Psychiatric Care (psychiatric + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

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No abstract is available for this article. [source]

Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience

V. DAHLQVIST rnt phd
The aim of this study is to illuminate the meaning of encounters with a troubled conscience among psychiatric therapists. Psychiatric care involves ethical dilemmas which may affect conscience. Conscience relates to keeping or losing a sense of personal integrity when making judgments about one's actions. Ten psychiatric therapists were interviewed in June 2006. The interviews were tape-recorded, transcribed verbatim and interpreted using a phenomenological-hermeneutic method. Two themes Facing inadequacy and Struggling to view oneself as being ,good enough' are presented. In the therapists interviewed, awareness of their use of power, a sense of powerlessness and a sense of blame gave rise to feelings of betrayals and shameful inadequacy. By sharing their inadequacy with co-workers, they managed to endure the sense of their inadequacy which otherwise would have threatened to paralyse them. Finding consolation in sharing wearing feelings, becoming realistic and attesting their worthiness, they reached reconciliation and found confirmation of being good enough. The findings are interpreted in light of Lögstrup's ethics of trust, according to which conscience alerts us to silent but radical ethical demand and the risk of self-deception. [source]

Theory of mind functioning in mentally disordered offenders detained in high security psychiatric care: its relationship to clinical outcome, need and risk

David Murphy
Background,Theory of mind (ToM) refers to the cognitive mechanisms that allow us to infer our own mental states and those of others. Whilst ToM deficits are frequently observed among individuals with schizophrenia, little is known about their relationship to functional outcome. Aims,Among patients with schizophrenia in a high security hospital, to test whether ToM performance, in relation to other cognitive and clinical variables, is related to measures of subsequent clinical outcome. Methods,ToM was assessed using the modified advanced test (MAT) and the revised eyes task (RET). Outcome, including ongoing need and risk, was assessed using the HoNOS secure, CANFOR and HCR-20 respectively three years post ToM assessment. Results,Performance on the RET was the only variable to be significantly correlated with the symptom ratings of the HoNOS secure and the HCR-20 total scores. Performance on the RET also accounted for approximately half of the variance in the CANFOR ratings and a third in the risk management item ratings of the HCR-20. Age, number of years diagnosed with schizophrenia and other aspects of cognition were also significantly correlated with the HoNOS security scale. Conclusions,The results suggest that social perceptual ToM may be a useful prognostic indicator, but also that ToM impairments may represent an unmet need. Replication of the work with larger and more diverse samples of people with schizophrenia is necessary, as well as trials of therapeutic effort directed at improvement of ToM impairments. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Mortality among mentally disordered offenders: a community based follow-up study

Tabita Björk
Background Follow-up information about outcome for hospitalized mentally disordered offenders (MDO) is necessary for evaluation and improvement in quality of forensic psychiatric care. Aim A study was undertaken to estimate the standard mortality rate (SMR) of a population based sample of people sentenced to forensic psychiatric care. Method All MDOs in Örebro County, Sweden, discharged from a forensic psychiatric treatment unit between 1992 and 1999 were identified (n = 46). The variables were gender, age, offence, diagnosis and duration of admission. Case linkage was made with the National Cause-of-Death register. Median follow-up time was 53 months (0,93). Results The sample yielded a significantly elevated SMR 13.4 (95% CI 4.35,31.3) times higher than that in the general population, mostly due to suicide. Conclusions The cohort size is small but representative, and it provides data from an additional country for the growing international pool confirming the high risk of premature, generally self-inflicted death among MDOs. Resettlement and rehabilitation services for them may need to take as much account of mortality risk as that of reoffending. Copyright © 2005 Whurr Publishers Ltd. [source]

A survey of female patients in high security psychiatric care in Scotland

Dr Lindsay D.G. Thomson MD MPhil MRCPsych Senior Lecturer in Forensic Psychiatry Honorary Consultant Forensic Psychiatrist
Background The State Hospital, Carstairs, is the sole high security psychiatric facility for Scotland and Northern Ireland. Method This study compares the female (n = 28) and male (n = 213) patients resident there between 1992 and 1993 using data derived from case-note reviews and interviews with patients and staff. Results Nearly three-quarters of both the male and female populations had a primary diagnosis of schizophrenia, and secondary diagnoses of substance abuse and antisocial personality disorder were common. Female patients were more frequently admitted from other psychiatric hospitals, had less serious index offences and more minor previous convictions, and were less likely to be subject to a restriction order. They had more often experienced depressive symptoms and had significantly greater histories of self-harm, physical and sexual abuse. At interview, nearly three-quarters had active delusions and over half had recently behaved in an aggressive manner. Almost 90% were said not to require the security of the State Hospital. Conclusions It was concluded that mental illness and adverse social circumstances had combined to create a very disadvantaged group of women in high security psychiatric care in Scotland. As a group these women were inappropriately placed and their requirement was for intensive, rather than high security psychiatric care. Copyright © 2001 Whurr Publishers Ltd. [source]

The Stockholm non-affective psychoses study (snaps): the importance of including out-patient data in incidence studies

L. Jörgensen
Jörgensen L, Ahlbom A, Allebeck P, Dalman C. The Stockholm non-affective psychoses study (snaps): the importance of including out-patient data in incidence studies. Objective:, To estimate the incidence rate of schizophrenia and non-affective psychoses from registers, to highlight the importance of including data from out-patient care, and to assess the proportion of persons treated in out-patient care only. Method:, Data from out-patient and in-patient psychiatric care in Stockholm and information from several national registers constitute ,The Stockholm Non-Affective Psychoses Study' (SNAPS). Incidence rates based on SNAPS data were calculated and compared to in-patient care incidence rates. Results:, The incidence rate was 72/100 000 for non-affective psychoses (age group 18,44) and 28/100 000 for schizophrenia (age group 18,34) in the SNAPS. This was higher compared to in-patient based incidence rates (42 and 13/100 000 respectively). The proportion of individuals with psychosis treated in out-patient care only was 25%. Conclusion:, There are substantial differences in the incidence rates of non-affective psychoses and schizophrenia depending on the availability of data. Not including out-patient care will underestimate the incidence rates. [source]

Torsade de pointes in a patient with complex medical and psychiatric conditions receiving low-dose quetiapine

W. V. R. Vieweg
Objective:, Describe potential cardiac complications of low-dose quetiapine and other atypical antipsychotic drugs. Method:, We present a case report of a 45-year-old Black woman with multiple medical and psychiatric problems taking low-dose quetiapine. Results:, Coincident with a generalized seizure, the patient developed ,ventricular fibrillation'. She was countershocked with restoration of normal sinus rhythm. The initial electrocardiogram showed QT interval prolongation. Shortly thereafter, classical torsade de pointes appeared, lasted 10 min, and resolved spontaneously. Hypomagnesemia was present. A cardiac electrophysiologist was concerned that the very slow shortening of the prolonged QTc interval after magnesium replacement implicated quetiapine as a risk factor for QTc interval prolongation and torsade de pointes. A psychosomatic medicine consultant asserted that the fragmented medical and psychiatric care almost certainly contributed to the patient's medical problems. We discuss other cases of QT interval prolongation by newer antipsychotic drugs and previous reports by our group concerning the association of psychotropic drugs, QT interval prolongation, and torsade de pointes. Conclusion:, Atypical antipsychotic drug administration, when accompanied by risk factors, may contribute to cardiac arrhythmias including torsade de pointes. [source]

Lithium monitoring before and after the distribution of clinical practice guidelines

John M. Eagles
Objective: To determine whether distribution of clinical practice guidelines improves lithium monitoring and whether standards of monitoring differed between patients in psychiatric contact and those seen only in primary care. Method: Standards of monitoring were assessed for patients on lithium in northeast Scotland throughout 1995 and/or throughout 1996. Guidelines were circulated in January 1996 to all local general practitioners and psychiatrists. Monitoring was compared between 1995 and 1996 and for patients with and without psychiatric contact. Results: Both primary care and psychiatric records were scrutinized for 422 and 403 patients prescribed lithium throughout 1995 and 1996, respectively. While monitoring was poor on several parameters during both years, frequency of measurement of both thyroid and renal function improved in 1996. Standards of monitoring were better for patients in psychiatric care. Conclusion: Standards of lithium monitoring require further improvement. Locally agreed practice guidelines are helpful but patients on lithium should be in continuing contact with an experienced psychiatrist. [source]

The Declaration of Hawaii andClarence Blomquist

J. O. Ottosson
The international code of ethics of psychiatry, the Declaration of Hawaii was in the main the achievement of Clarence Blomquist. There were several prerequisites for the success of this work. 1. The unique profile of the education of Clarence Blomquist, combining training to be a specialist in psychiatry with a doctor's degree in practical philosophy. 2. An outstanding competence in analyzing complicated issues and in putting thoughts into words. 3. The courage to challenge the Hippocratic ethics and adapt the principles of ethics to modern health care. 4. A scholarship at the Institute of Society, Ethics and the Life Sciences, Hastings-on-Hudson, New York, where he could test his ideas in an intellectual interdisciplinary atmosphere. 5. Support from the late Professor Leo Eitinger, Norway and Professor Gerdt Wretmark, Sweden, who together with Clarence Blomquist constituted a task force on ethics of the World Psychiatric Association. 6. A continuous backing-up by Dr Denis Leigh, the then secretary general of the World Psychiatric Association. Denis Leigh was convinced that a code of ethics was the only means to reconcile the various member countries on issues of misuse of psychiatry and, in addition, would raise the quality of psychiatric care throughout the world. [source]

Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literature

Janine Collet
Abstract Background Nursing home residents needing both psychiatric care and nursing home care for either somatic illness or dementia combined with psychiatric disorders or severe behavioural problems are referred to as Double Care Demanding patients, or DCD patients. Integrated models of care seem to be necessary in order to improve the well-being of these residents. Objectives Two research questions were addressed. First, which integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are described in the research literature? And second, which outcomes of integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are reported in the literature? Method A critical review of studies was done that involved integrated interventions combining both psychiatric care and nursing home care on psychiatric disorders and severe behavioural problems in nursing home patients. A systematic literature search was performed in a number of international databases. Results Eight intervention trials, including four RCTs (2b level of evidence), were identified as relevant studies for the purpose of this review. Seven studies, three of which were RCTs, showed beneficial effects of a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions on severe behavioural problems in DCD nursing home patients. Conclusions Important elements of a successful treatment strategy for DCD nursing home patients include a thorough assessment of psychiatric, medical and environmental causes as well as programmes for teaching behavioural management skills to nurses. DCD nursing home patients were found to benefit from short-term mental hospital admission. This review underlines the need for more rigorously designed studies to assess the effects of a comprehensive, integrated multidisciplinary approach towards DCD nursing home residents. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Next of kin's conceptions of the quality of care in the psychiatric setting: A phenomenographic study

Agneta Schröder
ABSTRACT:, The next of kin play a decisive role in the care provided for patients. This and their unique experience of psychiatric care make it important to include them when defining quality of care. The aim of the present study was to describe how next of kin perceive the concept of quality of care in the case of psychiatric care. Twelve next of kin were included in a qualitative interview study and a phenomenographic approach was used for the analysis of the interviews. The next of kin described quality of care mainly from their own perspective but also to a large extent from the patient's perspective as well. Five descriptive categories resulted: dignity, security, participation, recovery, and health-promoting surroundings. Good relations and communication between staff, patients, and next of kin emerged as the central factors regarding the quality of psychiatric care. The next of kin asked for information about psychiatric illnesses and wanted to cooperate in the care. They avoid telling others about their family member's psychiatric illness because of a feeling of shame and guilt. Staff education regarding such feelings and stigmatization could be useful in furthering the understanding of the next of kin's distress and developing interventions to alleviate it. Clinical practice can be improved by guidelines and instruments developed on the basis of this study. [source]

Patients' perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study

Agneta Schröder MSc
Aim., The aim was to describe how patients perceived the concept of quality of care in psychiatric care. Background., It is important to include patients' experiences in defining quality of care and in the development of instruments measuring quality of psychiatric care, as patients have unique information. But only a limited number of studies have directly involved patients. Design., It was a qualitative interview study with 20 adult in and outpatients from psychiatric care. Method., A phenomenographic approach was used for the analysis of the interviews. Results., The results showed that quality of care was perceived as a positive concept, namely as ,good' quality of care. The normative component was striking. Five descriptive categories emerged: The patient's dignity is respected; The patient's sense of security with regard to care; The patient's participation in the care; The patient's recovery; and The patient's care environment. Two conceptions emerged that had not emerged explicitly in earlier studies of quality of care: Being helped to reduce the shame and Being looked upon as like anyone else. Conclusions., The findings emphasize the importance of the interpersonal relationship between patients and staff. There is a need for further exploration of central aspects of quality in psychiatric care. Relevance to clinical practice., It is important that the knowledge about how patients perceived the quality of care in psychiatric care is included in the planning and evaluation of care. The guidelines should designate quality of care from the patient perspective as the goal of interventions. [source]

Supplementary prescribing: potential ways to reform hospital psychiatric care

A. JONES phd rn
The objective of this study was to explore perceptions held by nurses and psychiatrists towards the potential application of supplementary prescribing on acute psychiatric wards. Six focus groups were conducted with 19 nurses and seven psychiatrists who worked on three wards. Two major themes were identified: first, ways in which patients could receive care and treatment through supplementary prescribing and in new forms of partnership and second, ways by which nurses and psychiatrists could be organized to deliver their care through a supplementary prescribing framework. Nurses and psychiatrists were generally positive about the advent of prescribing and offered positive views as to how patient care could be improved and a general willingness for nurses to adapt and work differently. Findings from this exploratory study offer practical solutions to how supplementary prescribing could work on acute psychiatric wards. [source]

Opening up: psychiatric nurses' experiences of participating in reflection groups focusing on the use of coercion

B. OLOFSSON rn phd
Psychiatric staff report that the use of coercion towards patients in psychiatric care engenders feelings of discomfort and conflicts. The aim of this study was to describe psychiatric nurses' experiences of participating in reflection groups focused on the use of coercion, in relation to their views regarding systematic clinical supervision and staff support. Twenty-one nurses who had participated in reflection groups were interviewed retrospectively. The structured interview focused on: (i) their views of clinical supervision and support in general; (ii) their views of clinical supervision and support specifically concerning the use of coercion; and (iii) their experiences of participating in groups reflecting the use of coercion. Nurses were largely positive about participating in reflection groups, as expressed in the subthemes: having time for reflection; being confirmed; gaining new perspectives; sharing fellowship with colleagues; and relating more effectively to patients. Complications concerning participation in the reflection groups and other forms of clinical supervision as reported by nurses were: providing time for participation; having a common aim; being vulnerable in difficult situations; and assuming that the need for supervision and support could indicate that they were not coping with their job. [source]

Quality of life: a basis for clinical decision-making in community psychiatric care

E. H. CLARK rn msn med phd
This descriptive study used grounded theory methodology to illuminate how the concept of quality of life influences the practice of community psychiatric nurses caring for individuals with serious mental illnesses. In-depth interviews captured the practice wisdom of expert nurses. Data were verified through focus groups, member checks and peer debriefing. The constant comparative method was used to categorize data and identify key themes and concepts. Informants regarded the concept of quality of life as central to nursing practice. They cited examples of how it serves as a goal and philosophy of care, a basis for forming relationships, and a lens through which the nursing role becomes clearer. Quality of life is acknowledged to be a subjective concept. It is assessed in light of the individual's hopes, dreams and values, and within the context of his or her whole life. A quality of life focus is supported by the philosophies of holism and empowerment. Nurses promote quality of life through symptom management, educating and advocating for clients. Minimizing barriers to quality of life and helping the individual to have a broader vision of what his or her life could be, are also central to the psychiatric nursing role. [source]

Nurses' ethical perceptions about coercion

M. LIND mscnrn
Purpose of the study: The purpose of this study was to describe Finnish psychiatric nurses' ethical perceptions about coercive measures in acute psychiatric setting. Methods: The data were collected with a questionnaire developed for this study. The sample included 170 Finnish psychiatric nurses on acute wards in five psychiatric hospitals. The data were analysed using frequency and percentage distributions, mean and standard deviations. The internal consistency of the instrument was explored with Cronbach's alpha. The association between the background variables and the sum score of the items of the questionnaire was tested with Mann,Whitney U -test and Kruskal,Wallis test. The open-ended question was analysed with content analysis. Results: Some psychiatric nurses perceived coercive measures as ethically problematic. In particular, the implementation of forced medication (18%), four-point restraints (16%) and patient seclusion (11%) were perceived as ethically problematic. Female nurses and nurses who worked on closed wards perceived the measures to be more problematic than male nurses and nurses who did not work on closed wards. Conclusion: In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients' rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care. [source]

,Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient care

The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed. [source]

Patients' satisfaction with outpatient psychiatric care

The purpose of this study was to describe patient satisfaction with outpatient psychiatric care in two community care clinics in Finland. Data were collected using a structured questionnaire from 300 outpatients between February and March 2000. A total of 171 patients returned completed questionnaires (response rate 57%). The data analysis was based on descriptive statistics, chi-square test, the Mann,Whitney U -test and the Kruskal,Wallis test. Item homogeneity was analysed using Cronbach alpha coefficient. The results showed that patient satisfaction was highest in areas pertaining to staff and care discussions, and lowest in areas pertaining to information. Patients who considered the wait for treatment to be too long were more dissatisfied with staff, their chance of influencing their own care, and the help they received, compared with patients who considered the wait to be reasonable in length. We can conclude that although patients are quite satisfied with their outpatient treatment in general, the patient information process is not at a satisfactory level at outpatient psychiatric clinics. In the future, more emphasis should be put on developing more innovative methods to increase psychiatric patients' knowledge level regarding their own illness and treatment. [source]

Patients' experience of involuntary psychiatric care: good opportunities and great losses

Patients who are involuntary admitted to psychiatric care are extremely vulnerable as a consequence of the control from others, and of the personal limitations due to a psychiatric disease that can influence their own control of their lives. This group of patients are seldom asked about their experiences of being cared for. In this study five involuntary hospitalized psychiatric patients narrated their experience of being subjected to involuntary psychiatric care. The aim of the study was to obtain a deeper understanding of this experience. The interview text was analysed by means of a phenomenological hermeneutic method. The result of the analysis gave a complex picture of both support and violation. On the one hand experiences of not being seen or heard, of loss of liberty and of violation of integrity were found. On the other hand, there were experiences of respect and caring and opportunities to take responsibility for oneself were offered. Being treated involuntarily in psychiatric care was interpreted as a balancing act between good opportunities and great losses. [source]

Mobile Crisis Team Intervention to Enhance Linkage of Discharged Suicidal Emergency Department Patients to Outpatient Psychiatric Services: A Randomized Controlled Trial

Glenn W. Currier MD
Abstract Objectives:, Many suicidal patients treated and released from emergency departments (ED) fail to follow through with subsequent outpatient psychiatric appointments, often presenting back for repeat ED services. Thus, the authors sought to determine whether a mobile crisis team (MCT) intervention would be more effective than standard referral to a hospital-based clinic as a means of establishing near-term clinical contact after ED discharge. This objective was based on the premise that increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patients successfully linked to care. Methods:, In a rater-blinded, randomized controlled trial, 120 participants who were evaluated for suicidal thoughts, plans, or behaviors, and who were subsequently discharged from an urban ED, were randomized to follow-up either in the community via a MCT or at an outpatient mental health clinic (OPC). Both MCTs and OPCs offered the same structured array of clinical services and referral options. Results:, Successful first clinical contact after ED discharge (here described as "linkage" to care) occurred in 39 of 56 (69.6%) participants randomized to the MCT versus 19 of 64 (29.6%) to the OPC (relative risk = 2.35, 95% CI = 1.55,3.56, p < 0.001). However, we detected no significant differences between groups using intention-to-treat analyses in symptom or functional outcome measures, at either 2 weeks or 3 months after enrollment. We also found no significant differences in outcomes between participants who did attend their first prescribed appointment via MCT or OPC versus those who did not. However divided (MCT vs. OPC, present at first appointment vs. no show), groups showed significant improvements but maintained clinically significant levels of dysfunction and continued to rely on ED services at a similar rate in the 6 months after study enrollment. Conclusions:, Community-based mobile outreach was a highly effective method of contacting suicidal patients who were discharged from the ED. However, establishing initial postdischarge contact in the community versus the clinic did not prove more effective at enhancing symptomatic or functional outcomes, nor did successful linkage with outpatient psychiatric care. Overall, participants showed some improvement shortly after ED discharge regardless of outpatient clinical contact, but nonetheless remained significantly symptomatic and at risk for repeated ED presentations. ACADEMIC EMERGENCY MEDICINE 2010; 17:36,43 © 2009 by the Society for Academic Emergency Medicine [source]

Treatment, management, and control: Improving outcomes through more treatment and less control

Richard H. Hunter President
Outcomes in psychiatric care are improved by expanding treatment options and reducing dependence on management and control interventions. [source]

Accommodation and resistance to the dominant cultural discourse on psychiatric mental health: oral history accounts of family members

Geertje Boschma
Oral history makes a critical contribution in articulating the perspectives of people often overlooked in histories written from the standpoint of dominating class, gender, ethnic or professional groups. Using three interrelated approaches , life stories, oral history, and narrative analysis , this paper analyzes family responses to psychiatric care and mental illness in oral history interviews with family members who experienced mental illness themselves or within their family between 1930 and 1975. Interviews with three family members in Alberta, Canada are the primary focus. These stories provide an important avenue to understand the meaning and transformations of mental health-care from the point of view of families. Family members' stories reveal contradictory responses to the dominant cultural discourse. Using a performative framework of interpretation, the narratives reveal a complex interplay between medical, social and cultural conceptions of mental illness, deepening our understanding of its meaning. The history of mental health-care can be substantially enriched by the analysis of family members' stories, not only revealing the constructed nature of mental illness, but also illustrating the family as a mediating context in which the meaning of mental illness is negotiated. [source]

Gender and professional identity in psychiatric nursing practice in Alberta, Canada, 1930,75

Geertje Boschma
This paper examines gender-specific transformations of nursing practice in institutional mental health-care in Alberta, Canada, based on archival records on two psychiatric hospitals, Alberta Hospital Ponoka and Alberta Hospital Edmonton, and on oral histories with psychiatric mental health nurses in Alberta. The paper explores class and gender as interrelated influences shaping the work and professional identity of psychiatric mental health nurses from the 1930s until the mid-1970s. Training schools for nurses in psychiatric hospitals emerged in Alberta in the 1930s under the influence of the mental hygiene movement, evolving quite differently for female nurses compared to untrained aides and male attendants. The latter group resisted their exclusion from the title ,nurse' and successfully helped to organize a separate association of psychiatric nurses in the 1950s. Post-World War II, reconstruction of health-care and a de-institutionalization policy further transformed nurses' practice in the institutions. Using social history methods of analysis, the paper demonstrates how nurses responded to their circumstances in complex ways, actively participating in the reconstruction of their practice and finding new ways of professional organization that fit the local context. After the Second World War more sophisticated therapeutic roles emerged and nurses engaged in new rehabilitative practices and group therapies, reconstructing their professional identities and transgressing gender boundaries. Nurses' own stories help us to understand the striving toward psychiatric nursing professionalism in the broader context of changing gender identities and work relationships, as well as shifting perspectives on psychiatric care. [source]

Combat Stress Casualties in Iraq.

Part 1: Behavioral Health Consultation at an Expeditionary Medical Group
PURPOSE.,We review the role of military mental health professionals in consulting with inpatient medical patients and staff at a combat hospital and aeromedical evacuation staging facility in Iraq. CONCLUSIONS.,Behavioral health consultation with medical and surgical patients during hospitalization and prior to aeromedical evacuation can help identify patients with combat stress exposure that may require future mental health follow-up. PRACTICE IMPLICATIONS.,Extensive use of civilian mental health practitioners including nurse psychotherapists and psychiatric nurse practitioners will be needed to provide psychiatric care for the large number of U.S. veterans who return from deployment with combat stress related disorders. [source]

Governing the Captives: Forensic Psychiatric Nursing in Corrections

Dave Holmes RN
TOPIC/PROBLEM:,Since 1978, the federal inmates of Canada serving time have had access to a full range of psychiatric care within the carceral system. Five psychiatric units are part of the Federal Correctional Services. Nursing practice in forensic psychiatry opens up new horizons in nursing. This complex professional nursing practice involves the coupling of two contradictory socio-professional mandates: to punish and to provide care. METHOD:,The purpose of this article is to present the results of a grounded theory doctoral study realized in a multi-level security psychiatric ward of the Canadian Federal Penitentiary System. The theoretical work of the late French philosopher, Michel Foucault, and those of sociologist, Erving Goffman, are used to illuminate the qualitative data that emerged from the author's fieldwork. FINDINGS:,A Foucauldian perspective allows us to understand the way forensic psychiatric nursing is involved in the governance of mentally ill criminals through a vast array of power techniques (sovereign, disciplinary, and pastoral) which posited nurses as "subjects of power". These nurses are also "objects of power" in that nursing practice is constrained by formal and informal regulations of the penitentiary context. CONCLUSION:,As an object of "governmental technologies", the nursing staff becomes the body onto which a process of conforming to the customs of the correctional milieu is dictated and inscribed. The results of this qualitative research, from a nursing perspective, are the first of their kind to be reported in Canada since the creation of the Regional Psychiatric Correctional Units in 1978. [source]

Countertransference to psychiatric patients in a clinical setting: Development of the Feeling Checklist,Japanese version

Abstract, Countertransference is an important dimension of the therapeutic alliance between care providers and patients. The Feeling Checklist (FC) is a self-report questionnaire for the assessment of countertransference by hospital staff toward patients. The FC was translated from English into Japanese and its factor structure, reliability, and validity in the Japanese version (FC-J) were examined. A total of 281 Japanese psychiatric nurses were tested with the FC-J. All nurses were primarily involved in provision of psychiatric care. Principal-component factor analysis with varimax rotation was performed to identify the potential components of the FC-J. In a factor analysis of the FC-J, seven factors were extracted. The five subscales that were determined and labeled included Reject, Distance, Helpfulness, Closeness, and Involvement, which collectively accounted for 56.0% of the variance. Cronbach's ,, a measure of internal consistency, for individual subscales was 0.833 for Reject, 0.763 for Distance, 0.768 for Helpfulness, 0.617 for Closeness, and 0.663 for Involvement. Notably, there was a significant correlation between the FC-J and the Nurse Attitude Scale (P < 0.0001). Moreover, one-way anova was performed with each FC-J subscale to examine differences among psychiatric diagnoses in the study sample. A significant difference was found for Involvement (P < 0.001), with the total score on Involvement being the highest in the personality disorder group. These results are considered to verify the reliability and validity of the FC-J as a scale to measure countertransference among Japanese care providers. The use of this scale allows individual care providers to recognize and be cognizant of their own countertransference objectively and thereby contributes to improve the relationship between patients and care providers. [source]

What should non-US behavioral health systems learn from the USA?: US behavior health services trends in the 1980s and 1990s

Abstract Several countries, such as the USA, inadvertently created a different behavioral health payment system from the rest of medicine through the introduction of diagnostic-related group exemptions for psychiatric care. This led to isolation in the administration and delivery of care for patients with mental health and substance abuse disorders from other medical services with significant, yet unintended, consequences. To insure an efficient and effective health-care system, it is necessary to recognize the problems introduced by segregating behavioral health from the rest of medical care. In this review, the authors assess trends in behavioral health services during the last two decades in the USA, a period in which independently managed behavioral health care has dominated administrative practices. During this time, behavioral health has been an easy target for aggressive cost cutting measures. There have been no clinically significant improvements in the number of adults receiving minimally adequate treatment or in the percentage of the population with behavior health problems receiving psychiatric care with the possible exception of depression. While decreased spending for behavioral health services has been well documented during this period, these savings are offset by costs shifted to greater medical service use with a net increase in the total cost of health care. Targeting behavioral health for reduction in health-care spending through independent management, starting with diagnostic procedure code or diagnostic-related group exemption may not be the wisest approach in addressing the increasing fiscal burden that medical care is placing on the national economy. [source]

Nurses' collaboration with physicians in managing medication improves patient outcome in acute psychiatric care

Abstract, The aim of the present paper was to examine the impact of nurses' collaboration with physicians in medication management on patient outcome in acute psychiatric care. Data for 143 patients with schizophrenia were assessed based on information given by nurses and physicians in charge. Twenty-two patients were defined as a collaborative group when physicians changed medication after receiving reports that nurses perceived the necessity to change. A control group was formed from the 50 patients when nurses perceived the necessity to change medication but did not tell physicians, or nurses advised of the necessity to physicians but medication was not changed. Physicians retrospectively evaluated patients' social functioning and acceptance of medication at admission and discharge. Social functioning was measured by Global Assessment of Functioning (GAF), and acceptance of medication by a single item using Japanese version of Schedule for Assessment of Insight (SAI-J). Changes in the scores from admission to discharge on GAF and acceptance of medication were defined as outcome measures. Nurses recognized the necessity to change medication for patients with frequent aggressive behavior and younger age. Compared with the control group, the collaborative group had less instruction for use of drugs, and more perceived necessity to decrease the current dose or the number of drugs because of stable symptoms. The collaborative group demonstrated significantly greater improvement in social functioning. The collaborative group improved acceptance of medication, although there were no significant differences between the two groups. Nurses' collaboration with physicians in medication management improved patient outcome in acute psychiatric care. [source]

Living without psychiatrists in the Andes: Plight and resilience of the Quichua (Inca) People

Mario Incayawar MD MSc DESS
Abstract There is an estimated 30 million indigenous peoples in South America. Most of them live in the Andes. Regional states and governments neglect their health care needs and exclude them from the conventional Western health services in general and mental health care in particular. This review first describes this population's current situation of social exclusion, poverty and poor health. The problem of mental health care inequities in the region is illustrated through the case of the Quichua people. Indeed, for the population of over 5 million Quichua people in Ecuador, there are no psychiatric services. There are no culturally sensitive services offered in the Quichua language. The doctor,Quichua patient communication is poor and interactions are loaded with prejudice. The review provides a rationale for the Quichuas' reluctance to seek medical doctors in Ecuador. Finally, traditional healers' contribution to the mental health care of indigenous peoples is stressed, as well as their preference for a form of medical pluralism, mainly combining both traditional Quichua medicine and Western medicine. Woeful inequalities and inaccessibility to psychological and biomedical psychiatric care still widely affect the children of the sun in the Pacific Rim. [source]

Telepsychiatry with rural American Indians: issues in civil commitments

Jay H. Shore M.D., M.P.H.
The use of live interactive videoconferencing to provide psychiatric care, telepsychiatry, has particular relevance for improving mental health treatment to rural American Indian reservations. There is little literature on civil commitments in telepsychiatry and none specifically addressing this topic among American Indians. This article reviews telepsychiatry in the mental health care of American Indians, civil commitments and telepsychiatry in general, and the current state of civil commitments in American Indian communities. We conclude by considering commitment through telepsychiatry in rural reservations and offering guidelines to assist practitioners in navigating this challenging landscape. Civil commitments of American Indian patients residing in rural reservations can be successfully accomplished through videoconferencing by thoughtful and informed clinicians. However, much more work is needed in this area, including research into the cultural attitudes and perspectives towards commitments and further inquiry regarding potential legal precedents, as well as case reports and examples of this work. Copyright © 2008 John Wiley & Sons, Ltd. [source]