DISTANCE EDUCATION: PEDAGOGY FOR PSYCHIATRIC-MENTAL HEALTH NURSING

Education of undergraduates in mental health nursing necessitates modeling interpersonal relationships and providing accessible educational experiences. This article describes (1) a distance education strategy that promotes interpersonal learning, and (2) a qualitative study exploring faculty's experience with this pedagogy. Several themes emerged from the data: I Feel Like I'm In A Different World; I Don't Get To Know The Students; They Have My Face; I Am Caught Up In The Technology; It Is A Lot Like Teaching In The Classroom; and It Is Helping Me Grow In My Teaching. A metaphor, "bringing it to life,"captures faculty members' capability to change lifeless lecture content into a learning experience involving human beings.     

PSYCHIATRIC-MENTAL HEALTH NURSING AT THE INTERFACE: REVISIONING EDUCATION FOR THE SPECIALTY

In the emerging health care environment, families and communities are facing a broad range of conditions that require more integrated views of wellness and illness, mind and body, and the biomedical and the behavioral. This also calls for an enhanced care delivery system. Three interfacing areas of practice have particular significance for the psychiatric-mental health nursing workforce: enhanced primary care, public health or population-focused health interventions, and managed care. This paper addresses the broad range of knowledge, skills, and competencies that are required for the future of advanced practice psychiatric-mental health nursing and describes interactive learning experiences and new pedagogies to deliver them.     

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.     

OWLS,LARKS AND THE SIGNIFICANCE OF MORNINGNESS/EVENINGNESS RHYTHM PROPENSITY IN PSYCHIATRIC-MENTAL HEALTH NURSING

In the last decade there has been an upsurge in the research focusing on the interplay between the human circadian timing system and behavioral patterns in health and illness. Of particular interest in this area of inquiry is the overlay of what has been termed chronotype. What this refers to is the propensity of biological rhythms to express themselves in certain patterns of behavior. Commonly, these patterns have received names such as owl (evening chronotype) or lark (morning chronotype). Many people are neither a strong morning nor evening chronotype. If illness represents a change in the way a person's body functions within a given environment, then it is reasonable to believe that an "owl's" symptom presentation may vary significantly from the patterns of a "lark" who becomes ill. Recognizing that psychiatric nurses at both the generalist and the advanced practice levels have a strong interest in patterns of behavior, it stands to reason that using a lens that incorporates notions of the body's clock becomes essential. The interplay between the body's timing system thousands of other psychobiological rhythmic occurring everyday and within every human being to as chronobiology. This article provides a primer a for psychiatric nurses on issues of chronobiology to morningness and eveningness rhythm propensity.     

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.     

THE CENTRE FOR PSYCHIATRIC NURSING RESEARCH AND PRACTICE: AN INNOVATIVE APPROACH TO ENHANCING CLINICAL NURSING RESEARCH IN THE PSYCHIATRIC/MENTAL HEALTH FIELD

The available nursing literature suggests that nurses engaged in clinical practice hold a somewhat ambivalent attitude towards nursing research. On the one hand, its value is acknowledged, but on the other, its relevance to clinical practice is questioned. This situation poses a significant barrier to the involvement of clinicians in research and the utilisation of findings in practice. This paper describes the implementation of a model to facilitate the development of a systematic research approach at the Centre for Psychiatric Nursing Research and Practice in Victoria, Australia. The development of strong relationships between the Centre and the clinical field was considered crucial in determining the success of this initiative. The introduction of a number of programs to foster the conduct and utilisation of clinical research are described, including: The Nursing Clinical Development Unit Program, the Clinical Research Fellowship Program, clinical research projects, the Collaborative Psychiatric Nursing Conference and strategies to encourage the dissemination of research information. In combination, these initiatives are expected to contribute to a systematic approach to engendering a research culture within psychiatric nursing in Victoria, Australia.     

DISSOCIATIVE SYMPTOM DISORDERS IN ADVANCED NURSING PRACTICE: BACKGROUND,TREATMENT, AND INSTRUMENTATION TO ASSESS SYMPTOMS

Less well-known among the psychiatric disorders, dissociation is one of the most common underlying symptoms of individuals seeking mental health care (Maldonado, 2001). Closely associated with post-traumatic stress disorder, dissociation characteristics may include inconsistent consciousness, autobiographical forgetfulness, difficulties in self-regulation, regressions, alternate identities, disorganization in the development of a cohesive sense of self, depersonalization, and derealization (Trickett, Noll, Reiffman & Putnam, 2001). The major constructs and dimensions of the dissociative symptom disorders in adults are introduced. Several of the most prominent psychometric instruments that nurses and other mental health clinicians may use as adjuncts to diagnosis and treatment are described.     

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.     

WEAVING A NEW SAFETY NET OF MENTAL HEALTH CARE IN RURAL AMERICA: A MODEL OF INTEGRATED PRACTICE

Life in rural America is often idealized, yet rural Americans suffer from mental illness in rates comparable to urban America and require similar types of support and services. However, millions of individuals living in rural areas go without needed mental health services. The dominant care model allows the treatment of mental illness to be delivered by non-mental health professionals with little or no education or training in psychiatric care and who have little desire to provide this type of care, resulting most often in ineffective or inappropriate treatment. Lacking access to appropriate and effective care, rural mentally ill individuals are more often symptomatic than their urban counterparts and may never find relief from the disabling symptoms of treatable mental illnesses. This article will focus on the current state of psychiatric-mental health care in the context of these realities and discuss the impact of the current trend of mental illness being treated by non-mental health professionals. The article will conclude by proposing a model of advanced practice nursing that the authors believe will increase both access and efficacy of treatment for the mentally ill living in rural America. This Integrated Model views the current system of care that completely separates location for traditional physical and mental health care as antithetical to integration and to holism and presents a new model for understanding and provided integrated health care to meet the needs of rural mentally ill individuals and families.