Deodorising dressings for malodorous wounds

When patients don't understand how to care for their chronic illness, frequent hospitalization results. One example is the patient who is admitted to a medical nursing unit in end stage renal disease (ESRD), the common complications of which are hypervolemia, hypovolemia and associated electrolyte imbalances. To prevent further disease progression and frequent hospitalization, an accurate measurement of fluid intake and output is critical, as is the patient's ability to understand and take responsibility for his/her own care.     

The esophageal temperature gradient in anesthetized children

Radical changes in the health care system, including the paradigm shift from an acute to chronic illness model, and advances in managing major neuroscience patient populations are redefining neuroscience nursing practice in the 1990s. For example, advances in management mean that many more neurotrauma patients and patients with cerebrovascular disorders survive. Once stabilized, illness may become chronic and require long-term management. There are also promising developments in managing major neurological diseases. The decade of the 90s will require more collaboration, new practice models and a greater focus on rehabilitation. Research and education must support practice in reshaping neuroscience nursing.     

Trajectory and empowerment theory applied to care of patients with multiple sclerosis

Two theoretical frameworks were examined for their applicability to nursing care of multiple sclerosis (MS) patients. The Corbin and Strauss Trajectory Framework assumes that the course of chronic illness (eg, MS) varies over time and can be reconfigured by treatment and management. Miller's theory of chronically ill patient's empowerment to promote successful coping is derived by combining previously developed concepts of coping and empowerment to maintain control and enhance the quality of life. These theoretical frameworks offer great potential for guiding the nursing care of MS patients who require extensive repertoires of coping skills to deal with the stress of this chronic illness. However, further research is required to establish their validity.     

Functional performance in people with chronic obstructive pulmonary disease

The extent to which individuals with a chronic physical illness perform their day-to-day activities and maintain the independence and autonomy they desire is both an indicator of adaptation and an important clinical outcome criterion. Yet the concept of functional performance is not well understood. Studies of people with chronic obstructive pulmonary disease (COPD) have attempted to identify physiologic and psychosocial factors that contribute to functioning in this population. These studies have used a melange of terms, including functional status, functional ability, quality of life, and health status interchangeably. They have also employed a variety of instruments to operationalize functional performance and an assortment of predictors to understand the phenomena. Perhaps as a result of this disarray, no attempt has been made to synthesize the literature for nursing research and practice. The purpose of this paper is to summarize the research on functional performance in people with COPD, indicate areas of understanding and quandary, suggest possible flaws, and propose several new directions for practice and research.     

Prescribing psychologists and patients' medical needs: Lessons from clinical psychiatry.

Psychologists who acquire prescribing privileges will assume an expanded obligation to address patients' medical (physical) conditions. Development of a training and practice model for prescribing psychologists may be informed by an awareness of how psychiatrists fulfill this obligation. Surveys of psychiatrists indicate that they rarely perform physical or neurological examinations. They typically participate only obliquely in the evaluation of patients presenting with acute behavioral or emotional symptoms suggesting organic illness, and they virtually never treat concomitant medical conditions of their patients. Other than in psychopharmacology, psychiatrists use their residual medical knowledge only indirectly. Findings imply that training for prescribing psychologists can be focused according to their expected clinical activities and that a model of practice emphasizing collaboration with nonpsychiatric physicians is feasible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social course of schizophrenia: local and societal factors

In this paper, we propose a model of social course of schizophrenia based on cross-cultural research on the influence of family, wider social network, work, political economy, and legal and mental health care institutions on the experience of illness. We posit the way these ordinary arrangements of daily living organize the course of schizophrenia in part through cultural processes that affect the body-self in suffering and in part through social processes that establish an intersubjective matrix for the experience of illness. We believe this model can be generalized to other chronic illness such as depression, diabetes, asthma, osteoarthritis, chronic pain syndrome, chronic fatigue syndrome, and even heart disease and cancer. We develop the implications of this anthropological approach for research and practice.     

The link between knowledge and remembering in Alzheimer''s disease

This article presents results from a retrospective study of psychological assessments of elderly persons with chronic mental illness residing in nursing homes. All residents (N = 570) received this assessment as part of federally mandated screening for mentally ill persons residing in long-term care. The process, the Preadmission Screening and Resident Review, was mandated by the Omnibus Budget Reconciliation Act (OBRA 87). These assessments were the first stage in a process to determine if the nursing home was the most appropriate placement for each resident. If nursing home care was deemed appropriate, then a psychological treatment program was to be established within the nursing home setting. The sample ranged in age from 50 to 104 (mean of 70). The majority had a diagnosis of schizophrenia and a history of psychiatric hospitalization occurring early in their life. The assessments did not include any quantifiable data on activities of daily living, cognitive functioning, or level of psychiatric impairment. Therefore, the researchers coded the narrative data so that it could be interpreted. The majority functioned within the none-to-mild range of cognitive impairment, and very few were completely dependent in the need for physical care. The most recorded symptom was social withdrawal. Neuroleptic medications were administered to 64% of elderly persons with chronic mental illness. Importantly, there was no relationship between demographic or clinical information and treatment recommendations. Implications of these findings for psychiatric nurses are discussed.     

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends there specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, through their contact with primary care-oriented psychiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.     

Beliefs about mental illness as a functon of psychiatric status and psychiatric hospitalization.

Beliefs about mental illness were assessed among psychiatric inpatients at a VA hospital, the mental health staff responsible for their treatment, and a group of medical and surgical (control) patients. Results indicated that: (a) Psychiatric and nonpsychiatric patients generally hold similar opinions regarding mental illness. Severely disturbed psychiatric patients, however, view mental illness in more moralistic terms than do "normals." (b) Psychiatric hospitalization is generally accompanied by a change in the patient's beliefs concerning mental illness, toward those held by the staff. (c) Psychiatric patients whose beliefs about mental illness are most strikingly influenced by the staff tend to respond most favorably to treatment, as measured by length of hospital stay and gains in self-esteem during the 1st month of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Working it out: Using exercise in psychotherapy.

Reviews the book, Working it out: Using exercise in psychotherapy by Kate F. Hays (see record 1999-02984-000). In this book, Hays presents a thoughtful, albeit at times controversial, advocacy for integration of physical exercise into the practice of psychotherapy in an explicit way. Although many mental health practitioners recognize the healing value of physical exercise and even encourage their patients to pursue physical activity, as part of their treatment, Dr. Hays takes this approach to an entirely different level. She argues persuasively that physical exercise, promoted by the therapist in the context of a cognitive-behavioral treatment model, represents for many who seek the services of a psychotherapist a treatment of first choice. She supports her views on this matter by skillfully weaving throughout the book a comprehensive and scholarly review of relevant clinical empirical literature, along with case studies from her own clinical practice. The case studies are a particularly appealing part of this book because they clearly and instructively give the reader an impression of what transpires between Dr. Hays and her clients or patients. One senses that above all she is a warm, empathic, and sensitive clinician who skillfully applies a blend of cognitive-behavioral interventions, enhanced by individually tailored regimens of physical exercise. As stated in the introduction, the author intends "…to inspire mental health professionals to bring to their work a clearer understanding of, interest in, and enthusiasm for exercise in the process of recovery from mental and emotional problems." Dr. Hays identifies practicing psychotherapists as the primary intended audience for her book, but it seems more likely to appeal to students in training for this craft. The more seasoned veterans among us are less likely to be inspired by Dr. Hays's enthusiasm for jogging with our patients, and her proposals for doing this certainly raises many serious concerns and potentially hazardous issues regarding the nature of the relationship between therapist and client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of coping strategies of aging mothers of adults with mental illness or mental retardation.

Differences in coping by 105 aging mothers of adults with mental illness and 389 similar mothers of adults with mental retardation were investigated. Although no differences in problem-focused coping were found, mothers of adults with mental illness used more emotion-focused coping, which predicted greater maternal depression. For mothers of adults with retardation, depressive symptoms were a function of their child's behavior problems, although this source of stress was buffered by coping. For mothers of adults with mental illness, depression was a function of caregiving demands, but coping did not buffer the effects of stress. Explanations for findings include maternal perceptions of the context of care, of her control over the disability, and her caregiving efficacy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

General practitioners'' attitudes to psychiatric and medical illness

BACKGROUND: General practitioners are increasingly involved in the care of patients with long-term psychiatric disorders. We have previously reported that general practitioners are less willing to treat patients with schizophrenia than those without such a diagnosis, but this may have been attributable to a reluctance to treat patients with any psychiatric or chronic illness. We, therefore, examined general practitioners' attitudes to patients with chronic psychiatric or medical illnesses. METHODS: A random sample of 260 local general practitioners were each sent one of our case vignettes which were identical apart from mention of a previous diagnosis of schizophrenia, depression, diabetes or no illness. The general practitioners were asked to indicate their level of agreement with 13 attitudinal statements based on the vignette. RESULTS: One hundred and sixty-six (66%) of the general practitioners responded to the case vignettes. Those responding to the vignette about the patient with schizophrenia were less happy to have that patient on their practice list and were more concerned about the risk of violence and the child's welfare. Those responding to the depression vignette were more likely to offer the patient antidepressants or counselling; and those who replied to the diabetes case were most likely to refer the patient to a hospital specialist. These differences were not attributable to the personal or practice characteristics of the general practitioners. CONCLUSIONS: Patients with schizophrenia arouse concerns in general practitioners that are not simply due to those patients suffering from a psychiatric or chronic illness. Our results suggest that some patients with schizophrenia may find it difficult to register with a general practitioner and receive the integrated community-based health care service they require. Psychiatrists should provide education and support to general practitioners who look after patients with schizophrenia.     

Calcitonin and bipolar disorder: a hypothesis revisited

Many of the great discoveries and developments in the sciences and the arts were made by people who were 'mentally different'. Some such pioneers or innovators had experiences that were indistinguishable from the phenomena defined as mental illness (or madness). It has been argued that such experiences are a necessary constituent of the creative process, and that this may apply to the sciences as much as to the arts. Increasingly, scientists propose a means by which it may be possible to identify (and eliminate) the factors that influence the altered states associated with mental illness. This may be an appropriate time to review the cultural and social significance of all forms of 'madness', especially in the light of emerging models of psychiatric nursing practice.     

Prisoners as patients. The experience of delivering mental health nursing care in an Australian prison

Correctional or prison mental health nursing is a highly specialized area of practice that has undergone substantive role development in recent years. However, little research has explored aspects of prison-based nursing practice or practice arrangements. The experience of delivering mental health nursing care in prison can be disempowering, resulting in feelings of frustration, isolation, and stigma. In developed nations, prison mental health nurses face the rewarding challenge of gaining greater recognition for the specialized nature of their practice and their key role in the correctional and criminal justice continuum.     

An overview of sleep and common sleep problems

The purpose of this article is to review what is currently known about healthy sleep patterns, physiological alterations during various sleep stages, and factors that affect sleep patterns. How sleep patterns are altered, either by illness or environmental situations is of major concern to nursing practice. Sleep pattern disturbances are categorized and discussed as dyssomnias, parasomnias, and sleep disorders associated with medical or psychiatric disorders. Implications for nursing research and practice are briefly addressed in the conclusion.     

Emerging trends in mental health policy and practice

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.     

Review of Pure Types are Rare.

Reviews the book, Pure Types Are Rare by Irwin Silverman. This is a provocative book. In it, Silverman, with ambitious abandon, sets out to denude the "medical model of mental illness" of its Emperor's Clothing. Unceremoniously, Silverman strips away the clothing of the medical model: psychiatric diagnoses are unreliable and invalid, labels are applied at the whim of the psychodiagnostician; mental illness bears no resemblance to physical disease, mental "illness" is a myth; biological causes of mental illness do not exist; biological treatments serve only to mask the real social and psychological causes of madness; psychotherapy is no treatment at all, there are no "treatment" principles or methods. What remains after Silverman's assault on the medical model? The medical model as Emperor remains, albeit naked. Silverman views the medical model and the entire mental health enterprise as an Emperor indeed: it is a political ideology that serves to control the socially and economically impoverished. Silverman goes on to offer an alternative to the medical model, a social psychological perspective on madness. He favours a view of madness as a social role which may be adopted by a person in the process of coping with life conflict. Silverman attacks practically all of the important assumptions and practices of psychiatry and clinical psychology. His radical social perspective on mental illness is at such odds with the common psychological perspective that, obviously, most psychologists, be they practitioners or researchers, will not like this book. Silverman insists on too radical a departure from our common beliefs. Despite the reviewer's disagreement with Silverman's radical social perspective on mental illness, he thinks that this is a worthwhile book. While the reviewer disagrees with his premise that clinical practices are exclusively or primarily political in essence, the reviewer does agree that there are essential social and political functions served by our practices. Silverman relentlessly and effectively uncovers important social and political meanings of diagnostic and treatment practices. This, according to the reviewer, is the strength of the book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric assessments of nursing home residents under OBRA-87: should PASARR be reformed? Pre-Admission Screening and Annual Review

OBJECTIVE: As part of nursing home practice reforms, OBRA-87 mandates formal psychiatric assessments (PASARR) of nursing home residents suspected of having mental disorders, a responsibility it delegates individually to states. We describe the initial year of implementation of the PASARR process in King County, Washington, and characterize the mental disorders and mental health services needs of nursing home residents referred for psychiatric screening. DESIGN: Cross-sectional study. SETTING: The 54 Medicare-certified King County nursing homes (total beds = 7013). PARTICIPANTS: All patients referred for psychiatric evaluation under PASARR (n = 510). MEASUREMENTS: A systematic, multidimensional evaluation including a semistructured psychiatric diagnostic examination, validated measures of cognitive dysfunction, depression, and global psychopathology, functional variables relevant to need for nursing home care, and selected mental health services indicators. RESULTS: Fewer than 10% of all nursing home residents were referred for psychiatric evaluation. A primary mental illness, evenly divided between psychoses and mood disorders, was found in 60% of the sample, and a psychiatric disorder associated with dementia or mental retardation was found in 25%. Six percent had complex neuropsychiatric features defying classification, and 4% had no mental disorder. Other disorders, such as substance abuse, were rare. Cognitive impairment and global psychopathology were prevalent in all diagnostic groups, and depressive symptoms were common even in patients without affective diagnoses. Eighty-eight percent of the sample were appropriately placed, based on their needs for daily care. Fifty-five percent had unmet mental health services needs. CONCLUSIONS: The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.