MENTAL HEALTH SERVICES FOR PERSONS WITH MENTAL RETARDATION: ROLE OF THE ADVANCED PRACTICE PSYCHIATRIC NURSE

The term dual diagnosis is frequently used by mental health professionals to refer to people who have mental illness complicated by substance abuse. A less commonly recognized population are those individuals who have the dual diagnosis of mental retardation and mental illness. In this paper the author discusses (1) the mental health needs of persons with mental retardation and (2) the current state of services for them. There is a significant lack of appropriately trained professionals to help address the needs of this population. Traditionally, nurses have primarily been identified as providers of physical care. Advanced practice psychiatric nurses, however, are an underutilized group of professionals who have the capacity to assume a leadership role in clinical care, service coordination, and advocacy for individuals and families affected by mental illness and mental retardation.     

SPLITTING THE DIFFERENCE: THE HEROES AND VILLAINS OF MENTAL HEALTH POLICY AND NURSING PRACTICE

Drawing on psychodynamic and managerialist concepts, this paper explores possible consequences for patients and mental health nurses of the policy driven “splitting” of mental health service provision in the UK. Services and resources are now split for those with a severe and enduring mental illness and those with a common mental problem. We argue the damaging divisiveness in creating these two “political” groups makes determining how to meet the needs of individuals with common yet complex problems more difficult. The way in which an increased awareness and understanding of psychodynamic concepts can help the mental health nurse deal with such complexity is explored.     

TRANSFORMATION OF STORY TO PRACTICE: AN INNOVATIVE APPROACH TO LONG-TERM CARE

The negative effects of institutionalization in a long-term care facility include depersonalization, decreased self-concept and self-esteem, and decreased psychological well being. To modify these effects, an innovative narrative approach to long-term care in the format of story telling and listening is proposed. Narrative practice, in the format of story telling and listening, leads to an ethics-based care that prioritizes the resident's personal meanings, values staff-patient relationships, and permits the resident to define quality care. The purpose of this article is to demonstrate how the functions of storytelling can be applied in the long-term care setting using the themes that emerge in the life story of a particular resident. These themes, findings of a phenomenological study, were incorporated into the resident's care plan by staff and, consequently, quality of care improved. Recognizing the value of story and incorporating the themes that emerge into a personalized care plan transforms nursing practice.     

THE NEUROBIOLOGY OF ANXIETY DISORDERS: IMPLICATIONS FOR PSYCHIATRIC NURSING PRACTICE

This era of neurobiological advances challenges psychiatric nurses to develop innovative practice models that address the needs of clients with anxiety disorders. Technological discoveries and molecular and genetic research provide a wealth of evidence-based data that serve as the basis of symptom management, prevention, and health promotion and maintenance in clients experiencing anxiety disorders. This article provides an overview of current data-based studies and conceptual models of various anxiety disorders and their key components. Underpinnings include the interrelationship among neurotransmitter systems, neuroendocrinological processes, and neuroanatomical structures and their role in mediating stress, normal anxiety, and various anxiety disorders. Treatment considerations are also an integral part of this article. The discussion of pharmacologic and nonpharmacological interventions reflect dysregulation of intricate neurobiologic processes and concurrent behaviors and individual client needs.     

CLINICAL SUPERVISION,BURNOUT, AND JOB SATISFACTION AMONG MENTAL HEALTH AND PSYCHIATRIC NURSES IN FINLAND

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.     

THE GAP BETWEEN RESEARCH AND CLINICAL PRACTICE FOR INJURY PREVENTION IN ELITE SPORT: A CLINICAL COMMENTARY

As clinicians strive to apply evidence-based principles, team-based practitioners have identified a large gap as it relates to published research, ideal applications of evidence-based practice, and actual clinical practice related to injury prevention in elite sport within the United States. For rehabilitation professionals, especially those intimately involved in the research of injury prevention, the solution often seems quite clear and defined. However, preventing injury by implementing the latest recommendation from the most recent prospective study on the using the FIFA 11 + warm-up, a Copenhagen Adduction exercise, or a plyometric drill with elite athletes may not be as effective as was seen among the cohort used in the study. In addition to extrapolating research, clinicians face additional challenges such as variance among professions, schedule density, and off-season contacts with athletes. There is an inherent difficulty in the application of research to practice in elite sport as it relies on the teamwork of not only the practitioner and athlete, but the entire sporting organizational structure and those involved in athlete participation. The purpose of this clinical commentary is to explore the difficulty with application of research in clinical practice and to discuss potential strategies for improving carry over from research to clinical practice.     

STAFF AND PATIENT PERCEPTIONS OF RESEARCH IN AN INTEGRATED MENTAL HEALTH SERVICE

The purpose of this research was to survey staff and patients about their experience, knowledge, and attitudes regarding research. One hundred and sixty patients were interviewed using a questionnaire. In addition, a modified version of the same questionnaire was sent to multidisciplinary staff (n = 476), and about two-fifths (n = 181, 38%) were returned. Participants were interested in research and keen to know more about methods and processes. There were significant differences between staff and patients in terms of attitudes towards evidence-based practice and knowledge about research. The findings support the notion that staff and patients hold similar views about research methods and influences.     

THE CULTURAL REALITIES OF CLINICAL SUPERVISION IN AN ACUTE INPATIENT MENTAL HEALTH SETTING

In this paper, the cultural realities of clinical supervision (CS) in acute inpatient mental health settings are explored using an ethnographic approach. Findings suggest that there is a verbal acceptance of CS by mental health nurses but a cultural belief that it has limited experiential value and, thus, a cautious attitude towards its adoption is in practice. This may, in part, be attributable to many nurses believing that they are already undertaking CS, although the informal supervision described does not fit with established definitions of formal supervision. The language used by nurses demonstrates an understanding and appreciation of the benefits of clinical supervision. However, the belief that existing structures inherent to nursing practice already convey these benefits may contribute to the culture of passive resistance to clinical supervision revealed by the findings. This study contributes to current discussions regarding the purpose of CS, the realities of its implementation, and its role relative to existing professional support opportunities.     

CLIENTS WITH MENTAL ILLNESS AND THEIR CHILDREN: IMPLICATIONS FOR CLINICAL PRACTICE

The problem of adults with severe mental illness parenting minor children is a growing concern. These clients suffer from concerns that negatively affect them and their children. This study showed many clients seeking services at public mental health agencies are parents of minor children and have had a history of family dysfunction. Prevalence rates, demographic characteristics, types of mental illness diagnoses, family background variables, and some current issues regarding these clients were examined. The study concludes with clinical implications for clients and their families and calls for a family focused approach.     

MENTAL HEALTH STATUS IN REFUGEES: AN INTEGRATIVE REVIEW OF CURRENT RESEARCH

The purpose of this integrative review was to assess the results of current published quantitative research about refugees and their mental health status. An extensive literature review using several approaches was performed. A group of 12 articles met inclusion criteria for this study sample (N = 12). All 12 studies showed negative mental health status in the refugees sampled. Mental health outcomes included posttraumatic stress disorder, depression, anxiety, psychosis, and dissociation. This review revealed a lack of culturally sensitive understandings and diagnostic measures in the majority of current published quantitative research on refugees. The scope of this research for health professionals is broad, as the number of refugees continues to rise. Recommendations for clinicians include an expanded range of practice to incorporate refugee-specific assessment and treatment.