Journal of the American Psychiatric Nurses Association current issue

Not Just Another Evidence-Based Practice Column!

Stein, K. F. — 2008-05-23

Psychiatric Mental Health Evidence-Based Practice

Rice, M. J. — 2008-05-23

This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798

Tobacco Intervention Training in Graduate Psychiatric Nursing Education Programs

Price, J. H., Jordan, T. R., Jeffrey, J. D., Stanley, M. S., Price, J. A. — 2008-05-23

BACKGROUND: Tobacco use is the leading cause of preventable death, with the highest rate of cigarette smoking seen in mentally ill people. OBJECTIVE: This study assessed the content, amount of time, and educational techniques used in tobacco education training for graduate psychiatric nurses. STUDY DESIGN: A national mail survey of all graduate psychiatric nursing education programs. RESULTS: One-third of programs offered detailed (>1 hr) information on stages of change, the 5 A's and 5 R's. The majority of basic science tobacco topics were not covered or were covered briefly, and the 6 sociopolitical topics were not covered by the majority of programs. Training was by the traditional didactic method using scientific literature reviews. CONCLUSIONS: This study provides evidence of the need to improve the education of psychiatric nurses as tobacco interventionists at both the individual level and the legislative and policy formulation level. J Am Psychiatr Nurses Assoc, 2008; 14(2), 117-124. DOI: 10.1177/1078390307311973

Factors Associated With Perceived Burden, Resourcefulness, and Quality of Life in Female Family Members of Adults With Serious Mental Illness

Zauszniewski, J. A., Bekhet, A. K., Suresky, M. J. — 2008-05-23

BACKGROUND: Each year, 54 million American adults are affected by serious mental illness. Most of these persons depend on female family members for support or assistance, and unless these women are resourceful, they may experience considerable burden, stigma by association, depressive thoughts, and poor quality of life. OBJECTIVE: In this study, we examined the associations between characteristics of female family members (age, race, education), adults with serious mental illness (age, diagnosis), and the family situation (relationship, living arrangements, care provided) and caregivers' burden, stigma, depressive cognitions, resourcefulness, and quality of life. STUDY DESIGN: In this descriptive, cross-sectional study, a convenience sample of 60 female relatives of adults with serious mental illness provided demographic information and completed established measures of the study variables. RESULTS: We discuss associations between contextual variables and process regulators, resourcefulness, and quality of life. CONCLUSIONS: The results highlight the importance of targeting interventions for caregivers of adults with serious mental illness who are parents, caregivers of younger seriously mentally ill persons in earlier stages of diagnosis, and caregivers of persons who have bipolar disorder. J Am Psychiatr Nurses Assoc, 2008; 14(2), 125-135. DOI: 10.1177/1078390308315612

Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence

Courey, T. J., Martsolf, D. S., Draucker, C. B., Strickland, K. B. — 2008-05-23

BACKGROUND: Individuals who experience sexual violence often seek services in a variety of health care settings. Although research indicates that survivors often report that interactions with health care professionals are distressing, little is known about what renders these encounters helpful or hurtful. OBJECTIVE: The purpose of this study was to use Hildegard Peplau's (1952) conceptualization of nurses' helping roles (i.e., stranger, resource person, teacher, leadership, surrogate, counselor, technical expert) in nurse—client interactions to explore how survivors of sexual violence perceive their encounters with health care professionals. STUDY DESIGN: Content analysis was conducted on the transcripts of 60 minimally structured interviews in which participants discussed their experiences of sexual violence. RESULTS: The results revealed that the helping roles of counselor and technical expert, as identified by Peplau, were most important to survivors of sexual violence. Regardless of role, participants perceived health care professionals to be helpful when they exhibited interpersonal sensitivity, especially in regard to the participants' experiences with violence. CONCLUSIONS: The findings indicate that health care professionals need to maintain an attentive and compassionate stance when working with survivors of sexual violence. Those who serve in a counselor role need to create an atmosphere of trust so that clients may explore in depth how violence has affected their lives. J Am Psychiatr Nurses Assoc, 2008; 14(2) , 136-143. DOI: 10.1177/1078390308315613

Psychopharmacologic First-Line Strategies in the Treatment of Major Depression and Psychosis: A Survey of Advanced Practice Nurses

Wolfe, B. E., Talley, S. L., Smith, A. T. — 2008-05-23

BACKGROUND: Developments in psychopharmacology have led to a broad range of medication choices for prescribing clinicians. Although there have been advances in drug development, less is known about the prescribing strategies used by psychiatric—mental health advanced practice nurses or the extent to which these practices reflect existing practice guidelines. OBJECTIVES: This study examined the prescribing practices of advanced practice nurses attending a psychopharmacology continuing education program. Participants were surveyed about (a) first-line strategies for the treatment of major depression and first-episode psychosis and (b) choices for managing insomnia and the side effect of weight gain. STUDY DESIGN: Participants completed an onsite questionnaire regarding advanced practice characteristics and management of specific clinical situations. RESULTS: The majority of prescribing advanced practice nurses surveyed were psychiatric—mental health specialists. Approximately two thirds (65.9%) of the advanced practice nurses prescribed psychotropic medications, most often for depression. First-choice agents for depression and first-episode psychosis were selective serotonin reuptake inhibitors (97.3%) and atypical antipsychotics (93.9%), respectively. Interventions for insomnia and medication-related weight gain were more varied. CONCLUSIONS: For the advanced practice nurses surveyed, first-line strategies for depression and first-episode psychosis appear consistent with literature and practice guidelines. Future studies and educational offerings would benefit from addressing dosing and switching strategies and optimizing approaches for managing side effects. J Am Psychiatr Nurses Assoc , 2008; 14(2), 144-151. DOI: 10.1177/1078390308316124