able to offer informed data regarding questions in these areas and then to serve with the attorney as an interdisciplinary team to respond quickly and effectively to these legitimate personal concerns.     

Validating the Draw-A-Man Test as a personal neglect test.

OBJECTIVES: The purpose of this study was to determine the reliability and validity of a Draw-A-Man Test in measuring personal neglect in patients with right brain stroke. METHOD: Draw-A-Man Test was administered to 51 persons with right cerebrovascular accident (CVA) and 110 age-matched persons without brain insult. A categorical classification was developed based on the man drawn in the test. Participants who showed homogeneous bilateral representation of body parts were considered to not have personal neglect, whereas those who showed unilateral body parts were considered to have personal neglect. The completed tests were used to blindly categorize the persons with and without personal neglect according to the above definition by two raters for calculating interrater reliability. The Klein-Bell ADL (Activities of Daily Living) Scale was also administered to the participants with right CVA to validate the Draw-A-Man Test. RESULTS: This dichotomy--bilateral representation versus unilateral representation--showed a high percentage of agreement between two raters. Rater A classified all 110 "normal" participants as being without personal neglect and classified 13 of the 51 participants with stroke as having personal neglect. Participants demonstrating personal neglect showed significantly poorer ADL performance than did those without personal neglect. ADL performance was also found to be significantly related to somatosensation, motor status of the impaired limbs, and muscle strength of the sound limbs. However, even after controlling the effect of these variables by partial correlation, personal neglect was still highly related to ADL performance. CONCLUSION: The Draw-A-Man Test is a reliable and valid tool for discriminating clients with personal neglect from those without.     

Personal safety, violence, and home health

A critical issue facing the health care industry today is the potential impact of community and interpersonal violence on home health care. The purposes of this study were to (1) serve as a source for understanding the personal safety risk issues facing home care staff in a large Midwest region and its surrounding rural areas; (2) provide an understanding of how perceived threats to personal safety may impact patient care and patient outcomes; (3) identify strategies for increasing the personal safety of direct care staff; and (4) identify organizational, educational, and procedural issues that impede or enhance staff safety. A triangulated qualitative design was used including focus groups, in-depth individual interviews, critical event narratives, and a participant self-report form. The study used a purposive sample consisting of 5 men and 56 women who were either administrators or direct care staff from 13 home health agencies. Seven major themes emerged: (1) unsafe conditions that direct care staff must face; (2) organizational and administrative issues that impede or promote the personal safety of staff; (3) ethical issues staff face daily; (4) protective factors associated with maintaining safety; (5) issues of gender, race, age, and experience; (6) education and training; and (7) the potential impact that staff's fear of interpersonal and community violence can have on patient care and patient outcomes.     

Failure to Mourn as a Possible Contributory Factor to Headache Onset in Adolescence

SYNOPSIS
Patients who have suffered from chronic headaches frequently are unable to identify a triggering physical or emotional event that precipitated the headache process. This study examined the headachehistories of teenage headache patients, the majority of whom were found to be depressed, and found that personal loss occurred within 12 months of headache onset in 11 of 15 cases. Among the losses that were identified were those involving terminal illness and death of family members, separation and/or divorce in the family, or change of residence from a familiar area.
It is recommended that opportunities for dealing with feelings about their losses should be presented to patients, whether or not the patients express a need for this. Furthermore, it is recommended that patients of any age who cannot identify a triggering event prior to the onset of their headache histories should be questioned in detail about the possible correlation with personal loss.     

Preliminary study of chronic pain patients' concerns about cannabinoids as analgesics

OBJECTIVE: This was a preliminary investigation of patients' beliefs about cannabinoids and the associations between those beliefs, beliefs about medication, and personal and pain variables with regard to patients' willingness to try cannabinoids as analgesics. DESIGN: A self-completion questionnaire was used. SETTING: The investigation took place in an outpatient pain clinic. PATIENTS: Sixty-seven patients with chronic pain were involved. OUTCOME MEASURES: The outcome measures were patients' stated willingness to use cannabinoids and the extent of their agreement or disagreement with statements concerning cannabinoids and medicines in general. RESULTS: Fifty-two percent of patients were doubtful about taking cannabinoids: unwillingness was strongly associated with specific concerns about side effects, addiction, tolerance, and losing control but not with general beliefs about medication or personal or medical variables other than age. CONCLUSIONS: The concerns of patients with chronic pain about taking cannabinoids as analgesics may reduce their utility and efficacy; accurate information is required to counter this effect.     

Nurse burnout: Personal and environmental factors as predictors

The aim of this study is to investigate the level of burnout of clinical nurses and to examine the influence of personal and environmental factors on nurse burnout. A total of 717 full‐time nurses from six hospitals in Tianjin, China, completed five questionnaires: a demographic questionnaire, the Maslach Burnout Inventory, the General Self‐Efficacy Scale, the Practice Environment Scale of the Nursing Work Index and the Nurse Job Stressor Scale. The participants had moderate levels of emotional exhaustion (mean score 23.95 ± 11.11) and depersonalization (mean score 7.90 ± 6.58) and a high level of reduced personal accomplishment (mean score 27.51 ± 10.96). Both personal and environmental factors were correlated with nurse burnout; however, personal factors played bigger roles in predicting personal accomplishment, whereas environmental factors played bigger roles in predicting emotional exhaustion and depersonalization. In order to reduce nurse job burnout effectively, administrators should pay more attention to the improvement of nurses' self‐efficacy and professional nursing practice environment and the reduction of stressors.     

Presence of trauma and suicide risk: Personal control as a moderator

Given past findings that have linked trauma and lack of personal control to greater suicidal risk in adults, the present study examined how trauma presence and personal control are uniquely involved in predicting suicidal risk in a sample of 469 college students. Regression analyses indicated that both trauma presence and personal control were significant predictors of suicidal risk, as was their interaction. The present findings suggest a need to consider both trauma presence and low personal control in assessing for suicidal risk in college students.     

Disaster preparedness for vulnerable persons receiving in-home, long-term care in South Carolina

PURPOSE: The purpose of this study was to examine how agencies in South Carolina that provide in-home health care and personal care services help older and/or disabled clients to prepare for disasters. The study also examines how agencies safeguard clients' records, train staff, and how they could improve their preparedness. METHODS: The relevant research and practice literature was reviewed. Nine public officials responsible for preparedness for in-home health care and personal care services in South Carolina were interviewed. A telephone survey instrument was developed that was based on these interviews and the literature review. Administrators from 16 agencies that provide in-home personal care to 2,147 clients, and five agencies that provide in-home health care to 2,180 clients, were interviewed. Grounded theory analysis identified major themes in the resulting qualitative data; thematic analysis organized the content. RESULTS: Federal regulations require preparedness for agencies providing in-home health care ("home health"). No analogous regulations were found for in-home personal care. The degree of preparedness varied substantially among personal care agencies. Most personal care agencies were categorized as "less" prepared or "moderately" prepared. The findings for agencies in both categories generally suggest lack of preparedness in: (1) identifying clients at high risk and assisting them in planning; (2) providing written materials and/or recommendations; (3) protecting records; (4) educating staff and clients; and (5) coordinating disaster planning and response across agencies. Home health agencies were better prepared than were personal care agencies. However, some home health administrators commented that they were unsure how well their plans would work during a disaster, given a lack of training. The majority of home health agency administrators spoke of a need for better coordination and/or more preparedness training. CONCLUSIONS: Agencies providing personal care and home health services would benefit from developing stronger linkages with their local preparedness systems. The findings support incorporating disaster planning in the certification requirements for home health agencies, and developing additional educational resources for administrators and staff of personal care agencies and their clients.     

Preparing case reports as a nurse legal consultant

Nurses acting as legal consultants in malpractice, workers' compensation, or personal injury litigation may be asked to provide a report that assesses a client's past, present, and future healthcare needs. This article describes the composition of such a report, using the nursing process and nursing models. The format illustrates the comprehensive nature of a nurse's contribution to the resolution of legal actions.     

Alternative therapies and nurse practitioners: knowledge,professional experience,and personal use

An anonymous questionnaire was mailed to all members of the Connecticut Nurse Practitioner Group, Inc. to identify their knowledge, and personal and professional experiences with alternative therapies. Of the 202 respondents (a 73% return), 78% described themselves as "slightly" or "quite" knowledgeable about alternative therapies in general and 63% reported personal experience. Approximately half of the nurse practitioners (NP) (49%) indicated they "sometimes" or "usually" ask about their clients' use of such therapies and 65% have referred for or recommended one or more of these modalities. Additionally, some NPs have provided alternative therapies directly (30%). One third (31%) indicated they had received training in one or more therapy(ies) and 65% would be "extremely" or "quite" interested in learning more.     

So, you are buying your first computer.

Buying your first computer need not be that complicated. The first thing that is needed is an understanding of what you want and need the computer for. By making a list of the various essentials, you will be on your way to purchasing that computer. Once that is completed, you will need an understanding of what each of the components of the computer is, how it works, and what options you have. This way, you will be better able to discuss your needs with the salesperson. The focus of this article is limited to personal computers or PCs (i.e., IBMs [Armonk, NY], IBM clones, Compaq [Houston, TX], Gateway [North Sioux City, SD], and so on). I am not including Macintosh or Apple [Cupertino, CA] in this discussion; most software is often made exclusively for personal computers or at least on the market for personal computers before becoming available in Macintosh version.     

Personal physicians as study investigators: Impact on patients' willingness to participate in clinical trials

BackgroundWe asked whether patients are more willing to participate (WTP) in a cardiovascular drug trial if their personal rather than an unfamiliar physician were engaged as the study investigator.MethodsWe approached 1440 randomly selected patients from 13 Maryland-based outpatient cardiology and general medicine clinics to complete an 86-item self-administered questionnaire. We then asked respondents their WTP if their personal rather than an unfamiliar physician were the study investigator, as well as their trust in physicians and quality of their health care experiences.ResultsOf 1132 patients eligible, 789 (70%) patients responded and 666 had complete data. Patients were “very likely/likely” to participate in the study 56% of the time if conducted by their personal compared to only 36% if by an unfamiliar physician (p < 0.0001). After adjusting for age, race, gender, and socioeconomic and health status, only the presence of a family member or friend in health care was positively associated with “very likely/likely” WTP with unfamiliar physician (OR, 95% CI = 1.42, 0.99–2.03). If by a personal physician, however, trust in physician (1.57, 1.16–2.11, per 1/5 unit increase), rating of health care quality (1.18, 1.06–1.31 per 1/10 unit increase), and having a family member or friend in health care (1.57, 1.16–2.11) were important predictors of WTP.ConclusionPatients are much more likely to enroll in a clinical trial if their personal physician is engaged as a study investigator, which could relate to the importance of communication, trust, and familiarity with the health care system.     

Support as a complement, intrusion and right--evidence from ageing and disability support service users in Sweden and Australia

How service users conceptualise their personal support services is under researched, even though this understanding is important for responsive policy development and service implementation. This paper tests the proposition that service users understand formal support in three ways: support is a complement to their other arrangements, an intrusion into their personal life and a right. These three concepts were identified using discourse analysis in a Swedish study of older people wanting in-home support services. To test generalisability of these concepts, they were applied to data from an Australian study of people using disability personal support. The analysis found that the three concepts were core to people's views of their support, although the construction of the concepts differed in the two countries. Service users in Sweden asserted their right to services more forcefully than those in Australia, and they had higher expectations that their support needs would be met. These differences reflect the impact of each country's social policy environment on service users' expectations. The analysis suggests that service users and their families want to control their formal support arrangements to complement their informal care and their life preferences and to minimise the intrusive aspects of formal support. The findings imply that the three concepts have utility for theorising service users' perspectives, informing policy and developing implementation strategies which enhance peoples' quality of life.     

Nurses as imperfect role models for health promotion

The purpose of this qualitative study was to discover ways in which nurses describe themselves as health-promoting role models. Focus groups and individual interviews were conducted with nurses working in a variety of settings. Transcribed interviews were analyzed thematically. Nurses defined themselves as role models of health promotion according to the meaning they gave the term, their perceptions of societal expectations, and their self-constructed personal and professional domains. The term role model evoked diverse interpretations ranging from negative perceptions of the idealized image to a humanized, authentic representation. Nurses perceived that society expected them as role models to be informational resources and to practice what they preached. Nurses defined themselves independently of societal expectations according to personal and professional domains. Valuing health, accepting imperfections, and self-reflecting were aspects of the personal domain, whereas gaining trust, caring, and partnering were facets of the professional domain.     

Operationalizing a Pandemic-Ready,Telemedicine-Enabled Drive-Through and Walk-In Coronavirus Disease Garage Care System as an Alternative Care Area: A Novel Approach in Pandemic Management

ObjectiveEmergency departments face unforeseen surges in patients classified as low acuity during pandemics such as the coronavirus disease pandemic. Streamlining patient flow using telemedicine in an alternative care area can reduce crowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment use. This quality improvement project describes critical elements and processes in the operationalization of a telemedicine-enabled drive-through and walk-in garage care system to improve ED throughput and conserve personal protective equipment during 3 coronavirus disease surges in 2020.MethodsStandardized workflows were established for the operationalization of the telemedicine-enabled drive-through and walk-in garage care system for patients presenting with respiratory illness as quality improvement during disaster. Statistical control charts present interrupted time series data on the ED length of stay and personal protective equipment use in the week before and after deployment in March, July, and November 2020.ResultsPhysical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the telemedicine-enabled drive-through and walk-in garage care system. On average, the ED length of stay decreased 17%, from 4.24 hours during the week before opening to 3.54 hours during the telemedicine-enabled drive-through and walk-in garage care system operation. There was an estimated 25% to 41% reduction in personal protective equipment use during this time.ConclusionLessons learned from this telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce crowding, improve throughput, and conserve personal protective equipment during a pandemic.