A general family practitioner approach for Asian-American mental health services.

A psychologist in general family practice functions as a primary care provider, who is similar to the traditional family doctor who provides treatment for clients and their families. The psychologist has an ongoing interaction with the family and serves as a resource for the family to consult when in difficulty; he or she uses knowledge of the client, as well as knowledge of the client's family, community, and social environment. This approach seems particularly suitable for Asian Americans whose culture emphasizes the role of the family. It helps to minimize the client's inhibition against seeking mental health services and provides the psychologist with certain clinical advantages. Two cases are presented to illustrate the application of this approach to Asian American clients. Situations in which family members should not be seen by the same psychologist and the issues of transference, countertransference, and confidentiality are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major causes of death and hospitalization in Canadian seniors

The case management approach is described for children with nonorganic failure to thrive in the pediatric tertiary care setting. An advanced practice nurse facilitated the organization of a planning committee, the construction of a care path, and the evaluation of the case management model. A 4-day care path is presented to show staff nursing functions in the nurse case manager role. Special issues are discussed for developing care paths for organic-based failure to thrive where parent reports can help guide health care interventions.     

Antibiotic sensitivity of hospital strains of Staphylococcus

1. Changing trends in health care reflect increasing involvement with clients and families in the development of treatment plans, such as self medication planning. 2. Acting as an advocate for the client, the nurse, in consultation with the client and the multidisciplinary team, developed a consumer-centered program, which allowed the client to master a complicated medication regime prior to discharge. 3. Discharge planning, follow-up, and evaluation of medication compliance, ensured continuity of care, successful outcomes, and reduced use of in-hospital health care dollars.     

Roles of advanced practice nurses in oncology

Managed care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care's rapid transformation of specialty practices, such as oncology, is redirecting classic nursing functions toward market initiatives that value the design of care/case management systems and the implementation of multidisciplinary "patient-centered" care models. As health-care systems continue to evolve, advanced practice nurses (APNs) are redefining their roles and enhancing their skills to meet the demands of the marketplace. Advanced practice nurses are defined as registered nurses who have met advanced educational and practice requirements and are prepared at the graduate level. This paper will identify the four established APN roles: nurse practitioner (NP), nurse anesthetist, nurse midwife, and clinical nurse specialist (CNS), as well as highlight the nurse practitioner and clinical nurse specialist as the leadership APN roles within oncology practice. The adaption to managed care has identified new functions and created opportunities for these APN specialties that are being viewed both competitively by other oncology health-care providers and creatively by managed-care organizations. The integration of these emerging roles within the new advanced nursing market and their contributions to oncology care are also discussed.     

Perceived social support and community adaptation in schizophrenia

Prompted by the continuing transition to community care, mental health nurses are considering the role of social support in community adaptation. This article demonstrates the importance of distinguishing between kinds of social support and presents findings from the first round data of a longitudinal study of community adaptation in 156 people with schizophrenia conducted in Brisbane, Australia. All clients were interviewed using the relevant subscales of the Diagnostic Interview Schedule to confirm a primary diagnosis of schizophrenia. The study set out to investigate the relationship between community adaptation and social support. Community adaptation was measured with the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP) and measures of dissatisfaction with life and problems in daily living developed by the authors. Social support was measured with the Arizona Social Support Interview Schedule (ASSIS). The BPRS and ASSIS were incorporated into a client interview conducted by trained interviewers. The LSP was completed on each client by an informal carer (parent, relative or friend) or a professional carer (case manager or other health professional) nominated by the client. Hierarchical regression analysis was used to examine the relationship between community adaptation and four sets of social support variables. Given the order in which variables were entered in regression equations, a set of perceived social support variables was found to account for the largest unique variance of four measures of community adaptation in 96 people with schizophrenia for whom complete data are available from the first round of the three-wave longitudinal study. A set of the subjective experiences of the clients accounted for the largest unique variance in measures of symptomatology, life skills, dissatisfaction with life, and problems in daily living. Sets of community support, household support and functional variables accounted for less variance. Implications for mental health nursing practice are considered.     

The impact of power in therapeutic relationships

Power is an important factor in how health care is delivered. Neither health care professionals nor clients fully appreciate the power that they exercise, nor how they influence others. Understanding how power works, however, is vital to establishing a helping relationship. In a traditionally rigid health care system, professionals who try to empower clients can create conflicts among colleagues. A possible solution is an explicit contract with a client, setting out the responsibilities of those involved.     

Undercover careseekers: simulated clients in the study of health provider behavior in developing countries

The simulated client method (SCM) has been used for over 20 years to study health care provider behavior in a first-hand way while minimizing observation bias. In developing countries, it has proven useful in the study of physicians, drug retailers, and family planning services. In SCM, research assistants with fictitious case scenarios (or with stable conditions or a genuine interest in the services) visit providers and request their assistance. Providers are not aware that these clients are involved in research. Simulated clients later report on the events of their visit and these data are analyzed. This paper reviews 23 developing country studies of physician, drug retail, and family planning services in order to draw conclusions about (1) the advantages and limitations of the methods; (2) considerations for design and implementation of a simulated client study; (3) validity and reliability; and (4) ethical concerns. Examples are also drawn from industrialized countries, related methodologies, and non-health fields to illustrate the issues surrounding SCM. Based on this review, we conclude that the information gathered through the use of simulated clients is unique and valuable for managers, intervention planners and evaluators, social scientist, regulators, and others. Areas that need to be explored in future work with this method include: ways to ensure data validity and reliability; research on additional types of providers and health care needs; and adaptation of the technique for routine use.     

Community resources for clients with mobility problems

Clients are leaving the hospital "quicker and sicker," and they frequently have acute care needs that must be met by resources outside the hospital setting. Community resources are diverse, vary widely from place to place, and have no central administration. Thus, using them can be challenging for both the nurse, client, and family. Reimbursement mechanisms underlie a person's ability to use resources and receive health care. By presenting two actual case scenarios where clients have mobility problems commonly seen by orthopaedic nurses, the authors discuss the community resources available, avenues of access to them, and their reimbursement mechanisms.     

Measuring outcomes in nursing centers: otitis media as a sample case

While it is generally recognized that NPs offer affordable, quality health care, few studies have measured outcomes of clients who seek primary care services from NPs. This pilot study describes the outcomes of children with otitis media who received care from NPs employed in an academic nursing center. Outcome measurements included issues related to timing, level of analysis, and attribution. Parents of 27 children participated in a telephone survey consisting of seven questions relating to the care their children received from NPs and their recovery path. Although every respondent reported having a positive visit at the nursing center, concerns for NPs surfaced during the process of measuring outcomes. This study emphasizes the need for measuring outcomes in nursing clinics and demonstrates one way to measures client outcomes, revealing both general health care and specific nursing practice implications.     

Nurse managed occupational health centers: an overview

1. Nurse managed centers provide clients with direct access to professional nursing care. 2. Lillian Wald, Mary Breckenridge, and Margaret Sanger established nurse managed centers at the beginning of this century. 3. Primary, secondary, and tertiary prevention programs and services are based on the mission, outcomes, staffing, and financing of the occupational health center. 4. Essential parameters for comprehensively evaluating an occupational health nurse managed center include, client outcomes, client satisfaction, and cost-benefit.     

Differentiating multiple relationships from multiple dimensions of involvement: Therapeutic space at the interface of client, therapist, and society.

This article focuses on redirecting current thinking from multiple relationships to the multiple dimensions of our involvements with clients. Given that people's readiness for human involvement is both desirable and unavoidable, recognizing and managing these multiple dimensions of involvement is at the heart of professional interactions. A triangular space, formed at the intersection of societal, therapist and client features, forms the framework in which therapeutic work occurs. In practice, a balance should be maintained within and among five principles of clinical and ethical practice. These are beneficence, respect for client autonomy, self-awareness, self-interest, and openness to objective input. An applied section considers the sources of imbalance in the proper management of the multiple dimensions of therapists' involvements in the psychotherapeutic relationship via a brief consideration of two case situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directions for clinical research and genomic research into the next decade: implications for informatics

Managed care continues to revolutionize the provision of mental health services in the United States. Long-term, open-ended therapies have been replaced by short-term, highly focused interventions. Increasingly, managed care organizations rely on standardized preferred practice guidelines to give direction and focus to social work and other therapeutic interventions. Critics argue that changes effected by managed care, particularly the use of treatment guidelines, depersonalize the client-worker relationship and significantly reduce the role of empathy in the therapeutic process. Moreover, these critics suggest that overall client satisfaction with mental health services has deteriorated. This article presents a study that examined clients' perceptions of empathy and overall satisfaction with managed behavioral health care when the clients were in unstructured individual therapy or in time-limited standardized group therapy. The results reveal no significant difference in the clients' perception of empathy or of their overall satisfaction regardless of the type of treatment they received. This article describes the rationale and design of the study, presents the results, and discusses the implications for social work practice.     

Premorbid brain size as a determinant of reserve capacity against intellectual decline in Alzheimer''s disease

With funding from the Administration on Aging, the National Resource Center: Diversity and Long-Term Care surveyed state administrators of programs serving elders in 24 states in 1994. This survey sought to document what written guidelines and training case managers receive in promoting client autonomy in care planning. In discussions with respondents and review of written materials provided by the states, surveyors explored whether clients received written information about services, the structure for seeking client input into care planning, and the structure for soliciting client feedback once the care plan was in place. Of the states included in this survey, few have developed and implemented guidelines or provide case managers training to promote client autonomy in the care-planning process. After reviewing the survey findings, the authors make two policy recommendations for states to consider in this area.     

Excipients and their use in injectable products

This article describes the role of the nurse practitioner in sexual health assessment and sexual counseling. Topics of potential sexual health concerns of primary care clients are identified. The essential components of sexual counseling consist of establishing a trusting relationship with the client, developing a systematic repertoire of questions to screen for sexual health concerns, and one-on-one counseling with the permission, limited information, specific suggestions, and intensive therapy (PLISSIT) model. References for further information on sexual education and sexual health are identified.     

Psychologists' Clinical Evaluations and Attitudes: An Examination of the Influence of Gender and Sexual Orientation.

Becoming aware of factors that may affect differential treatment of clients is necessary for psychologists to practice competently. Scholarly writing and empirical studies have suggested that therapist gender, client gender, and client sexual orientation are 3 such factors. This study examined therapist gender, client gender, and client sexual orientation in relation to psychologists' attitudes and clinical evaluations for clients. Results indicated that female psychologists held more positive attitudes and treatment expectations for clients than did male psychologists and that some psychologists hold inconsistent attitudes toward female clients generally and lesbian, gay, and bisexual clients in particular. Continuing education and consultation are recommended to increase psychologists' awareness of gender and sexual orientation issues and potential influences in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a multidrug chemotherapy protocol (ACOPA II) in dogs with lymphoma

The introduction of market forces into health care delivery systems has had a number of important influences on the roles nurses perform. There have been increasing efforts to find alternative and more cost-effective ways of delivering care. One facet of this situation has been the examination of the roles and responsibilities of registered nurses (RNs) with the view of exploring different ways of using professional skills and determining if RN services are always required. One result of this has been the increased use of unlicensed personnel. The substitution of professional nursing staff by unlicensed personnel has become a major concern for practitioner, manager and client alike. This paper reviews some of the concepts of economic substitution as well as the assumptions advanced for the use of unlicensed personnel in clinical areas as a substitute for nursing services. While there has been increased use of unlicensed staff, the evaluation of clinical outcomes has been poor. This paper reviews primarily the hospital-based evidence about the impact of using unlicensed personnel in practice, and suggests there are methodological problems with the research published to date. Findings suggest that substitute service providers generally 'do no harm'. By contrast, evidence is presented indicating the major contributions nurses make to client care when adopting advanced practice roles (acting as a substitute for other professionals).     

The delivery of culturally sensitive health care to Native Americans

Cultural factors significantly influence the Native American's perspectives of traditional professional health care practices. To most effectively deal with Native American clients, health care providers must understand, respect, and demonstrate sensitivity to the values and implications of the Native American culture. A basic understanding of a group's cultural beliefs, values, and practices will enable the holistic nurse to appreciate the importance of appropriate interactions and techniques and, therefore, make health care more readily accepted. This article reviews the health and illness beliefs, the traditional remedies, the critical need for holistic health care, and the Five Great Values that guide Native American behavior. Familiarization with these cultural components will facilitate the provision of quality, holistic health care through improved interactions with Native American clients.     

Varicella zoster virus in the health care setting: risk and management

1. Varicella zoster poses a threat to clients and staff in health care settings because of its ease of transmission and incidence of complications in those over age 20, neonates, and the immunocompromised. 2. Risk surveillance of personnel via a comprehensive screening program will establish the pool of seronegative (or "at risk") health care workers. 3. Clear policies on restricting client admission or visitors, and work restrictions for health care workers related to varicella will aid in preventing outbreaks in the health care setting. 4. Prompt follow up of exposures is best accomplished using an established protocol for loss control.