Archives of Psychiatric Nursing - Articles in Press

The Described Experience of Primary Caregivers of Children With Mental Health Needs - Corrected Proof

2012-02-16

About 10% of our nation's children have serious mental health needs that result in significant functional impairments. Although research has found that primary caregivers of children with mental health needs have high levels of depressive symptoms and distress, little is known about the challenges these caregivers face. Focus groups with 20 caregivers of children with mental health needs between 2 and 17 years of age revealed these themes: struggling with care systems, living in fear, being burdened and exhausted, worrying about the rest of the family, and having good things happen. Caregivers described extreme challenges and many unmet needs that are important to consider in efforts to improve both children's and caregivers' well-being.

Clinging to Any Bit of Joy: Urban, Ethnically Diverse, Impoverished Women's Descriptions of Anxiety and Depression - Corrected Proof

Mary Molewyk Doornbos, Gail Landheer Zandee, Joleen DeGroot — 2012-02-16

Depression and anxiety are mental health issues that disproportionately affect women. This study sought to capture perceptions of anxiety and depression in 3 urban, ethnically diverse, underserved, and impoverished neighborhoods. Using community-based participatory research, in the context of long-term partnerships between a department of nursing and these neighborhoods, the researchers recruited 61 women aged 18 to 69 years. Data were collected via 6 homogeneous focus groups composed of Black, Hispanic, and White women, respectively. The women identified themes pertaining to the manifestations and effects of anxiety and depression as well as unique coping strategies.

Sixteen-Month Evaluation of Depressive Symptomatology in Older Adults - Corrected Proof

Graham J. McDougall, Stephanie Morgan, Phillip W. Vaughan — 2012-02-10

We examined the prevalence of depressive symptoms over time in a sample of community-residing older adults at baseline, 2 months, 6 months, and 14 months. The nonprobability sample (N = 222) was 90% female, 87% Caucasian, 15% Hispanic, and 12% African American with an average age of 75 years. If depressive symptoms had been measured at only one time, 19% of the sample would have scored above the cutoff versus 39% scoring above the cutoff when measured at all 4 periods. The findings provide evidence that depressive symptoms in older adults are variable and fluctuate over time. The significance of this research was the longitudinal evaluation of depressive symptoms in community-residing elders.

Engagement in Primary Care Treatment by Persons With Severe and Persistent Mental Illness - Corrected Proof

Patricia Galon, Christine Heifner Graor — 2012-01-20

Even when primary care provider relationships exist, persons with severe and persistent mental illness (SPMI) are more likely to be undertreated and seek care from emergency room settings. The purpose of this study was to describe the social process of engagement in primary care treatment from the perspective of persons with SPMI. Using grounded theory and semistructured interviews, 32 adults were interviewed. The process of engagement includes mattering, being perceived as credible and capable, and working together. Clinical, education, and research implications are discussed. Future studies should explore engagement in primary care with this population from the perspective of providers.

The Experiences of Nurses With Mental Health Problems: Colleagues' Perspectives - Corrected Proof

2012-01-20

A 3-stage qualitative study conducted in 2008 aimed to explore the issues to inform a mental health education program to deliver to nurses. This article presents the findings of Stage 1. Data were collected from semistructured interviews conducted with 14 Australian nurses. The interviews explored nurses' knowledge and understanding of mental health problems and their workplace experiences of working with nurses with mental health problems. The interviews were audiotaped, transcribed, and analyzed for the main themes: textbook knowledge, day-to-day support, and workplace considerations. These nurses' narratives guided the implementation of a mental health education workshop targeting nurses (Stage 2).

Health Service Use Among Persons With Self-Reported Depression: A Longitudinal Analysis of 7,164 Women - Corrected Proof

Jon Adams, David Sibbritt, Chi-Wai Lui — 2012-01-13

Objective: Depression is a common mental disorder and a leading contributor to the global burden of disease. In Australia, depression is reportedly the leading cause of morbidity for young women. In addition to conventional treatments, there is also some evidence that there is common use of complementary and alternative medicine (CAM) among people with depressive symptoms. However, there has been little research focus upon broad health care and practitioner use (including consumption of both conventional and CAM practitioners as well as self-prescribed care) among young adults with depression. This article aims specifically to address this knowledge gap by providing the first longitudinal analysis of the use of health service among women with self-reported depression.Methods: Data from a longitudinal cohort study (Australian Longitudinal Study on Women's Health) conducted over a 3-year period on 7,164 young Australian women were analyzed. Information on health status, health service use, and self-prescribed treatments was obtained from two questionnaires mailed to study participants in 2003 and 2006.Results: The study identified that only a small proportion of the women had sought professional assistance for their self-reported depression. It also shows that many women who reported depression used CAM alongside or as a complement to conventional health care services. In particular, young women who did not seek help for their depression were more likely to self-prescribe CAM than were women without depression.Conclusion: The frequent use of a range of conventional providers and practitioner-based CAM and self-prescribed CAM among women with self-reported depression warrants further investigation.

Autobiographical Accounts of Sensing in Asperger Syndrome and High-Functioning Autism - Corrected Proof

Marie Elwin, Lena Ek, Agneta Schröder, Lars Kjellin — 2012-01-13

Sensory experiences in Asperger syndrome (AS) or high-functioning autism (HFA) were explored by qualitative content analysis of autobiographical texts by persons with AS/HFA. Predetermined categories of hyper- and hyposensitivity were applied to texts. Hypersensitivity consists of strong reactions and heightened apprehension in reaction to external stimuli, sometimes together with overfocused or unselective attention. It was common in vision, hearing, and touch. In contrast, hyposensitivity was frequent in reaction to internal and body stimuli such as interoception, proprioception, and pain. It consists of less registration, discrimination, and recognition of stimuli as well as cravings for specific stimuli. Awareness of the strong impact of sensitivity is essential for creating good environments and encounters in the context of psychiatric and other health care.

Determinants of Seclusion After Aggression in Psychiatric Inpatients - Corrected Proof

2012-01-13

Some aggressive incidents in psychiatric wards result in seclusion, whereas others do not. We used the Staff Observation Aggression Scale–Revised and the mental health trust's database to identify determinants that predicted seclusion after aggression. These consisted of demographic, diagnostic, contextual, and aggression characteristics and were analyzed in a multilevel logistic regression. This showed associations between seclusion and aggression for the following: younger age, involuntary status, history of previous aggression, physical or dangerous violence, aggression being directed against objects, and a more severe incident. Thus, seclusion after aggression appears to be mainly predicted by aggression itself.

What is Good Mental Health Nursing? A Survey of Irish Nurses - Corrected Proof

Richard Lakeman — 2012-01-13

The practice, theory, and preparation associated with nursing people with mental health issues has changed in profound ways in recent decades. This has in part been reflected by a shift in nurses identifying as being mental health rather than psychiatric nurses. Context, theory, and values shape what it means to be a mental health nurse. Thirty experienced mental health nurses in Ireland completed a survey on what good mental health nursing is and a definition induced from their responses. Mental health nursing is a professional, client-centered, goal-directed activity based on sound evidence, focused on the growth, development, and recovery of people with complex mental health needs. It involves caring, empathic, insightful, and respectful nurses using interpersonal skills to draw upon and develop the personal resources of individuals and to facilitate change in partnership with the individual and in collaboration with friends, family, and the health care team. This appears to encapsulate the best of what it meant to be a psychiatric nurse, but challenges remain regarding how to reconcile or whether to discard coercive practices incompatible with mental health nursing.

A Comparison of Suboxone and Clonidine Treatment Outcomes in Opiate Detoxification - Corrected Proof

Anthony Steele, Patricia Cunningham — 2012-01-13

Purpose: This retrospective quality improvement study was to evaluate if Suboxone therapy reduced the risk of terminating treatment against medical advice compared with the use clonidine in men aged 18–-55 years.Methods: Data were collected through chart review for all opioid-addicted male clients admitted voluntarily to a community-based treatment center between July 1, 2009, and December 30, 2009.Findings: The chi-square test of independence between treatment completion and treatment noncompletion was found to be significant at the 5% critical level (P = .027) for Suboxone therapy.Conclusions: Suboxone treatment decreased premature termination of opioid detoxification completion when compared with clonidine.

Crisis Emergencies for Individuals With Severe, Persistent Mental Illnesses: A Situation-Specific Theory - Corrected Proof

Laura Brennaman — 2012-01-13

This article presents an extension of Ball's midrange theory of crisis for individuals with severe, persistent mental illnesses (SPMI) by placing Balls' model in the specific situation of the individual seeking help in an emergency setting, creating the situation-specific theory of crisis emergencies for individuals with SPMI. There is a large and growing presence of clients with SPMI in crisis engaging nurses in emergency departments. Through application of an integrative approach, a situation-specific theory for nurses in emergency departments to distinguish between a need for mental health crisis intervention and mental health emergency intervention has been developed, with implications for nursing practice, policy, and research.

Health-Seeking Behaviors of Native American Indians With Persistent Mental Illness: Completing the Circle - Corrected Proof

Eleanor E. Yurkovich, Izetta Hopkins (Lattergrass), Stuart Rieke — 2012-01-13

Nationally, disparity exists in the delivery of mental health services to minority groups, and an imperative exists that expects culturally responsive care. The purpose of this grounded theory study was to discover health-seeking practices used by Native American Indians (NAIs) with persistent mental illness (PMI). Eighteen interviews were examined using constant comparative analysis. Health-seeking practices emerged as two central categories: health engagement strategy and avoidant strategy. This research assists mental health caregivers in approaching the NAI with PMI in a culturally responsive manner by providing a NAI's perception of health and knowledge of their health-seeking behaviors/practices.

Integrating the Transitional Relationship Model into Clinical Practice - Corrected Proof

2012-01-11

Background: The challenge of facilitating knowledge translation in clinical practice includes enabling practitioners and agencies to implement a common set of best practices, such as the Transitional Relationship Model (TRM). In 1992, a participatory action project implemented the TRM on a long-term psychiatric hospital ward in Ontario, Canada. All participants were successfully “bridged” to the community. Despite positive outcomes associated with the TRM, implementation of any best practice is difficult because it involves changing processes. Objective: It was hypothesized that using multiple implementation strategies developed by wards that had already implemented the model would result in improved TRM implementation. Method: This study compared three groups of hospital wards; Group A wards had already adopted the TRM, Group B wards implemented the TRM in Year 1, and Group C wards implemented the TRM in Year 2. An iterative process was used in which strategies suggested by the A wards were used to enhance implementation on the B and C wards, respectively. These included enhancing staff participation, creating/maintaining supportive ward milieus, meeting specific educational needs, and supporting managers throughout the implementation process. The degree of actual implementation on each ward served as the primary outcome measure. Results: Group C implemented the TRM model significantly quicker than the other groups. Sustainability in the initial A wards required the implementation of additional strategies used by the later wards.

Influence of Race on Outpatient Commitment and Assertive Community Treatment for Persons With Severe and Persistent Mental Illness - Corrected Proof

Patricia A. Galon, N. Margaret Wineman, Thomas Grande — 2011-12-15

Critics of outpatient commitment (OPC) suggest that African Americans with severe and persistent mental illness may be more frequently subjected to coercive treatment. This study examines the frequency of use of OPC and assertive community treatment and compares their influence on the perceptions of procedural justice/choice and coercion/negative pressure on African Americans and Whites. No significant differences were found in the rate at which OPC was applied to African Americans or in the use of assertive community treatment. Although procedural justice/choice does contribute significantly to the perception of coercion/negative pressure in both groups, its influence is diminished in African Americans.

Anger in the Trajectory of Healing From Childhood Maltreatment - Corrected Proof

Sandra P. Thomas, Sarah C. Bannister, Joanne M. Hall — 2011-12-15

When a girl is abused during childhood, she may not experience anger, only helplessness or numbness. Only later may the emotion of anger surface. Little is known about anger cognitions or behaviors as they occur across the years of the healing trajectory from childhood maltreatment. Data for the present secondary analysis were derived from a large narrative study of women thriving in adulthood despite childhood abuse. The purpose of this analysis was to examine the phenomenon of anger and its role in the recovery process of 6 midlife women. The 6 cases were purposefully selected because their interviews contained rich descriptions of anger experiences. Because each woman was interviewed 3 times over a 6- to 12-month period, 18 transcripts were available for in-depth examination. A typology was constructed, depicting 5 types of anger. Anger ranged from nonproductive, self-castigating behavior to empowering, righteous anger that enabled women to protect themselves from further abuse and to advocate for abused children. Study findings are relevant to extant theories of women's anger and feminist therapies.

HIV Disclosure by Perinatal Women in Thailand - Corrected Proof

Ratchneewan Ross, Andrea W. Stidham, Barbara L. Drew — 2011-12-15

Little is known about HIV disclosure among perinatal women, although we do know that disclosure can facilitate timely initiation of appropriate interventions for infected individuals and their families. This study, therefore, examined predictors of HIV disclosure among perinatal Thai women. Data (N = 207) were extracted from two larger studies of depressive symptoms in HIV-positive pregnant or postpartum women in Thailand in which participants completed questionnaires. Most participants had low socioeconomic status. Logistic regression indicated that significant predictors of disclosure included older age, employment, and high family support. Psychiatric mental health nursing interventions to promote family support are critical during this time.

Developing a Reflection-Centered Curriculum for Graduate Psychiatric Nursing Education - Corrected Proof

Sara Horton-Deutsch, Angela M. McNelis, Pamela O'Haver Day — 2011-12-12

This article discusses theoretical underpinnings, teaching strategies, and preliminary evaluation relative to the development of a reflective curriculum used in our distance-accessible graduate psychiatric nursing program. Influenced by the collective ideas of J. Dewey (1993), J. Reed and S. Proctor (1993), D. A. Kolbe (1984), J. Mezirow (1981), C. Johns (2006), D. Schön (1983), D. Freshwater (2008), and others who have promoted reflection as a transformative teaching and learning process, we sought to develop a curriculum that balanced knowledge and skill acquisition with critical reflective practices that would instill habits of lifelong learning. We began with traditional approaches to psychiatric nursing education, including case study analysis and modified lectures that we call mini lectures. We then added principles and practices of reflection to allow for merging these traditional approaches with contemporary reflection-focused approaches. Specific ways to use reflection in a graduate psychiatric nursing curriculum are described to demonstrate how we have taken our curriculum beyond traditional ways of teaching and learning toward one that emphasizes building knowledge and skill through reflective practice.

Mental Health of Elders in Retirement Communities: Is Loneliness a Key Factor? - Corrected Proof

Abir K. Bekhet, Jaclene A. Zauszniewski — 2011-12-12

Loneliness is often manifested by intense feelings of emptiness and abandonment and can lead to depression and suicide. The prevalence of loneliness in older adults is estimated to be 40%. This secondary analysis examined differences between elders reporting and elders not reporting loneliness and the effect of gender on resourcefulness and measures of physical and mental health within the context of L. C. Hawkley and J. T. Cacioppo's (2010) theoretical model of loneliness. A descriptive, comparative design was used to examine gender differences and associations among loneliness and indicators of physical and mental health. Results indicated that for overall health, and indicators of physical health (functional status and number chronic conditions), no significant differences were found between those who reported loneliness and those who reported no loneliness. There were significant differences, however, between lonely elders and nonlonely elders on indicators of mental health, including both anxiety and depressive symptoms. Differences between lonely elders and nonlonely elders on measures of resourcefulness approached significance. The findings from this study suggest that intervention programs designed to prevent or reduce loneliness in older adults may be beneficial for preserving their mental health.

Help-Seeking Behaviors of Turkish Patients Prior to Accessing a Psychiatric Polyclinic - Corrected Proof

Perihan Güner-Küçükkaya, Satı Ünal — 2011-11-30

Despite the high prevalence of mental illness worldwide, people often do not receive adequate care and treatment. This study determined the help-seeking behaviors, prior to attending a psychiatric outpatient clinic, among Turkish patients (N = 225) with mental illness. Prior to attending the clinic, 29.3% of patients surveyed indicated they used self-implementation techniques, 17.78% consulted someone other than a physician, and 9.3% visited special healing sites other than hospitals. More than 50% used alternative therapies rather than conventional treatment. Mental health nurses must be aware of these health-seeking behaviors when planning individualized patient care and treatment.

The Family-Focused Mental Health Practice Questionnaire - Corrected Proof

Darryl Maybery, Melinda Goodyear, Andrea Reupert — 2011-11-14

It is estimated that 1 in 5 children have a parent with a mental illness, and studies have shown that such children are more likely to develop mental health problems when compared with their peers. Research has demonstrated the benefits of mental health clinician family-sensitive practice to both parents and their children; however, a measure of clinician practice is not available. The psychometric properties of a questionnaire measuring family-focused practice in the psychiatric setting are reported here. There were 307 public adult mental health worker participants, predominantly from the nursing profession and working full time. Principal component analysis highlighted 14 subscales that summarize 49 items reflecting organizational and worker factors, such as skill/knowledge about the impact of parental mental illness on children and worker confidence. Subscales are discussed in relation to the literature and psychiatric policy. The measure appears a useful tool for evaluation, benchmarking for training and organizational improvement, and ultimately, for increasing quality services to parents, families, and particularly children associated with psychiatric services.

Provision of Preventive Services for Cancer and Infectious Diseases Among Individuals with Serious Mental Illness - Corrected Proof

Brenda Happell, David Scott, Chris Platania-Phung — 2011-11-14

Individuals living with serious mental illness (SMI) have increased mortality chiefly because of a higher prevalence of chronic disorders, including some cancers and infectious diseases. Although increased prevalence of these disorders may be attributable to lifestyle and risk behaviors, there is evidence that they may not be appropriately addressed by health professionals. We conducted a review of the literature describing preventive services for cancer and infectious diseases provided to individuals with SMI. Most studies demonstrated a 20%–30% reduced likelihood of breast, cervical, and colorectal cancer screening, or immunizations for influenza and pneumonia, in patients with SMI compared with those without SMI. This is most common in those with the most severe forms of SMI. HIV and hepatitis were more commonly screened for in people with SMI than the general population, likely because of the increased risk for these disorders within this group, but there were still substantial proportions of individuals with SMI who had never received a screening, or had not received a recent screening, for these disorders. The mental health nursing profession has an opportunity to address the disparity in care for cancer and infectious diseases, as well as other physical disorders, experienced by mental health consumers. With systemic support and ongoing education, mental health nurses may be capable of conducting or recommending screening for disorders and providing lifestyle advice. These practices may help to reduce the increased prevalence of chronic disease in SMI populations.

Development of an Instrument to Measure Self-Efficacy for Social Participation of People With Mental Illness - Corrected Proof

Manami Amagai, Mayo Suzuki, Fumie Shibata, Jack Tsai — 2011-11-14

Promoting social participation is consistent with the principles of psychiatric rehabilitation of people with severe mental illness, but lack of self-efficacy in social participation is a major barrier to the community integration of these people. The purpose of this study was to develop an instrument in the form of a mental illness scale (self-efficacy for social participation [SESP]) to measure self-efficacy in social participation among Japanese people and to evaluate the scale's reliability and validity. Devised from a content analysis of interviews with 12 patients regarding their participation in socialization programs, the scale consisted of 37 items. The scale's validity and reliability were tested in a total of 340 community-dwelling individuals with severe mental illness. The final scale consisted of four dimensions with 27 items. Internal consistency of the overall SESP-27 was excellent (α = .96). The scale demonstrated adequate criterion and construct validity and was psychometrically sound. The scale may offer clinicians a tool for planning how to help individuals with mental illness boost their self-efficacy in social participation and community integration.

Predictors of Eating Attitudes and Behaviors Among Gay Hispanic Men - Corrected Proof

2011-10-13

Gay men are a vulnerable population at risk for a number of health disparities, but little is known about eating disorders among gay Hispanic men. The purpose of this study was to examine the relationship of eating attitudes and behaviors with alcohol abuse, body image, depression, self-esteem, and sexual behaviors to determine predictors of eating attitudes and behaviors in a community sample of gay Hispanic men. Significant numbers of the participants were at risk for eating disorders (13%), alcohol abuse (18%), body image disturbance (29%), depression (25%), low self-esteem (12%), and high-risk sexual behaviors (34%). Alcohol abuse, body image, depression, self-esteem, and sexual behaviors were significant predictors of eating attitudes and behaviors and accounted for 38% of the variance in eating attitudes and behaviors. Nurses providing care to this population of gay men must be aware of this cluster of related mental health conditions that are experienced by these men. Addressing and treating these health conditions as a group of related mental health conditions are necessary. More research is needed to further explore this cluster of health issues among gay Hispanic men.

Depressive Symptoms After a Myocardial Infarction and Self-care - Corrected Proof

Mary Kathleen Coyle — 2011-10-05

This descriptive study examined depressive symptoms impacting the performance of self-care behaviors in patients (N = 62) who have experienced a myocardial infarction (MI). Having had a prior MI is inversely associated with decreased self-care behaviors at 30 days. Depressive symptoms of agitation and loss of energy significantly impacted self-care performance 30 days after discharge from the hospital. A variance of 21% (P < .05) in patients who experienced a prior MI and exhibited depressive symptoms of agitation and loss of energy at 30 days suggests patient vulnerability after discharge and a window for therapeutic interventions.

The Influence of Psychosomatic Symptoms, Physical and Sexual Abuse, and Coping Strategies on Delinquent Behavior Among Korean Adolescents - Corrected Proof

Hyun-Sil Kim, Hun-Soo Kim, Joan Samuels-Dennis — 2011-10-05

Purpose: This cross-sectional study was undertaken to examine the contributing factors related to juvenile delinquency, as well as to identify the effect of psychosomatic symptoms, physical abuse, sexual abuse, and coping strategies on delinquent behavior among Korean adolescents.Methods: To investigate the research problem, 2,146 adolescents, including 1,350 student adolescents and 796 delinquent adolescents, were assessed using a cross-sectional descriptive design study via anonymous, self-reporting questionnaires. Almost all research variables were measured using the Mental Health Questionnaire for Korean Adolescents.Results: Our results revealed that delinquent adolescents showed a greater incidence of psychosomatic symptoms, higher levels of physical and sexual abuse, and a higher level of less effective coping strategies compared with student adolescents. Our path analysis revealed that the likelihood of delinquent behavior among adolescents appeared to be influenced mainly by sexual abuse, Psychosomatic Symptoms I, and physical abuse, with these three variables having the highest total effect.Conclusions: This study confirms the relationships previously identified among stress, somatic complaints, and ineffective coping. In addition, we demonstrated that these relationships cover a wide spectrum, ranging from psychosomatic symptoms to behavioral problems. Further implications of the results and research limitation were discussed.

WITHDRAWN: SERPN News - Corrected Proof

Linda Rose — 2010-08-05

The Publisher regrets that this article is an accidental duplication of an article that has already been published, doi:10.1016/j/apnu.2010.05.002. The duplicate article has therefore been withdrawn.

WITHDRAWN: Consider This...Nurses Need to Debate Involuntary Outpatient Treatment - Corrected Proof

Anthony John O'Brien — 2009-01-16

The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.apnu.2008.10.001. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.