Journal of the American Psychiatric Nurses Association recent issues

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

Readership Survey Results

Stein, K. F. — 2008-02-29

Psychiatric Nursing Education at a Distance

Shea, C. A. — 2008-02-29

Accessibility is a major impediment to nursing education, whether you live in densely populated southern California or rural upstate New York. During the past 10 years, there have been scientific advances, technological breakthroughs, new reimbursement mechanisms and regulatory practices, and shifts in society's priorities. Consequently, the focus of master's programs and the role of graduates has adapted to the needs of the mental health care delivery system. What has not changed much is the way we offer psychiatric nursing education. There is still a strong emphasis on traditional classroom teaching, on campus-based activities and face-to-face supervision. One solution that might increase access to psychiatric nursing programs is to develop educational programs with quality distance education standards and practices as a primary means for educating future psychiatric nurses. Psychiatric nursing faculties need to design creative scenarios and interactive activities to engage students in online learning about psychiatric and mental health nursing. J Am Psychiatr Nurses Assoc, 2008; 14(1), 36-38. DOI: 10.1177/1078390307307451

Dementia-Specific Assisted Living: Clinical Factors and Psychotropic Medication Use

Smith, M., Buckwalter, K. C., Kang, H., Ellingrod, V., Schultz, S. K. — 2008-02-29

BACKGROUND: Assisted living (AL) is an increasingly popular long-term care alternative for older adults with dementia, making this setting an important focus for both clinical practice and research among psychiatric nurses. OBJECTIVES: This article describes results from a pilot study focusing on residents' cognitive and emotional status as well as psychotropic drug use. Findings are compared to reports from larger studies in the literature. STUDY DESIGN: A descriptive, correlational design was used to collect data from 17 residents in two dementia-specific AL facilities. RESULTS: Thirty-one psychiatric diagnoses were identified for 17 participants. Anxiety and depression symptoms were endorsed by more than 50% of participants, and 88% were prescribed psychotropic medications. CONCLUSIONS: AL residents may experience problems with cognition and emotional symptoms such as anxiety and depression, creating important roles for psychiatric nurses in staff education, promotion of nonpharmacologic interventions, and monitoring of psychotropic medication use in this growing population. J Am Psychiatr Nurses Assoc, 2008; 14(1), 39-49. DOI: 10.1177/1078390307310692

Parent--Adolescent Communication About Sexual Pressure, Maternal Norms About Relationship Power, and STI/HIV Protective Behaviors of Minority Urban Girls

Teitelman, A. M., Ratcliffe, S. J., Cederbaum, J. A. — 2008-02-29

Racial/ethnic minority adolescent girls bear a disproportionate risk for HIV and face barriers to autonomous sexual decision making, but parental messages may help protect against sexual risk taking. The authors examined African American and Hispanic girls' sexually transmitted infection (STI) and HIV prevention practices, parent—adolescent communication about sexual pressure, and maternal gender norms (N = 118). Teens were more likely to practice consistent STI/HIV prevention when mothers talked about partner sexual pressure (p = .017) and fathers talked about resisting partner sexual pressure (p = .034). Sexually active girls who perceived that their mothers held egalitarian beliefs about partner decision making had more consistent condom use (p = .029). Given the context of increased STI/HIV risk, it is critical that parents discuss partner dynamics with daughters. Nurses play a unique role in facilitating these conversations; they provide parents with age-appropriate resources and assist in normalizing fears, which can help increase parent—child sexual-risk communication. J Am Psychiatr Nurses Assoc, 2008; 14(1), 50-60. DOI : 10.1177/1078390307311770

Are You Including Genomics in Nursing Practice?

Pestka, E. L. — 2008-02-29

A national consensus panel representing 48 nursing organizations, including the American Psychiatric Nurses Association, identified and endorsed essential genetic and genomic competencies for all registered nurses regardless of academic preparation, role, or clinical specialty. The competencies were designed to guide academic curricula, continuing education, and specialty certification. A 5-year implementation plan for these competencies includes components applicable to practicing psychiatric nurses, regulatory and quality control issues, and academics. This article will describe the implementation strategies identified, some examples of genetics and genomics nursing activities in the psychiatric specialty, and recommendations that support the national implementation plan. J Am Psychiatr Nurses Assoc, 2008; 14(1), 63-68. DOI: 10.1177/1078390307311974

Comment on Lessons Learned Column

Harrison, P. — 2008-02-29

Erratum

2008-02-29

Issues of Body Weight and Eating Behavior in Psychiatric and Mental Health Nursing Practice

Wolfe, B. E. — 2007-12-13

Bipolar Disorder and Weight Gain: A Multifactorial Assessment

Simmons-Alling, S., Talley, S. — 2007-12-13

Obesity is highly prevalent in persons with bipolar disorder. This results in increased physical morbidity and poorer psychiatric outcomes. Multiple variables have been identified as potentially responsible for the weight gain in these individuals. Efforts to use successful treatment strategies require an understanding of these variables and methods that clinicians and their clients can use to reduce or minimize these risk factors. This article will review the emerging findings related to primary and secondary weight gain in bipolar disorder. The sequelae of weight gain on psychiatric and medical morbidity will be discussed. Lastly, a model for nursing assessment will propose methods for modifying risk factors and encouraging healthy lifestyle changes. The goal is to improve this component of quality of life for persons with bipolar disorder. J Am Psychiatr Nurses Assoc, 2008; 13(6), 345-352. DOI: 10.1177/1078390307310145

Pilot Study of a Cognitive Behavioral Group Intervention to Prevent Further Weight Gain in Hispanic Individuals With Schizophrenia

Weber, M., Colon, M., Nelson, M. — 2007-12-13

BACKGROUND: Obesity and type 2 diabetes are increasing significantly in the Hispanic population and in the Hispanic population with schizophrenia. In the Diabetes Prevention Project (DPP), cognitive—behavioral (CB) interventions were more effective in reducing weight and preventing diabetes. OBJECTIVE: To test a CB group intervention based on the DPP model among Hispanic individuals with schizophrenia on weight, body mass index (BMI), and waist—hip circumference (WH). STUDY DESIGN: Pilot study using a pre—post quasi-experimental design and convenience sample of 8 subjects from a public mental health clinic who met for 8 weekly group meetings. RESULTS: No significant differences in BMI, weight, or WH scores based on t-test results; the subjects' weight remained stable, there was a trend toward weight loss, and no one gained weight during the trial. CONCLUSIONS: No further weight gain is a finding that merits further research using a larger sample size and a randomized controlled design. J Am Psychiatr Nurses Assoc, 2008; 13(6), 353-359.

Eating Behavior in Persons With Moderate to Late-stage Dementia: Assessment and Interventions

Amella, E. J., Grant, A. P., Mulloy, C. — 2007-12-13

Persons with various forms of dementia suffer from a progressive disease in which memory and the ability to function independently are lost. During moderate to late-stage dementia, individuals experience increased difficulty with eating and require more feeding assistance. Clinicians working with this population must acknowledge the multifactorial aspects of eating behavioral issues, use a team approach, and make careful assessments using appropriate instruments. Interventions should include attention to cognitive impairment, nutritional intake, training of caregivers, modification of the environment, and the quality of the interaction. Planning for care should include promoting the highest quality of life for these individuals and their caregivers. J Am Psychiatr Nurses Assoc, 2008; 13(6), 360-367.

The Individual Within a Condition: A Qualitative Study of Young People's Reflections on Being Treated for Anorexia Nervosa

Tierney, S. — 2007-12-13

BACKGROUND: Anorexia nervosa is a mental health problem that can seriously impede the physical, social, and psychological functioning of those who develop it. Unfortunately, outcome for this patient group, even after treatment, is not necessarily promising. OBJECTIVE: To explore the views of young people about being treated for anorexia. STUDY: DESIGN: Qualitative interviews were conducted with 10 adolescents. All interviews were recorded with participants' written consent and transcribed verbatim. A thematic analysis was applied to these data. RESULTS: Five themes were derived from the analysis: a) accessing appropriate care, b) balancing the physical and psychological, c) qualities required in professionals, d) help from nonprofessional routes, and e) perceived progress. CONCLUSIONS: Participants were clear about needing to be motivated to change. Practitioners can help by challenging patients in a nonconfrontational manner, treating them as individuals rather than cases of anorexia, and considering their psychosocial and physical functioning. J Am Psychiatr Nurses Assoc, 2008; 13(6), 368.-375. DOI: 10.1177/1078390307309215

Weight-Related Concerns and Behaviors in Children and Adolescents With Type 1 Diabetes

Howe, C. J., Jawad, A. F., Kelly, S. D., Lipman, T. H. — 2007-12-13

Children and adolescents with type 1 diabetes are at risk for disordered eating and unhealthy weight-control practices. This study describes (a) participants' weight perception and weight satisfaction, (b) participants' scores on the Diabetes Eating Problem Survey (DEPS), (c) prevalence of weight-control behaviors, and (d) association of DEPS and weight-control behaviors with race, gender, age, body mass index (BMI), hemoglobin A1c (HbA1c), weight satisfaction, and weight perception. TheAHEAD survey was completed by 295 participants to determine weight satisfaction, weight perception, and weight-control behaviors. Height, weight, and HbA1c were obtained from clinic charts. Older females with higher BMI and elevated HbA1c used significantly more weight-control behaviors. Weight dissatisfaction and heavy weight perception were associated with significantly more unhealthy weight-control practices. Prevention programs should be directed toward the preteen female. Older female teens presenting with higher BMI, elevated HbA1c, weight dissatisfaction, and heavy weight perception should be formally assessed for unhealthy weight-control behaviors. J Am Psychiatr Nurses Assoc, 2008; 13(6), 376-385. DOI: 10.1177/1078390307310154

Advances in the Management of Psychotic Disorders: Optimizing Patient Outcomes

McEnany, G. P. — 2007-10-25

Psychopharmacologic Strategies and Associated Challenges in the Long-Term Treatment of Schizophrenia

Phillips McEnany, G. — 2007-10-25

The comprehensive treatment of persons who have been diagnosed with schizophrenia requires the application of an effective and tolerable pharmacologic treatment regimen in conjunction with psychosocial interventions. The mainstay of pharmacologic treatment of persons diagnosed with schizophrenia is antipsychotic medication. The most commonly prescribed are the atypical or second-generation antipsychotic medications that have efficacy that matches, or in many cases is superior to that of conventional antipsychotics. In practice, however, medication adherence, as much as medication efficacy, is the key to improving patient outcomes. J Am Psychiatr Nurses Assoc, 2007; 13(S5), S6.-S15. DOI: 10.1177/1078390307304078

Management of Bipolar Disorder in the Acute and Maintenance Settings

Baldassano, C. F. — 2007-10-25

Bipolar disorder is a devastating condition that affects approximately 3% of the population. Diagnosis of bipolar disorder is often confounded by the lack of insight patients have into their manic episodes; the end result is that many patients are not diagnosed until years after their first episode and receive no treatment or inappropriate treatment in the interim. Once the diagnosis is made, medication must be chosen that can control symptoms in the short term and prevent relapse in the long term. Medication tolerability affects treatment adherence and thus determines whether a medication will be effective, especially in the long-term maintenance phase of treatment. Thus, medication tolerability has important implications for the management of bipolar disorder because of the chronic nature of the disease and the need for long-term therapy. J Am Psychiatr Nurses Assoc, 2007; 13(S5), S16-S22. DOI: 10.1177/1078390307305790

Considering the Impact on Overall Patient Health When Choosing Antipsychotic Therapy

Jarboe, K. S. — 2007-10-25

Schizophrenia is a chronic and debilitating illness characterized by behaviors that markedly impair social and occupational functioning. Atypical antipsychotic medications have greatly improved outcomes for patients with these psychiatric disorders. Unfortunately, many patients do not respond adequately to therapy because of treatment-limiting adverse events, (AEs) which also limit therapeutic adherence. It is now widely accepted that the "real-world" clinical effectiveness of an atypical antipsychotic depends on its safety and tolerability as much as its efficacy. A number of clinical studies have shown that certain atypical antipsychotics are associated with unwanted sedation and a significant risk of weight gain, diabetes, and dyslipidemia. The risk of hyperprolactinemia is also significantly elevated with some atypical antipsychotics. To minimize the risk of adversely impacting overall patient health, each patient's metabolic and cardiovascular risk profile, as well as the potential impact of sedation on his or her quality of life, should be evaluated before beginning therapy and regularly thereafter. J Am Psychiatr Nurses Assoc, 2007; 13(S5), S23-S28. DOI: 10.1177/1078390307299810

Continuing Education

2007-10-25