Psychiatric mental health nursing: challenge and change

. We invited Dr Peplau to provide a personal reflection on the recent history of psychiatric nursing and her thoughts on immediate challenges facing the profession. The paper is an individual scholar's commentary on the way that psychiatry has waxed and waned over the years, in relation to nursing. This historical review discovers and reports a challenge to current practice. Dr Peplau describes a professional shift that is pulling nurses toward the subordinate role observed earlier this century. The paper draws attention to how contemporary practice can be positively influenced, e.g., by giving a structure to the allocation and conduct of nurse–patient time.     

Calming an Escalated Psychiatric Milieu

On inpatient psychiatric units, nurses control the tone, pace, and activity level of the environment. But under the influence of factors such as high patient acuity and negative group contagion, a milieu can become unacceptably loud and chaotic. A volatile milieu is a potentially dangerous environment because patients' anxiety and agitation can quickly lead to acting out and aggression. This article focuses on how nurses can regain control of a milieu spiralling into chaos by tightening the structure of the routine, anticipating potential problems, and maintaining a confident calm manner. The charge nurse orchestrates the staff group's response to escalation through detailed planning, decisive interventions, and strategic use of every available resource.     

Ictal Single-Photon Emission Computed Tomography Imaging in Extra Temporal Lobe Epilepsy Using Statistical Parametric Mapping

PURPOSE: To examine the application of statistical parametric mapping (SPM) to analyze ictal single-photon emission computed tomography (SPECT) scans in surgical candidates with extratemporal lobe epilepsy. METHODS: The authors selected patients who underwent successful ictal SPECT acquisition in the process of surgical treatment of intractable partial epilepsy. Thirteen patients were identified who met inclusion criteria for confident seizure localization from either intracranial electroencephalogram recordings or epilepsy surgery outcome. In these cases, ictal scans were registered to an in-house-developed normal SPECT atlas composed of 14 spatially normalized brains of normal subjects. SPM96 was used to test on a voxel-by-voxel basis for statistically significant increases in blood flow associated with each patient's ictal scan. The results were then mapped back onto the patient's magnetic resonance image (MRI) for final interpretation. Statistical parametric mapping (SPM) analysis of ictal SPECT scans was compared to both conventional visual interpretation and the analysis of subtraction ictal SPECT co-registered to MRI (SISCOM). RESULTS: Ten of 13 patient scans showed localizing focal ictal increases in regional cerebral blood flow, all of which were concordant with ultimate epilepsy localization. Of the 3 cases not localized with SPM, 1 was localized by conventional visual interpretation and another, not localized by visual interpretation, was correctly localized with SISCOM. Two cases not localized by SISCOM were localized by both visual and SPM analysis. CONCLUSIONS: This work provides supportive evidence for proof of principle that SPM can be used to provide objective, accurate analysis of ictal SPECT scans in patients with extratemporal lobe epilepsy.     

The nurse''s decision-making process and the implementation of psychogeriatric nursing in a mental hospital

This study looks at the psychogeriatric nurse's decision-making process and on this basis seeks to describe the implementation of psychogeriatric nursing in a mental hospital. The subjects consist of 26 nurses working on the psychogeriatric wards of one hospital. The data were collected using a questionnaire (n = 26), a 1-week time-usage analysis, content analysis of nursing plans (n = 56), and observation of planning meetings (n = 15). The results for different phases of the decision-making process suggested that nurses had little difficulty with the identification of problems. Data collection tended to concentrate on the physical side of nursing work. The setting of explicit targets for nursing care proved to be difficult. The vast majority of the nurses (85%) felt that decision-making on different nursing alternatives was only moderately or not at all successful. Over half of the nurses felt that their ability to evaluate the outcome of treatment and nursing was either satisfactory or poor. Time-usage analysis indicated that the nurses had frequent interaction with their patients in connection with basic care, although the nurses themselves did not regard this part of their work as active interaction with the patient.     

Peripheral and central arterial haemodynamic interactions are early abnormalities in young male cigarette smokers.

BACKGROUND: smoking, result in endothelial dysfunction and this affects systemic and local haemodynamics. The aim was to assess interactions of the left ventricle and arterial system of smokers at baseline and after a physiological stimulus--the cold pressor test (CPT) which causes a sympathetically driven vasoconstriction that counteracts the normal endothelial dependent vasodilatation. MATERIALS AND METHODS: male smokers and controls were compared using applanation tonometry. Parameters included systolic and diastolic blood pressure, ejection duration, heart rate, aortic augmentation index (AAI), and sub-endocardial viability ratio (SEVR). The CPT was performed at 1 and 3 min following immersion of the hand in ice. RESULTS: smokers have abnormal baseline cardiac timing (heart rate and ejection duration), systolic and diastolic blood pressures which are due to increased peripheral wave reflection (AAI) and thus affect the SEVR. Following CPT, the pressure wave differential, dP/dt, was significantly increased in smokers compared to non-smokers who had a decrease at 1 min in ice. Mean systolic and diastolic pressure was significantly increased in both groups at 1 and 3 min as was end systolic pressure in non-smokers. CONCLUSIONS: baseline ventriculo-vascular dynamics, are abnormal as was the evoked response to CPT. The blunted blood pressure increase of smokers compared to controls following CPT, may represent altered nitric oxide production in the macro and microcirculation through differential upregulation of endothelial nitric oxide synthase (eNOS) and inducible NOS respectively. The potential for therapeutic intervention and prevention of ongoing endothelial injury, requires further investigation.     

Loneliness among elderly people living in Stockholm: a population study

The purpose was to investigate experienced loneliness among the elderly. The material included 1725 people, aged 75 and over. The study describes relationships between loneliness, social network, cognitive function and health. Thirty-five per cent experienced loneliness, and a higher percentage was found among women. A gradual increase in loneliness was found up to the age of 90, after which a levelling was found. Elderly persons living together with a partner experienced less loneliness. There were no significant differences between those with and without children. Ten per cent reported not having any friends and, of these, one out of two experienced loneliness. A high frequency of experienced loneliness was found among elderly people with reduced cognitive function. Subjectively experienced bad health and loneliness were strongly related to each other, i.e. a person who experienced loneliness did usually not feel completely healthy.