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Sample records for advanced practice psychiatric

  1. Epigenetics: An Emerging Framework for Advanced Practice Psychiatric Nursing.

    PubMed

    DeSocio, Janiece E

    2016-07-01

    The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.

  2. Blueprint for development of the advanced practice psychiatric nurse workforce.

    PubMed

    Hanrahan, Nancy P; Delaney, Kathleen R; Stuart, Gail W

    2012-01-01

    The mental health system is inefficient and ineffective in providing behavioral health care services to the 1 in 4 Americans who have a mental illness or a substance abuse problem. Current health care reform initiatives present a significant opportunity for advanced practice psychiatric nurses-psychiatric mental health (APRN-PMH) to develop action-oriented recommendations for developing their workforce and thereby increasing access to high-quality and full-spectrum behavioral health care services. If endorsed by the professional nursing associations and the APRN-PMH workforce, the strategies presented in this paper provide a blueprint for developing the APRN-PMH workforce. Achieving these goals will significantly reform the APRN-PMH workforce, thereby contributing to the overall goal of supporting an integrated model of behavioral health care. No change has as much potential to influence the APRN-PMH workforce as the uniting of all APRN-PMHs in a "Blueprint for APRN-PMH Workforce Development."

  3. The psychiatric advanced practice nurse with prescriptive authority: role development, practice issues, and outcomes measurement.

    PubMed

    Cornwell, C; Chiverton, P

    1997-04-01

    Within the rapidly changing health care system, there is an increased need for professionals who can provide cost-effective primary health care for mentally ill patients. This article discusses the role of the Psychiatric Advanced Practice Nurse (APN) with Prescriptive Authority as a cost-effective, high-quality component of comprehensive mental health care delivery. Historical aspects of the development of the Nurse Practitioner (NP) role are discussed, as well as issues specific to the role in psychiatric nursing. The implementation of this role at Rochester is described, followed by recommendations for studying the impact of the psychiatric NP on care delivery, including process and outcome variables.

  4. Joint crisis plans and psychiatric advance directives in German psychiatric practice.

    PubMed

    Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

    2014-05-01

    This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

  5. Health Care Reform and the Federal Transformation Initiatives: Capitalizing on the Potential of Advanced Practice Psychiatric Nurses

    PubMed Central

    Hanrahan, Nancy P.; Delaney, Kathleen; Merwin, Elizabeth

    2012-01-01

    In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed. PMID:21233135

  6. The evolution of the advanced practice role in psychiatric mental health in New Jersey: 1960-2010.

    PubMed

    Caldwell, Barbara A; Sclafani, Michael; Piren, Karen; Torre, Carolyn

    2012-04-01

    This historical perspective is focused on the contribution of Hildegard E. Peplau in laying the foundation for advanced practice nursing and the development of the roles of clinical nurse specialists and psychiatric nurse practitioners. An overview is provided of legal developments within the state that enabled Advanced Practice Nurses to provide mental health services. A description of a recent specialized state-funded initiative is outlined, focused on the development and contributions of psychiatric advanced practice nurses in community settings in New Jersey. Implications for the advanced practice nursing role in New Jersey are presented based on national and state initiatives.

  7. Psychiatric Mental Health Nursing Advanced Practice Workforce: Capacity to Address Shortages of Mental Health Professionals.

    PubMed

    Delaney, Kathleen R

    2017-09-01

    There is a recognized shortage of mental health professionals licensed to provide the full scope of mental health services, including assessment, diagnosis, and prescribing. Psychiatric mental health advanced practice nurses (PMH APNs) have the education and licensure to provide these services, address provider shortages and increase access to services. Unfortunately, federal reports and mental health workforce studies inaccurately depict important characteristics of PMH APNs, particularly their scope of practice, a situation that creates misunderstanding and impedes workforce planning. This Open Forum provides an accurate depiction of the PMH APN workforce, its size, scope of practice, and its capacity to increase access to mental health services. Also considered are the implications of using integrated care to increase access to mental health treatment. PMH APNs could increase the reach of these collaborative care models, which require constructing interprofessional teams in which each provider practices to the top of his or her license.

  8. Psychiatric Advance Directives: Getting Started

    MedlinePlus

    ... More... Home Getting Started National Resource Center on Psychiatric Advance Directives - Getting Started Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...

  9. Reflections from Dutch advanced nursing practice students on psychiatric mental healthcare in the United States.

    PubMed

    Maas, Lillian Garcia; Ezeobele, Ifeoma Ezebuiro

    2014-12-01

    An international clinical learning experience is a unique opportunity to witness another nursing and healthcare system. The Master of Advanced Nursing Practice (MANP) program at Rotterdam University of Applied Sciences in the Netherlands, mandates an international experience. Semi-structured qualitative interviews, a focus group session and written reflections were used for data collection with 6 Dutch MANP nursing students who specialized in psychiatric mental healthcare. Five major themes were revealed from the data. The themes identified were as follows: (1) pride and passion for mental health profession (2) role diversity within psychiatric mental health nursing (3) nursing leadership at the organization level (4) comparable Westernized approaches to mental healthcare and (5) differences in access to care. Incorporating a mandatory international clinical experience is a beneficial tool to promote a global understanding of the unique advanced practice nursing student's academic and professional development. The international clinical learning experience is considered a highlight of the 2-year MANP program. The students are able to gain a new and broader vision of the APN role and a greater appreciation for the Dutch healthcare system. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Advanced practice psychiatric mental health nursing, finding our core: the therapeutic relationship in 21st century.

    PubMed

    Perraud, Suzanne; Delaney, Kathleen R; Carlson-Sabelli, Linnea; Johnson, Mary E; Shephard, Rebekah; Paun, Olimpia

    2006-11-01

    Increasingly, students from various professional backgrounds are enrolling in Psychiatric Mental Health (PMH) Nursing graduate programs, especially at the post-master's level. Faculty must educate these students to provide increasingly complex care while socializing them as PMH advanced practitioners. To present how one online program is addressing these issues by reasserting the centrality of the relationship and by assuring it has at least equal footing with the application of a burgeoning knowledge base of neurobiology of mental illness. Published literature from nursing and psychology. The PMH graduate faculty believes that they have developed strategies to meet this challenge and to help build a PMH workforce that will maintain the centrality of the relationship in PMH practice.

  11. An American and Dutch partnership for psychiatric mental health advance nursing practice: nurturing a relationship across the ocean.

    PubMed

    Maas, Lillian; Ezeobele, I Ezebuiro; Tetteroo, Marieke

    2012-07-01

    The purpose of this article is to discuss the challenges and rewards of developing and nurturing an international clinical psychiatric mental health advanced nursing practice exchange between the Netherlands and the United States. Since 1997, Rotterdam University of Applied Sciences in the Netherlands has been participating in international clinical experiences for their psychiatric mental health (PMH) advanced practice nursing students. The international experience is mandatory prior to graduation and is the first of its kind in Europe to mandate such a unique experience. This study sample included eight Dutch PMH advanced practice nursing students enrolled in a full-time master's in advanced nursing practice program. The descriptive study included reflective reports and one-on-one discussions over a 3-year period. With proper planning, an international nursing experience provides a unique opportunity for nurses to think beyond their own culture and healthcare system. Solving problems together through different perspectives creates opportunities for creative solutions. International partnerships within PMH advanced practice nursing promotes sharing of knowledge and solutions as patients and diseases have no border. © 2011 Wiley Periodicals, Inc.

  12. Nutraceuticals in psychiatric practice.

    PubMed

    Chiappedi, Matteo; de Vincenzi, Silvia; Bejor, Maurizio

    2012-08-01

    Nutraceuticals can be defined as food components or active principles present in aliments which have positive effects for health and quality of life, including preventing or treating disorders. Herbal and "natural" food supplements are increasingly used to treat different psychiatric disorders, often as "self-prescribed" therapies. With factors such as chronic illness, poor health, emotional distress, and quality of life influencing the desire for complementary medicine, patients with comorbid medical and psychiatric problems seem likely to turn to this approach. We reviewed the most commonly used herbal and dietary supplements for which a certain efficacy on psychiatric symptoms or disorders has been claimed, checking current Pubmed-indexed literature (the most important being St. John's wort, Omega-3 fatty acids, valerian, Kava, Ginkgo, folate, B vitamins, S-Adenosylmethionine, inositol, alfa-lactoalbumin and passionflower). There is evidence of efficacy for some of these herbs an supplements, proved also by Cochrane's meta-analysis. However many different areas (including efficacy, tolerability, optimal dosing, adequate shelf life, drug and non-pharmacological interactions) need to be thoroughly studied; moreover political decisions need to be scientifically guided in order to best serve psychiatric patients' interests and to prevent using of expensive and sometimes un-useful therapies. This implies that a scientific strategy is needed to rule out any third-part economical interest which could in any way influence therapeutic choices. The article presents some promising patents on nutraceuticals in psychiatric practice.

  13. Abortion and psychiatric practice.

    PubMed

    Stotland, Nada L

    2003-03-01

    The subject of abortion is fraught with politics, emotions, and misinformation. A widespread practice reaching far back in history, abortion is again in the news. Psychiatry sits at the intersection of the religious, ethical, psychological, sociological, medical, and legal facets of the abortion issue. Although the religions that forbid abortion are more prominent in the media, many religions have more liberal approaches. While the basic right to abortion has been upheld by the U.S. Supreme Court, several limitations have been permitted, including parental notification or consent (with the possibility of judicial bypass) for minors, waiting periods, and mandatory provision of certain, sometimes biased, information. Before the Roe v. Wade decision legalizing abortion in 1973, many women were maimed or killed by illegal abortions, and psychiatrists were sometimes asked to certify that abortions were justified on psychiatric grounds. Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae. The psychiatric outcome of abortion is best when patients are able to make autonomous, supported decisions. Psychiatrists need to know the medical and psychiatric facts about abortion. Psychiatrists can then help patients prevent unwanted pregnancies, make informed decisions consonant with their own values and circumstances when they become pregnant, and find appropriate social and medical resources whatever their decisions may be.

  14. Achieving Full Scope of Practice Readiness Using Evidence for Psychotherapy Teaching in Web and Hybrid Approaches in Psychiatric Mental Health Advanced Practice Nursing Education.

    PubMed

    McCoy, Kathleen T

    2017-01-12

    Radical changes in role, education, and practice have affected how education of advance practice nurses and practice deliverables occur. This article examines the effects of distance education upon the teaching/learning of psychotherapy in integrating Web-based technology and platforms. With the advent and proliferation of online programs of study, the question begs: How do distance-linked programs successfully introduce, practice, and supervise one-to-one and group psychotherapy training? By employing evidence-based education strategies, technology, and strong interpersonal skills and evidence-based therapies, a charter Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice program paved an innovative and successful path. In that program, they prepared their students for full scope of practice, upon graduation, inclusive of psychotherapy as well as the other highly demanding and compressed requirements of the 3-year program. This article explores that journey and its recommendations for application derived from this 2010 cohort. © 2017 Wiley Periodicals, Inc.

  15. Advancing the Screening of Fibromyalgia in Late-Life Depression: Practical Implications for Psychiatric Settings

    PubMed Central

    Jochum, John R.; Begley, Amy; Dew, Mary Amanda; Weiner, Debra K.; Karp, Jordan F.

    2015-01-01

    Background Fibromyalgia (FM) is common in older adults suffering from mood disorders. However, clinical diagnosis of FM is challenging, particularly in psychiatric settings. We examined the prevalence of FM and the sensitivity of three simple screeners for FM. Methods Using cross-sectional data, we evaluated three tests against the American College of Rheumatology (ACR) 1990 Criteria for the Classification of Fibromyalgia: a “Do you often feel like you hurt all over?” question, a pain map score, and the Pope and Hudson (PH) interview for FM. Participants: were 185 community-dwelling adults ≥ 60 years old with comorbid depression and chronic low back pain evaluated at a late-life mental health clinic. Results 53 of 185 subjects (29%) met the ACR 1990 FM criteria. Compared to those without FM, the FM group had more “yes” answers to the “hurt all over?” question and higher pain map scores. To reach a sensitivity of at least 0.90, the cut-off score for the pain map was 8. The sensitivity of the pain map, “hurt all over?” question, and PH criteria were 0.92 [95%CI 0.82–0.98], 0.91 [95%CI 0.79–0.97], and 0.94 [95%CI 0.843–0.99] respectively. Conclusions Nearly one in three older adults suffering from depression and chronic low back pain met ACR 1990 FM criteria. Three short screening tests showed high sensitivity when compared to the ACR 1990 FM criteria. Implementation of one of the simple screeners for FM in geriatric psychiatry settings may guide the need for further diagnostic evaluation. PMID:25907254

  16. Authorizing psychiatric research: principles, practices and problems.

    PubMed

    Chong, Siow Ann; Huxtable, Richard; Campbell, Alastair

    2011-01-01

    Psychiatric research is advancing rapidly, with studies revealing new investigative tools and technologies that are aimed at improving the treatment and care of patients with psychiatric disorders. However, the ethical framework in which such research is conducted is not as well developed as we might expect. In this paper we argue that more thought needs to be given to the principles that underpin research in psychiatry and to the problems associated with putting those principles into practice. In particular, we comment on some of the difficulties posed by the twin imperatives of ensuring that we respect the autonomy and interests of the research subject and, at the same time, enable potentially beneficial psychiatric research to flourish. We do not purport to offer a blueprint for the future; we do, however, seek to advance the debate by identifying some of the key questions to which better answers are required.

  17. [Psychiatric advance directives--medical models into psychiatric medicine].

    PubMed

    Mautner, Sigal; Lachman, Max; Kaplan, Zeev; Shalev, Anat

    2014-01-01

    Since the year 2005, in the field of general medicine, the legislature in Israel determined ways to implement medically advanced directives according to the power of the law. Different states in the world had implemented parallel legislation for patients who suffer from mental illness. Psychiatric Advance Directives is a legitimate document which is valid in Australia, New Zealand, Scotland, England and in 25 countries in the U.S.A. Psychiatric advance directives (PAD's) allow competent persons, through advance instructions, to state their preferences for future mental health treatment in the event of an incapacitating psychiatric crisis. Self Determination Theory, Self Care and Autonomy are dominant supportive approaches in the creation of Psychiatric Advance Directives. Research conducted on psychiatric advance directives shows positive potential benefits for mental health clients, therapists and psychiatrists. More research in that area must be conducted. Psychiatric advance directives are currently developed and implemented with the cooperation of the Tauber Foundation and the Beer Sheva Mental Health Center. This is the first step in learning of effective ways to use this intervention in Israel and change perceptions toward a positive connection between medical efficiency and client preferences.

  18. The virtues in psychiatric practice.

    PubMed

    Mann, D W

    1997-01-01

    Using as a guide Pellegrino and Thomasma's "end-oriented beneficence model" of the virtues in medical practice, the author derives from the cardinal forms of psychiatric treatment a set of virtues particular to this field. Prior work from Jung, Havens and Menzer-Benaron helps to clarify the analysis.

  19. Continuing the cultural competency journey through exploration of knowledge, attitudes, and skills with advanced practice psychiatric nursing students: an exemplar.

    PubMed

    Hoke, Mary M; Robbins, Leslie K

    2011-06-01

    Numerous training and education programs have evolved to address culturally competent health care delivery. This article describes an exemplar educational approach used to teach cultural competency to beginning graduate psychiatric mental health nursing students. Using interactive strategies delivered within the 4 phases of the curriculum, the approach has been shown to facilitate students' ongoing journey to cultural competence. Building on baccalaureate nursing competencies, the course addresses attitudes, knowledge, skills, and cultural humility to strengthen cultural self-assessment, cross-cultural clinical practice expertise, and the use of culturally appropriate research for graduate students. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Psychotherapy in Contemporary Psychiatric Practice.

    PubMed

    Hadjipavlou, George; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2015-06-01

    American data suggest a declining trend in the provision of psychotherapy by psychiatrists. Nevertheless, the extent to which such findings generalize to psychiatric practice in other countries is unclear. We surveyed psychiatrists in British Columbia to examine whether the reported decline in psychotherapy provision extends to the landscape of Canadian psychiatric practice. A survey was mailed to the entire population of fully licensed psychiatrists registered in British Columbia (n = 623). The survey consisted of 30 items. Descriptive statistics were used to characterize the sample and psychotherapy practice patterns. Associations between variables were evaluated using nonparametric tests. A total of 423 psychiatrists returned the survey, yielding a response rate of 68%. Overall, 80.9% of psychiatrists (n = 342) reported practicing psychotherapy. A decline in the provision of psychotherapy was not observed; in fact, there was an increase in psychotherapy provision among psychiatrists entering practice in the last 10 years. Individual therapy was the predominant format used by psychiatrists. The most common primary theoretical orientation was psychodynamic (29.9%). Regarding actual practice, supportive psychotherapy was practiced most frequently. Professional time constraints were perceived as the most significant barrier to providing psychotherapy. The majority (85%) of clinicians did not view remuneration as a significant barrier to treating patients with psychotherapy. Our findings challenge the prevailing view that psychotherapy is in decline among psychiatrists. Psychiatrists in British Columbia continue to integrate psychotherapy and pharmacotherapy in clinical practice, thus preserving their unique place in the spectrum of mental health services.

  1. Psychotherapy in Contemporary Psychiatric Practice

    PubMed Central

    Hadjipavlou, George; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2015-01-01

    Objective: American data suggest a declining trend in the provision of psychotherapy by psychiatrists. Nevertheless, the extent to which such findings generalize to psychiatric practice in other countries is unclear. We surveyed psychiatrists in British Columbia to examine whether the reported decline in psychotherapy provision extends to the landscape of Canadian psychiatric practice. Method: A survey was mailed to the entire population of fully licensed psychiatrists registered in British Columbia (n = 623). The survey consisted of 30 items. Descriptive statistics were used to characterize the sample and psychotherapy practice patterns. Associations between variables were evaluated using nonparametric tests. Results: A total of 423 psychiatrists returned the survey, yielding a response rate of 68%. Overall, 80.9% of psychiatrists (n = 342) reported practicing psychotherapy. A decline in the provision of psychotherapy was not observed; in fact, there was an increase in psychotherapy provision among psychiatrists entering practice in the last 10 years. Individual therapy was the predominant format used by psychiatrists. The most common primary theoretical orientation was psychodynamic (29.9%). Regarding actual practice, supportive psychotherapy was practiced most frequently. Professional time constraints were perceived as the most significant barrier to providing psychotherapy. The majority (85%) of clinicians did not view remuneration as a significant barrier to treating patients with psychotherapy. Conclusions: Our findings challenge the prevailing view that psychotherapy is in decline among psychiatrists. Psychiatrists in British Columbia continue to integrate psychotherapy and pharmacotherapy in clinical practice, thus preserving their unique place in the spectrum of mental health services. PMID:26175328

  2. Character virtues in psychiatric practice.

    PubMed

    Radden, Jennifer; Sadler, John Z

    2008-01-01

    The character-focused approach known as virtue ethics is especially well suited to understanding and promoting ethical psychiatric practice. Virtues are stable dispositions and responses attributed to character, and a virtue-based ethics is one in which people's selves or characters are at the center of moral assessment. In this discussion by a clinician and a philosopher, clinical scenarios using exchanges and inner monologue illustrate key aspects of virtues. Virtues are acquired through habituation; they are habits of mind as much as behavior; they are as a group heterogeneous, and individually composite; they involve affective responses; they are not impartial; they are compatible with the "role morality" required of professionals; they are responses to particular temptations and weaknesses; and they include, in the capacity for practical judgment known as phronesis, a way of resolving many of the conflicts and dilemmas that arise in practice. The virtue approach to ethics will likely be most useful in the educational setting where practitioners are learning clinical skills and socialized into the broad ethos of professional practice. Aspects of this educational effort are briefly reviewed, including whether it ought to be undertaken at all, whether the effort to teach virtues is possible, and, if so, how it can be achieved.

  3. The Psychiatric Family Nurse Practitioner: A Collaborator in Family Practice

    PubMed Central

    Cunningham, Patricia D.

    1999-01-01

    The potential of the psychiatric family nurse practitioner (Psych.F.N.P.) to contribute to family practice through physical care and mental health care exists in the here and now. This role is a synthesis of 2 advanced practice roles, the psychiatric clinical nurse specialist (Psych.C.N.S.) and family nurse practitioner (F.N.P.), both of which continue to have great utility independently. This synthesis is a practical application of concepts that have evolved to meet the changing patterns of health care delivery. At this time, dual certification as a Psych.C.N.S. and F.N.P. best reflects the broad practice expertise of the psychiatric family nurse practitioner. The experienced psychiatric family nurse practitioner provides direct care for both physical and psychological needs of patients in a family practice setting. PMID:15014701

  4. Psychiatric education in an era of rapidly occurring scientific advances.

    PubMed

    Rubin, Eugene H; Zorumski, Charles F

    2003-04-01

    Scientific advances in the fields of molecular biology, neurobiology, pharmacology, epidemiology, genetics, neuroimaging, and cognitive neuroscience are influencing psychiatric diagnosis and treatment, and this influence will grow substantially in the future. The current shortage of psychiatrists will increase over the next several decades, resulting in the need to train primary care physicians in basic psychiatric care and the use of non-physician mental health professionals to administer time-intensive, formal psychotherapies. The juxtaposition of these two trends-an increasing scientific influence on the clinical practice of psychiatry and fewer psychiatrists to deliver that treatment-is cause for changes in the approach to psychiatric education. In addressing these issues, the authors suggest that (1) psychiatry should be more integrated into undergraduate medical education in both basic science and clinical curricula, (2) residents in primary care disciplines should have more direct exposure to psychiatric training, (3) joint instructional experiences involving psychiatry and primary care residents should be encouraged, (4) psychiatry residency programs should maintain flexibility in order to incorporate rapid advances in diagnostic procedures and treatments into residency training, (5) research experience should be integrated into psychiatry residency programs, and (6) departments of psychiatry must develop the leadership and expertise necessary to implement the incorporation of rapidly advancing scientific discoveries into the psychiatric curriculum.

  5. [Involuntary commitment: implication for psychiatric nursing practice].

    PubMed

    Moreira, Lilian Hortale de Oliveira; Loyola, Cristina Maria Douat

    2011-06-01

    The characteristics of involuntary psychiatric commitment (IPI) may cause implications on the nursing/patient relationship. The objectives of this study were to list the forms of nursing care delivered to psychiatric patients, according to the type of commitment; analyze the reaction of the nursing team towards the IPI patient, and discuss on the implications that IPI have on the practice o psychiatric nursing. A field research was performed with the nursing team of a psychiatric institution in Rio de Janeiro. After 50 hours of participant observation and 9 of focal group meetings, we found that the teams are concerned with the clinical evolution of the patients. No references of the nursing team to the IPI patient were observed. There are no records or actions of any kind that would suggest a specific look towards this type of patient. Nursing professionals are not able to clearly identify this type of patient, thus the care is provided as per the patient's needs or requests.

  6. Practice Parameter for Psychiatric Consultation to Schools

    ERIC Educational Resources Information Center

    Journal of the American Academy of Child and Adolescent Psychiatry, 2005

    2005-01-01

    This practice parameter reviews the topic of psychiatric consultation to schools. The review covers the history of school consultation and current consultative models; the process of developing a consultative relationship; school administrative procedures, personnel, and milieu; legal protections for students with mental disabilities; and issues…

  7. Ideology, psychiatric practice and professionalism.

    PubMed

    Bouras, N; Ikkos, G

    2013-01-01

    Psychiatry, associated as it is with social and cultural factors, has undergone profound changes over the last 50 years. Values, attitudes, beliefs and ideology all influence psychiatry. Deinstitutionalisation, the normalization principle, advocacy, empowerment and the recovery model are ideologies that have been closely associated with policy, service developments and clinical practice in psychiatry. A "new professionalism" is emerging as a consequence of a number of changes in mental health care that needs to be guided by the highest standards of care which are best epitomized in psychiatry as a social contract with society. Looking to the future it is important that the profession recognises the impact ideology can make, if it is not to remain constantly on the defensive. In order to engage proactively and effectively with ideology as well as clinical science and evidence based service development, psychiatry as a profession will do best to approach significant future policy, practice and service changes by adopting an ethical approach, as a form a social contract. Psychiatrists must pay increasing attention to understanding values as expressed by ideologies, working in a collaborative way with other mental health professionals, involve service users and manage systems as well as be competent in clinical assessment and treatment. Whether in time of plenty or in times of deprivation, ideology produces effects on practice and in the context of constantly changing knowledge and the current financial stress this is likely to be more the case (and not less) in the foreseeable future. Psychiatrists must take into consideration the new social problems seen in some high income countries with the increased availability of highly potent "street drugs", perceived threats from various immigrant and minority communities and breakdown of "social capital" such as the decline of the nuclear family.

  8. Psychiatric Advance Directives in India: What will the future hold?

    PubMed

    Ratnam, Ashutosh; Rudra, Abhijit; Chatterjee, K; Das, R C

    2015-08-01

    Psychiatric Advance Directives (PADs) have been incorporated into India's Mental Health Care Bill, 2013. This is the first time any form of Advance Directive stands to receive legal sanction in India. PADs have numerous theoretical and empirically tenable therapeutic and financial advantages. Western experiences have shown high acceptance for the concept among psychiatric patients, and illustrated that most stable patients with severe mental illness retain the capacity to frame PADs consistent with community practice standards. However active psychopathology does impair this capacity, and therein, current subjective assessments of competence performed by Physicians without objective instruments are often inaccurate. Though PADs champion patient autonomy, when applied and studied, they have shown little significant advantage-there is currently not enough data to support evidence-based universal recommendations for PADs. PADs as incorporated into the Mental Health Care Bill model on existing Western statutes, and though many of the strengths of earlier systems have been subsumed, so have several of the shortcomings. The risks, benefits and applicability of PADs in India are complicated by the social re-calibration of patient autonomy, mental-healthcare delivery system weaknesses, and the relatively peripheral role the Psychiatrist is mandated to play in the entire advance directive process. Treating patients within the framework of their pre-stated wishes will be a much more intricate and arduous task than most of modern Psychiatric practice in India, but the difficulties, obstacles and inevitable failures encountered will provide evidence of the delivery system's weaknesses and thereby contribute to its strength. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. University Students' Views on the Utility of Psychiatric Advance Directives

    ERIC Educational Resources Information Center

    Scheyett, Anna M.; Rooks, Adrienne

    2012-01-01

    Objective: Rates of serious mental illnesses (SMIs) among university students are increasing, and universities are struggling with how to respond to students who show SMI symptoms. Psychiatric advance directives (PADs) allow individuals, when well, to document their wishes for treatment during a psychiatric crisis. This project explored the…

  10. Psychiatric Advance Directives and Social Workers: An Integrative Review

    ERIC Educational Resources Information Center

    Van Dorn, Richard A.; Scheyett, Anna; Swanson, Jeffrey W.; Swartz, Marvin S.

    2010-01-01

    Psychiatric advance directives (PADs) are legal documents that allow individuals to express their wishes for future psychiatric care and to authorize a legally appointed proxy to make decisions on their behalf during incapacitating crises. PADs are viewed as an alternative to the coercive interventions that sometimes accompany mental health crises…

  11. Teaching safe sex practices to psychiatric patients.

    PubMed

    Sladyk, K

    1990-03-01

    An occupational therapist presented her 45-minute program called AIDS Education and Safe Sex 5 times to female mental patients in the locked ward of Cedarcrest Regional Hospital in Newington, Connecticut, to inform them about safe-sex practices and AIDS. She first administered a pretest then spoke briefly about AIDS and safe-sex practices. The lecture emphasized various important points such as no cure for AIDS exist, casual contact (e.g., kiss on the cheek, handshake) cannot transmit HIV, and effectiveness of using latex condoms. The occupational therapist spent much of her time addressing myths about AIDS and what safe-sex practices are. The patients discussed sexual abuse and dishonest partners. She administered a posttest which was the same as the pretest. Some sessions attracted more people than did other sessions. Test scores increased for every patient and for every session. They ranged from a 5% (68-73%) increase for the 3rd session to a 24% (67-91%) increase for the last session. She was not able to determine, however, whether the increased knowledge would translate into positive behavioral changes. Patients' psychiatric symptoms may have interfered with learning resulting in less than ideal improvements in knowledge. These symptoms were hypomanic behavior, restlessness, and distractibility. Perhaps other sessions with experiential techniques (e.g., putting condoms on dummies) would increase their understanding. This program helps fill the information gap not provided by the mass media which avoid mentioning safe-sex practices.

  12. Psychiatric Advance Directives and Social Workers: An Integrative Review

    PubMed Central

    Van Dorn, Richard A.; Scheyett, Anna; Swanson, Jeffrey W.; Swartz, Marvin S.

    2013-01-01

    Psychiatric Advance Directives (PADs) are legal documents that allow individuals to express their wishes for future psychiatric care and to authorize a legally appointed proxy to make decisions on their behalf during incapacitating crises. PADs are viewed as an alternative to the coercive interventions that sometimes accompany mental health crises for persons with mental illness. Insofar as coercive interventions can abridge clients’ autonomy and self-determination -- values supported by the Profession’s Code of Ethics -- social workers have a vested interest in finding ways to reduce coercion and increase autonomy and self-determination in their practice. However, PADs are also viewed as having the potential to positively affect a variety of other clinical outcomes, including but not limited to treatment engagement, treatment satisfaction, and working alliance. This article reviews the clinical and legal history of PADs and empirical evidence for their implementation and effectiveness. Despite what should be an inherent interest in PADs, and the fact that laws authorizing PADs have proliferated in the past decade, there is little theoretical or empirical research in the social work literature. PMID:20408357

  13. [Philosophy of science for psychiatric practice].

    PubMed

    Ralston, A S G

    2010-01-01

    The prevailing view is that psychiatry has its roots in two separate methodologies: the natural sciences and the social sciences. It is assumed that these are separate domains, each with its own way of knowing. Psychiatric and psychological theories are based mainly on one or other of these two types of science; this leads to a ongoing dualism in psychiatry, which some people regard as problematical. This article aims to make a methodological contribution to the scientific and philosophical foundations of psychiatry. This philosophical and theoretical dichotomy is criticized in this article in the light of recent developments in the philosophy of science, and two methods are introduced which offer an alternative analysis: values-based practice and actor-network theory. Brief examples are given which demonstrate that a combination of these two methods can be productive for psychiatry. Values-based practice and actor-network theory provide a way of resolving the stalemate in the conflict between the physical sciences and the sciences of the mind, a conflict that is dominated by professionals. In addition these two new methods empower the professionals by not deriving legitimacy from the false image of a dichotomous science, but from a normative sense of professionalism.

  14. Advanced urology nursing practice.

    PubMed

    Crowe, Helen

    2014-03-01

    Urology nursing has developed as a specialty over the past few decades in response to several factors, workload demands being a prime reason. Nurses are taking on additional roles and activities including procedures such as cystoscopy and prostate biopsy, and running nurse-led clinics for a variety of urological conditions. Audits of advanced urological nursing practice have shown this care to be of a high standard and investigative procedures performed by these nurses match the diagnostic quality of existing services. Professional urological nursing organizations support the professional needs of these nurses, but the provision of education and training for advanced practice activities remains an unaddressed need. A range of confusing advanced urology nursing titles exists, and uncertainty regarding the roles and scope of practice for these nurses remains a concern. Acceptance and support from medical colleagues is required for the success of advanced urological nursing practice, but opinions on these roles remain divided.

  15. Advance directives in psychiatric care: a narrative approach

    PubMed Central

    Widdershoven, G.; Berghmans, R.

    2001-01-01

    Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives (or so-called "Ulysses contracts"), it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised. Ulysses contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition. Key Words: Medical ethics • narrative ethics • advance directives • psychiatry PMID:11314165

  16. Advancing advanced practice - clarifying the conceptual confusion.

    PubMed

    Stasa, Helen; Cashin, Andrew; Buckley, Thomas; Donoghue, Judith

    2014-03-01

    In recent years, there has been a substantial increase in the number of nurses holding advanced practice nursing positions. However, the lack of clarity regarding key terms such as 'advanced practice nursing', 'advanced nursing practice', 'scope of practice' and 'extended practice', and international variability in how these terms are used has created significant confusion. This lack of clarity is problematic for nurses, other health professionals, health service consumers, educators and policy makers, particularly given the global mobility of the nursing workforce. 1) To highlight the significant international variability in how advanced practice nursing, and associated terms such as extended and expanded practice, are defined and regulated across a variety of different English speaking countries, including the US, UK, New Zealand, Canada and Australia. 2) To propose innovative formulations for how the nursing profession may attempt to ensure greater precision and agreement around advanced practice terminology. Discursive paper. It was found that there is a considerable lack of clarity regarding the precise definitions of key terms surrounding the discussion of advanced practice. Additionally, there are large disparities in how the five chosen countries regulate advanced practice nursing, and roles such as that of the nurse practitioner. It is suggested that the confusion regarding advanced practice terminology can be reduced definitionally by minimising the use of the term 'expanded practice'; defining advanced practice nursing to refer to the type of practice in defined and regulated advanced practice nursing scopes; and defining advanced nursing practice as expert practice within a regulated nursing scope. © 2013.

  17. Cultural Competence in Child Psychiatric Practice

    ERIC Educational Resources Information Center

    Jellinek, Michael S.; Henderson, Schuyler W.

    2009-01-01

    The U.S. faces a changing demographic landscape that is increasingly multiracial. The application of a cultural competence model for assessing and treating the psychiatric disorders of minority youths in light of this demographic change is discussed.

  18. Competency for creation, use, and revocation of psychiatric advance directives.

    PubMed

    Srebnik, Debra S; Kim, Scott Y

    2006-01-01

    Psychiatric advance directives help promote patient involvement in treatment and expedite psychiatric care. However, clinicians are unsure of how to use directives, partly due to poor clarity regarding standards for capacity to create, use, and revoke them. This article recommends possible capacity standards. Capacity to create directives is a legal presumption, supported by empirical data. Standards are discussed for the subset of cases in which capacity assessment is needed. Use of directives may be triggered by incapacity to provide informed consent to treatment, although tailored, individualized points of activation may also be considered. In many states, revocation of a psychiatric advance directive requires adequate decision-making capacity. Setting a capacity standard for revocation presents challenges, however, in light of obstacles to providing treatment when revocation is attempted and the fact that many patients prefer revocable directives. As more directives are created and used, additional research and statutory refinements are warranted.

  19. Advance directives in psychiatric care: a narrative approach.

    PubMed

    Widdershoven, G; Berghmans, R

    2001-04-01

    Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives (or so-called "Ulysses contracts"), it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised. Ulysses contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition.

  20. Psychiatric epidemiology: selected recent advances and future directions.

    PubMed Central

    Kessler, R. C.

    2000-01-01

    Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations. PMID:10885165

  1. The Nursing Students' Experience of Psychiatric Practice in South Korea.

    PubMed

    Song, Eunju

    2015-10-01

    In 1995, South Korea passed the Mental Health Act, and since this time it has developed many mental health policies and facilities. The aim of this study is to understand and explore the experience of nursing students in the changed psychiatric practice environment since 1995. The present study is a qualitative thematic analysis. Interviews were conducted with 11 third and fourth grade nursing students who had experienced psychiatric practice in South Korea. A thematic analysis of 11 in-depth student interviews identified three themes: 'orientation before psychiatric practice', 'facing the mental hospital', and 'change and choice'. After practicing, nursing students developed positive attitude regarding psychiatry. Educators will have to focus more on education and support in order for the students to maintain positive attitude throughout their experience. The research herein shows that the role of the educators and psychiatric nurses is extremely important for nursing students in the elimination of a negative attitude towards psychiatry.

  2. Computer-assisted creation of psychiatric advance directives.

    PubMed

    Sherman, P S

    1998-08-01

    Results are reported from a project that involved design, production, and feasibility testing of the use of a multimedia computer program to: 1) educate MH consumers about psychiatric advance directives (ADs), and 2) assist them in creating ADs. The feasibility results, based on a random sample of 60 adults meeting criteria for having a serious and persistent mental illness, were positive. Sixty-five percent of the sample were able to complete their ADs. Educational level, presence of a learning disability, and minority-group membership, but not diagnosis, were related to completion rates. The results dispel several popular myths about psychiatric ADs.

  3. Psychobiotics: An emerging probiotic in psychiatric practice.

    PubMed

    Kali, Arunava

    2016-06-01

    Intestinal microbial flora plays critical role in maintenance of health. Probiotic organisms have been recognized as an essential therapeutic component in the treatment of intestinal dysbiosis. Current research suggests their health benefits extends beyond intestinal disorders. The neuroactive molecules produced by the gut microbiota has been found to modulate neural signals which affect neurological and psychiatric parameters like sleep, appetite, mood and cognition. Use of these novel probiotics opens up the possibility of restructuring of intestinal microbiota for effective management of various psychiatric disorders.

  4. Psychiatric Nurses' Attitude and Practice toward Physical Restraint.

    PubMed

    Mahmoud, Amal Sobhy

    2017-02-01

    This study was to assess psychiatric nurses' attitude and practice toward physical restraint among mentally ill patients. A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included. The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: The first comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses' attitudes toward physical restraint, and the third was used to assess nurses' practices regarding use of physical restraint. There were insignificant differences between attitudes and practices in relation to nurses' sex, level of education, years of experience and work place. Moreover, a positive significant correlation was found between nurses' total attitude scores, and practices regarding use of physical restraint. Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. About the practice of psychiatric euthanasia: a commentary.

    PubMed

    Lopez-Castroman, Jorge

    2017-06-27

    Euthanasia motivated by mental disorders is legal in only a few countries and has a short history. In a recent report of all psychiatric euthanasia cases in Belgium between 2002 and 2013, Dierickx and colleagues suggest that the number of these cases is increasing, and provide a profile of the applicants. To date, knowledge of the practice of psychiatric euthanasia is limited, but rising public awareness might increase the number of requests. The authors reveal several shortcomings in cases of psychiatric euthanasia and open avenues for future research.Please see related article: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1369-0.

  6. The social life of psychiatric practice: trauma in postwar Kosova.

    PubMed

    Kienzler, Hanna

    2012-01-01

    This article traces the social life of psychiatric practice in the context of war and postwar societies. It is argued that although psychiatric knowledge and practice is situated and grounded in particular cultural, social, and political contexts, it is important to examine how transnational networks situate local systems of meaning in much larger settings. I illustrate this claim by examining discourses and observations concerning health-seeking behaviors of Kosovar Albanian women and ways in which Kosovar health practitioners help them by employing, adapting, and changing the psychiatric tools and lessons learned during (trauma) training provided by international health professionals during the Yugoslav war and postwar eras. Thereby, I hope to contribute to a better understanding of how local health beliefs and practices are nested in the processes involved in international health policymaking and, thereby, relate to higher level structures such as international political economy, regional history, and development ideology.

  7. Different Places, Different Ideas: Reimagining Practice in American Psychiatric Nursing After World War II.

    PubMed

    Smith, Kylie M

    2018-01-01

    In 1952, Hildegard Peplau published her textbook Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. This was the same year the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (1st ed.; DSM-I; APA). These events occurred in the context of a rapidly changing policy and practice environment in the United States after World War II, where the passing of the National Mental Health Act in 1946 released vast amounts of funding for the establishment of the National Institute of Mental Health and the development of advanced educational programs for the mental health professions including nursing. This article explores the work of two nurse leaders, Hildegard Peplau and Dorothy Mereness, as they developed their respective graduate psychiatric nursing programs and sought to create new knowledge for psychiatric nursing that would facilitate the development of advanced nursing practice. Both nurses had strong ideas about what they felt this practice should look like and developed distinct and particular approaches to their respective programs. This reflected a common belief that it was only through nurse-led education that psychiatric nursing could shape its own practice and control its own future. At the same time, there are similarities in the thinking of Peplau and Mereness that demonstrate the link between the specific social context of mental health immediately after World War II and the development of modern psychiatric nursing. Psychiatric nurses were able to gain significant control of their own education and practice after the war, but this was not without a struggle and some limitations, which continue to impact on the profession today.

  8. Patterns of Psychiatric Outpatient Practice in Taiwan: A Nationwide Survey

    PubMed Central

    Dai, Ying-Xiu; Chen, Mu-Hong; Chen, Tzeng-Ji; Lin, Ming-Hwai

    2016-01-01

    (1) Background: Limited studies have utilized nationwide data to assess the patterns of psychiatric practice in other countries. In this study, data from the National Health Insurance Research Database in Taiwan (NHIRD-TW) for 2012 was analyzed to determine the patterns of psychiatric outpatient practice in Taiwan; (2) Methods: To determine the patterns of psychiatric outpatient practice in Taiwan, the data were drawn from the datasets of Taiwan’s National Health Insurance Research Database for 2012, with 619,760 records of outpatient visits representing 1/500 of all the claims in Taiwan for that year. The analysis of psychiatric outpatient visits included patient demographics, diagnoses, and prescribed medications; (3) Results: Neurotic disorders were the most prevalent diagnoses (43.1%, n = 5714). Hypnotics-sedatives and anxiolytics were prescribed in 51.7% (n = 6850) and 39.1% (n = 5181) of psychiatric visits, respectively, with zolpidem being the most commonly prescribed drug (22.6%, n = 2998); and (4) Conclusion: Hypnotics and sedatives were widely prescribed for the outpatient population, and zolpidem had the highest annual prevalence of use. These findings deserve the attention of clinicians and policy makers for monitoring the abuse and dependence of these agents and subsequent adverse events. PMID:27690067

  9. Educational assessment of general practice experience for psychiatric trainees.

    PubMed

    Burns, T; MacDonald, L; Sibbald, B; Gask, L; Roberts, G

    1995-03-01

    Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at a baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitation of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.

  10. Students with Psychiatric Disabilities: An Exploratory Study of Program Practices

    ERIC Educational Resources Information Center

    GlenMaye, Linnea F.; Bolin, Brien

    2007-01-01

    This article presents findings of an exploratory study addressing social work program practices regarding psychiatric disabilities among social work students. An e-mail invitation to participate in an online survey was sent to approximately 875 social work educators, with 71 individuals choosing to participate. The findings indicated that 88% of…

  11. Psychiatric Nursing Faculty Practice: Care within the Community Context.

    ERIC Educational Resources Information Center

    Richie, Mary Fern; And Others

    1996-01-01

    Psychiatric nursing faculty practice offers the academic nurse opportunity to generate salary support and integrate students into the real world of mental health care. It promotes scholarship and knowledge-building and has a direct impact on the lives of patients. (Author/JOW)

  12. Barriers to practice and impact on care: an analysis of the psychiatric mental health nurse practitioner role.

    PubMed

    Muxworthy, Heather; Bowllan, Nancy

    2011-01-01

    This paper is a retrospective review of the literature analyzing the role of the psychiatric mental health nurse practitioner in the community. Presented here is an appraisal of national and state mental health initiatives. Professional nursing regulations are reviewed, focusing on New York State advanced practice nursing. Barriers to practice are assessed with discussion on how barriers, such as statutory collaboration, impede access to treatment in the community for mentally ill psychiatric patients. The current New York State legislative agenda is featured. Clinical vignettes from a nurse practitioner's private community practice are presented to introduce and conclude how clinical practice barriers impede autonomous practice.

  13. Evaluation of outcomes in Psychiatric Consultation-Liaison Nursing practice.

    PubMed

    Yakimo, Richard; Kurlowicz, Lenore H; Murray, Ruth Beckmann

    2004-12-01

    This report describes and evaluates the current status of outcome analysis in Psychiatric Consultation-Liaison Nursing (PCLN) and offers suggestions for future development. The status of outcome evaluation generally in psychiatric nursing is described with attention given to the scope of practice of PCLN and outcomes used by psychiatric consultation-liaison nurses (PCLNs) to evaluate their interventions. An evaluation framework based on Donabedian's paradigm of structure, process, and outcome is presented and its applicability shown to PCLN. This framework is further explicated with regard to a review of published studies of PCLN within the outcome domains of cost reduction, satisfaction with services, changes in clinical status, and perceptions of work environment. Finally, recommendations for further development of outcomes in PCLN are offered, based on the strengths and limitations of the extant literature.

  14. Implementing psychiatric advance directives: service provider issues and answers.

    PubMed

    Srebnik, Debra; Brodoff, Lisa

    2003-01-01

    Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to document treatment preferences in advance of periods of incapacity. This article presents and responds to issues most frequently raised by service providers when planning for implementation of PADs. Issues discussed include access to PADs; competency to execute PADs; the relationship of PADs to standards of care, resource availability, and involuntary treatment; roles of service providers and others in execution of PADs; timeliness and redundancy of PAD information; consumer expectations of PADs; complexity of PADs; revocation and "activation"; legal enforceability of PADs; the role and powers of agents; liability for honoring and not honoring PADs; and use of PADs to consent for release of health care information. Recommendations are made for training staff and consumers, consideration of statute development, and methods to reduce logistical, attitudinal, and system barriers to effective use of PADs.

  15. Understanding the domestic rupture in forensic psychiatric nursing practice.

    PubMed

    Jacob, Jean Daniel

    2014-01-01

    The objective of this article is to examine the tensions that exist between care and custody in correctional environments by presenting the (im)possibilities of psychiatric nursing practice within this context. The analysis will be guided by empirical data obtained from a qualitative research conducted in a correctional setting. Semistructured interviews with nurses were conducted and used as the primary source of data for analysis. This article will explore the contextual characteristics of psychiatric nursing practice in correctional settings, describe the alienating effects of this context on nursing practice, theorize nurses' experience using Festinger's theory on cognitive dissonance, and, finally, explore how some nurses engage in the reconstruction of their care to counter the effects of working in correctional settings.

  16. An existential understanding of psychotherapy and psychiatric practice.

    PubMed

    Schlimme, Jann E

    2013-01-01

    In this paper Karl Jaspers' writings on psychotherapy and the psychiatric practice will be profoundly investigated and a meticulous reconstruction of the development of his understandings in the course of his oeuvre will be presented. This reconstruction allows for arguing that Jaspers displays a methodologically critical attitude towards medicine as a 'science of actions' and that he did refrain from developing an existential psychotherapy for methodological and existential reasons. Nonetheless and aside from Jaspers' abstention, some of his concepts from existential philosophy, like 'Grenzsituation' (border-situation, limit-situation) or 'Gehäuse' (shell, housings), can be extraordinarily fruitful in psychotherapy and in the psychiatric practice because it requires a change of attitude in order to bring these concepts into play. This different attitude could be called the attitude of the fellow sufferer, or, more neutral, the attitude of the fellow human being. © 2013 S. Karger AG, Basel

  17. Psychiatric advance directives in Australian mental-health legislation.

    PubMed

    Ouliaris, Calina; Kealy-Bateman, Warren

    2017-09-01

    Following the recent widespread reform of mental-health legislation in Australia, psychiatric advance directives (PADs) have now been incorporated in four jurisdictions. We contextualise the potential role for PADs within the Australian legal framework and note their varying introduction across jurisdictions, with a focus on progressive legislation in the Australian Capital Territory (ACT). The formal recognition of PADs effectively shifts the trajectory of mental-health law towards a stronger recognition of consumer autonomy, albeit to varying degrees across jurisdictions. The most inspiring of these changes may be seen in the ACT Act, where an innovative framing of PAD provisions creates a safe space for clinicians and patients to engage, build therapeutic alliances and develop appropriate frameworks for further change.

  18. Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital

    PubMed Central

    Trigoboff, Eileen; Opler, Lewis; Demler, Tammie Lee

    2016-01-01

    Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital. PMID:27803841

  19. Variations in Consumer Self-Determination within US Psychiatric Advance Directives

    ERIC Educational Resources Information Center

    Zeman, Laura Dreuth; Swanke, Jayme

    2008-01-01

    Advance directives are legal documents that formalize consumer psychiatric care preferences. This article examines the statutes and goals of US psychiatric advance directives within the framework of consumer self-determination, a priority in national mental health reform. It seeks to distinguish between state models based on the degree that…

  20. Developing practice protocols for advanced practice nursing.

    PubMed

    Paul, S

    1999-08-01

    In most states, the role of an advanced practice nurse is dependent on practice protocols that provide an organized method for analyzing and managing a disease or major symptom. They are also used to control the process of medical care and to specify steps in the delivery of that care. Creating appropriate practice protocols is one of the most important precursors to implementing the advanced practice role, because they virtually drive the clinician's ability to treat or manage clinical situations or disease states. This article outlines the steps involved in developing practice protocols and discusses the content that should be included in a protocol, providing an example of narrative and algorithm format protocols. Pros and cons, as well as legal issues related to practice protocols, are also presented.

  1. Best practices: environmental and therapeutic issues in psychiatric hospital design: toward best practices.

    PubMed

    Karlin, Bradley E; Zeiss, Robert A

    2006-10-01

    The psychiatric hospital environment plays a significant, though often underappreciated, role in patient and staff functioning. This column reviews the literature on important environmental and therapeutic issues in psychiatric hospital design. Research findings and clinical conjecture reported over the past 50 years indicate that intervening environmentally through clinically informed, patient-centered design can improve functioning both among and between patients and staff. This column identifies specific best practice considerations and recommendations for designing inpatient psychiatric facilities and may serve as a useful planning resource to those interested in adopting a patient-centered, inclusive approach to design and treatment.

  2. Preparation for Advanced Nursing Practice.

    ERIC Educational Resources Information Center

    Frik, Seigina M.; Pollock, Susan E.

    1993-01-01

    Lehman College's graduate nursing program uses theory-based courses to prepare advanced nurse practitioners. Students increase scholarly inquiry skills and clinical decision making; use of nursing conceptual models helped them plan and evaluate their practice. (SK)

  3. Mindfulness meditation practices as adjunctive treatments for psychiatric disorders.

    PubMed

    Marchand, William R

    2013-03-01

    Mindfulness meditation-based therapies are being increasingly used as interventions for psychiatric disorders. Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have been studied extensively. MBSR is beneficial for general psychological health and pain management. MBCT is recommended as an adjunctive treatment for unipolar depression. Both MBSR and MBCT have efficacy for anxiety symptoms. Informed clinicians can do much to support their patients who are receiving mindfulness training. This review provides information needed by clinicians to help patients maximize the benefits of mindfulness training and develop an enduring meditation practice. Published by Elsevier Inc.

  4. Culture and history in psychiatric diagnosis and practice.

    PubMed

    Fàbrega, H

    2001-09-01

    out their lives, phenomena that are critical to the expression, interpretation, diagnosis, and treatment of psychiatric disorders. That the science and practice of modern psychiatry incorporate an ethnocentric, Anglo European bias or slant on psychopathology is an integral assumption of cultural psychiatry. By describing how other non-Western systems of psychiatry have operated, for example, their theories and practices, one gains a further appreciation of the important role of culture in shaping Western psychiatry. This is taken up in an article by Fàbrega elsewhere in this issue where concepts and practices of traditional Chinese and Indian medicine that pertain to mental health and illness are reviewed.

  5. Use of empathy in psychiatric practice: constructivist grounded theory study

    PubMed Central

    Watling, Chris

    2017-01-01

    Background Psychiatry has faced significant criticism for overreliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and medications with purported disregard for empathetic, humanistic interventions. Aims To develop an empirically based qualitative theory explaining how psychiatrists use empathy in day-to-day practice, to inform practice and teaching approaches. Method This study used constructivist grounded theory methodology to ask (a) ‘How do psychiatrists understand and use empathetic engagement in the day-to-day practice of psychiatry?’ and (b) ‘How do psychiatrists learn and teach the skills of empathetic engagement?’ The authors interviewed 17 academic psychiatrists and 4 residents and developed a theory by iterative coding of the collected data. Results This constructivist grounded theory of empathetic engagement in psychiatric practice considered three major elements: relational empathy, transactional empathy and instrumental empathy. As one moves from relational empathy through transactional empathy to instrumental empathy, the actions of the psychiatrist become more deliberate and interventional. Conclusions Participants were described by empathy-based interventions which are presented in a theory of ’empathetic engagement’. This is in contrast to a paradigm that sees psychiatry as purely based on neurobiological interventions, with psychotherapy and interpersonal interventions as completely separate activities from day-to-day psychiatric practice. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28243463

  6. Psychiatric disabilities and the Americans with Disabilities Act: implications for policy and practice.

    PubMed

    Pardeck, J T

    1998-01-01

    People with psychiatric disabilities are often victims of job discrimination. The Americans with Disabilities Act (ADA) of 1990 makes it very clear that job discrimination based on a psychiatric impairment is illegal. The Equal Employment Opportunity Commission (EEOC) reports that psychiatric disability is one of the leading causes why persons file discrimination complaints. Given this situation, an analysis is offered of what constitutes a psychiatric disability under the ADA. An overview, an analysis, and examples of the kinds of accommodations employers can be expected to provide people with psychiatric disabilities are offered. The policy and practice implications of the employment provisions (Title I) in the area of psychiatric disabilities are presented.

  7. [Preliminary reports on psychiatric practice in correctional facilities].

    PubMed

    Hirata, Toyoaki; Nakajima, Naoshi; Yoshioka, Ryuichi; Iimori, Makio; Itoh, Tetsuhiro; Okae, Akira; Oda, Tatsuro; Ohara, Motoo; Katsuragawa, Syuichi; Kawazoe, Yasunari; Shiraishi, Hiromi; Tsukada, Kazumi; Nagao, Takuo; Hara, Takashi; Hirano, Makoto; Hirayasu, Yoshio; Matsubara, Saburo; Miura, Isao; Yamazumi, Syun; Moriyama, Kimio

    2004-01-01

    In October 2001, Nanashakon, a council composed of seven psychiatry-related organizations in Japan, decided to launch an investigation into forensic psychiatry in Japan, and established a working team (WT) for this purpose. From its establishment to March 2004, the WT performed surveys and analyses of the current situation of preliminary reports by psychiatric experts (preliminary reports) and of psychiatric practice in correctional facilities. Based on the results, the WT has presented proposals including guidelines for preliminary reports. In January 2002, the WT conducted an awareness survey on the status quo of testimony by psychiatric experts and forensic psychiatry, targeting the members of the Japanese Society of Psychiatry and Neurology, and obtained 666 replies. The survey revealed various critical opinions such as skepticism over the current punishment imposed on criminal patients with mental disorders. In February 2002, the WT obtained data on preliminary reports (2,042 cases) compiled prior to prosecution in FY2000 from the Japanese Ministry of Justice. Reviewing the details and differences between the evaluation by psychiatrists and the decision by public prosecutors, the WT pointed out the ambiguity of criteria used for the evaluation of competency of weak-minded persons and the criteria for criminal punishment. Around the same time, the WT was also asked by a news agency to analyze the preliminary reports of 50 district public prosecutor offices. The results revealed marked regional differences in the operation of the preliminary evaluation system for competency. In January 2003, the WT collected 146 preliminary reports from around the country for comparison and review, and again found conspicuous individual and regional discrepancies in the format and content. Based on these results, the WT conducted a hearing of 41 expert opinions on preliminary reports, and in January 2004, proposed guidelines outlining a format model of preliminary reports, and a

  8. [The practice guideline 'Consultation psychiatry' of the Dutch Psychiatric Association for psychiatric consultations in primary care and the hospital].

    PubMed

    Leentjens, A F G; van der Feltz-Cornelis, C M; Boenink, A D; van Everdingen, J J E

    2008-08-30

    Psychiatric consultation in primary care as well as in the hospital is both effective and cost-effective if certain procedures are followed. With the professional guideline 'Consultation psychiatry', the Dutch Psychiatric Association aims at setting a standard for psychiatric consultations in non-psychiatric settings. In general practice, the psychiatric consultation is preferably embedded in 'collaborative care', an integrated care model including the general practitioner and a case manager (usually a nurse), with the consultant psychiatrist being regularly available for clearly defined indications. The psychiatrist should see the patient himself or herself, establish a diagnosis and treatment plan, and provide the general practitioner and the patient with a so-called 'consultation letter', which is then discussed with both. In a general hospital, systematic screening of patients at risk of psychiatric comorbidity can be organised. Early detection of complex patients can further improve the effectiveness of psychiatric consultation. Follow-up contacts and investing in liaison contacts improve adherence to the advice provided.

  9. Private practice--an advanced practice option.

    PubMed

    Wilson, Anne; Jarman, Heather

    2002-10-01

    Currently there is considerable debate on the role and function of nurses in Australia and internationally. This debate stems from developments within the nursing profession itself from political and economic issues in health platforms, due to restructuring of the health care system, consumer expectations of health care and nurses' expectations of a career. This paper provides the opportunity to reflect on the development of the role of the private practice (independent nurse) and where that role is situated in the nursing profession. This forms the basis for discussion of the development of specialty practice at an advanced level in Australia and to demonstrate its relationship with the nurse practitioner movement in Australia.

  10. [Psychiatric occupational therapy practice in Shinshu University Hospital--collaboration with psychiatrist].

    PubMed

    Kobayashi, Masayoshi; Fukushmima, Sachie; Kawano, Koujiro; Ohnishi, Ayumi; Ogiwara, Tomomi; Hagiwara, Tetsuya; Takahashi, Toru; Washizuka, Shinsuke; Amano, Naoji

    2011-01-01

    This report describes psychiatric occupational therapy practice and collaboration between occupational therapists and psychiatrists at Shinshu University Hospital. Collaboration with psychiatrists enables us to provide the following occupational therapy programs. (1) Individual occupational therapy approaches for patients at the early recovery stage in the psychiatric ward. (2) Psychoeducational interventions by a multi-disciplinary team (MDs, nurses, OTRs, PSWs, CPs). (3) Occupational therapy approaches used in combination with m-ECT for severe psychiatric disorders. (4) Recovery support programs for psychiatric outpatients. It is suggested that occupational therapists should collaborate with psychiatrists in order to facilitate rehabilitation services for people with psychiatric disorders.

  11. Indian Psychiatric Society Survey on Clinical Practice Guidelines

    PubMed Central

    Grover, Sandeep; Avasthi, Ajit

    2017-01-01

    Aim: This survey aimed to assess the utility of the earlier published clinical practice guidelines (CPGs) by IPS and to understand the expectations of members of Indian Psychiatric Society from the proposed revised CPGs. In addition, the survey also evaluated the current level of practice of psychiatry in terms of availability of different investigation facilities, prescription patterns in terms of use of polypharmacy, and competence in carrying out certain nonpharmacological treatments. Methodology: An online survey was received by 3475 psychiatrist, of whom 608 (17.5%) participants completed the survey. Results: Almost all (93.8%) of the psychiatrists agreed that there should be separate CPGs for Indian setting. In terms of problems with the previous version of the CPGs, this survey shows that the previous version of guidelines was used in making clinical decisions by only one-third (31.25%) of the participating psychiatrists. The major limitations of the previous version of CPGs which were pointed out included the lack of consideration of socio-cultural issues (33.2%), lack of recommendations for many clinical situations that are encountered in clinical practice (43.15) and poor dissemination (35.2%). In terms of expectations, the membership expects the society to come up with guidelines, which are shorter in length (82.2%), has significant proportion of information in the form of tables and flow diagrams (58.7%), besides the evidence base must also take expert opinions into account (84.7%), must be circulated before adopting (88.7%), must be disseminated by displaying the same on the website (72%), and also by sending the same by E-mails (62%). Further, the membership expects the IPS to design online continuing medical education program on CPGs (54.3%). The survey also suggests that it is feasible on the part of more than two-third of the psychiatrists to monitor the metabolic parameters in routine clinical practice and carryout various nonpharmacological

  12. Psychiatric neural networks and neuropharmacology: Selected advances and novel implications

    PubMed Central

    Ghanemi, Abdelaziz

    2013-01-01

    Psychiatric disorders are often considered as simple imbalances between a limited number of cerebral neurotransmitters. In fact, it is more complicated than this “simple approach” and each psychiatric disorder constitutes network dysfunction within which several agents and factors are implicated. Thus, the therapeutical perspectives and implications are as vast and as numerous as the diversity of those network dysfunctions. Furthermore, the description of factors influencing diseases prognoses and treatment efficacy indicates new elements to consider both in therapies and drug researches. PMID:24648819

  13. Supported education for adults with psychiatric disabilities: an innovation for social work and psychosocial rehabilitation practice.

    PubMed

    Mowbray, Carol T; Collins, Mary E; Bellamy, Chyrell D; Megivern, Deborah A; Bybee, Deborah; Szilvagyi, Steve

    2005-01-01

    With medications that improve cognition and advances in knowledge of successful rehabilitative approaches, adults with psychiatric disabilities are increasingly able to pursue desired personal and career goals in their communities. This article focuses on supported education (SEd)-one of the newest psychosocial rehabilitation (PSR) models for adults with mental illness. The mission, principles, and service components of SEd are presented, reflecting its basis in PSR practice. Evidence of the effectiveness of supported education, based on research and evaluation studies, is provided. The authors conclude with a discussion of why PSR and SEd are important to social work and how social workers can effectively use this evidence-based practice to maximize opportunities for consumers with a mental illness.

  14. Walking on the sunny side: what positive psychology can contribute to psychiatric rehabilitation concepts and practice.

    PubMed

    Moran, Galia S; Nemec, Patricia B

    2013-09-01

    This article suggests a positive psychology framework to strengthen and broaden psychiatric rehabilitation and recovery thought and practice. We inform about positive psychology concepts and measures that can be used to further knowledge, enhance practice, and guide research. Foundational concepts are drawn from the published literature. Specific positive psychology concepts and measures are highlighted: complete mental health, well being, flourishing, positive emotions, flow, self-determination, posttraumatic growth, and resilience. Employing a positive psychology framework can advance research on recovery phenomena and be used to assess rehabilitation outcomes. In addition we advocate positive psychology interventions in education and training of service providers that will enhance a positive focus and the culture of recovery. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  15. Jail administrators' perceptions of the use of psychiatric advance directives in jails.

    PubMed

    Scheyett, Anna M; Vaughn, Jennifer S; Francis, Annie M

    2010-04-01

    Individuals with serious mental illnesses are at high risk of incarceration. Jails are often unable to obtain information needed to provide appropriate care. Psychiatric advance directives may be useful tools to communicate treatment information to jails. This study explored their use as a novel intervention for individuals with mental illnesses in jails. Eighty jail administrators in North Carolina were surveyed to determine their support for psychiatric advance directives in jails. Relationships between respondents' job type (jail administrator or medical administrator) or jail census and support for the directives were examined by using chi square tests. Open-ended responses were analyzed using qualitative methods. Seventy-three percent of respondents indicated they supported psychiatric advance directives. Respondents from jails at or below a median census of 120 were significantly more likely to support psychiatric advance directives than those from larger jails. Psychiatric advance directives' informational function may prove valuable in jail settings. Additional research assessing directives as interventions for individuals with mental illnesses at risk of incarceration is needed.

  16. Users' and health professionals' values in relation to a psychiatric intervention: the case of psychiatric advance directives.

    PubMed

    Nicaise, P; Soto, V E; Dubois, V; Lorant, V

    2015-07-01

    Although clinical and organisational benefits have been expected from Psychiatric Advance Directives (PADs), their take-up rates remain low and their evaluation disappointing. The endorsement of PADs by stakeholders is decisive for their use and understanding stakeholders' preferences for implementation is crucial. A Multinomial Discrete Choice analysis was carried out of options for designing, completing, and honouring PADs, with a view to enhancing user autonomy, therapeutic alliance, care coordination, and feasibility. Although autonomy underlies the whole process, the criteria determining options varied with the stage of the intervention. These criteria should be taken into account in future PAD intervention and evaluation processes.

  17. [The safety of herbal medicines in the psychiatric practice].

    PubMed

    Boniel, T; Dannon, P

    2001-08-01

    The use of alternative medicines is increasing world-wide and in Israel. These drugs, considered by the Ministry of Health as food supplements, are to be obtained at pharmacies and health stores and are being sold freely, without any professional advice. Many of the herbs are used by patients to treat psychiatric disorders. These herbs have a pharmacological activity, adverse effects and interactions with conventional drugs, which can produce changes in mood, cognition, and behavior. We present the most commonly used herbal drugs, and discuss their safety and efficacy in psychiatric practice. Hypericum--used as an antidepressant and as an antiviral medicine, was reported in 23 randomized clinical trials reviewed from the MEDLINE. It was found to be significantly more effective than placebo and had a similar level of effectiveness as standard antidepressants. Recent studies almost clearly prove that this herb, like most of the conventional antidepressants, can induce mania. Valerian--is used as an anti-anxiety drug, and reported to have sedative as well as antidepressant properties. In contrast to the significant improvement in sleep that was found with the use of valerian, compared to placebo, there are several reports on the valerian root toxicity. This includes nephrotoxicity, headaches, chest tightness, mydriasis, abdominal pain, and tremor of the hands and feet. Ginseng--another plant that is widely used as an aphrodisiac and a stimulant. It has been associated with the occurrence of vaginal bleeding, mastalgia, mental status changes and Stevens-Johnson syndrome after it's chronic administration. It has interactions with digoxin, phenelzine and warfarin. Ginkgo--in clinical trials the ginkgo extract has shown a significant improvement in symptoms such as memory loss, difficulties in concentration, fatigue, anxiety, and depressed mood. Long-term use has been associated with increased bleeding time and spontaneous hemorrhage. Ginkgo should be used cautiously in

  18. The Practice of Psychiatry in the 21st Century: Challenges for Psychiatric Education

    ERIC Educational Resources Information Center

    Yager, Joel

    2011-01-01

    Objective: To consider how shifting scientific, technological, social, and financial pressures are likely to significantly alter psychiatric practice, careers, and education in the 21st century, this article reviews trends and innovations likely to have an effect on tomorrow's psychiatrists and their educators. Results: The psychiatric profession…

  19. The Practice of Psychiatry in the 21st Century: Challenges for Psychiatric Education

    ERIC Educational Resources Information Center

    Yager, Joel

    2011-01-01

    Objective: To consider how shifting scientific, technological, social, and financial pressures are likely to significantly alter psychiatric practice, careers, and education in the 21st century, this article reviews trends and innovations likely to have an effect on tomorrow's psychiatrists and their educators. Results: The psychiatric profession…

  20. Traditional Healing Practices Sought by Muslim Psychiatric Patients in Lahore, Pakistan

    ERIC Educational Resources Information Center

    Farooqi, Yasmin Nilofer

    2006-01-01

    This research explored the type of traditional healing practices sought by Muslim psychiatric patients treated at public hospitals of Lahore city, Pakistan. The sample comprised 87 adult psychiatric patients (38% male and 62% female). The patients self-reported on the Case History Interview Schedule that they had sought diverse traditional healing…

  1. Traditional Healing Practices Sought by Muslim Psychiatric Patients in Lahore, Pakistan

    ERIC Educational Resources Information Center

    Farooqi, Yasmin Nilofer

    2006-01-01

    This research explored the type of traditional healing practices sought by Muslim psychiatric patients treated at public hospitals of Lahore city, Pakistan. The sample comprised 87 adult psychiatric patients (38% male and 62% female). The patients self-reported on the Case History Interview Schedule that they had sought diverse traditional healing…

  2. Mental Health In-Service Training; Some Practical Guidelines for the Psychiatric Consultant.

    ERIC Educational Resources Information Center

    Parker, Beulah

    Based on the author's personal observations and opinions as a former public health psychiatric consultant, this book offers a theoretical orientation and practical guidelines for psychiatrists, analysts, clinical psychologists, psychiatric social workers, and others who hope to participate in community psychiatry as mental health consultants to…

  3. A Window into the Brain: Advances in Psychiatric fMRI

    PubMed Central

    Zhan, Xiaoyan; Yu, Rongjun

    2015-01-01

    Functional magnetic resonance imaging (fMRI) plays a key role in modern psychiatric research. It provides a means to assay differences in brain systems that underlie psychiatric illness, treatment response, and properties of brain structure and function that convey risk factor for mental diseases. Here we review recent advances in fMRI methods in general use and progress made in understanding the neural basis of mental illness. Drawing on concepts and findings from psychiatric fMRI, we propose that mental illness may not be associated with abnormalities in specific local regions but rather corresponds to variation in the overall organization of functional communication throughout the brain network. Future research may need to integrate neuroimaging information drawn from different analysis methods and delineate spatial and temporal patterns of brain responses that are specific to certain types of psychiatric disorders. PMID:26413531

  4. Staying Awake and Aware: The Importance of Sleep in Psychiatric Nursing Practice.

    PubMed

    Tobin, Thomas; Tobin, Mary L

    2017-07-26

    Given that approximately 70 million Americans suffer from sleep-wake disorders and their under-recognized role in practice, psychiatric nurses may see, or may be already seeing, patients with undiagnosed sleep disorders. Assessment of sleep-wake disorders can and should be a part of psychiatric nursing education and practice. Many practicing clinicians lack formal training regarding sleep-wake issues and treatment. Even as sleep disturbances are common concerns among psychiatric populations, sleep-wake issues may go unrecognized. The article presents a stylized progression of care to enable clinicians to identify, address, and treat underlying sleep-wake disorders in psychiatric settings. The article recommends instituting screening procedures for sleep-wake issues and follow-up assessments, particularly overnight pulse oximetry and polysomnograms. Just as clinicians already screen for physical conditions that would affect psychiatric care, practitioners can evaluate patients for potential sleep-wake disorders as part of their existing practice and intake procedures. Further, the piece details implications for psychopharmacology as well as evidence from clinical practice. Psychiatric nurses should stay awake to the importance of sleep medicine and aware of how sleep-wake disorders can affect psychiatric populations.

  5. Relationship of comorbid substance and alcohol use disorders to disability among patients in routine psychiatric practice.

    PubMed

    Wilk, Joshua; West, Joyce C; Rae, Donald S; Regier, Darrel A

    2006-01-01

    The primary aim of this study was to present data on the relationship of mental and comorbid substance use disorders to work disability and functioning in routine psychiatric practice in the United States. Data were used from the 1997 and 1999 American Psychiatric Institute for Research and Education's Practice Research Network Study of Psychiatric Patients and Treatments, totaling 754 psychiatrists and 3,088 patients. Results found patients with comorbid substance use disorders had significantly higher rates of work disability. These findings highlight the critical need to address the disturbing lack of substance use treatment and rehabilitation services for this population.

  6. An ontological view of advanced practice nursing.

    PubMed

    Arslanian-Engoren, Cynthia; Hicks, Frank D; Whall, Ann L; Algase, Donna L

    2005-01-01

    Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.

  7. Psychiatric Resident and Attending Diagnostic and Prescribing Practices

    ERIC Educational Resources Information Center

    Tripp, Adam C.; Schwartz, Thomas L.

    2008-01-01

    Objective: This study investigates whether two patient population groups, under resident or attending treatment, are equivalent or different in the distribution of patient characteristics, diagnoses, or pharmacotherapy. Methods: Demographic data, psychiatric diagnoses, and pharmacotherapy data were collected for 100 random patient charts of…

  8. Malaysian child psychiatric practice: a pragmatic and rational approach.

    PubMed

    Yeoh, K L; Ong, S B

    1982-06-01

    A pragmatic and rational approach to the management of five child psychiatric cases in Malaysia is briefly reviewed. The significance of sociocultural factors in treating these cases within the context of a rapidly developing plural society is emphasized. The implications of overemphasis on educational and material achievements are noted.

  9. Psychiatric Resident and Attending Diagnostic and Prescribing Practices

    ERIC Educational Resources Information Center

    Tripp, Adam C.; Schwartz, Thomas L.

    2008-01-01

    Objective: This study investigates whether two patient population groups, under resident or attending treatment, are equivalent or different in the distribution of patient characteristics, diagnoses, or pharmacotherapy. Methods: Demographic data, psychiatric diagnoses, and pharmacotherapy data were collected for 100 random patient charts of…

  10. NIH Roundtable on Opportunities to Advance Research on Neurologic and Psychiatric Emergencies.

    PubMed

    D'Onofrio, Gail; Jauch, Edward; Jagoda, Andrew; Allen, Michael H; Anglin, Deirdre; Barsan, William G; Berger, Rachel P; Bobrow, Bentley J; Boudreaux, Edwin D; Bushnell, Cheryl; Chan, Yu-Feng; Currier, Glenn; Eggly, Susan; Ichord, Rebecca; Larkin, Gregory L; Laskowitz, Daniel; Neumar, Robert W; Newman-Toker, David E; Quinn, James; Shear, Katherine; Todd, Knox H; Zatzick, Douglas

    2010-11-01

    for development of (1) a research infrastructure for the rapid identification, consent, and tracking of research subjects that incorporates innovative informatics technologies, essential for future research; (2) diagnostic strategies and tools necessary to understand key populations and the process of medical decisionmaking, including the investigation of the pathobiology of symptoms and symptom-oriented therapies; (3) collaborative research networks to provide unique opportunities to form partnerships, leverage patient cohorts and clinical and financial resources, and share data; (4) formal research training programs integral for creating new knowledge and advancing the science and practice of emergency medicine; and (5) recognition that emergency care is part of an integrated system from emergency medical services dispatch to discharge. The NIH Roundtable "Opportunities to Advance Research on Neurological and Psychiatric Emergencies" created a framework to guide future emergency medicine-based research initiatives. Emergency departments provide the portal of access to the health care system for most patients with acute neurologic and psychiatric illness. Emergency physicians and colleagues are primed to investigate neurologic and psychiatric emergencies that will directly improve the delivery of care and patient outcomes. Copyright © 2010. Published by Mosby, Inc.

  11. Clinical practice opportunities for advanced practice nurses.

    PubMed

    Marfell, Julie A

    2002-09-01

    With approximately 132,000 practicing APNs and a continued need for APNs, the role will continue to expand. Many different business options and models for healthcare practice exist for the APN. Commonly thought of professional practice options for APNs include private practice, joint or collaborative practice, and group practice. Each model of professional practice brings with it different roles and responsibilities, rewards and challenges, and criteria for success. When evaluating different practice opportunities. APNs must be aware of each of these factors and evaluate each factor based on his or her chosen lifestyle. This article has presented an overview of common practice models and the roles and responsibilities, challenges and rewards, criteria for success, and lifestyle considerations inherent in each.

  12. National agenda for advanced practice nursing: the practice doctorate.

    PubMed

    Clinton, Patricia; Sperhac, Arlene M

    2006-01-01

    The purpose of this article was to provide the background and rationale for the practice doctorate in nursing. The American Association of Colleges of Nursing's Position Statement on the Practice Doctorate in Nursing, approved in October 2004, will be discussed. Outlined are some of the changes that will be needed in education, regulation, and advanced practice. Common questions and concerns that advanced practice nurses have, including titling, salary, and transitioning to the doctor of nursing practice degree, will be addressed.

  13. Herbals and natural dietary supplements in psychiatric practice.

    PubMed

    Chiappedi, Matteo; Bejor, Maurizio

    2010-06-01

    There is some evidence that links the increase of mental disorders' prevalence with a deterioration of Western countries' nutritional habits and it is found that the use of herbal and "natural" food supplements to treat different disorders is increasing. With factors such as chronic illness, poor health, emotional distress, and quality of life influencing the desire for complementary medicine, patients with comorbid medical and psychiatric problems seem likely to turn to this approach. We reviewed the most commonly used herbal and dietary supplements for which a certain efficacy on psychiatric symptoms or disorders has been claimed, checking current Pubmed-indexed literature (the most important being St. John's wort, Omega-3 fatty acids, valerian, Kava, Ginkgo, folate, B vitamins, SAMe, Inositol). There is an evidence of efficacy for some of these herbs an supplements, but current studies are often insufficient to reach a final conclusion; still patents are being requested and registered. Many different areas (including efficacy, tolerability, optimal dosing, adequate shelf life, drug and non-pharmacological interactions) need to be thoroughly studied; moreover political decisions need to be scientifically guided in order to best serve psychiatric patients' interests and to prevent the usage of expensive and sometimes un-useful therapies. This implies that a scientific strategy has to be used to rule out any third-part economical interest which could in any way influence therapeutic choices.

  14. The precarious practice of forensic psychiatric risk assessments.

    PubMed

    Nilsson, Thomas; Munthe, Christian; Gustavson, Christina; Forsman, Anders; Anckarsäter, Henrik

    2009-01-01

    The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, "dangerousness" has been reworded into "risk". Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of "mental disorder" and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.

  15. Biomarker identification in psychiatric disorders: from neuroscience to clinical practice.

    PubMed

    Razafsha, Mahdi; Khaku, Aunali; Azari, Hassan; Alawieh, Ali; Behforuzi, Hura; Fadlallah, Bilal; Kobeissy, Firas H; Wang, Kevin K; Gold, Mark S

    2015-01-01

    Patients with psychiatric disorders exhibit several neurobehavioral and neuropsychological alterations compared to healthy controls. However, signature endpoints of these behavioral manifestations have not yet been translated into clinical tests for diagnosis and follow-up measures. Recently, neuroproteomic approaches have been utilized to identify unique signature markers indicative of these disorders. Development of reliable biomarkers has the potential to revolutionize the diagnosis, classification, and monitoring of clinical responses in psychiatric diseases. However, the lack of biological gold standards, the evolving nosology of psychiatric disorders, and the complexity of the nervous system are among the major challenges that have hindered efforts to develop reliable biomarkers in the field of neuropsychiatry and drug abuse. While biomarkers currently have a limited role in the area of neuropsychiatry, several promising biomarkers have been proposed in conditions such as dementia, schizophrenia, depression, suicide, and addiction. One of the primary objectives of this review is to discuss the role of proteomics in the development of biomarkers specific to neuropsychiatry. We discuss and evaluate currently available biomarkers as well as those that are under research for clinical use in the future.

  16. Respect in forensic psychiatric nurse-patient relationships: a practical compromise.

    PubMed

    Rose, Donald N; Peter, Elizabeth; Gallop, Ruth; Angus, Jan E; Liaschenko, Joan

    2011-03-01

    The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient being depersonalized and dehumanized. Although respect is fundamental to ethical nursing practice, it has not been adequately explored conceptually or empirically. As a result, little knowledge exists that identifies how nurses develop, maintain, and express respect for patients. The purpose of this study is to analyze the concept of respect systematically, from a forensic psychiatric nurse's perspective using the qualitative methodology of focused ethnography. Forensic psychiatric nurses were recruited from two medium secure forensic rehabilitation units. In the first interview, 13 registered nurses (RNs) and two registered practical nurses (RPNs) participated, and although all informants were invited to the second interview, six RNs were lost to follow-up. Despite this loss, saturation was achieved and the data were interpreted through a feminist philosophical lens. Respect was influenced by factors categorized into four themes: (1) emotive-cognitive reactions, (2) nonjudgmental approach, (3) social identity and power, and (4) context. The data from the themes indicate that forensic psychiatric nurses strike a practical compromise, in their understanding and enactment of respect in therapeutic relationships with forensic psychiatric patients.

  17. Update on parasomnias: a review for psychiatric practice.

    PubMed

    Markov, Dimitri; Jaffe, Fredric; Doghramji, Karl

    2006-07-01

    Parasomnias, defined as undesirable behavioral, physiological, or experiential events that accompany sleep, are common in the general population. As a rule, they occur more frequently in children than in adults with the exception of REM sleep behavior disorder (RBD), which is more common in men over 50. No longer considered to be invariably a sign of psychopathology, parasomnias are currently understood as clinical phenomena that arise as brain transitions between REM sleep, non-REM sleep, and wakefulness. This paper presents a clinical approach to diagnosing and treating parasomnias in the general population and in psychiatric patients.

  18. The implementation of psychiatric advance directives: experiences from a Dutch crisis card initiative.

    PubMed

    van der Ham, Alida J; Voskes, Yolande; van Kempen, Nel; Broerse, Jacqueline E W; Widdershoven, Guy A M

    2013-06-01

    The crisis card is a specific form of psychiatric advance directive, documenting mental clients' treatment preferences in advance of a potential psychiatric crisis. In this paper, we aim to provide insight into implementation issues surrounding the crisis card. A Dutch crisis-card project formed the scope of this study. Data were collected through interviews with 15 participants from six stakeholder groups. Identified implementation issues are: (a) The role of the crisis-card counselor, (b) lack of distribution and familiarity, (c) care professionals' routines, and (d) client readiness. The crisis-card counselor appears to play a key role in fostering benefits of the crisis card by supporting clients' perspectives. More structural integration of the crisis card in care processes may enhance its impact, but should be carefully explored. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  19. Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research.

    PubMed

    Dowling, N A; Merkouris, S S; Lorains, F K

    2016-07-01

    Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice.

    PubMed

    Dell'Osso, Bernardo; Albert, Umberto; Atti, Anna Rita; Carmassi, Claudia; Carrà, Giuseppe; Cosci, Fiammetta; Del Vecchio, Valeria; Di Nicola, Marco; Ferrari, Silvia; Goracci, Arianna; Iasevoli, Felice; Luciano, Mario; Martinotti, Giovanni; Nanni, Maria Giulia; Nivoli, Alessandra; Pinna, Federica; Poloni, Nicola; Pompili, Maurizio; Sampogna, Gaia; Tarricone, Ilaria; Tosato, Sarah; Volpe, Umberto; Fiorillo, Andrea

    2015-01-01

    More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.

  1. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

    PubMed Central

    Dell’Osso, Bernardo; Albert, Umberto; Atti, Anna Rita; Carmassi, Claudia; Carrà, Giuseppe; Cosci, Fiammetta; Del Vecchio, Valeria; Di Nicola, Marco; Ferrari, Silvia; Goracci, Arianna; Iasevoli, Felice; Luciano, Mario; Martinotti, Giovanni; Nanni, Maria Giulia; Nivoli, Alessandra; Pinna, Federica; Poloni, Nicola; Pompili, Maurizio; Sampogna, Gaia; Tarricone, Ilaria; Tosato, Sarah; Volpe, Umberto; Fiorillo, Andrea

    2015-01-01

    More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review. PMID:26257524

  2. [Applying the human dignity ideals of Confucianism and Kant to psychiatric nursing: from theory to practice].

    PubMed

    Lee, Mei-Hsiu; Lee, Shui-Chuen; Lee, Shu-Chen

    2012-04-01

    Literature articles and clinical observation suggest disease and environmental factors as primary causes of the low self-esteem and stigmatization that typify most psychiatric patients. These patients are at risk of injury when subjected to inappropriate physical restraint. Hospital staffs, including nurses, are in immediate and close contact with psychiatric patients. Mencius's and Kant's thoughts on human dignity can enhance reflections on clinical nursing practices. Mencius's belief that preserving life is not the most desirable thing and death is not the most hated thing can help nurses realize the human dignity of psychiatric patients by understanding that, as an unrighteous act is more detestable than death, the meaning and value of righteousness are greater than life itself. In light of Kant's views on human dignity, nurses should treat patients as goals rather than means. Exploring such ideas can raise nursing quality, restore a positive sense of humanity to psychiatric patients, and develop nursing values and meaning to a higher plane.

  3. Ethically Relevant Differences in Advance Directives for Psychiatric and End-of-Life Care.

    PubMed

    Olsen, Douglas P

    2016-01-01

    Psychiatric advance directives (PADs) represent a shift from more coercive to more recovery-oriented care and hold the promise of empowering patients while helping fill the gap in treatment of non-dangerous patients lacking decision-making capacity. Advance directives for end-of-life and psychiatric care share an underlying rationale of extending respect for patient autonomy and preventing the harm of unwanted treatment for patients lacking the decision-making capacity to participate meaningfully in planning their care. Ethically relevant differences in applying advance directives to end-of-life and psychiatric care are discussed. These differences fall into three categories: (1) patient factors, including decision-making capacity, ability to communicate, and prior experience; (2) decisional factors, including expected outcome and the nature of the decisions; and (3) historical-legal precedent. Specific recommendations are offered. Clinicians need to appreciate the ethical implications of these differences to effectively invoke PADs or assist patients in creating PADs. © The Author(s) 2016.

  4. Advanced midwifery practice: An evolutionary concept analysis.

    PubMed

    Goemaes, Régine; Beeckman, Dimitri; Goossens, Joline; Shawe, Jill; Verhaeghe, Sofie; Van Hecke, Ann

    2016-11-01

    the concept of 'advanced midwifery practice' is explored to a limited extent in the international literature. However, a clear conception of advanced midwifery practice is vital to advance the discipline and to achieve both internal and external legitimacy. This concept analysis aims to clarify advanced midwifery practice and identify its components. a review of the literature was executed using Rodgers' evolutionary method of concept analysis to analyze the attributes, references, related terms, antecedents and consequences of advanced midwifery practice. an international consensus definition of advanced midwifery practice is currently lacking. Four major attributes of advanced midwife practitioners (AMPs) are identified: autonomy in practice, leadership, expertise, and research skills. A consensus was found on the need of preparation at master's level for AMPs. Such midwives have a broad and internationally varied scope of practice, fulfilling different roles such as clinicians, clinical and professional leaders, educators, consultants, managers, change agents, researchers, and auditors. Evidence illustrating the important part AMPs play on a clinical and strategic level is mounting. the findings of this concept analysis support a wide variety in the emergence, titles, roles, and scope of practice of AMPs. Research on clinical and strategic outcomes of care provided by AMPs supports further implementation of these roles. As the indistinctness of AMPs' titles and roles is one of the barriers for implementation, a clear conceptualization of advanced midwifery practice seems essential for successful implementation. an international debate and consensus on the defining elements of advanced midwifery practice could enhance the further development of midwifery as a profession and is a prerequisite for its successful implementation. Due to rising numbers of AMPs, extension of practice and elevated quality requirements in healthcare, more outcomes research exclusively

  5. Advances in grazing distribution practices

    USDA-ARS?s Scientific Manuscript database

    Grazing distribution management practices are intended to improve livestock production efficiency while conserving or enhancing environmental conditions, and sustaining or promoting other ecosystem services on grazed lands. Ancient practices such as herding, fencing, vegetation treatment (e.g., fi...

  6. Praying with a patient constitutes a breach of professional boundaries in psychiatric practice.

    PubMed

    Poole, Rob; Cook, Christopher C H

    2011-08-01

    The extent to which religion and spirituality are integrated into routine psychiatric practice has been a source of increasing controversy over recent years. While taking a patient's spiritual needs into account when planning their care may be less contentious, disclosure to the patient by the psychiatrist of their own religious beliefs or consulting clergy in the context of treatment are seen by some as potentially harmful and in breach of General Medical Council guidance. Here, Professor Rob Poole and Professor Christopher Cook debate whether praying with a patient constitutes a breach of professional boundaries in psychiatric practice.

  7. [A glance at the safe: suicide prevention in private psychiatric practice. A retrospective study].

    PubMed

    Gysin, Fátima; Gysin, François

    2007-01-01

    The presence and importance of the theme suicide as it appears in the full time private psychiatric practice of one psychiatrist is evaluated in a retrospective quantitative study. Of the decade 1995-2005 of private clinical practice one year, 2003, was selected its data analyzed for 40% of all patients followed in 2003. The treatment of the simple patients was covered by a specific health insurance that had a contractual link to the psychiatrist. Prevalence and incidence of suicidality as a theme were established on the background of the caracteristics of the clinical activity in the examined psychiatric office: diagnostics, number of visits and duration of treatment. A third of this ambulatory population in private psychiatric office showed suicidal ideation and fantasies. One in ten patients had more serious sucidal risk. Suicidality was significatively correlated with the presence of a depressive mood disorder. In depressed patients the suicidal theme was three times more frequente compared with other patients. The frequent presence of the suicide figure in the context of private psychiatric consultation contrasts with the fact that suicidal acts are rare. Psychiatric response to suicidal ideation in the context of private practice is an efficient prevention when certain conditions are fullfilled concerning accessability, duration and frequence of the consultations.

  8. Service user and clinical perspectives of psychiatric advance directives in New Zealand.

    PubMed

    Thom, Katey; O'Brien, Anthony John; Tellez, Juan Jose

    2015-12-01

    Advance care planning is becoming an increasingly important feature of health service provision. Although the New Zealand Mental Health Commission has advocated strongly for the provision of advance directives in mental health services, little is known about clinician or service user views on advance directives. The aim of the study was to survey the perspectives of service users and clinicians on the use of psychiatric advance directives. The study used an anonymous online survey to collect data from 110 mental health service users and 175 clinicians. Survey items included existing knowledge, preferred content and potential benefits of advance directives. Descriptive statistics and intergroup comparisons were conducted. Over 90% of service users and clinicians agreed that they support advance directives in mental health. There were similarities in the preferred content of an advance directive across the two groups, particularly regarding the notification of support persons, cultural support and preferred methods of de-escalation. Significant differences in opinion were found regarding the use of coercive measures and the ability of mental health legislation to override advance directives. The results indicate strong support for the use of advance directives within New Zealand mental health services, as well as for further research in the area.

  9. Specialty practice entrepreneur: the advanced practice nurse.

    PubMed

    Kowal, N

    1998-01-01

    There are many opportunities in the health care arena to make a difference. The structured sense of change is "old school." New "surfers" of the system will be entrepreneurial in spirit, energy, and flexibility. There is no job description for the perfect person, only a sense of excitement and innovation that gives one the feeling energetic change is about to happen. In nursing, the risk takers are abundant in the APN role. It is the reason why they walk the line of provider/nurse. Making a difference to patients is important. Riding the waves of clinical care is the excitement. The final results are "the big waves" of life--a patient's life. A provider who defines the reality of practice creates a vision and skillfully bridges the road between the two. Design the surfboard--catch the wave.

  10. Education of advanced practice nurses in Canada.

    PubMed

    Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba

    2010-12-01

    In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

  11. Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice.

    PubMed

    Yadav, B L; Fealy, G M

    2012-03-01

    Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence. © 2011 Blackwell Publishing.

  12. Mathematics in Secondary Psychiatric Schools: Curricular and Assessment Policies and Practices

    ERIC Educational Resources Information Center

    Gagnon, Joseph Calvin; Maccini, Paula; Mulcahy, Candace

    2014-01-01

    The current study focuses on results from a national survey of special education mathematics teachers in secondary psychiatric schools. A total of 115 (33.04%) respondents completed a mail or online survey concerning school-level mathematics curriculum and assessment policies and practices. No statistically significant differences existed between…

  13. Implementation of information technology in nursing practice - challenge for management in psychiatric nursing.

    PubMed

    Koivunen, Marita; Hätönen, Heli; Välimäki, Maritta

    2009-01-01

    The implementation of information technology (IT) applications in nursing practice requires systematic investments and guidance. A collaborative organisational culture, and systematic and close clinical and administrative cooperation during the implementation process support the acceptance of IT among users in organisation. Although knowledge of IT projects management exists, there is a lack of knowledge about nursing management in IT implementation processes in psychiatric nursing.

  14. Mathematics in Secondary Psychiatric Schools: Curricular and Assessment Policies and Practices

    ERIC Educational Resources Information Center

    Gagnon, Joseph Calvin; Maccini, Paula; Mulcahy, Candace

    2014-01-01

    The current study focuses on results from a national survey of special education mathematics teachers in secondary psychiatric schools. A total of 115 (33.04%) respondents completed a mail or online survey concerning school-level mathematics curriculum and assessment policies and practices. No statistically significant differences existed between…

  15. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  16. Introducing Narrative Practices in a Locked, Inpatient Psychiatric Unit

    PubMed Central

    Mehl-Madrona, Lewis

    2007-01-01

    Introduction: Narrative approaches to psychotherapy are becoming more prevalent throughout the world. We wondered if a narrative-oriented psychotherapy group on a locked, inpatient unit, where most of the patients were present involuntarily, could be useful. The goal would be to help involuntary patients develop a coherent story about how they got to the hospital and what happened that led to their being admitted and link that to a story about what they would do after discharge that would prevent their returning to hospital in the next year. Methods: A daily, one-hour narrative group was implemented on one of three locked adult units in a psychiatric hospital. Quality-improvement procedures were already in place for assessing outcomes by unit using the BASIS-32 (32-item Behavior and Symptom Identification Scale). Unit outcomes were compared for the four quarters before the group was started and then four months after the group had been ongoing. Results: The unit on which the narrative group was implemented had a mean overall improvement in BASIS-32 scores of 2.8 units, compared with 1.0 unit for the other locked units combined. The results were statistically significant at the p < 0.0001 level. No differences were found between units for the four quarters prior to implementation of the intervention, and no other changes occurred during the quarter in which the group was conducted. Qualitative descriptions of the leaders' experiences are included in this report. Conclusions: A daily, one-hour narrative group can make a difference in a locked inpatient unit, presumably by creating cognitive structure for patients in how to understand what has happened to them. Further research is indicated in a randomized, controlled-trial format. PMID:21412477

  17. Elevated serum creatine kinase levels in psychiatric practice: differential diagnosis and clinical significance: A brief, practical guideline for clinicians.

    PubMed

    Voros, Viktor; Osvath, Peter; Fekete, Sandor; Tenyi, Tamas

    2008-01-01

    Introduction. Elevated serum CK levels often occur in psychiatric in-patient practice. Although the majority of cases are benign and temporary, it is important to recognize and treat these conditions. Aims. To discuss the etiology, the clinical significance and the management of elevated creatine kinase levels in psychiatric in-patient practice, focusing on antipsychotic-induced rhabdomyolysis. To compare the pathogenesis and the clinical features of rhabdomyolysis and neuroleptic malignant syndrome. Methods. Review of the literature. Results. A brief, practical guideline is introduced, which may help clinicians in the differential diagnosis and in the management of patients with elevated creatine kinase activity in emergent psychiatric practice. Conclusions. The most common etiologic factors (prescription drugs, alcohol, physical reasons, cardiac etiology) and clinical syndromes (rhabdomyolysis, neuroleptic malignant syndrome, acute coronary syndrome) should be considered, when elevated creatine kinase levels are encountered in psychiatric in-patients. Routine creatine kinase measurements in asymptomatic patients on antipsychotic medications are not recommended, but patients should be carefully followed for the development of rhabdomyolysis, when muscular symptoms arise. Careful monitoring of symptoms and potential complications is critical in order to avoid devastating clinical consequences. Cautiously challenging patients with another antipsychotic after an antipsychotic-induced rhabdomyolysis is recommended to decrease the possibility of recurrence.

  18. Hospice referral after inpatient psychiatric treatment of individuals with advanced dementia from a nursing home.

    PubMed

    Epstein-Lubow, Gary; Fulton, Ana Tuya; Marino, Louis J; Teno, Joan

    2015-06-01

    This report addresses the discharge disposition following inpatient psychiatric treatment for advanced dementia. The total population included 685 305 Medicare fee-for-service decedents with advanced cognitive and functional impairment, with a mean age of 85.9 years who had resided in a nursing home. In the last 90 days of life, 1027 (0.15%) persons received inpatient psychiatry treatment just prior to the place of care where the individual died. Discharge dispositions included 132 (12.9%) persons to a medical hospital, 728 (70.9%) to nursing home without hospice services, 73 (7.1%) to hospice services in a nursing home, 32 (3.1%) to home without hospice services, and 16 (1.6%) to hospice services at home. Overall, the rate of referral to hospice services for advanced dementia was relatively low.

  19. The psychiatric cultural formulation: translating medical anthropology into clinical practice.

    PubMed

    Aggarwal, Neil Krishan

    2012-03-01

    This article reviews proposed revisions to the DSM-IV Outline for Cultural Formulation for clinical practice. The author begins by exploring the theoretical development of and assumptions involved in the Cultural Formulation. A case presentation is then used to demonstrate shortcomings in the current implementation of the Cultural Formulation based on older definitions of culture. Finally, the author recommends practical questions based on the growing anthropological literature concerning the interpersonal elements of culture and the social course of illness. A simple clear format that clinically translates social science concepts has the potential to increase use of the Cultural Formulation by all psychiatrists, not just those specializing in cultural psychiatry.

  20. Nurses' information retrieval skills in psychiatric hospitals - are the requirements for evidence-based practice fulfilled?

    PubMed

    Koivunen, Marita; Välimäki, Maritta; Hätönen, Heli

    2010-01-01

    Nursing professionals have long recognized the importance to practice of research and the value of research evidence. Nurses still do not use research findings in practice. The purpose of this paper was to describe nurses' skills in using literature databases and the Internet in psychiatric hospitals and associations of nurses' gender, age, and job position with their information retrieval skills. The study was carried out in 2004 among nursing staff (N=183) on nine acute psychiatric wards in two psychiatric hospitals in Finland (n=180, response rate 98%). The Finnish version of the European Computer Driving Licence test (ECDL) was used as a data collection instrument. The study showed that there were clear deficits in information retrieval skills among nurses working in psychiatric hospitals. Thus, nurses' competence does not support the realization of evidence-based practice in the hospitals. Therefore, it is important to increase nurses' information retrieval skills by tailoring continuing education modules. It would be also advisable to develop centralized systems for the internal dissemination of research findings for the use of nursing staff.

  1. The Detrimental Impact of Maladaptive Personality on Public Mental Health: A Challenge for Psychiatric Practice.

    PubMed

    Hengartner, Michael Pascal

    2015-01-01

    Experts in personality psychology and personality disorders have long emphasized the pervasive and persistent detrimental impact of maladaptive personality traits on mental health and functioning. However, in routine psychiatric practice, maladaptive personality is readily ignored and personality traits are seldom incorporated into clinical guidelines. The aim of this narrative review is to outline how pervasively personality influences public mental health and how personality thereby challenges common psychiatric practice. A comprehensive search and synthesis of the scientific literature demonstrates that maladaptive personality traits and personality disorders, in particular high neuroticism and negative affectivity, first, are risk factors for divorce, unemployment, and disability pensioning; second, relate to the prevalence, incidence, and co-occurrence of common mental disorders; third, impair functioning, symptom remission, and recovery in co-occurring common mental disorders; and fourth, predispose to treatment resistance, non-response and poor treatment outcome. In conclusion, maladaptive personality is not only involved in the development and course of mental disorders but also predisposes to chronicity and re-occurrence of psychopathology and reduces the efficacy of psychiatric treatments. The pernicious impact of maladaptive personality on mental health and functioning demands that careful assessment and thorough consideration of personality should be compulsory in psychiatric practice.

  2. The Detrimental Impact of Maladaptive Personality on Public Mental Health: A Challenge for Psychiatric Practice

    PubMed Central

    Hengartner, Michael Pascal

    2015-01-01

    Experts in personality psychology and personality disorders have long emphasized the pervasive and persistent detrimental impact of maladaptive personality traits on mental health and functioning. However, in routine psychiatric practice, maladaptive personality is readily ignored and personality traits are seldom incorporated into clinical guidelines. The aim of this narrative review is to outline how pervasively personality influences public mental health and how personality thereby challenges common psychiatric practice. A comprehensive search and synthesis of the scientific literature demonstrates that maladaptive personality traits and personality disorders, in particular high neuroticism and negative affectivity, first, are risk factors for divorce, unemployment, and disability pensioning; second, relate to the prevalence, incidence, and co-occurrence of common mental disorders; third, impair functioning, symptom remission, and recovery in co-occurring common mental disorders; and fourth, predispose to treatment resistance, non-response and poor treatment outcome. In conclusion, maladaptive personality is not only involved in the development and course of mental disorders but also predisposes to chronicity and re-occurrence of psychopathology and reduces the efficacy of psychiatric treatments. The pernicious impact of maladaptive personality on mental health and functioning demands that careful assessment and thorough consideration of personality should be compulsory in psychiatric practice. PMID:26106335

  3. Brain perfusion single photon emission computed tomography in major psychiatric disorders: From basics to clinical practice

    PubMed Central

    Santra, Amburanjan; Kumar, Rakesh

    2014-01-01

    Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF). It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings. Though there is ample evidence validating brain SPECT as a technique to track human behavior and correlating psychiatric disorders with dysfunction of specific brain regions, only few psychiatrists have adopted brain SPECT in routine clinical practice. It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary. In this article, we have reviewed the available studies in this regard from existing literature and tried to present the evidence for establishing the clinical role of brain SPECT in major psychiatric illnesses. PMID:25400359

  4. American Psychiatric Nurses Association-Transitions in Practice Certificate Program: Bridging the Knowledge Gap in Caring for Psychiatric Patients Within the General Nursing Workforce.

    PubMed

    Adams, Susie M; Black, Patricia

    2016-01-01

    The purpose of this article is to publicize an important new Web-based educational program. Recognizing the growing gap in psychiatric-mental health knowledge and the need to better prepare new graduates and nurses transitioning from other service lines into psychiatric inpatient nursing settings, the American Psychiatric Nurses Association developed a 15-hour, modularized curriculum to provide foundational psychiatric-mental health knowledge. This modularized curriculum, called American Psychiatric Nurses Association Transitions in Practice (ATP) focuses on the knowledge and skills to insure the success of nurses new to psychiatric-mental health nursing settings and to improve the overall care for persons with mental health and substance use disorders. The ATP program is also proving to be useful content for nurses in emergency departments, hospitals, and other health settings to improve their care of patients with psychiatric and mental health needs. A summary of the program modules and a toolkit with suggested measures for nurses, patients, and agency outcomes is described. Feedback from participants completing the ATP program within the first 6 months is overwhelmingly positive and holds promise for widespread application across a variety of health care settings.

  5. Teaching Research Synthesis to Advanced Practice Nurses.

    ERIC Educational Resources Information Center

    Upchurch, Sandra; Brosnan, Christine A.; Grimes, Deanna E.

    2002-01-01

    A process for teaching research synthesis to advanced practice nurses includes two courses: a first research applications course in which students build bibliographic databases, practice statistical analysis, and develop search skills; and a second course in which they complete literature reviews or meta analyses of research on clinical practice…

  6. Teaching Research Synthesis to Advanced Practice Nurses.

    ERIC Educational Resources Information Center

    Upchurch, Sandra; Brosnan, Christine A.; Grimes, Deanna E.

    2002-01-01

    A process for teaching research synthesis to advanced practice nurses includes two courses: a first research applications course in which students build bibliographic databases, practice statistical analysis, and develop search skills; and a second course in which they complete literature reviews or meta analyses of research on clinical practice…

  7. Social factors, mental illness, and psychiatric care: recent advances from a sociological perspective.

    PubMed

    Greenley, J R

    1984-08-01

    The author reviews advances in the sociological perspective on mental health over the past four years. He examines research on such topics as community acceptance of the mentally ill, arrest rates among former psychiatric inpatients, and the effect of social factors on the type of mental health treatment received. Other research areas surveyed include the influence of social factors on service utilization and on life stress and psychological distress, sex differences in psychological problems, and the relationship between organization of service delivery systems and patient outcome.

  8. Convergence of advances in genomics, team science, and repositories as drivers of progress in psychiatric genomics.

    PubMed

    Lehner, Thomas; Senthil, Geetha; Addington, Anjené M

    2015-01-01

    After many years of unfilled promise, psychiatric genetics has seen an unprecedented number of successes in recent years. We hypothesize that the field has reached an inflection point through a confluence of four key developments: advances in genomics; the orientation of the scientific community around large collaborative team science projects; the development of sample and data repositories; and a policy framework for sharing and accessing these resources. We discuss these domains and their effect on scientific progress and provide a perspective on why we think this is only the beginning of a new era in scientific discovery. Published by Elsevier Inc.

  9. Practical Advances in Petroleum Processing

    NASA Astrophysics Data System (ADS)

    Hsu, Chang S.; Robinson, Paul R.

    "This comprehensive book by Robinson and Hsu will certainly become the standard text book for the oil refining business...[A] must read for all who are associated with oil refining." - Dr. Walter Fritsch, Senior Vice President Refining, OMV "This book covers a very advanced horizon of petroleum processing technology. For all refiners facing regional and global environmental concerns, and for those who seek a more sophisticated understanding of the refining of petroleum resources, this book has been long in coming." - Mr. Naomasa Kondo, Cosmo Oil Company, Ltd.

  10. Story theory: advancing nursing practice scholarship.

    PubMed

    Smith, Mary Jane; Liehr, Patricia

    2005-01-01

    Stories are a fundamental dimension of human experience and nursing practice. Story theory describes a narrative happening that occurs through intentional nurse-person dialogue. Seven inquiry phases are associated with story theory, including gathering the story, reconstructing the story, connecting it to the literature, naming the complicating health challenge, describing the story plot, identifying movement toward resolving, and gathering additional stories. This article describes the use of story theory to advance nursing practice scholarship in both academic and everyday nursing practice.

  11. Parameters of training, academic involvement, and practice setting predictive of retention in combined medical-psychiatric practice.

    PubMed

    Silberman, Edward; Summergrad, Paul; Price, Lori

    2014-08-01

    The authors contrasted physicians trained in both psychiatry and another specialty who continue to practice both specialties vs. those who practice only psychiatry, in terms of their training, academic profile, and practice setting. The authors analyzed survey responses from 132 doubly boarded physicians who vary in whether or not they continue to practice both specialties. Group results were compared using chi square, Fisher exact, and t tests. Of graduates of double-board programs, 79.2% continue in dual practice. Other factors associated with continued combined practice were training in neurology-psychiatry, greater academic involvement, high motivation, practice in a non-public hospital setting, and demonstrated leadership capacity. Double-board training programs have been successful in producing a group of clinicians committed to long-term combined medical-psychiatric practice, but this effect is stronger in psychiatry-neurology than in other types of combined practice. Future research should investigate other practice parameters that foster or impede integrated medical-psychiatric care.

  12. The Psychiatric Cultural Formulation: Applying Medical Anthropology in Clinical Practice

    PubMed Central

    Aggarwal, Neil Krishan

    2014-01-01

    This paper considers revisions to the DSM-IV Outline for Cultural Formulation from the perspective of clinical practice. First, the paper explores the theoretical development of the Cultural Formulation. Next, a case presentation demonstrates challenges in its actual implementation. Finally, the paper recommends a set of questions for the clinician on barriers to care and countertransference. The development of a standardized, user-friendly format can increase the Cultural Formulation’s utilization among all psychiatrists beyond those specializing in cultural psychiatry. PMID:22418398

  13. An introduction to Rasch analysis for Psychiatric practice and research.

    PubMed

    da Rocha, Neusa Sica; Chachamovich, Eduardo; de Almeida Fleck, Marcelo Pio; Tennant, Alan

    2013-02-01

    This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

    PubMed Central

    Swanson, Jeffrey W.; Appelbaum, Paul S.; Swartz, Marvin S.; Ferron, Joelle; Van Dorn, Richard A.; Wagner, H. Ryan

    2013-01-01

    Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N = 469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid. PMID:17294136

  15. Normal or abnormal? 'Normative uncertainty' in psychiatric practice.

    PubMed

    Bassett, Andrew M; Baker, Charley

    2015-06-01

    human societies. The three models of 'absolutism', 'universalism' and 'cultural relativism' have not only important consequences for the nature and conduct of research enquiry, but also have implications for how the dilemma of 'culture' or 'psychopathology' is attended to in clinical practice.

  16. The Mentally Ill in Jail: Contemporary Clinical and Practice Perspectives for Psychiatric-Mental Health Nursing.

    PubMed

    Ellis, Horace; Alexander, Vinette

    2017-04-01

    Individuals with serious mental illnesses (SMI) who are incarcerated pose major treatment challenges for both correctional personnel and healthcare providers, yet deserve the same high standards of care as those in traditional mental health facilities. The literature references these challenges as types of mental health treatment disparities, and calls for improvement measures from clinicians, researchers, policy-makers, and advocates. From the standpoint of psychiatric-mental health (PMH) nursing, this paper explores, examines, and offers some contemporary clinical and practice perspectives for providing best-practice psychiatric care for SMI individuals who are in jails. The diverse roles of PMH nursing can contribute meaningfully to tackling quality improvement initiatives on mental health treatment agendas for SMI inmates.

  17. Developing the Advanced Practice Nurse in Catalonia.

    PubMed

    Comellas-Oliva, Montserrat

    2016-01-01

    The development of advanced practice nurses (APN) has proved a challenge for nurses in countries such as the USA, Canada, Great Britain, and Australia among others. It is only in recent years that the system has been considered in Catalonia and Spain as a way to develop new roles to bring effectiveness and efficiency to the health system. From the standpoint of training and implementation of the above-mentioned new nursing roles, the following article aims to conceptualise APN and its reference models, as well as to contextualise and reflect on APN in Catalonia in order to assimilate them into advanced practice.

  18. Advanced Practice Nursing Education: Challenges and Strategies

    PubMed Central

    Fitzgerald, Cynthia; Kantrowitz-Gordon, Ira; Katz, Janet; Hirsch, Anne

    2012-01-01

    Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicine's “Future of nursing” report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change. PMID:22220273

  19. Contrasting demographic patterns of minor psychiatric morbidity in general practice and the community.

    PubMed

    Finlay-Jones, R A; Burvill, P W

    1978-08-01

    The 60-item General Health Questionnaire was completed by 90% of 4798 patients aged 15--69 years who consulted, on one day, the general practitioners of 97% of practices in the Perth Statistical Division. A point prevalence rate of minor psychiatric morbidity in various demographic groups was calculated in terms of the population at risk. The demographic pattern of morbidity was compared with that found in a probability sample of 2324 community residents drawn from the same population at risk, and surveyed at the same time using the same time using the same screening instrument. Widowed persons, British-born men who had recently migrated to Australia, and lower-social-class men with minor psychiatric morbidity were under-represented in general practice. Elderly men and women in upper-class occupations with minor psychiatric morbidity were over-represented in general practice. These differences, unlike others that were found, could not be explained by differing consulting habits or by differing completion rates of the screening instrument.

  20. Exploring the influence of gestalt therapy training on psychiatric nursing practice: stories from the field.

    PubMed

    Kelly, Teresa; Howie, Linsey

    2011-08-01

    Psychiatric nurses interested in extending their interpersonal and psychotherapeutic skills sometimes undertake postgraduate training in gestalt therapy. Little is known about how this new knowledge and psychotherapeutic skill base informs their practice. This paper presents the findings of a qualitative study that aimed to explore the influence of gestalt therapy training on psychiatric nursing practice. Within a framework of narrative inquiry, four psychiatric nurses trained in gestalt therapy were invited to tell their stories of training in a gestalt approach to therapy, and recount their experiences of how it influenced their practice. In keeping with narrative analysis methods, the research findings were presented as a collection of four stories. Eight themes were derived from a thematic analysis conducted within and across the four stories. The discussion of the themes encapsulates the similarities and differences across the storied collection, providing a community and cultural context for understanding the individual stories. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  1. [Advanced imaging methods as a basis for more reliable classification and better treatment for patients with depressive symptoms--an example for conceptual change in the psychiatric diagnostic method].

    PubMed

    Vishne, Tali

    2011-10-01

    The current editorial study focuses on the idea of using advanced imaging methods in order to better classify and treat patients with depression and other psychiatric illnesses. The editorial is based on the review of Heymann and Bonne, published in this issue of the journal, showing differences between bi-polar and uni-polar depression using functional neuroimaging methods. This example, although not applicable yet in clinical practice, is the basis for future advances in psychiatric classification, together with clinical subtyping, and more biological markers, including genetic profiling.

  2. Integrating Practice and Theory for Advancement

    ERIC Educational Resources Information Center

    Bakewell, Thomas

    2005-01-01

    This is the first installment of a multipart practitioners' guide focused on strategic planning, organizational development, and legal issues. It features practical advice and powerful insights for implementing advancement programs that are organized, productive, and legal--and that generate top results. The author, an organizational development…

  3. A unique perspective on advanced practice nursing.

    PubMed

    Sieloff, C L; DiCarlo, B L; Killeen, M B; McDermott, S D

    1994-01-01

    This article presents a working definition of the advanced practice registered nurse (APRN). The types of nurses that could be included in this definition and the benefits of broadening the category are discussed, as well as possible reasons for the less inclusive, previous definition of this category. Strategies are proposed for resolving concerns about broadening the category.

  4. Advanced practice nursing role: nurse practitioner.

    PubMed

    Pastorino, C

    1998-01-01

    Nurse Practitioners are advanced practice nurses (APNs) who provide primary and acute care to individuals in many settings. The NP diagnoses and treats medical and surgical conditions that require acute, short-term management and chronic, long-term treatment. States vary in regulating processes regarding collaborative agreements, prescriptive authority, medical staff privileges, and insurance/third party reimbursement.

  5. Taking personal responsibility: Nurses' and assistant nurses' experiences of good nursing practice in psychiatric inpatient care.

    PubMed

    Gabrielsson, Sebastian; Sävenstedt, Stefan; Olsson, Malin

    2016-10-01

    Therapeutic nurse-patient relationships are considered essential for good nursing practice in psychiatric inpatient care. Previous research suggests that inpatient care fails to fulfil patients' expectations in this regard, and that nurses might experience the reality of inpatient care as an obstruction. The aim of the present study was to explore nurses' and assistant nurses' experiences of good nursing practice in the specific context of psychiatric inpatient care. Qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and assistant nurses in order to explore their experiences with nursing practice related to psychiatric inpatient care. Interviews were transcribed and analysed using an interpretive descriptive approach. Findings describe good nursing practice as a matter of nurses and assistant nurses taking personal responsibility for their actions and for the individual patient as a person. Difficulties in providing dignified nursing care and taking personal responsibility cause them to experience feelings of distress and frustration. Shared values and nursing leadership supports being moral and treating patients with respect, having enough time supports being present and connecting with patients, and working as a part of a competent team with critical daily discussions and diversity supports being confident and building trust. The findings suggest that taking personal responsibility is integral to good nursing practice. If unable to improve poor circumstances, nurses might be forced to promote their own survival by refuting or redefining their responsibility. Nurses need to prioritize being with patients and gain support in shaping their own nursing practice. Nursing leadership should provide moral direction and defend humanistic values. © 2016 Australian College of Mental Health Nurses Inc.

  6. Technological advances for deciphering the complexity of psychiatric disorders: merging proteomics with cell biology.

    PubMed

    Wesseling, Hendrik; Guest, Paul C; Lago, Santiago G; Bahn, Sabine

    2014-08-01

    Proteomic studies have increased our understanding of the molecular pathways affected in psychiatric disorders. Mass spectrometry and two-dimensional gel electrophoresis analyses of post-mortem brain samples from psychiatric patients have revealed effects on synaptic, cytoskeletal, antioxidant and mitochondrial protein networks. Multiplex immunoassay profiling studies have found alterations in hormones, growth factors, transport and inflammation-related proteins in serum and plasma from living first-onset patients. Despite these advances, there are still difficulties in translating these findings into platforms for improved treatment of patients and for discovery of new drugs with better efficacy and side effect profiles. This review describes how the next phase of proteomic investigations in psychiatry should include stringent replication studies for validation of biomarker candidates and functional follow-up studies which can be used to test the impact on physiological function. All biomarker candidates should now be tested in series with traditional and emerging cell biological approaches. This should include investigations of the effects of post-translational modifications, protein dynamics and network analyses using targeted proteomic approaches. Most importantly, there is still an urgent need for development of disease-relevant cellular models for improved translation of proteomic findings into a means of developing novel drug treatments for patients with these life-altering disorders.

  7. The clinical nurse leader: helping psychiatric mental health nurses transform their practice.

    PubMed

    Seed, Mary S; Torkelson, Diane J; Karshmer, Judith F

    2009-04-01

    The national movement to transform the health care delivery systems must include a focus on mental health treatment. To address similar deficits across other practice domains, the Clinical Nurse Leader (CNL) role has been created. The CNL is a master's degree that prepares a nurse to use a systems perspective to improve outcomes for a cohort of patient, deliver care based on best practices, and coordinate care in a multidisciplinary team. Applying the CNL role to mental health care could help psychiatric mental health nursing be at the forefront in the transformation of mental health care delivery.

  8. Detection and treatment of omega-3 fatty acid deficiency in psychiatric practice: Rationale and implementation.

    PubMed

    Messamore, Erik; McNamara, Robert K

    2016-02-10

    A body of translational evidence has implicated dietary deficiency in long-chain omega-3 (LCn-3) fatty acids, including eicosapenaenoic acid (EPA) and docosahexaenoic acid (DHA), in the pathophysiology and potentially etiology of different psychiatric disorders. Case-control studies have consistently observed low erythrocyte (red blood cell) EPA and/or DHA levels in patients with major depressive disorder, bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder. Low erythrocyte EPA + DHA biostatus can be treated with fish oil-based formulations containing preformed EPA + DHA, and extant evidence suggests that fish oil supplementation is safe and well-tolerated and may have therapeutic benefits. These and other data provide a rationale for screening for and treating LCn-3 fatty acid deficiency in patients with psychiatric illness. To this end, we have implemented a pilot program that routinely measures blood fatty acid levels in psychiatric patients entering a residential inpatient clinic. To date over 130 blood samples, primarily from patients with treatment-refractory mood or anxiety disorders, have been collected and analyzed. Our initial results indicate that the majority (75 %) of patients exhibit whole blood EPA + DHA levels at ≤ 4 percent of total fatty acid composition, a rate that is significantly higher than general population norms (25 %). In a sub-set of cases, corrective treatment with fish oil-based products has resulted in improvements in psychiatric symptoms without notable side effects. In view of the urgent need for improvements in conventional treatment algorithms, these preliminary findings provide important support for expanding this approach in routine psychiatric practice.

  9. Advanced practice nurse as outcomes manager.

    PubMed

    Houston, S; Luquire, R

    1997-01-01

    Outcomes management as a patient management system has been designed to impact and improve select outcomes. Central to the development and implementation of best practice senario identified throughout outcomes management is the advanced practice nurse. SLEH has been in the forefront of development and implementation of an outcomes management program. This article describes the outcomes management position and shares the job description and performance evaluation used at this institution. The tools allow for measuring and quantifying the impact of the outcomes manager position on improving patient outcomes. The improvement of outcomes has increased the value of the advanced practice nurse and provided the institution with a solid future necessary for survival in a managed care market.

  10. Psychiatric advance directives, a possible way to overcome coercion and promote empowerment.

    PubMed

    Khazaal, Yasser; Manghi, Rita; Delahaye, Marie; Machado, Ariella; Penzenstadler, Louise; Molodynski, Andrew

    2014-01-01

    Psychiatric advance directives (ADs) allow an individual to state their preferences for future treatment at times when they may be unable to make considered decisions. There are differences in their form and legal value and the process associated with their use and completion. Several studies have now been completed to assess the impact of ADs on service use and coercion. Their results give a mixed picture but directives nevertheless have the potential to support the empowerment process, minimize experienced coercion, and improve coping strategies. These may in turn reduce the frequency of in-patient service use. Further studies on the different processes of facilitation involved and on different populations are necessary to improve our knowledge and use of these potentially powerful interventions.

  11. Managerial reforms and specialised psychiatric care: a study of resistive practices performed by mental health practitioners.

    PubMed

    Saario, Sirpa

    2012-07-01

    Throughout Western Europe, psychiatric care has been subjected to 'modernisation' by the implementation of various managerial reforms in order to achieve improved mental health services. This paper examines how practitioners resist specific managerial reforms introduced in Finnish outpatient clinics and a child psychiatry clinic. The empirical study involves documentary research and semi-structured interviews with doctors, psychologists, nurses and social workers. The analysis draws on notions of Foucault's conception of resistance as subtle strategies. Three forms of professional resistance are outlined: dismissive responses to clinical guidelines; a critical stance towards new managerial models; and improvised use of newly introduced information and communications technologies (ICTs). Resistance manifests itself as moderate modifications of practice, since more explicit opposition would challenge the managerial rhetoric of psychiatric care which is promoted in terms of positive connotations of client-centredness, users' rights, and the quality of the care. Therefore, instead of strongly challenging managerial reforms, practitioners keep them 'alive' and ongoing by continuously improvising, criticising and dismissing reforms' non-functional features. In conclusion it is suggested that managerial reforms in psychiatric care can only be implemented successfully if frontline practitioners themselves modify and translate them into clinical practice. The reconciliation between this task and practitioners' therapeutic orientation is proposed for further study. © 2012 The Author. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  12. Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.

    PubMed

    Easter, Michele M; Swanson, Jeffrey W; Robertson, Allison G; Moser, Lorna L; Swartz, Marvin S

    2017-07-01

    Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams. A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion. The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis. Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care.

  13. Quality of life in mental health services with a focus on psychiatric rehabilitation practice.

    PubMed

    Gigantesco, Antonella; Giuliani, Massimo

    2011-01-01

    Only recently the interest in the quality of life (QoL) has gained prominence in mental health practice with respect to other medical disciplines, such as oncology or cardiology, perhaps because the QoL measures were considered as tautological and largely overlapping with measures of psychopathology. Moreover, most of the recognized components of QoL represent the main areas of psychiatric intervention. For example, psychological functioning impairment represents the main area of psychotherapeutic and psychopharmacological interventions, social functioning impairment the main area of rehabilitation intervention. In addition, measures of QoL in psychiatric patients may be biased by some aspects of the disease, including impaired evaluation capacity or decreased expectations. Nowadays, QoL issues in relation to mental health care are especially relevant with regard to part of evaluation of treatment outcomes. Suggestions for the choice of the most appropriate QoL instruments for research and routine evaluation in mental health care are given.

  14. Don't get bugged: practical strategies for managing bedbug infestation in psychiatric rehabilitation programs.

    PubMed

    Zipple, Anthony M; Batscha, Catherine L; Flaherty, Peggy; Reynolds, Jared L

    2012-07-01

    Bedbug infestation has become a major problem in the United States. Infestations can be frightening and expensive and appear to be more prevalent in urban settings and low-income housing such as homeless shelters, public housing, and single-room occupancy apartments. This exposes consumers and staff of psychiatric rehabilitation agencies to higher risk of infestation. This brief report outlines practical suggestions for managing bedbug infestation in such agencies. Drawing on resources readily available on the Internet and the experience of Thresholds, a large provider of psychiatric rehabilitation services based in Chicago, this report describes strategies for responding to infestation. Providers need to assume that bedbug infestation is a significant risk and prepare accordingly. Assertive, persistent, and calm response is recommended.

  15. Therapist Adherence to Good Psychiatric Practice in a Short-Term Treatment for Borderline Personality Disorder.

    PubMed

    Kolly, Stéphane; Despland, Jean-Nicolas; de Roten, Yves; Marquet, Pierre; Kramer, Ueli

    2016-07-01

    Therapist adherence describes the quality of interventions according to the imperatives of a treatment model. We examined the relationship between therapist adherence and symptom change in the context of a short-term treatment with respect good psychiatric management (GPM) principles. Based on a parent trial, borderline personality disorder patients (N = 40) benefited from a 10-session intervention. Adherence to GPM was assessed using a GPM Adherence Scale (GPMAS). The psychometric properties of the GPMAS were excellent, and the adherence to GPM explained 16% of the general symptom improvement (t(1) = 2.38, β = 0.40, p = 0.02) and 23% of the borderline symptom improvement (t(1) = 2.46, β = 0.48, p = 0.02). Because GPM adherence predicts the outcome after only 10 sessions, GPMAS is a valuable measure early on in psychiatric practice as part of an initial step to longer-term treatment, to quickly detect problems and correct them.

  16. Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients.

    PubMed

    Broderick, Kerry B; Lerner, E Brooke; McCourt, John D; Fraser, Emily; Salerno, Killian

    2002-01-01

    To describe the testing requirements and practices of emergency physicians (EPs) when conducting a medical screening examination of psychiatric patients. An anonymous survey was developed and mailed to 500 EPs randomly selected through American College of Emergency Physicians membership rolls. Two hundred ninety surveys were returned (58%). Eighty-five percent of the respondents were male, 70% practiced in a community setting and 28% in an academic setting, 58% were emergency medicine (EM) residency-trained, and 88% were EM board-certified or board-eligible. Ninety-eight percent stated they were actively involved with the psychiatric medical screening exam (PMSE). Routine testing was required by 35% of the respondents, with 16% being required by ED protocol, and 84% by the psychiatrist/psychiatric institute. Of those with required testing, tests required were: complete blood cell count (56%), electrolytes (56%), serum alcohol (85%), serum toxicology screen (31%), urine toxicology screen (86%), electrocardiogram (18%), liver function test (16%), blood urea nitrogen (45%), and creatinine (40%). Many clinicians believed that certain tests were unnecessary as part of a PMSE. There was no statistical difference between the opinions of the physicians required to test and those not required to test in terms of which tests they thought were a necessary part of a PMSE regardless of the patient's clinical presentation. The EM-trained physicians were also found to be significantly less likely to think certain tests were necessary for the PMSE when compared with the non-EM-trained physicians. Routine testing was required as part of the medical screening examination of psychiatric patients for only one-third of the respondents. Few respondents believed that any of these tests were necessary. Emergency medicine-trained physicians were less likely to feel that routine testing was necessary.

  17. Unpacking the psychiatric advance directive in low-resource settings: an exploratory qualitative study in Tamil Nadu, India

    PubMed Central

    2013-01-01

    Background Psychiatric advance directives, a tool to document preferences for care in advance of decisional incapacity, have been shown to benefit persons with mental illness in a number of countries through improving medication adherence, reducing symptoms from escalating in a crisis, accelerating recovery, and enhancing service user autonomy. While concepts such as autonomy are important in a number of high-income country settings, it remains unclear whether tools like psychiatric advance directives are suitable in a different context. The recent introduction of the psychiatric advance directive into draft legislation in India prompts the question as to how feasible psychiatric advance directives are in the Indian context. The aim of this study is to explore the feasibility and utility of PADs in India, with a focus on the need for individual control over decision making and barriers to implementation, by exploring views of its central stakeholders, service users and carers. Methods Qualitative semi-structured interviews (n = 51) with clients (n = 39) and carers (n = 12) seeking mental health treatment at outpatient clinics in urban and rural settings provided by a non-profit organisation in Tamil Nadu, India. Results Clients engaged in a number of forms of decision-making (passive, active, and collaborative) depending on the situation and decision at hand, and had high levels of self-efficacy. Most clients and carers were unfamiliar with PADs, and while some clients felt it is important to have a say in treatment wishes, carers expressed concerns about service user capacity to make decisions. After completing PADs, clients reported an increase in self-efficacy and an increased desire to make decisions. Conclusions The introduction of psychiatric advance directives in India appears to be associated with positive outcomes for some service users, however, there is a need to better understand how this tool can be adapted to better suit the care context in

  18. Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals

    PubMed Central

    HOLLEN, VERA; SCHACHT, LUCILLE

    2016-01-01

    Objectives: The goal of this study was to explore antipsychotic medication prescribing practices in a sample of 86,034 patients discharged from state psychiatric inpatient hospitals and to find the prevalence of patients discharged with no antipsychotic medications, on antipsychotic monotherapy, and on antipsychotic polypharmacy. For patients discharged on antipsychotic polypharmacy, the study explored the adjusted rates of antipsychotic polypharmacy, the reasons patients were discharged on antipsychotic polypharmacy, the proportion of antipsychotic polypharmacy by mental health disorder, and the characteristics associated with being discharged on antipsychotic polypharmacy. Methods: This cross-sectional study analyzed all discharges for adult patients (18 to 64 y of age) from state psychiatric inpatient hospitals between January 1 and December 31, 2011. The relationship among variables was explored using χ2, t test, and analysis of variance. Logistic regression was used to determine predictors of antipsychotic polypharmacy. Results: The prevalence of antipsychotic polypharmacy was 12%. Of the discharged patients receiving at least 1 antipsychotic medication (adjusted rate), 18% were on antipsychotic polypharmacy. The strongest predictors of antipsychotic polypharmacy being prescribed were having a diagnosis of schizophrenia and a length of stay of 90 days or more. Patients were prescribed antipsychotic polypharmacy primarily to reduce their symptoms. Conclusions: Antipsychotic polypharmacy continues at a high enough rate to affect nearly 10,000 patients with a diagnosis of schizophrenia each year in state psychiatric inpatient hospitals. Further analysis of the clinical presentation of these patients may highlight particular aspects of the illness and its previous treatment that are contributing to practices outside the best-practice guideline. An increased understanding of trend data, patient characteristics, and national benchmarks provides an opportunity for

  19. Advancing practice relating to SEA alternatives

    SciTech Connect

    González, Ainhoa; Thérivel, Riki; Fry, John; Foley, Walter

    2015-07-15

    Developing and assessing alternatives is a key and central stage to Strategic Environmental Assessment (SEA). However, research has repeatedly reported this stage as one of the most poorly undertaken aspects of the SEA process. Current practice limitations include belated consideration of reasonable alternatives, narrow scope of alternatives that often include unrealistic or retrofitted options, limited stakeholder and public involvement in their identification, assessment and selection, lack of systematic approaches to their assessment and comparison, and inadequate reporting of the ‘storyline’ on how they were identified, what the potential impacts are and why the preferred alternative was selected. These issues have resulted in objections and judicial reviews. On the positive side, a number of good practice case studies enable extraction of key lessons and formulation of a set of general recommendations to advance practice in SEA alternatives. In this paper, practical guidance on the identification and development of alternatives, their assessment and comparison, selection of the preferred option, and documentation of the process and the reasons for selection is provided and discussed to frame good practice approaches. - Highlights: • Alternatives are one of the most poorly completed aspects of Strategic Environmental Assessment. • Current practice limitations need to be addressed to enhance SEA effectiveness. • A set of recommendations are extracted from good practice case studies. • These recommendations can be applied across jurisdictions and sectors and tailored as necessary.

  20. Doctor of Nursing Practice Education: Impact on Advanced Nursing Practice.

    PubMed

    Paplham, Pamela; Austin-Ketch, Tammy

    2015-11-01

    To discuss how doctoral education, specifically the doctorate of nursing practice (DNP) can promote changes in advanced practice nursing. Medline, CINAHL, PubMed. Variations continue to exist in educational curricula, program plans, and scholarly projects, leading to a lack of consistency in experiential learning. At this point in time it is too early in the DNP implementation process to determine ultimate impact. Continuous program self-assessment and evaluation of DNP education programs will be of paramount importance to assure program quality and optimization of health trajectories. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. The contemporary practice of psychiatric surgery: results from a global survey of functional neurosurgeons.

    PubMed

    Mendelsohn, Daniel; Lipsman, Nir; Lozano, Andres M; Taira, Takaomi; Bernstein, Mark

    2013-01-01

    Interest in neurosurgery for psychiatric diseases (NPD) has grown globally. We previously reported the results of a survey of North American functional neurosurgeons that evaluated general attitudes towards NPD and the future directions of the field. The purpose of this study was to expand on our previous work and obtain a snapshot in time of global attitudes towards NPD among practicing functional neurosurgeons. We measure general and regional trends in functional neurosurgery and focus specifically on surgery for mind and mood, while exploring the future prospects of the field. We designed an online survey and distributed it electronically to 881 members of the following international organizations: World Society for Stereotactic and Functional Neurosurgery, European Society for Stereotactic and Functional Neurosurgery, Asian-Australasian Society for Stereotactic Functional Neurosurgery and the South and Latin American Society for Stereotactic and Functional Neurosurgery. Subsequent statistical and thematic analysis was performed on the data obtained. Of 881 surveys distributed, 106 were returned (12.8%). Eighty-two percent of functional neurosurgeon respondents were fellowship trained, with movement disorders and pain making up the majority of their practice. Psychiatric indications are the most frequently treated conditions for 34% of survey respondents, and over half of participants (51%) perform epilepsy surgery. Of the psychiatric conditions, obsessive-compulsive disorder and depression are the most common disorders treated. The majority of respondents (90%) felt optimistic about the future of NPD. Two thirds cited the reluctance of psychiatrists to refer patients as the greatest obstacle facing the field, and a majority reported that a cultural stigma surrounding psychiatric diseases exists in their community. In response to hypothetical situations involving cognitive and personality enhancement, opinions varied, but the majority opposed enhancement

  2. Body mass index and blood glucose in psychiatric and general practice populations

    PubMed Central

    McAvoy, Sarah; Cordiner, Matthew; Kelly, Jackie; Chiwanda, Laura; Jefferies, Christine; Miller, Kirsteen; Shajahan, Polash

    2016-01-01

    Aims and method Using a retrospective observational approach, we aimed to discern whether there was a difference in metabolic parameters between psychiatric and general practice populations in the same locality. Second, we aimed to establish differences in metabolic parameters of patients taking olanzapine, clozapine or aripiprazole. Results Patients with psychiatric illness had a body mass index (BMI) comparable to that of the general practice population (28.7 v. 29.7 kg/m2), but blood glucose was significantly lower in the general practice population (4.8 v. 6.1 mmol/L). Olanzapine was associated with the lowest BMI (26.1 kg/m2) and aripiprazole the highest (32.2 kg/m2), with no difference in blood glucose between antipsychotics. Clinical implications Awareness of environmental factors and how they affect individuals is important and medications are not the only cause of metabolic effects. There may be a channelling bias present, meaning practitioners are cognisant of potential metabolic effects prior to prescribing. Overall monitoring of physical health is important regardless of potential cause. PMID:27280032

  3. [Coercive procedures in forensic psychiatry : Current treatment practice in forensic psychiatric hospitals from a medical ethics perspective].

    PubMed

    Jakovljević, A-K; Wiesemann, C

    2016-07-01

    In 2011 the legal foundations of coercive treatment in German forensic psychiatric clinics were declared to be unconstitutional. In the present study we analyzed the frequency of coercive procedures in forensic psychiatric hospitals before and after 2011, the consequences for medical care as well as the ethical assessments by attending chief physicians. By a questionnaire-based survey of views of attending chief physicians in forensic psychiatric clinics in 2013, data on the current state of patient care were collected and analyzed from an ethical perspective. These were compared with treatment data from a large forensic psychiatric clinic collected over the period 2007-2013. Even after 2011 coercive forms of treatment were applied in forensic psychiatric hospitals. In practice, there is a high degree of legal uncertainty regarding the limits of coercive treatment. Of all patients treated in forensic psychiatric clinics in 2012, on average 13 % had been in isolation at least once, approximately 3 % had been treated under fixation at least once and 2.2 % had been subjected to coercive medical treatment at least once. From an ethical perspective an open debate about the practice of coercive treatment is urgently required. Legal regulations, ethical guidelines and treatment standards have to be developed for the special situation of patient care in forensic psychiatric hospitals.

  4. Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies.

    PubMed

    Nieminen, Anna-Lena; Mannevaara, Bodil; Fagerström, Lisbeth

    2011-12-01

    To describe and explore Advanced Practice Nurses' clinical competencies and how these are expressed in clinical practice. Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined. The study's theoretical framework emanates from Aristotle's three-dimensional view of knowledge that is epistêmê, technê, and phronesis. Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis. Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients' caring needs and nursing care activities, (B) the caring relationship, (C) multi-professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture. Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs' scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011

  5. A psychiatric medication decision support guide for social work practice with pregnant and postpartum women.

    PubMed

    Bentley, Kia J; Price, Sarah Kye; Cummings, Cory R

    2014-10-01

    In their work in human services organizations and community agencies across service sectors, social workers encounter pregnant and postpartum women experiencing mental health challenges. This article offers an evidence-informed Decision Support Guide designed for use by social workers working with pregnant and postpartum women who are struggling with complicated decisions about psychiatric medication use. The guide is built on contemporary notions of health literacy and shared decision making and is informed by three areas: (1) research into the lived experiences of pregnant and postpartum women and health care providers around psychiatric medication decision making, (2) a critical review of existing decision aids, and (3) feedback on the strategy from social work practitioners who work with pregnant and postpartum women. Emphasizing the relational nature of social work in supporting effective health-related decision making, the guide relies on maintaining a collaborative practice milieu and using a decision aid that engages clients in discussions about mental health during and around the time of pregnancy. The guide offers social workers a practice tool to support responsive and compassionate care by embracing their roles in problem solving and decision making, providing emotional and psychosocial support, and making appropriate referrals to prescribers.

  6. Designer drugs in psychiatric practice - a review of the literature and the recent situation in Hungary.

    PubMed

    Szily, Erika; Bitter, István

    2013-12-01

    In recent years service providers experienced a new phenomenon in the drug markets of Hungary: the dramatically increasing sale and use of designer drugs. In psychiatric practice, the first sign of this new trend was the increasing number of hospitalized patients with acute psychosis using a new type of designer drug: MDPV (3,4-Methylenedioxypyrovalerone). The range of designer drugs available is wider than ever before. They are inexpensive and many times are known to be legal, undetectable, safe or natural to the consumers. In fact, the compounds and their biological effects are many times unknown to the consumers and to the physicians as well, while a recently emerging body of data suggests that the somatic and mental consequences of their consumption are frequent, severe, and sometimes even life-threatening. The aims of this paper are to summarize the most important general information about some widely used designer drugs (synthetic cathinones and cannabinoids); to draw attention to present and upcoming trends of substance abuse patterns; and to highlight the importance and consequences of these trends in every day clinical practice, considering the most important and challenging somatic and psychiatric consequences of designer drug abuse.

  7. Difficult encounters with psychiatric patients: a South Texas Psychiatry practice-based research network (PBRN) study.

    PubMed

    Sellers, Randall V; Salazar, Ricardo; Martinez, Cervando; Gelfond, Stephen D; Deuter, Melissa; Hayes, Holly G; Ketchum, Norma; Pollock, Brad H

    2012-01-01

    To examine the prevalence of difficult psychiatrist-patient interactions of 20 psychiatrists in the South Texas Psychiatric practice-based research network, determine what characteristics were associated with "difficult" patients, and compare findings with previous studies in primary care. During a 2-month observational study, psychiatrists collected patient information on setting, demographics, diagnoses, and medications and rated the patients using the Difficult Doctor-Patient Relationship Questionnaire, which had previously been used and validated in the primary care setting. A total of 905 valid data cards were collected. Difficult patients were identified in 15% of the sample. Diagnoses of schizophrenia, alcohol/substance abuse, and personality disorder were associated with difficulty. Psychiatrists least burdened by difficult patients were older and in a solo practice and worked 51 to 55 hours per week. This cross-sectional study demonstrates that psychiatrists encounter difficult patients at a rate (15%) similar to that of primary care physicians. Mentoring programs and structured treatment interventions for the most difficult patient groups may assist all physicians who treat psychiatric patients, whether in specialty, family medicine, or other primary care settings.

  8. Child Rearing Practices and Their Relationship to Psychiatric Disturbances. Unit for Child Studies Selected Papers Number 4.

    ERIC Educational Resources Information Center

    Rickarby, Geoff

    Theories furthering understanding of the effects of child rearing practices on psychiatric disturbance are briefly reviewed. Particular attention is given to family dynamics, the double-bind hypothesis, and the development of schizophrenia and related border line syndromes that lead to psychotic phenomena. The issue of child rearing practices is…

  9. Child Rearing Practices and Their Relationship to Psychiatric Disturbances. Unit for Child Studies Selected Papers Number 4.

    ERIC Educational Resources Information Center

    Rickarby, Geoff

    Theories furthering understanding of the effects of child rearing practices on psychiatric disturbance are briefly reviewed. Particular attention is given to family dynamics, the double-bind hypothesis, and the development of schizophrenia and related border line syndromes that lead to psychotic phenomena. The issue of child rearing practices is…

  10. The nature and extent of the use of physical restraint and seclusion in psychiatric practice: Report of a survey

    PubMed Central

    Khastgir, Udayan; Kala, Anirudh; Goswami, Utpal; Kumar, Satindra; Behera, Debakanta

    2003-01-01

    Restraint and seclusion has been used to manage patients despite all controversies. Our study analyzed the opinions of different psychiatrists on the use of this method in their clinical practice. Most of them (80%) practice restraints as a treatment modality and believe that they are integral to the management of psychiatric patients. None is using seclusion. PMID:21206846

  11. Psychiatric diagnosis, psychiatric power and psychiatric abuse.

    PubMed Central

    Szasz, T

    1994-01-01

    Psychiatric abuse, such as we usually associate with practices in the former Soviet Union, is related not to the misuse of psychiatric diagnoses, but to the political power intrinsic to the social role of the psychiatrist in totalitarian and democratic societies alike. Some reflections are offered on the modern, therapeutic state's proclivity to treat adults as patients rather than citizens, disjoin rights from responsibilities, and thus corrupt the language of political-philosophical discourse. PMID:7996558

  12. Good Practices For Infection Prevention and Control at a Psychiatric Hospital in Brazil.

    PubMed

    Piai-Morais, Thaís Helena; Fortaleza, Carlos Magno Castelo Branco; Figueiredo, Rosely Moralez de

    2015-07-01

    This exploratory cross-sectional study aims to investigate good practice for preventing and controlling infections in a psychiatric hospital and for limiting potential exposure to biohazards for nursing professionals at this hospital located in the State of São Paulo, Brazil. The researchers directly and systematically observed 830 nursing procedures, 40.6% of which presented a moderate to high risk of biohazard exposure. Results indicate very low adherence to hand hygiene (1.2% before procedures, 2.9% after procedures), inappropriate use of gloves, and other instances of noncompliance to the standards of good practice for preventing and controlling infection, such as a lack of concurrent/terminal cleaning of dirty beds (132 instances) and careless manipulation of sharp devices (34 instances).

  13. Trauma advanced practice nurses: implementing the role.

    PubMed

    Martin, Kathleen D; Molitor-Kirsch, Shirley; Elgart, Heidi; Ruffolo, Daria C; Sicoutris, Corinna; Meredith, Denise

    2004-01-01

    The need for advanced practice nurses (APN) has expanded over the past several decades as a result of the changing healthcare environment. Increased patient acuity and decreased resident work hours have lead to a need for additional clinical expertise at the bedside. APNs are becoming an integral part of the acute care delivery team in many trauma programs and intensive care units. To date little has been published regarding the role of the APN in Trauma Centers. This article outlines the wide variety of responsibilities and services provided by a select group of nurse practitioners who work in trauma centers throughout the United States.

  14. Jainism - Its relevance to psychiatric practice; with special reference to the practice of Sallekhana.

    PubMed

    Somasundaram, Ottilingam; Tejus Murthy, A G; Raghavan, D Vijaya

    2016-01-01

    Jainism is one of the oldest religions of India. Since the founding of the religion, Jainism has given prominence to Sallekhana, death by ritual fasting facing north, as exemplified in the deaths of Bhadrabahu and Chandragupta Maurya. The controversy whether this religious form of starvation is related to suicide is debated since the time of the early Jain teachers. History is replete with instances where kings and warriors who have failed in their duty punish themselves for their sin and welcome death as expiation. Such starvation deaths are referred to as vadakirutthal (literally, facing north) and become quite prevalent during the Sangam age, probably copied from the Jain culture. The present-day thinking on Sallekhana needs to be considered here in more detail which should be brought to the knowledge of current-day psychiatrists. These ideas are relevant to psychiatric counseling of the ordinary people and would be very useful if included in the armamentarium of the mental health professionals.

  15. Psychiatric Advance Directives as a complex and multistage intervention: a realist systematic review.

    PubMed

    Nicaise, Pablo; Lorant, Vincent; Dubois, Vincent

    2013-01-01

    Psychiatric Advance Directives (PADs) are documents that allow users with severe and chronic mental illnesses to notify their treatment preferences for future crisis relapses and to appoint a surrogate decision-maker for a period of incompetence. Despite many supposed clinical and organisational benefits, their take-up rate has remained very low and their clinical evaluation has given contradictory results for organisational outcomes. Intermediary results are available, however, which rely on different theoretical views about how PADs are supposed to work. We carried out a realist systematic review that considered the PAD as a multistage intervention including the definition of the document, its completion and its access and honouring. We identified the theoretical frameworks underlying this kind of intervention and examined the available evidence that supported or contradicted the expectations at each stage of the intervention. Forty-seven references were retrieved, ranging from 1996 to 2009. Three frameworks underlie a PAD intervention: enhancement of the autonomy of the user, improvement of the therapeutic alliance and integration of care through partnership working. Although designed in the first place with a view to sustaining the user's autonomy, results indicate that the intervention is more efficient within a therapeutic alliance framework. Moreover, much is known about the completion process and the content of the document, but very little about its access and honouring. The mixture of expectations makes the purpose of PADs unclear, for example, crisis relapse prevention or management, advance planning of long-term or emergency care, or reduction in the resort to coercion. This may explain their low take-up rates. Hence, frameworks and purpose have to be clarified. The shape of the whole intervention at each stage relies on such clarification. More research is needed, particularly on the later stages of the intervention, as the evidence for how PADs should

  16. AAPL Practice Guideline for the forensic psychiatric evaluation of competence to stand trial.

    PubMed

    Mossman, Douglas; Noffsinger, Stephen G; Ash, Peter; Frierson, Richard L; Gerbasi, Joan; Hackett, Maureen; Lewis, Catherine F; Pinals, Debra A; Scott, Charles L; Sieg, Karl G; Wall, Barry W; Zonana, Howard V

    2007-01-01

    Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized

  17. "A world crazier than us": Vanishing social contexts and the consequences for psychiatric practice in contemporary Romania.

    PubMed

    Friedman, Jack R

    2016-04-01

    Since the end of Communism, mental health care in Romania has increasingly sought to align its practices with idealized models of Western psychiatric practice. Much of this realignment has been made possible by accessing and integrating new pharmaceuticals into psychiatric hospital settings. Less straightforward have been the painful attempts to create a system modeled on international standards for training and certifying psychotherapists. Unfortunately, the political, economic, infrastructural, and epistemological environment of the Romanian mental health care system has prevented many other reforms. This paper examines the ironic trajectory that Romanian psychiatry has taken since the end of state socialism. Specifically, this paper shows how psychiatric practice in most places (outside of university-training hospitals) is increasingly disconnected from a concern with the social conditions that surround mental illness during a period when social upheaval is profoundly impacting the lives of many people who receive mental health care. Thus, as the contribution of social problems to the suffering of those with mental illnesses has increased, some Romanian mental health practitioners have moved away from a concern with these social problems under the guise of aligning their psychiatric practices with (imagined) Western standards of biomedical care. The paper provides a brief history of Romanian psychiatry and explores contemporary challenges and contradictions in many Romanian psychiatric treatment settings through the case study of a 31-year-old Romanian female diagnosed with paranoid schizophrenia. © The Author(s) 2015.

  18. A critical engagement with the concept of advancing nursing practice.

    PubMed

    Por, Jitna

    2008-01-01

    This paper aims to elucidate the concept of advancing nursing practice by engaging critically with developments in policy in the UK and ongoing debates in the international literature. Advancing practice to the outer edges of nursing's scope of practice is a challenge for the profession both in the UK and elsewhere. However, defining what advancing nursing practice is and what it might become remains problematic. Critical analysis of published papers and policy documents pertaining to the concept of advancing nursing practice. Advancing nursing practice as a concept offers enormous potential for nurses and has been the subject of numerous debates over the last 25 years. Previous history of advanced practice offers no imperative practice and informs us little about the future roles of advanced nurse practitioners. Current understanding about the role of advanced nurse practitioner and the nature of advanced practice remains unclear. Measuring the impact and outcome of the complex advanced practice nursing roles remains a challenge. While it is difficult to articulate succinctly what constitutes advancing nursing practice, defining the activities nurses engage in, the skills and competencies involved and the qualities and attributes required help reduce the ambiguities of the role.

  19. Neurological and psychiatric diseases and their unique cognitive profiles: implications for nursing practice and research.

    PubMed

    Vance, David E; Dodson, Joan E; Watkins, Jason; Kennedy, Bridgett H; Keltner, Norman L

    2013-04-01

    To successfully negotiate and interact with one's environment, optimal cognitive functioning is needed. Unfortunately, many neurological and psychiatric diseases impede certain cognitive abilities such as executive functioning or speed of processing; this can produce a poor fit between the patient and the cognitive demands of his or her environment. Such nondementia diseases include bipolar disorder, schizophrenia, post-traumatic stress syndrome, depression, and anxiety disorders, just to name a few. Each of these diseases negatively affects particular areas of the brain, resulting in distinct cognitive profiles (e.g., deficits in executive functioning but normal speed of processing as seen in schizophrenia). In fact, it is from these cognitive deficits in which such behavioral and emotional symptoms may manifest (e.g., delusions, paranoia). This article highlights the distinct cognitive profiles of such common neurological and psychiatric diseases. An understanding of such disease-specific cognitive profiles can assist nurses in providing care to patients by knowing what cognitive deficits are associated with each disease and how these cognitive deficits impact everyday functioning and social interactions. Implications for nursing practice and research are posited within the framework of cognitive reserve and neuroplasticity.

  20. Practice Parameter for the Psychiatric Assessment and Management of Physically Ill Children and Adolescents

    ERIC Educational Resources Information Center

    Journal of the American Academy of Child & Adolescent Psychiatry, 2009

    2009-01-01

    An introduction for any medical health clinician on the knowledge and skills that are needed for the psychiatric assessment and management of physically ill children and adolescents is presented. These parameters are presented to assist clinicians in psychiatric decision making.

  1. Practice Parameter for the Psychiatric Assessment and Management of Physically Ill Children and Adolescents

    ERIC Educational Resources Information Center

    Journal of the American Academy of Child & Adolescent Psychiatry, 2009

    2009-01-01

    An introduction for any medical health clinician on the knowledge and skills that are needed for the psychiatric assessment and management of physically ill children and adolescents is presented. These parameters are presented to assist clinicians in psychiatric decision making.

  2. Jainism - Its relevance to psychiatric practice; with special reference to the practice of Sallekhana

    PubMed Central

    Somasundaram, Ottilingam; Tejus Murthy, A. G.; Raghavan, D. Vijaya

    2016-01-01

    Jainism is one of the oldest religions of India. Since the founding of the religion, Jainism has given prominence to Sallekhana, death by ritual fasting facing north, as exemplified in the deaths of Bhadrabahu and Chandragupta Maurya. The controversy whether this religious form of starvation is related to suicide is debated since the time of the early Jain teachers. History is replete with instances where kings and warriors who have failed in their duty punish themselves for their sin and welcome death as expiation. Such starvation deaths are referred to as vadakirutthal (literally, facing north) and become quite prevalent during the Sangam age, probably copied from the Jain culture. The present-day thinking on Sallekhana needs to be considered here in more detail which should be brought to the knowledge of current-day psychiatrists. These ideas are relevant to psychiatric counseling of the ordinary people and would be very useful if included in the armamentarium of the mental health professionals. PMID:28197009

  3. Psychiatric Emergencies

    PubMed Central

    Bayrakal, Sadi

    1972-01-01

    Dr. Bayrakal believes that the time has come for the family physician to deal with minor psychiatric disturbances in his office as well as psychiatric emergencies in the emergency department. The newly emerging medico-social philosophy of both the federal and provincial governments, he says, is giving greater responsibility and authority to the family physician in every area of medicine, including psychiatry. The author discusses major psychiatric emergencies (suicide, suicidal attempt, homicide, social scandal, as well as other psychiatric emergencies) on the ward including adolescent psychiatry. (The descriptions and treatment procedures are given on a concrete clinical level without theoretical overload.) In the family physician's work, psychological understanding is of profound importance. Giving him the added scope of psychiatric consideration to see the patient in bio-psycho-social totality will enable him to practice a more humanized form of medicine. PMID:20468779

  4. Pharmacogenomic testing and outcome among depressed patients in a tertiary care outpatient psychiatric consultation practice.

    PubMed

    Rundell, J R; Harmandayan, M; Staab, J P

    2011-05-10

    The authors tested the hypothesis that pharmacogenomic genotype knowledge is associated with better clinical and cost outcomes in depressed patients, after controlling for other factors that might differentiate tested and non-tested patients. Medical records of 251 patients, seen in the Mayo Clinic Rochester outpatient psychiatric practice, who had patient health questionnaire-9 (PHQ-9) scores before and after consultation, were reviewed. Comparisons of differences in pre-consultation and post-consultation depression scores and slopes between tested and non-tested patients and between genotype categories of tested patients, were evaluated, along with healthcare cost and utilization comparisons between tested and non-tested patients, using Kruskal-Wallis tests, Wilcoxon rank-sum tests and group mean comparisons, controlling for significant univariate demographic and clinical differences. Tested patients had significantly higher depression diagnosis frequency, baseline PHQ-9 scores, family history of depression, psychiatric hospitalization history, and higher numbers of antidepressant, mood stabilizer and antipsychotic medication trials. After controlling for these differences, there were no differences between tested and non-tested patients in post-baseline depression scores or slopes for CYP genotype categories. For patients with 5-HTTLPR testing, there was significantly more depression score improvement for patients with the long/long genotype at time 4 (N=55, χ(2)-value=8.0492, P=0.018) and at time 5 (N=44, χ(2)-value=6.1492, P=0.046). For a subgroup (n=46) with ≥two pre- and ≥two post-baseline PHQ-9 scores, the mean difference between pre-baseline and post-baseline PHQ-9 score slopes for tested patients was -0.08 (median -0.01; range -1.20 to 0.15) compared with 0.13 (median 0.02; range -0.18 to 2.16) for non-tested patients (P=0.03). Among genotype categories, mean differences between pre-consultation and post-consultation slopes were significantly better

  5. Subjectivity in clinical practice: on the origins of psychiatric semiology in early French alienism.

    PubMed

    Huertas, Rafael

    2014-12-01

    The aim of this article is to contribute to the analysis of the origins of psychiatric semiology, which by emphasizing subjectivity in clinical practice, gave birth to psychopathology as the scientific and intellectual enterprise of alienism. In other words, beyond simple anatomical and clinical observation, there was an effort to 'listen to' and 'read' the patient's delirium. In essence, the basic thesis which this short paper seeks to defend is that, despite a growing anatomical and clinical mind-set and a clear interest in physically locating mental illness within the body, during the Romantic period, psychiatry was able to construct a semiology largely based on the experience of the ego, on the inner world of the individual. This makes it possible to establish, from a clinical perspective, that the birth of alienism - of psychiatry - must be situated within the framework of a modernity in which the culture of subjectivity was one of its most characteristic features. © The Author(s) 2014.

  6. An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice.

    PubMed

    Mun, Mi Suk

    2010-02-01

    The development of students' critical thinking abilities is one of the greatest challenges facing contemporary nursing educators. Nursing educators should know about what kind of contents or situations need critical thinking. The research was undertaken to identify the critical thinking contexts that nursing students confront in psychiatric clinical practices. Students were asked to document their everyday experience. The narratives were analysed and interpreted from the philosophical notion of hermeneutics. Four themes emerged as critical thinking contexts: anxiety, conflict, hyper-awareness, dilemmas. Writing narratives appear to provide opportunities for reflection in addition to facilitating critical thinking and communicative skills in students. Also, for the instructor, students' clinical narratives could provide insight to understand how students are thinking and to share student's personal difficulties.

  7. Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice

    PubMed Central

    Desplenter, Franciska A.; Laekeman, Gert J.; De Coster, Sandra; Reyntens, Johan; De Baere, Sheila; De Boever, Willy; De Vos, Marc; Vrijders, Danny; De Fré, Claudine; De Keyster, Cécile; De Meulemeester, Katharina; Heremans, Marise; Rutgeerts, Cathérine; Simoens, Steven R.

    Background Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. Objective This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. Methods A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. Results Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. Conclusions Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and

  8. Supported education for individuals with psychiatric disabilities: State of the practice and policy implications.

    PubMed

    Ringeisen, Heather; Langer Ellison, Marsha; Ryder-Burge, Amy; Biebel, Kathleen; Alikhan, Shums; Jones, Emily

    2017-06-01

    Supported education (SEd) is a promising practice that supports and encourages educational goals and attainment among individuals with psychiatric disabilities. This paper provides insights into how SEd objectives are pursued in different settings, assesses the evidence base, and discusses policy implications. Insights from 3 data sources were synthesized: published literature, an environmental scan, and 3 site visits to programs that support the education goals of individuals with psychiatric disabilities. While setting, target populations, level of coordination with supported employment, and financing strategies varied, common SEd components emerged: specialized and dedicated staffing, one-on-one and group skill-building activities, assistance with navigating the academic setting and coordinating different services, and linkages with mental health counseling. The evidence base is growing; however, many published studies to date do not employ rigorous methodology. Conclusions and Implications for Policy and Practice: Continued specification, operationalization, and testing of SEd core components are needed. The components of the evolving SEd model would benefit from rigorous testing to evaluate impact on degree completion and other key impacts such as employment; health, mental health, or recovery; and community participation. In addition to funding streams from special education and Medicaid, new opportunities for increasing the availability of SEd include the Workforce Innovation and Opportunities Act (WIOA) reauthorization, which requires state vocational rehabilitation agencies to fund preemployment services for transition-age individuals. New "set-aside" requirements for the Mental Health Services Block Grant will increase funding for early intervention services for individuals with serious mental illness, potentially including SEd. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. An Advanced Pharmacy Practice Experience in Academia

    PubMed Central

    Sylvia, Lynne M.

    2006-01-01

    Objectives To create an advanced pharmacy practice experience (APPE) that would encourage students to consider a career in academia. Design A 6-week, 6-credit elective APPE was created that offered students the opportunity to observe and participate in activities consistent with a full-time faculty appointment. Assessment A 9-question survey instrument was administered to 27 students who completed the APPE between 2000 and 2004 to determine the impact of the APPE on the student's career choice. Sixteen (59%) of the 27 students returned the completed survey instrument. Ten of the 16 respondents noted that the APPE had influenced their pursuit of a position with a teaching component. Conclusion Offering APPEs in academia may encourage students to incorporate teaching and scholarship into their career plans. PMID:17149426

  10. Neonatal resuscitation: advances in training and practice

    PubMed Central

    Sawyer, Taylor; Umoren, Rachel A; Gray, Megan M

    2017-01-01

    Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR) reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA) develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP) translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. PMID:28096704

  11. Special observations in forensic psychiatric practice: gender issues of the watchers and the watched.

    PubMed

    Mason, T; Mason-Whitehead, E; Thomas, M

    2009-12-01

    Special observations in psychiatric practice may create tensions for both the patient under surveillance and the staff undertaking the procedure. This study reports on special observations undertaken in forensic settings focusing specifically on the gender-sensitive issues. The aim of the study was to investigate the specific gender issues relating to special observations in relation to those under the procedure and those engaged in observing. Three medium secure units in the UK formed the sampling frame, and the population studied was eight female and seven male clinical Registered nurses. Semi-structured interviews were conducted, audio-tape-recorded and transcribed for analysis. The analysis involved a Grounded Theory approach to explicate categories and formulate two overarching themes: (1) the psychosocial fusion; and (2) the private as spectacle. There are implications for practice in relation to policy formulation and the implementation of special observations following risk assessment and individual skill identification. It is concluded that gender issues are extremely important for all concerned in this intrusive practice.

  12. [Antipsychotics and rhabdomyolysis. Differential diagnosis and clinical significance of elevated serum creatine kinase levels in psychiatric practice].

    PubMed

    Vörös, Viktor; Osváth, Péter; Fekete, Sándor; Tényi, Tamás

    2009-01-01

    Elevated serum CK levels often occur in everyday psychiatric clinical practice. Although the majority of cases are benign and temporary, it is important to recognize and treat these conditions. Review of the literature and case reports. The authors discuss the etiology, the clinical significance and the management of elevated serum creatine-kinase levels in psychiatric in-patient practice, focusing on antipsychotic-induced rhabdomyolysis. The authors also compare the pathogenesis, the clinical features and the treatment of neuroleptic malignant syndrome and rhabdomyolysis. A brief, practical guideline is introduced, which may help clinicians in the differential diagnosis and in the management of patients with elevated serum creatine kinase activity in emergent psychiatric practice. The most common etiologic factors (prescription drugs, alcohol, physical reasons, cardiac etiology) and clinical syndromes (rhabdomyolysis, neuroleptic malignant syndrome, acute coronary syndrome) should be considered, when elevated creatine kinase levels are encountered in psychiatric in-patients. Routine creatine kinase measurements in asymptomatic patients on antipsychotic medications are not recommended, but patients should be carefully followed for the development of rhabdomyolysis, when muscular symptoms arise. Cautiously challenging patients with another antipsychotic after an antipsychotic-induced rhabdomyolysis is recommended to decrease the possibility of recurrence. Careful monitoring of symptoms and potential complications is critical in order to avoid devastating clinical consequences.

  13. Competency frameworks for advanced practice nursing: a literature review.

    PubMed

    Sastre-Fullana, P; De Pedro-Gómez, J E; Bennasar-Veny, M; Serrano-Gallardo, P; Morales-Asencio, J M

    2014-12-01

    This paper describes a literature review that identified common traits in advanced practice nursing that are specific to competency development worldwide. There is a lack of international agreement on the definition of advanced practice nursing and its core competencies. Despite the lack of consensus, there is an ongoing process worldwide to establish and outline the standards and competencies for advanced practice nursing roles. International agencies, such as the International Council of Nurses, have provided general definitions for advanced practice nursing. Additionally, a set of competency standards for this aim has been developed. A literature review and a directed search of institutional websites were performed to identify specific developments in advanced practice nursing competencies and standards of practice. To determine a competency map specific to international advanced practice nursing, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents and countries. The review process identified 119 relevant journal articles related to advanced practice nursing competencies. Additionally, 97 documents from grey literature that were related to advanced practice nursing competency mapping were identified. From the text analysis, 17 worldwide transversal competency domains emerged. Despite the variety of patterns in international advanced practice nursing development, essential competency domains can be found in most national frameworks for the role development of international advanced practice nursing. These 17 core competencies can be used to further develop instruments that assess the perceived competency of advanced practice nurses. The results of this review can help policy developers and researchers develop instruments to compare advanced practice nursing services in various contexts and to examine their association with related outcomes. © 2014 International Council of Nurses.

  14. Regional collaborative practice in psychiatric rehabilitation and recovery: a best practice model.

    PubMed

    Chambers, Ruth; Tullys, Toni; Mayer, Kimberly; Wigand, Donna

    2008-01-01

    This article reviews the current literature related to the elements that make collaboration within large systems successful. The Greater Bay Area Mental Health and Education Workforce Collaborative is highlighted as a California best practices model for regional partnership development and implementation. Also included is a second case example that takes similar collaborative elements and uses them in one of the Greater Bay Area Collaborative member counties.

  15. Practice parameter for cultural competence in child and adolescent psychiatric practice.

    PubMed

    Pumariega, Andrés J; Rothe, Eugenio; Mian, Ayesha; Carlisle, Lee; Toppelberg, Claudio; Harris, Toi; Gogineni, Rama Rao; Webb, Sala; Smith, Jacqueline

    2013-10-01

    The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families. Copyright © 2013. Published by Elsevier Inc.

  16. Who's your expert? Use of an expert opinion survey to inform development of American Psychiatric Association practice guidelines.

    PubMed

    Yager, Joel; Kunkle, Robert; Fochtmann, Laura J; Reid, Sara M; Plovnick, Robert; Nininger, James E; Silverman, Joel J; Vergare, Michael J

    2014-06-01

    For many clinical questions in psychiatry, high-quality evidence is lacking. Credible practice guidelines for such questions depend on transparent, reproducible, and valid methods for assessing expert opinion. The objective of this study was to develop and demonstrate the feasibility of a method for assessing expert opinion to aid in the development of practice guidelines by the American Psychiatric Association (APA). A "snowball" process initially soliciting nominees from three sets of professional leaders was used to identify experts on a guideline topic (psychiatric evaluation). In a Web-based survey, the experts were asked to rate their level of agreement that specific assessments improve specific outcomes when they are included in an initial psychiatric evaluation. The experts were also asked about their own practice patterns with respect to the doing of the assessments. The main outcome measures are the following: number of nominated experts, number of experts who participated in the survey, and number and nature of quantitative and qualitative responses. The snowball process identified 1,738 experts, 784 (45 %) of whom participated in the opinion survey. Participants generally, but not always, agreed or strongly agreed that the assessments asked about would improve specified outcomes. Participants wrote 716 comments explaining why they might not typically include some assessments in an initial evaluation and 1,590 comments concerning other aspects of the topics under consideration. The snowball process based on initial solicitation of Psychiatry's leaders produced a large expert panel. The Web-based survey systematically assessed the opinions of these experts on the utility of specific psychiatric assessments, providing useful information to substantiate opinion-based practice guidelines on how to conduct a psychiatric evaluation. The considerable engagement of respondents shows promise for using this methodology in developing future APA practice guidelines.

  17. Modifying autonomy--a concept grounded in nurses' experiences of moral decision-making in psychiatric practice.

    PubMed Central

    Lützén, K; Nordin, C

    1994-01-01

    Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making in psychiatric practice. PMID:8083870

  18. Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings.

    PubMed

    Ewashen, Carol; Lane, Annette

    2007-09-01

    Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between 'counselor', and 'caring educator'? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions.

  19. Mental health legislation in Lebanon: Nonconformity to international standards and clinical dilemmas in psychiatric practice.

    PubMed

    Kerbage, Hala; El Chammay, Rabih; Richa, Sami

    2016-01-01

    Mental health legislation represents an important mean of protecting the rights of persons with mental disabilities by preventing human rights violations and discrimination and by legally reinforcing the objectives of a mental health policy. The last decade has seen significant changes in the laws relating to psychiatric practice all over the world, especially with the implementation of the Convention for the Rights of People with Disabilities (CRPD). In this paper, we review the existing legislation in Lebanon concerning the following areas in mental health: treatment and legal protection of persons with mental disabilities, criminal laws in relation to offenders with mental disorders, and laws regulating incapacity. We will discuss these texts in comparison with international recommendations and standards on the rights of persons with disabilities, showing the recurrent contradiction between them. Throughout our article, we will address the clinical dilemmas that Lebanese psychiatrists encounter in practice, in the absence of a clear legislation that can orient their decisions and protect their patients from abuse.

  20. Identifying advanced practice: A national survey of a nursing workforce.

    PubMed

    Gardner, Glenn; Duffield, Christine; Doubrovsky, Anna; Adams, Margaret

    2016-03-01

    The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing. To identify and delineate advanced practice from other levels of nursing practice through examination of a national nursing workforce. A cross-sectional electronic survey of nurses using the validated Advanced Practice Role Delineation tool based on the Strong Model of Advanced Practice. Study participants were registered nurses employed in a clinical service environment across all states and territories of Australia. A sample of 5662 registered nurses participated in the study. Domain means for each participant were calculated then means for nursing position titles were calculated. Position titles were grouped by delineation and were compared with one-way analysis of variance on domain means. The alpha for all tests was set at 0.05. Significant effects were examined with Scheffe post hoc comparisons to control for Type 1 error. The survey tool was able to identify position titles where nurses were practicing at an advanced level and to delineate this cohort from other levels of nursing practice, including nurse practitioner. The results show that nurses who practice at an advanced level are characterised by high mean scores across all Domains of the Strong Model of Advanced Practice. The mean scores of advanced practice nurses were significantly different from nurse practitioners in the Direct Care Domain and

  1. Evolvement of French advanced practice nurses.

    PubMed

    Bonnel, Galadriel

    2014-04-01

    The purpose of this review is to chronicle the development of the advanced practice nurse (APN) in France and compare international APN indictors of quality care with French studies. A review of the literature was performed by accessing the MEDLINE, Science Direct, and Cochrane Databases for studies of quality of care by APNs during 1965-2012. The author's participation on a national task force in collaboration with the French Ministry of Health provided additional information. After applying limits of this search, 36 studies fulfilled inclusion and exclusion criteria. In both the French and international APN nursing literature, the most frequently described quality of care measures were level of patient satisfaction and other patient outcomes (clinical and laboratory measures) according to evidence-based guidelines. In three French studies (nephrology, neuro-oncology, and urology settings), nurses performed direct patient care and were legally permitted to take on some limited responsibilities usually held by French physicians, including clinical examinations, diagnosing, and prescribing. Creation of the APN role in France can respond to public health challenges including the rising incidence of chronic diseases and an impending physician shortage. Future APN research should focus on rigorous, innovative design development including collaborative care models. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  2. Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice

    PubMed Central

    Fairman, Nathan

    2013-01-01

    Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice. PMID:23794027

  3. Practice Experiences at a Single Institutional Practice Site to Improve Advanced Pharmacy Practice Examination Performance

    PubMed Central

    Britton, Mark L.; Wheeler, Richard E.; Carter, Sandra M.

    2014-01-01

    Objective. To determine whether sequential assignment of students to the same facility for institutional practice experiences improves their advanced pharmacy practice experience (APPE) examination scores. Design. Student volunteers were assigned to the same healthcare facility for all institutional introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs). Other students completed institutional IPPEs and APPEs at separate healthcare facilities, ranging from 2 to 4 different facilities per student. APPE examination scores of students assigned to the same facility for all institutional learning experiences were compared with those of students assigned to more than 1 institutional practice site. Assessment. Holding grade point average constant, students assigned to the same facility for institutional IPPEs and APPEs scored 3 percentage points higher on the APPE institutional examination compared with students assigned to separate facilities for these experiences. Conclusion. Assigning students to the same facility for both institutional IPPEs and APPEs positively influenced knowledge-based APPE examination performance. PMID:24761021

  4. A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice.

    PubMed

    Zhu, SuoYu; Zhang, TianHong; Yang, ChengQing; Wei, YanYan; Xu, LiHua; Wang, JunJie; Chow, Annabelle; Liu, XiaoHua; Jiang, KaiDa; Xiao, ZePing; Zhou, Hui; Wang, JiJun

    2017-09-27

    This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs. A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview. 685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China. Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.

  5. Scope of Practice Barriers for Advanced Practice Registered Nurses: A State Task Force to Minimize Barriers.

    PubMed

    Lofgren, Maria A; Berends, Susan K; Reyes, Jimmy; Wycoff, Carmen; Kinnetz, Meghan; Frohling, Ami; Baker, Laura; Whitty, Sue; Dirks, Mary; OʼBrien, Mary

    2017-09-01

    Collegial relationships, administrative champions, and persistence are key components to breaking down barriers to advanced practice RN (APRN) practice. This article addresses how Iowa APRNs in a state-sanctioned task force identified barriers for practicing at the top of their licensure in a full practice authority state including defending the right to control the scope of nursing practice in court.

  6. Advanced practice in paediatric intensive care: a review.

    PubMed

    Heward, Yvonne

    2009-02-01

    Advanced nursing roles are one way of encouraging experienced nurses to stay in clinical practice so they can provide expert care, develop practice and be role models for junior staff. A search for literature about advanced nurse practice in paediatric intensive care units in the UK identified just four articles, including one survey, but no reports of empirical research. There is some consensus on the nature and educational requirements for advanced practice but delays in agreeing a regulatory framework and failure to recognise the potential contribution of advanced roles mean that development is hindered. Although several UK units have developed or are developing the role, more insight and better evidence is needed on how nursing can be advanced in paediatric intensive care settings.

  7. Exploring Best Practices in Advance Care Planning

    DTIC Science & Technology

    2016-05-11

    Background: The factors that influence completion of advance care planning for elderly adults in the primary care setting are poorly understood...System factors such as expansion of technological and medical options added to lists of tasks primary care providers are expected to complete in ever...to low rates of completion. We hypothesized that prioritized utilization of motivational interviewing during a visit specified to address advance care planning will enhance completion rates of appropriate planning.

  8. Population-based advanced practice nursing: where does oncology fit in?

    PubMed

    Lattimer, Jennie Greco

    2013-12-01

    A national work group met in 2004 to discuss the future of advanced practice nursing. The representatives were nursing education, certification, accreditation, and regulation experts, and the goal was to develop a consensus model for advanced practice nursing regulation (Nevidjon et al., 2010). As a result, a set of recommendations was published in an article that defined a new consensus model for advanced practice registered nurse (APRN) regulation (APRN Consensus Workgroup, 2008; Goudreau, 2009). The new model included six population-based focuses of practice (i.e., family and individual across the lifespan, adult and gerontology, neonatal, pediatrics, women's health- and gender-related, and psychiatric and mental health) (Johnson, Dawson, & Brassard, 2010). A goal of the new model was to standardize the licensure, certification, and regulation of nurse practitioners into specific focuses. State boards were facing an increasing number of requests to recognize nurse practitioner specialties (e.g., organ specific, body systems, diseases) (Johnson et al., 2010). The new model helped standardize education programs, which may help certifying agencies set up curriculum review processes to ensure appropriate credentials for APRNs (Johnson et al., 2010). It also supported the mission of nursing to meet future healthcare needs of the public and to protect the public (Johnson et al., 2010). Some advantages exist to delineating into population-based focuses, but the new model leaves out many specialties (e.g., oncology) that encompass the whole person as well as concentrate on certain diseases.

  9. Culture, salience, and psychiatric diagnosis: exploring the concept of cultural congruence & its practical application

    PubMed Central

    2013-01-01

    Introduction Cultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct. Results The article distinguishes symbolic from phenomenological conceptions of culture, the latter expanded upon through two sources: Husserl’s phenomenological analysis of background intentionality and neuropsychological literature on salience. It is argued that culture is not limited to symbolic presuppositions and shapes subjects’ experiential dispositions. This conception is deployed to re-examine the meaning of (in)congruence. The main argument is that a significant, since foundational, deviation from culture is not from a value or belief but from culturally-instilled experiential dispositions, in what is salient to an individual in a particular context. Conclusion Applying the concept of cultural congruence must not be limited to assessing violations of the symbolic order and must consider alignment with or deviations from culturally-instilled experiential dispositions. By virtue of being foundational to a shared experience of the world, such dispositions are more accurate indicators of potential vulnerability. Notwithstanding problems of access and expertise, clinical practice should aim to accommodate this richer meaning of cultural congruence. PMID:23870676

  10. Culture, salience, and psychiatric diagnosis: exploring the concept of cultural congruence & its practical application.

    PubMed

    Rashed, Mohammed Abouelleil

    2013-07-16

    Cultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct. The article distinguishes symbolic from phenomenological conceptions of culture, the latter expanded upon through two sources: Husserl's phenomenological analysis of background intentionality and neuropsychological literature on salience. It is argued that culture is not limited to symbolic presuppositions and shapes subjects' experiential dispositions. This conception is deployed to re-examine the meaning of (in)congruence. The main argument is that a significant, since foundational, deviation from culture is not from a value or belief but from culturally-instilled experiential dispositions, in what is salient to an individual in a particular context. Applying the concept of cultural congruence must not be limited to assessing violations of the symbolic order and must consider alignment with or deviations from culturally-instilled experiential dispositions. By virtue of being foundational to a shared experience of the world, such dispositions are more accurate indicators of potential vulnerability. Notwithstanding problems of access and expertise, clinical practice should aim to accommodate this richer meaning of cultural congruence.

  11. Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice

    PubMed Central

    Zug, Keri Elizabeth; Cassiani, Silvia Helena De Bortoli; Pulcini, Joyce; Garcia, Alessandra Bassalobre; Aguirre-Boza, Francisca; Park, Jeongyoung

    2016-01-01

    Abstract Objective: to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. Method: a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. Result: the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. Conclusion: strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. PMID:27508923

  12. Quantitative comparison of cognitive behavioral therapy and music therapy research: a methodological best-practices analysis to guide future investigation for adult psychiatric patients.

    PubMed

    Silverman, Michael J

    2008-01-01

    While the music therapy profession is relatively young and small in size, it can treat a variety of clinical populations and has established a diverse research base. However, although the profession originated working with persons diagnosed with mental illnesses, there is a considerable lack of quantitative research concerning the effects of music therapy with this population. Music therapy clinicians and researchers have reported on this lack of evidence and the difficulty in conducting psychosocial research on their interventions (Choi, 1997; Silverman, 2003a). While published studies have provided suggestions for future research, no studies have provided detailed propositions for the methodology and design of meticulous high quality randomized controlled psychiatric music therapy research. How do other psychotherapies accomplish their databases and could the music therapy field borrow from their rigorous "methodological best practices" to strengthen its own literature base? Therefore, as the National Institutes of Mental Health state the treatment of choice for evidence-based psychotherapy is cognitive behavioral therapy (CBT), aspects of this psychotherapy's literature base were analyzed. The purpose of this literature analysis was to (a) analyze and identify components of high-quality quantitative CBT research for adult psychiatric consumers, (b) analyze and identify the variables and other elements of existing quantitative psychiatric music therapy research for adult consumers, and (c) compare the two data sets to identify the best methodological designs and variables for future quantitative music therapy research with the mental health population. A table analyzing randomized and thoroughly controlled studies involving the use of CBT for persons with severe mental illnesses is included to determine chief components of high-quality experimental research designs and implementation of quantitative clinical research. The table also shows the same analyzed

  13. Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice.

    PubMed

    Tremmery, S; Danckaerts, M; Bruckers, L; Molenberghs, G; De Hert, M; Wampers, M; De Varé, J; de Decker, A

    2014-09-01

    Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010-2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the 'chain of behavior' to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security.

  14. Accrediting advanced practice: who will benefit?

    PubMed

    2017-02-27

    Last month I attended the 2017 RCN advanced nurse practitioner (ANP) conference in London. The title of the conference referred to 'moving the agenda forward' and there were many examples of ANPs pioneering developments in emergency care, primary care, acute medicine, mental health and other services.

  15. Advancing the Practice of Systems Engineering at JPL

    NASA Technical Reports Server (NTRS)

    Jones, Ross; Jansma, Patti A.; Derro, Mary Ellen; Burns, Margaret J.; Blom, Kris

    2007-01-01

    Systems Engineering Advancement (SEA) practices at the Jet Propulsion Laboratory is presented. The topics include: 1) SEA background; 2) Three Key Components of change; and 3) Three Support Components of Change.

  16. Advancing Best Practices for Prescription Drug Labeling.

    PubMed

    Bailey, Stacy Cooper; Navaratnam, Prakash; Black, Heather; Russell, Allison L; Wolf, Michael S

    2015-11-01

    Problematic prescription drug labeling has been cited as a root cause of patient misunderstanding, medication errors, and nonadherence. Although numerous studies have recently been conducted to identify and test labeling best practices, the last systematic review on this topic was conducted a decade ago. The objective of this review was, therefore, to examine, summarize, and update best practices for conveying written prescription medication information and instructions to patients. English-language articles published from June 2005 to June 2015 were identified in MEDLINE and CINAHL by searching the following text words: 'medication OR prescription OR drug' AND 'label OR leaflet OR brochure OR pamphlet OR medication guide OR medication insert OR drug insert OR medication information OR drug information OR instructions' AND 'patient OR consumer.' Reference mining and secondary searches were also performed. A total of 31 articles providing evidence on how to improve written, prescription drug labeling for patient use were selected. Two reviewers independently screened articles, rated their quality, and abstracted data. Identified best practices included the use of plain language, improved formatting and organization, and more explicit instructions to improve patient comprehension. The use of icons had conflicting findings, and few studies tested whether practices improved knowledge or behaviors with patients' actual prescribed regimens. Future studies are needed to determine how specific modifications and improvements in drug labeling can enhance patient knowledge and behavior in actual use. Synthesizing best practices across all patient materials will create a more useful, coordinated system of prescription information. © The Author(s) 2015.

  17. Advanced Holistic Nursing Practice Narratives: A View of Caring Praxis.

    PubMed

    Enzman Hines, Mary; Gaughan, Jennifer

    2017-07-01

    Advanced holistic nurses (AHNs), emerging as leaders in health care transformation, are described as caregivers, but caring and caring-within-practice are often difficult for AHNs to explicate. Nursing research that describes caring in advanced practice is limited. Only one study has been reported that focused on describing practice for advanced practice nurses. This article presents a secondary analysis of narratives from a larger qualitative study of holistic pediatric nursing practice. From that study, narratives provided by six holistic advanced practice nurse participants, working in a variety of settings, were extracted and analyzed to illuminate caring-within-practice. Participants were asked to write a reflective narrative on a patient exemplar of caring and use John's model for structured reflection to provide a deeper reflection on their narrative of caring. Researchers analyzed the extracted narratives to identify common themes of caring-within-practice. Seven themes emerged depicting AHNs caring-within-practice: normalizing the environment, creating sacred space, being rooted in compassion, the art of being present, establishing trust-caring, coaching the family as caregiver, and inspiration for the future. This article provides excerpts from the narratives that support the themes, discusses the findings, and presents implications of the study.

  18. Doctoral education for WOC nurses considering advanced practice nursing.

    PubMed

    Pieper, Barbara; Colwell, Janice

    2012-01-01

    Advanced practice nursing education is at a crossroads. Societal changes, increased health care demands, and leadership nursing organizations have identified the need of a doctor of nursing practice (DNP) degree as the advanced practice degree. WOC nurses need to examine DNP programs when considering returning for an advanced practice degree. This article explores nursing education at the doctorate level and areas the WOC nurse should consider when making a decision about attending a program. The WOC nurse needs to understand the similarities and differences of the doctor of philosophy and the DNP, issues about each program and its completion, personal factors, and the application process. Although selecting a doctoral program is a daunting experience, the education will provide opportunities for the WOC nurse to excel as a scholar, thus influencing the profession and the practice.

  19. Psychiatric illness in the medical profession: incidence in relation to sex and field of practice.

    PubMed Central

    Watterson, D. J.

    1976-01-01

    The overall incidence of psychiatric illness among the physicians of British Columbia during 1970-74 was 1.27% per year. The overall suicide rate was more than 36.5/100 000. Incidence was not dependent on sex or age. The two specialties with the highest incidence--ophthalmology and psychiatry--had previously been demonstrated to have significantly high rates of suicide. The highest incidence was among psychiatric residents; in other resident groups collectively the incidence was at the expected rate. Greater severity of illness and poorer prognosis was found in family physicians compared with specialists, although the incidence was the same in the two groups. PMID:953898

  20. Integrating Advance Care Planning Into Practice.

    PubMed

    Dingfield, Laura E; Kayser, Joshua B

    2017-06-01

    Advanced respiratory diseases progress over time and often lead to death. As the condition worsens, patients may lose medical decision-making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals, and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences or the appointment of a health-care power of attorney (HCPOA). ACP discussions have multiple benefits for patients and their surrogate decision makers, including ensuring that the care provided is aligned with the patient's goals and preferences and decreasing stress, anxiety, and burden in surrogates. Time and provider comfort are often cited barriers to ACP, so it may be necessary for clinicians to gain experience in conversations and identify the patients most likely to benefit from ACP discussions. Two new Current Procedural Terminology (CPT) codes, 99497 and 99498, have been recognized by the Centers for Medicare and Medicaid Services (CMS) as of January 1, 2016 and are intended to incentivize clinicians to engage in ACP discussions with their patients earlier and with more frequency. This manuscript reviews the benefits and barriers to ACP in patients with advanced respiratory disease and provides guidance on the use of the new CPT codes for reimbursement of these conversations. Published by Elsevier Inc.

  1. Psychiatrists and psychiatric rehabilitation.

    PubMed

    Torrey, William C; Green, Ronald L; Drake, Robert E

    2005-05-01

    Interventions that focus directly on functional impairments related to mental illnesses are termed psychiatric rehabilitation. Research demonstrates that rehabilitation services are increasingly able to help adults with psychiatric disabilities achieve the functional outcomes they desire, particularly in the areas of housing and employment. To support the community lives of adults with severe mental illnesses, psychiatrists must stay current with advances in this field and know how to integrate psychiatric rehabilitation with other interventions. This article reviews the concept of psychiatric rehabilitation, current approaches in the field, the psychiatrist's role in these services, and implications for psychiatric training and continuing education.

  2. Broadening horizons: engaging advanced practice nursing students in faculty research.

    PubMed

    Weiss, Josie A

    2009-01-01

    Inviting advanced practice nursing students to participate in faculty research can be an innovative way to interest students in using current evidence as the basis for their practice. The author discusses strategies for effectively engaging graduate nursing students into research projects in ways that broaden the students' perspectives and strengthen their healthcare decision-making skills.

  3. Work and Psychiatric Illness in Aotearoa/New Zealand: Implications for Career Practice

    ERIC Educational Resources Information Center

    Southern, Annie; Miller, Judi

    2012-01-01

    This paper aims to examine the influence of Maori culture upon psychiatric service provision in Aotearoa/New Zealand and the implications of this for career counselling of people with experience of mental illness in Aotearoa/New Zealand. The research explored the experiences of a group of women in Aotearoa/New Zealand who have been diagnosed with…

  4. Work and Psychiatric Illness in Aotearoa/New Zealand: Implications for Career Practice

    ERIC Educational Resources Information Center

    Southern, Annie; Miller, Judi

    2012-01-01

    This paper aims to examine the influence of Maori culture upon psychiatric service provision in Aotearoa/New Zealand and the implications of this for career counselling of people with experience of mental illness in Aotearoa/New Zealand. The research explored the experiences of a group of women in Aotearoa/New Zealand who have been diagnosed with…

  5. Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services.

    PubMed

    Gilliland, Jill; Donnellan, Amy; Justice, Lindsey; Moake, Lindy; Mauney, Jennifer; Steadman, Page; Drajpuch, David; Tucker, Dawn; Storey, Jean; Roth, Stephen J; Koch, Josh; Checchia, Paul; Cooper, David S; Staveski, Sandra L

    2016-01-01

    The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs.

  6. Canadian educational approaches for the advancement of pharmacy practice.

    PubMed

    Frankel, Grace; Louizos, Christopher; Austin, Zubin

    2014-09-15

    Canadian faculties (schools) of pharmacy are actively engaged in the advancement and restructuring of their programs in response to the shift in pharmacy to pharmacists having/assuming an advanced practitioner role. Unfortunately, there is a paucity of evidence outlining optimal strategies for accomplishing this task. This review explores several educational changes proposed in the literature to aid in the advancement of pharmacy education such as program admission requirements, critical-thinking assessment and teaching methods, improvement of course content delivery, value of interprofessional education, advancement of practical experiential education, and mentorship strategies. Collectively, implementation of these improvements to pharmacy education will be crucial in determining the direction the profession will take.

  7. Partners in research: building academic-practice partnerships to educate and mentor advanced practice nurses.

    PubMed

    Harbman, Patricia; Bryant-Lukosius, Denise; Martin-Misener, Ruth; Carter, Nancy; Covell, Christine L; Donald, Faith; Gibbins, Sharyn; Kilpatrick, Kelley; McKinlay, James; Rawson, Krista; Sherifali, Diana; Tranmer, Joan; Valaitis, Ruta

    2017-04-01

    Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices. © 2016 John Wiley & Sons, Ltd.

  8. How can a competency framework for advanced practice support care?

    PubMed

    Stanford, Pamela Elizabeth

    2016-11-10

    Aim To explore whether perception of nurse practitioners in relation to whether a competency framework for advanced practice can support their work. Method A qualitative cross-sectional design was used, embedded in an interpretative paradigm of research. A non-probability sample of eight experienced nurse practitioners took part in focus groups and answered questionnaires. A mixture of phenomenological and grounded theory approaches were used to collect the data. Findings Four major themes were identified: competency frameworks can identify individual strengths and weaknesses, they can be used to set clear goals and targets, they can improve how practice is organised, and they have the potential to limit practice in terms of narrowing boundaries. The study also found competency frameworks could provide an structure to guide the development and evaluation of educational programmes. Conclusion Competency frameworks can be used so to target the development of new advanced nurse practitioners. They can address workforce development and governance by ensuring nurse practitioners have the competencies to provide safe, autonomous practice. Competency frameworks have been shown to ensure consistency in clinical practice skills underpinned with nurse practitioners' theoretical knowledge. They provide a clear development structure for career development and advanced practice. However, internationally, there is still a lack of definition of advanced practice and its core competencies.

  9. [Consensus on competencies for advanced nursing practice in Spain].

    PubMed

    Sastre-Fullana, Pedro; De Pedro-Gómez, Joan E; Bennasar-Veny, Miquel; Fernández-Domínguez, Juan C; Sesé-Abad, Albert J; Morales-Asencio, José M

    2015-01-01

    There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  10. Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.

    PubMed

    O'Connell, Jane; Gardner, Glenn; Coyer, Fiona

    2014-12-01

    This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education. © 2014 John Wiley & Sons Ltd.

  11. Effect on long-term survival of psychiatric disorder, inflammation, malnutrition, and radiotherapy-related toxicity in patients with locally advanced head and neck cancer.

    PubMed

    Unal, Dilek; Eroglu, Celalettin; Ozsoy, Saliha Demirel; Besirli, Asli; Orhan, Okan; Kaplan, Bunyamin

    2015-01-01

    To evaluate the effects on the long-term survival of psychiatric disorders, inflammation, malnutrition, and radiotherapy (RT)-related toxicity in patients with locally advanced head and neck cancer. Included were 47 patients who received RT for non-metastatic locally advanced head and neck cancer. The diagnosis of psychiatric disorder was made by the Diagnostic and Statistical Manual of Mental disorders (4th edn) (DSM-IV) criteria. Malnutrition was defined as weight loss >5% of baseline during RT. Interleukin 1β (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α) were analyzed by enzyme-linked immunosorbent assay (ELISA). RT-related acute toxicity was evaluated once a week using the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 2.0. The mean patient age was 57.3±11.4 years (range 33-80); 42 (89.4%) patients were male. Mean disease-free (DFS) and overall survival (OS) were 53 and 55 months, respectively. Mean DFS was significantly lower in patients with psychiatric disorder compared with those without (35 vs 59 months, p=0.013) and the same applied for mean OS (41 vs 61 months, p=0.008). There was no significant difference between patients with and without malnutrition in terms of OS. Similarly, no significant difference was seen between patients with and without RT-related toxicities in terms of OS. Age, psychiatric disorder, T status, and stage differed significantly between these groups (p<0.10) in univariate analysis. The multivariate Cox regression analysis identified that the OS was significantly associated only with psychiatric disorder (odds ratio/OR: 3.22, 95% confidence interval/CI: 1.29-8.41, p=0.013). Psychiatric disorders had unfavorable effects on OS in patients with locally advanced head and neck cancer. Inflammation, malnutrition and RT-related toxicity had no significant impact on OS.

  12. Improving the therapeutic relationship in inpatient psychiatric care: Assessment of the therapeutic alliance and empathy after implementing evidence-based practices resulting from participatory action research.

    PubMed

    Moreno-Poyato, Antonio R; Delgado-Hito, Pilar; Suárez-Pérez, Raquel; Lluch-Canut, Teresa; Roldán-Merino, Juan F; Montesó-Curto, Pilar

    2017-09-13

    To examine how evidence about the therapeutic alliance gleaned from participatory action project affected the level of this alliance and the degree of empathy of psychiatric nurses. Quasi-experimental study in two psychiatric units. In one group, evidence-based practices that affected the therapeutic alliance were implemented; in the comparison group, there was no such intervention. The nurses from the intervention group improved their degree of empathy and factors such as agreement on objectives and tasks with the patient. The results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care. © 2017 Wiley Periodicals, Inc.

  13. From the Netherlands to Japan: communicating psychiatric practice in the 1830s.

    PubMed

    Nakamura, Ellen

    2014-09-01

    This article explores an example of the transmission of Dutch psychiatric knowledge to Japan in the Edo period (1600-1868), through the translation of a case study first published by Schroeder van der Kolk in 1826. The translation appeared in an innovative new journal of Western medicine edited by the Japanese rangaku (Dutch-learning) scholar, Mitsukuri Genpo. The case study describes the symptoms and treatment of a woman who experienced delusions following an ear infection, in terms largely familiar to the Japanese doctors of the time. This translation provides opportunities to consider the globalization and localization of psychiatric knowledge, the medicalization of mental health care in Japan, and the growing interest in Western psychiatry before its official introduction to Japan after 1868.

  14. What are psychiatric nurses needed for? Developing a theory of essential nursing practice.

    PubMed

    Barker, P; Jackson, S; Stevenson, C

    1999-08-01

    Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. However, little study has been made, to date, of the discrete 'need' for psychiatric nursing within a multidisciplinary service. Employing an adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals, based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: 'knowing you--knowing me'. Within that complex, nurses either elected, or were required, to move--or 'toggle'--between three discrete domains of relating: the Ordinary Me (OM); the Pseudo-ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses' depth of knowing, power, use of time and use of translation, distinguished these domains. The emergent theory is discussed within the context of the emergent growth in user (consumer) influence and health care technology.

  15. Developing the scope of practice and education for advanced practice nurses in Finland.

    PubMed

    Fagerström, L

    2009-06-01

    The reorganization of Finnish healthcare services has required a restructuring of the areas of responsibility between healthcare professionals. To describe the need for Advanced Practice Nurses in Finland and the development process of a Master's programme in Health Promotion, Advanced Clinical Care. The study consisted of a survey of nurse managers (24) and focus group interviews with clinical nurse specialists (46). The expanded role includes advanced clinical skills and responsibility for health prevention and promotion, education, supervision, leadership, research and development. The legislation, scope and models have to be supported and further developed to promote the full scope of advanced practice.

  16. An examination of advanced practice nurses' job satisfaction internationally.

    PubMed

    Steinke, M K; Rogers, M; Lehwaldt, D; Lamarche, K

    2017-06-28

    To examine the level of job satisfaction of nurse practitioners/advanced practice nurses in developing and developed countries. The nurse practitioner/advanced practice nurse has the advanced, complex skills and experience to play an important role in providing equitable health care across all nations. Key factors that contribute to health disparities include lack of access to global health human resources, the right skill mix of healthcare providers and the satisfaction and retention of quality workers. The study utilized a descriptive analysis and cross-sectional survey methodology with quantitative and qualitative sections of 1419 job satisfaction survey respondents from an online survey. Age, number of hours worked in a week and length of time that nurse practitioners/advanced practice nurses worked in their current jobs were statistically significant in job satisfaction. A key barrier was the lack of respect from supervisors and physicians. It was clear from the number of comments in the qualitative section of the survey that having a wide scope of practice is rewarding and challenging to the nurse practitioner and advanced practice nurse. The challenges to transform healthcare gaps of access into a better distribution of health care in all countries would constitute a systematic change in policy including providing education and training for doctors and nurses that will match the skills needed in the workplace; emphasizing the right skill mix for the healthcare team; supporting advanced practice nurses in the workplace; and utilizing all healthcare providers to the fullest extent of their abilities. © 2017 International Council of Nurses.

  17. Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions.

    PubMed

    Rolin-Gilman, Cheryl; Fournier, Bonnie; Cleverley, Kristin

    2017-06-01

    Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patient's personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patient's quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  18. An overview of Medicare reimbursement regulations for advanced practice nurses.

    PubMed

    Frakes, Michael A; Evans, Tracylain

    2006-01-01

    The federal government spends nearly 15% of the budget on Medicare services annually, and advanced practice nurses are eligible for reimbursement from that pool. The regulations governing reimbursement are complex because of the social, political, and financial pressures involved in their development. Although economic viability and due diligence considerations make it incumbent on advanced practice nurses to understand the rules, the profession, as a whole, has knowledge deficits in this area. The essentials of regulatory development and structure are reviewed and considerations for optimizing reimbursement are described.

  19. Professional development for an advanced practice nursing team.

    PubMed

    Pye, Sherry; Green, Angela

    2011-05-01

    Since its development in 1998, the Cardiology Advanced Practice Nurse team has been plagued by retention issues. The coordinator for the team developed this leadership project while participating in the 2008 to 2009 Maternal-Child Health Leadership Academy sponsored by Sigma Theta Tau International and Johnson & Johnson. The focus of this project was to develop, implement, and evaluate initiatives to empower the advanced practice nurse team, promote their professional development, and ultimately improve retention of team members. Although evaluation data show progress toward addressing work environment issues, retention remains an ongoing problem.

  20. On the night shift: advanced nurse practice in emergency medicine.

    PubMed

    Jenkins, Jennifer

    2016-05-01

    Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.

  1. Advance Notice for Transition-Related Problem Behavior: Practice Guidelines.

    PubMed

    Brewer, Adam T; Strickland-Cohen, Kathleen; Dotson, Wesley; Williams, D Courtney

    2014-10-01

    Transitions between daily activities can occasion or elicit problem behavior in individuals with intellectual and developmental disabilities (IDD). Providing advance notice to signal an upcoming transition is a common practice in early and special education settings (e.g., Riffel 2010; Sandall et al. 2005). While the literature contains many demonstrations of the efficacy of various advance notice procedures, other studies have shown negative results. Practitioners are faced with the challenge of deciding whether advance notice is a viable treatment option for transition-related problem behavior in light of these contradictory findings. To assist the practitioner in this decision-making process, we provide a brief review of the advance notice literature, concentrating on the studies reporting that advance notice is ineffective at reducing transition-related problems. The goal is to provide practitioners with a better understanding of the environmental conditions under which advance notice is likely to be ineffective at decreasing problem behavior as well as the conditions under which it can be effective at reducing transition-related problem behavior. Discriminating these conditions may yield a useful set of practice guidelines for deciding when advance notice is a viable treatment option for decreasing transition-related problem behavior.

  2. A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

    PubMed Central

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to

  3. A systematic review of music therapy practice and outcomes with acute adult psychiatric in-patients.

    PubMed

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to develop specific music therapy models for this patient group that

  4. Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

    PubMed Central

    2013-01-01

    Background Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues. Methods A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought. Results Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate. Conclusion We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes. PMID:24066860

  5. The prescribing of buprenorphine by advanced practice addictions nurses.

    PubMed

    Strobbe, Stephen; Hobbins, Debra

    2012-02-01

    In order to increase safe access to buprenorphine treatment for patients with opioid dependence, it is the position of the International Nurses Society on Addictions (IntNSA) that the Drug Addiction Treatment Act of 2000 (DATA 2000) be amended to allow for the prescribing of buprenorphine by qualified advanced practice nurses who have both prescriptive authority and specialty certification in addictions nursing.

  6. Establishing radiation therapy advanced practice in New Zealand

    SciTech Connect

    Coleman, Karen; Jasperse, Marieke; Herst, Patries; Yielder, Jill

    2014-02-15

    Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommend (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board.

  7. Advancing Empirical Scholarship to Further Develop Evaluation Theory and Practice

    ERIC Educational Resources Information Center

    Christie, Christina A.

    2011-01-01

    Good theory development is grounded in empirical inquiry. In the context of educational evaluation, the development of empirically grounded theory has important benefits for the field and the practitioner. In particular, a shift to empirically derived theory will assist in advancing more systematic and contextually relevant evaluation practice, as…

  8. Training Advanced Writing Skills: The Case for Deliberate Practice

    ERIC Educational Resources Information Center

    Kellogg, Ronald T.; Whiteford, Alison P.

    2009-01-01

    The development of advanced writing skills has been neglected in schools of the United States, with even some college graduates lacking the level of ability required in the workplace (National Commission on Writing, 2003, 2004). The core problem, we argue, is an insufficient degree of appropriate task practice distributed throughout the secondary…

  9. Advancing Empirical Scholarship to Further Develop Evaluation Theory and Practice

    ERIC Educational Resources Information Center

    Christie, Christina A.

    2011-01-01

    Good theory development is grounded in empirical inquiry. In the context of educational evaluation, the development of empirically grounded theory has important benefits for the field and the practitioner. In particular, a shift to empirically derived theory will assist in advancing more systematic and contextually relevant evaluation practice, as…

  10. Residency and Fellowship Programs for RNs and Advanced Practice RNs.

    PubMed

    Cosme, Sheryl

    2015-09-01

    In this month's column, the Senior Accreditation Operations Manager of the American Nurses Credentialing Center (ANCC) discusses the value of nursing residency programs and current discussion in the profession, along with criteria offered by the ANCC to support this imperative for both RNs and advanced practice RNs including new graduates and those transitioning between clinical settings.

  11. A Pilot of a Gerontological Advanced Practice Nurse Preventive Intervention

    ERIC Educational Resources Information Center

    Hahn, Joan Earle; Aronow, Harriet Udin

    2005-01-01

    Background: Persons with an intellectual and developmental disability frequently face barriers in accessing preventive services in community-based health care systems. As they age into middle years, they are at increased risk for functional decline. This paper presents a description of an advanced practice nurse (APN) intervention used in a pilot…

  12. Training Advanced Writing Skills: The Case for Deliberate Practice

    ERIC Educational Resources Information Center

    Kellogg, Ronald T.; Whiteford, Alison P.

    2009-01-01

    The development of advanced writing skills has been neglected in schools of the United States, with even some college graduates lacking the level of ability required in the workplace (National Commission on Writing, 2003, 2004). The core problem, we argue, is an insufficient degree of appropriate task practice distributed throughout the secondary…

  13. Development of the transformational advanced professional practice model.

    PubMed

    Elliott, Elizabeth C; Walden, Marlene

    2015-09-01

    The purpose of this article is to describe the development of a professional practice model (PPM) for advanced practice registered nurses (APRNs). A literature review was conducted on PPMs. Simultaneous review of authoritative resources, including The National Organization of Nurse Practitioner Faculties (NONPF) and the Licensure, Accreditation, Certification and Education (LACE) Consensus Model, was performed. An expert panel was established to validate the transformational advanced professional practice (TAPP) model. APRNs are relied upon by organizations to provide leadership in the delivery of high-quality, cost-effective health care while improving access and eliminating preventable morbidities. Existing models fail to fully capture the professional scope of practice for APRNs. The TAPP model serves as a framework to guide professional development and mentorship of APRNs in seven domains of professional practice (DOPP). To meet the Institute of Medicine's recommendations for the future of nursing, APRNs should practice to the fullest extent of their education and training. Providing clarification regarding the DOPP of the APRN role is needed to standardized professional practice. The TAPP model is an inspiring blueprint that allows APRNs to model the way by delivering comprehensive health care in seven DOPP. ©2015 American Association of Nurse Practitioners.

  14. [The matter: No psychiatrization].

    PubMed

    Pisa, Hugo

    2015-09-01

    Anxiety, sadness, worries, fears, irritability, fatigue, tedium, are situations that life confront us with. They don't qualify as psychiatric disorders, but nevertheless they are treated as though. We refer to the psychiatrization of daily life. The aim of this article is to prevent such psychiatrization. To support this assertion, we are going to develop different aspects tending to explain the origins of the patient's demands and the answers given by the psychiatrist. A critical reflection of our practice is proposed.

  15. Relations between patients in psychiatric and psychotherapeutic inpatient care: a literature review and conclusions for clinical practice and research.

    PubMed

    Kastner, Sabrina; Linden, Michael

    2014-10-01

    In psychiatric inpatient units patients live closely together, which facilitates mutual interactions. Patient relations are part of the therapeutic milieu, which is an important factor in helping patients to recover. Types of patient relations are nonbinding superficial encounters, working alliances, personal relations like close partner relationships, or sexual contacts. Intimate relations between patients are scientifically and in clinical practice, a rather, neglected topic. A data search was conducted using the PubMed/MEDLINE databases with the key terms "patient relations" or "intimate relations between patients". Depending on the type of relation and inpatient unit, prevalence rates of 1.5-30% for intimate relations between patients in psychiatric hospitals are reported. Such relations can have beneficial effects, like the feelings of bonding or being liked, but also negative consequences, like burdening, worsening of the illness, treatment complications, or direct harm to the patient. Only a few units have development guidelines. It is the responsibility of the therapeutic staff and the hospital management to support a helpful therapeutic milieu, including positive patient interactions, and to protect as far as it is possible patients from negative encounters.

  16. The professional psychiatric/mental health nurse: skills, competencies and supports required to adopt recovery-orientated policy in practice.

    PubMed

    Cusack, E; Killoury, F; Nugent, L E

    2017-03-01

    WHAT IS KNOWN ON THE SUBJECT?: Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery. At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland. In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment. Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally.

  17. How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians' Practice.

    PubMed

    Leach, Emma; Morris, Emily; White, Hannah J; Inglis, Angela; Lehman, Anna; Austin, Jehannine

    2016-12-01

    Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians' minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians' awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.

  18. Canadian Educational Approaches for the Advancement of Pharmacy Practice

    PubMed Central

    Louizos, Christopher; Austin, Zubin

    2014-01-01

    Canadian faculties (schools) of pharmacy are actively engaged in the advancement and restructuring of their programs in response to the shift in pharmacy to pharmacists having/assuming an advanced practitioner role. Unfortunately, there is a paucity of evidence outlining optimal strategies for accomplishing this task. This review explores several educational changes proposed in the literature to aid in the advancement of pharmacy education such as program admission requirements, critical-thinking assessment and teaching methods, improvement of course content delivery, value of interprofessional education, advancement of practical experiential education, and mentorship strategies. Collectively, implementation of these improvements to pharmacy education will be crucial in determining the direction the profession will take. PMID:25258448

  19. Policy development in psychiatric disability and rehabilitation: best practice planning for positive system transformation.

    PubMed

    Taylor, Susan; Ekman, Lisa

    2008-01-01

    This article provides an overview of international, national, and local policy initiatives that support the clinical and programmatic changes being championed in psychiatric rehabilitation and recovery. California, with the 6th largest economy in the world and one of the largest public mental health systems, has become a leader both nationally and internationally in modeling such change efforts. The Mental Health Services Act of 2004 (MHSA) has been the vehicle within the state that has set up the framework for the transformation. Many of the components of the MHSA support the national recommendations of the President's New Freedom Commission. A case example contrasting the California MHSA and the President's New Freedom Commission recommendations is included to highlight how California has conceptualized and begun to implement those recommendations.

  20. Use of Metformin for Cardiometabolic Risks in Psychiatric Practice: Need-to-Know Safety Issues.

    PubMed

    Andrade, Chittaranjan

    2016-11-01

    Metformin, a biguanide drug, is emerging as an important treatment option for the prevention or treatment of weight gain, type 2 diabetes mellitus, and the metabolic syndrome in psychiatric patients, especially those who require or receive antipsychotic drugs. Metformin treatment is commonly associated with gastrointestinal adverse effects; the risk of these is reduced by gradual dose uptitration, administration of the drug with meals, and use of a time-release formulation. Lactic acidosis, a potentially fatal complication of biguanide therapy, is very rare with metformin; the risk can be reduced by avoidance of its prescription in patients with impaired renal function, impaired liver function, cardiac failure, and certain other conditions. Long-term metformin use is associated with decreased vitamin B₁₂ levels, and even with biochemical B₁₂ deficiency; this complication can detected early by annual assessments of serum B₁₂ levels and prevented by annual intramuscular B₁₂ administration.

  1. Autoimmune-induced glutamatergic receptor dysfunctions: conceptual and psychiatric practice implications.

    PubMed

    Rosenthal-Simons, Ayelet; Durrant, Andrea R; Heresco-Levy, Uriel

    2013-12-01

    Glutamatergic neurotransmission is mediated via complex receptorial systems including N-methyl-d-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolpropionic acid (AMPA) and metabotropic receptor subtypes and plays a critical role in the modulation of synaptic plasticity, mood, cognitive processes and motor behavior. Glutamatergic function deficits are hypothesized to contribute to the pathogenesis of neuropsychiatric disorders, including schizophrenia, mood and movement disorders. Accumulating data are rapidly leading to the characterization of specific types of autoimmune encephalitis in which the receptors and proteins critically involved in glutamatergic neurotransmission, e.g., NMDA, AMPA receptors, are antigen targets. Characteristic of these syndromes, antibodies alter the structure and/or function of the corresponding neuronal antigen resulting in clinical pictures that resemble pharmacological disease models. Presently the best characterized autoimmune glutamatergic disorder is anti-NMDA receptor encephalitis. This disorder manifests with intertwined psychiatric and neurological features, defines a new syndrome, reclassifies poorly defined clinical states and extends previous hypotheses, such as hypo-NMDA receptor function in schizophrenia. The characterization of autoimmune-induced glutamatergic receptor dysfunctions (AGRD) is likely to have a substantial conceptual impact upon our understanding of neuropsychiatric disorders including schizophrenia, affective and movement dysfunctions. Further definition of AGRD will provide additional guidelines for psychiatric diagnoses, identification of homogeneous patient subtypes within broad phenomenological classifications and will contribute to the development of personalized treatments. The body of knowledge already accumulated on anti-NMDA receptor encephalitis highlights the need for wide dissemination of these concepts among psychiatrists, and in suspected cases, for early recognition, prompt clinical

  2. Establishing advanced practice for medical imaging in New Zealand.

    PubMed

    Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

    2014-02-01

    IntroductionThis article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). MethodsThe study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. ResultsFindings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. ConclusionsThe authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

  3. Establishing advanced practice for medical imaging in New Zealand

    SciTech Connect

    Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

    2014-02-15

    Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

  4. The Impact of Organizational Factors and Government Policy on Psychiatric Nurses' Family-Focused Practice With Parents Who Have Mental Illness, Their Dependent Children, and Families in Ireland.

    PubMed

    Grant, Anne; Reupert, Andrea

    2016-05-01

    Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services. © The Author(s) 2016.

  5. Supporting children whose parent has a mental health problem: an assessment of the education, knowledge, confidence and practices of registered psychiatric nurses in Ireland.

    PubMed

    Houlihan, D; Sharek, D; Higgins, A

    2013-04-01

    Health professionals, including nurses, stand accused of ignorance or oversight of children whose parent experience a mental health problem. Psychiatric nurses are in an ideal position to respond to children's needs and support their parents in a proactive and sensitive manner. The aim of this study was to explore psychiatric nurses' education, knowledge, confidence and practice with regard to the support needs of children whose parent has a mental health problem. This study employed a self-completion anonymous survey design with a sample of registered psychiatric nurses from one integrated mental health service in Ireland. The sample reported relatively low levels of education, knowledge, confidence and supportive clinical practice when it came to children whose parent has a mental health problem. There is an urgent need for education on family-focused care, and the development of guidelines and child focused services if the needs of parents and children are to be met.

  6. Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses.

    PubMed

    Garrett, Bernard; Klein, Gerri

    2008-08-01

    The aims were to explore advanced practice nurses' perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. The wireless Personal Digital Assistant is becoming established as a hand-held computing tool for healthcare professionals. The reflections of advanced practice nurses' about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. A qualitative interpretivist design was used to explore advanced practice nurses' perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open-coding content analysis was performed using qualitative data analysis software. Wireless Personal Digital Assistant's use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless

  7. Defining features of advance directives in law and clinical practice.

    PubMed

    Olick, Robert S

    2012-01-01

    In the > 30 years since the New Jersey Supreme Court's seminal opinion in the case of Karen Ann Quinlan, all 50 states and the District of Columbia have enacted legislation to recognize the legal right of competent adults to write advance directives. The purpose of advance directives is to provide direction for health-care decisions near the end of life, when the ravages of illness, disease, or injury have taken the ability to decide for one's self. This article reviews the defining features of advance directives and the governing law, discusses some common practical concerns regarding the use and effectiveness of advance directives, and identifies several significant ethical-legal challenges for honoring advance directives at the bedside. With a primary focus on the health-care proxy, the anatomy of advance directives is analyzed under four general rubrics: formal requirements, decisional capacity and when the directive takes effect, rights and responsibilities of proxies and health-care providers, and the scope and limitations of decisions to forego life-sustaining treatment. There is much common ground among state laws, but particular legal provisions may vary from state to state. Physicians, nurses, social workers, and other health-care professionals should be familiar with the law of their home state.

  8. Advanced practice nursing in performing arts health care.

    PubMed

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  9. Writing an employer-focused resume for advanced practice nurses.

    PubMed

    Welton, Robert H

    2013-01-01

    The most important new trend in resumes is the employer-focused resume. Writing one is not difficult, but it requires a change in focus. The focus of this type of resume is on the needs of prospective employers. This new resume format allows applicants to describe to prospective employers what they can provide related to the employer's needs as opposed to a simple listing of their academic and work experiences without relation to the prospective new job. This article provides advanced practice nurses with sources to guide construction of informative text about their advanced practice nursing skills and competencies using language familiar to employers. Resumes and curriculum vitae formats are compared, and advice is provided on developing content for either format. Guidelines are provided about listing credentials, identifying clinical proficiencies from student clinical practicum, using qualification summaries rather than an objective statement, choosing references, and including essential components in a cover letter.

  10. Ethics education in advanced practice nursing: respect for human dignity.

    PubMed

    Kalb, Kathleen A; O'Conner-Von, Susan

    2007-01-01

    Ethics education is an essential component of academic programs that prepare nurses for advanced practice; the concept of respect for human dignity is integral to this education. Sixty-three graduate students enrolled in their first course of a nurse practitioner program completed a researcher-developed Ethics Questionnaire that was designed to elicit their baseline ethics-related knowledge, including their understanding of the concept "respect for human dignity". Qualitative analysis of data yielded findings that validate the importance of using the American Nurses Association Code of Ethics for Nurses with Interpretive Statements as an essential foundation for ethics content and as a framework for understanding the meaning of human dignity in advanced practice nursing. Assessment and learning strategies are recommended.

  11. Integrating Spiritual Bereavement Skills Into an Advanced Practice Curriculum.

    PubMed

    Bristol, Shirley T; Lloyd, Susan L; Bristol, Alycia A

    2017-07-01

    When advanced practice nurses (APNs) encounter the need to address a bereaved individual's spirituality, gaps in educational preparation may prevent effective intervention. In addition, past and current research studies have not provided clear guidance for spiritually based bereavement care curricula within the graduate APN program. Graduate advanced practice faculty successfully introduced classroom-based spiritual bereavement care education modules for APN students. Course evaluations indicated student appreciation for the new content and practicum experiences provided. Students felt the new content to be essential in their development as expert practitioners. Through this innovation, the authors found that a variety of learning activities that addressed spiritual needs during the bereavement process was perceived as highly satisfactory by APNs. Within an ever increasingly diverse society, APNs have a significant role in performing responsibilities for bereaved individuals. [J Nurs Educ. 2017;56(7):439-442.]. Copyright 2017, SLACK Incorporated.

  12. Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic.

    PubMed

    Deegan, Patricia E; Rapp, Charles; Holter, Mark; Riefer, Melody

    2008-06-01

    This column presents preliminary findings of an intervention to support shared decision making in psychopharmacology consultation. The waiting area in an urban psychiatric medication clinic was transformed into a peer-run Decision Support Center featuring a user-friendly, Internet-based software program with which clients could create a one-page computer-generated report for use in the medication consultation. The Decision Support Center was used 662 times by 189 unique users from a young-adult and general adult case management team from October 2006 to September 2007. All clients had severe mental disorders. Only ten clients refused to use the intervention at some point during the pilot study. Focus groups with medical staff (N=4), clients (N=16), case managers (N=14), and peer-specialist staff (N=3) reported that the intervention helped to create efficiencies in the consultation and empower clients to become more involved in treatment-related decision making. A randomized controlled trial is currently in process.

  13. Psychiatric Aspects of Dementia.

    PubMed

    Onyike, Chiadi U

    2016-04-01

    The psychiatric aspects of dementia are increasingly recognized as significant contributors to distress, disability, and care burden, and, thus, are of increasing interest to practicing neurologists. This article examines how psychiatric disorders are entwined with dementia and describes the predictive, diagnostic, and therapeutic implications of the psychiatric symptoms of dementia. Psychiatric disorders, particularly depression and schizophrenia, are associated with higher risk for late-life dementia. Psychiatric phenomena also define phenotypes such as frontotemporal dementia and dementia with Lewy bodies, cause distress, and amplify dementia-related disabilities. Management requires a multidisciplinary team, a problem-solving stance, programs of care, and pharmacologic management. Recent innovations include model programs that provide structured problem-solving interventions and tailored in-home care. There is new appreciation of the complexity of the relationship between psychiatric disorders and dementia as well as the significance of this relationship for treatment, community services, and research.

  14. Psychiatric Aspects of Dementia

    PubMed Central

    Onyike, Chiadi U.

    2016-01-01

    Purpose of Review: The psychiatric aspects of dementia are increasingly recognized as significant contributors to distress, disability, and care burden, and, thus, are of increasing interest to practicing neurologists. This article examines how psychiatric disorders are entwined with dementia and describes the predictive, diagnostic, and therapeutic implications of the psychiatric symptoms of dementia. Recent Findings: Psychiatric disorders, particularly depression and schizophrenia, are associated with higher risk for late-life dementia. Psychiatric phenomena also define phenotypes such as frontotemporal dementia and dementia with Lewy bodies, cause distress, and amplify dementia-related disabilities. Management requires a multidisciplinary team, a problem-solving stance, programs of care, and pharmacologic management. Recent innovations include model programs that provide structured problem-solving interventions and tailored in-home care. Summary: There is new appreciation of the complexity of the relationship between psychiatric disorders and dementia as well as the significance of this relationship for treatment, community services, and research. PMID:27042910

  15. Cognitive therapy: a training model for advanced practice nurses.

    PubMed

    Reilly, Christine E; McDanel, Heather

    2005-05-01

    1. Mental health needs exist in medically underserved areas and can be addressed in nurse-managed, community-based health centers. 2. Cognitive therapy techniques can be used in community-based health centers to intervene and alleviate patients' distress and improve their adherence to treatment. 3. A training program in cognitive therapy can help advanced practice nurses and other health care providers implement the techniques needed to address many behavioral and mental health problems.

  16. Consultant pharmacists, advanced practice nurses, and the interdisciplinary team.

    PubMed

    Resnick, Barbara

    2014-03-01

    Although in geriatrics we are better than many other clinical disciplines in terms of providing interdisciplinary care to older adults, I hope that we will continue to recognize how much more could actually be done. Before addressing the relationship between advanced practice nurses (APNs) and consultant pharmacists in real world settings, I want to review teamwork in geriatrics in general. It is critical to define what we mean by team, what type of team, and what the goals are of this teamwork.

  17. Advanced Practice Registered Nurses. Final rule with comment period.

    PubMed

    2016-12-14

    The Department of Veterans Affairs (VA) is amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting within the scope of their VA employment. Certified Registered Nurse Anesthetists (CRNA) will not be included in VA's full practice authority under this final rule, but comment is requested on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking. The final rulemaking establishes the professional qualifications an individual must possess to be appointed as an APRN within VA, establishes the criteria under which VA may grant full practice authority to an APRN, and defines the scope of full practice authority for each of the three roles of APRN. The services provided by an APRN under full practice authority in VA are consistent with the nursing profession's standards of practice for such roles. This rulemaking increases veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians, and it permits VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA.

  18. [Advance Directives: theoretical concept and practical significance in the USA].

    PubMed

    Vollmann, J; Pfaff, M

    2003-07-04

    The article examines on the basic of empirical data the discrepancy between the theoretical demand and the practical role of advance directives. Often advance directives have no influence on medical decision-making in clinical care of critically ill patients. The vague language of the widely used standard living wills and the lack of physician-patient communication in the process of delivering an advance directives are contributing factors. However, many physicians even disregard patients' preferences in concrete and meaningful living wills at the end of life. Besides the lack of information many even seriously ill patients do not deliver an advance because they misjudge their medical prognosis and life expectancy. Often the communication between patients and doctors are blocked because they expect from the each other the first step to talk about end of life decisions and advance directives. In this context physicians claim lack of time, training in communication skills and their discomfort in talking about death and dying with their patients.

  19. [Anticoagulant therapy clinic: moving towards Advanced Nursing Practice].

    PubMed

    Romero Ruiz, Adolfo; Parrado Borrego, Gema; Rodríguez González, José; Caparrós Miranda, Isabel S; Vargas Lirio, M Isabel; Ortiz Fernández, Primitiva

    2014-01-01

    There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.

  20. The advanced practice professionals' perspective: keys to a good working relationship between advanced practice professions and physicians.

    PubMed

    Polansky, Maura

    2013-01-01

    A strong working relationship between advanced practice professionals (APPs) and supervising oncologists is essential for reducing medical errors, retaining employees, and improving work environments. Although there is rather limited data on the unique relationship of the APP and physician, fundamental communication skills-including open communication, mutual respect, establishing expectations, and working with mutual purpose-should be the foundation of these relationships. This paper addresses various aspects of relationship building between APPs and physicians with suggestions for establishing successful working relationships.

  1. American Psychiatric Association

    MedlinePlus

    ... Foundation APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In Join General Residents and Fellows Medical Students International close menu Psychiatrists Education Practice Cultural Competency Awards & Leadership Opportunities Advocacy & APAPAC Meetings ...

  2. Online tobacco cessation education to optimize standards of practice for psychiatric mental health nurses.

    PubMed

    Amole, Jacques; Heath, Janie; Joshua, Thomas V; McLear, Beth

    2012-03-01

    This article presents an overview of an online education offering to improve standards of practice for nurses intervening with tobacco-dependent mentally ill populations. Designed as a pilot study and guided by the theory of reasoned action framework, the pretest-posttest educational program was conducted to examine attitudes and beliefs, knowledge, and intentions to integrate tobacco cessation interventions into practice. Although positive attitudes and beliefs were demonstrated, knowledge gaps continued to exist after the online program. Strengths and challenges of the online education offering are presented with recommendations for future research. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Perceived stress and coping strategies among Jordanian nursing students during clinical practice in psychiatric/mental health courses.

    PubMed

    Al-Zayyat, Abdulkarim Subhi; Al-Gamal, Ekhlas

    2014-08-01

    Clinical practice in the psychiatric/mental health nursing (PMHN) field is considered a highly-stressful experience for nursing students. The purpose of the present study was to identify the degrees of stress, the types of stressors, and coping strategies perceived by undergraduate nursing students during their clinical practice in PMHN courses. A descriptive, longitudinal design was used. Sixty-five students registered in PMHN clinical courses were recruited from five Jordanian universities using a systematic random-sampling method. Data collection was conducted in the second semester of the 2012-2013 academic year at two points of time: pre-PMHN clinical training and post-PMHN training. The Basic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were administered. Students' ages ranged from 20 to 25 years. The findings illustrate that the highest reported types of stressors at both data-collection times were taking care of patients, stress related to teachers and nursing staff, and from assignments and workloads. The most utilized coping strategy at both data-collection times was problem solving. The findings of the present study are useful for clinical educators in identifying nursing students' stressors, easing their learning in the clinical setting, and establishing an efficient PMHN course programme. © 2013 Australian College of Mental Health Nurses Inc.

  4. Residency Training and the Later Use of Marital and Family Therapy in Psychiatric Practice.

    ERIC Educational Resources Information Center

    Carter, Ross E.

    1989-01-01

    Compared marital and family therapy training during psychiatry residency to later use among psychiatrists (N=87). Results indicated that respondents reported modest to minimal amounts of training in residency but practiced marital and family therapy with variety of problems, identified spread of effect to other treatment modalities, and preferred…

  5. Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure

    PubMed Central

    Guan Ng, Chong; Dijkstra, Ellen; Smeets, Hugo; Boks, Marco PM; de Wit, Niek J

    2012-01-01

    Background It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease. Aim To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally ill patients in the GP setting, comparing both patients with terminal cancer and heart failure. Design and setting Retrospective cohort study using the Utrecht General Practitioner Research Network. Method Equally-sized groups of patients with terminal cancer and heart failure were randomly selected from the database of four general practices over the years 2005–2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical Therapeutic Chemical (ATC) Classification System codes. Results A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was 15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease and psychotropic drug prescription between patients with terminal cancer and heart failure. Conclusion The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure. PMID:23336475

  6. Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure.

    PubMed

    Ng, Chong Guan; Dijkstra, Ellen; Smeets, Hugo; Boks, Marco P M; de Wit, Niek J

    2013-01-01

    It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease. To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally ill patients in the GP setting, comparing both patients with terminal cancer and heart failure. Retrospective cohort study using the Utrecht General Practitioner Research Network. Equally-sized groups of patients with terminal cancer and heart failure were randomly selected from the database of four general practices over the years 2005-2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical Therapeutic Chemical (ATC) Classification System codes. A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was 15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease and psychotropic drug prescription between patients with terminal cancer and heart failure. The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure.

  7. Management of advanced pancreatic cancer in daily clinical practice.

    PubMed

    Giuliani, Jacopo; Piacentini, Paolo; Bonetti, Andrea

    2016-01-01

    The aim of this outcome study was to evaluate the management of advanced pancreatic cancer in a real-world clinical practice; few such experiences have been reported in the literature. A retrospective analysis was performed of all consecutive patients with advanced pancreatic ductal adenocarcinoma followed at our medical oncology unit between January 2003 and December 2013. We evaluated 78 patients, mostly with metastatic disease (64.1%). Median follow-up was 10.77 months, by which time 74 patients (94.9%) had died. Median overall survival was 8.29 months. Median age was 67 years. In univariate analysis, pain at onset (p = 0.020), ECOG performance status (p<0.001), stage (p = 0.047), first-line chemotherapy (p<0.001), second-line chemotherapy (p<0.001) and weight loss at diagnosis (p = 0.029) were factors that had an impact on overall survival. In multivariate analysis, the presence of pain at onset (p = 0.043), stage (p = 0.003) and second-line chemotherapy (p = 0.004) were confirmed as independent prognostic factors. Our data, derived from daily clinical practice, confirmed advanced pancreatic cancer as an aggressive malignant disease with a very short expected survival. Second-line treatment seems to provide an advantage in terms of overall survival in patients who showed a partial response as their best response to first-line treatment.

  8. Impact of advanced laparoscopy courses on present surgical practice.

    PubMed

    Houck, Jared; Kopietz, Courtni M; Shah, Bhavin C; Goede, Matthew R; McBride, Corrigan L; Oleynikov, Dmitry

    2013-01-01

    The introduction of new surgical techniques has made training in laparoscopic procedures a necessity for the practicing surgeon, but acquisition of new surgical skills is a formidable task. This study was conducted to assess the impact of advanced laparoscopic workshops on caseload patterns of practicing surgeons. After we obtained institutional review board approval, a survey of practicing surgeons who participated in advanced laparoscopic courses was distributed; the results were analyzed for statistical significance. The courses were held at the University of Nebraska Medical Center between January 2002 and December 2010. Questionnaires were mailed, faxed, and e-mailed to surgeons. Of the 109 surgeons who participated in the advanced laparoscopy courses, 79 received surveys and 30 were excluded from the survey because of their affiliation with the University of Nebraska Medical Center. A total of 47 responses (59%) were received from 41 male and 6 female surgeons. The median response time from completion of the course to completion of the survey was 13.2 months (range, 6.8-19.1 months). The mean age of participating surgeons was 39.2 years (range, 29-51 years). The mean time since residency was 8.4 years (range, 0.8-21 years). Eleven surgeons had completed a minimal number of laparoscopic cases in residency (<50), 17 surgeons had completed a moderate number of laparoscopic procedures in residency (50-200), and 21 surgeons had completed a significant number of cases during residency (>200). Of the surgeons who responded, 94% were in private practice. Fifty-seven percent of the participating surgeons who responded reported a change in laparoscopic practice patterns after the courses. Of these surgeons, 24% had a limited residency laparoscopy exposure of <50 cases. Surgeons who were exposed to ≥50 laparoscopic cases during their residency showed a statistically significant increase in the number of laparoscopic procedures performed after their class compared with

  9. Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors.

    PubMed

    Wisur-Hokkanen, Carola; Glasberg, Ann-Louise; Mäkelä, Carita; Fagerström, Lisbeth

    2015-12-01

    Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles. To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice. The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis. The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles. The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face

  10. Evaluation of a Longitudinal Advanced Pharmacy Practice Experience.

    PubMed

    Frasiolas, Jorie A; Wright, Kelly; Dzierba, Amy L

    2017-04-01

    Objective. To describe satisfaction and career path of students who participated in the longitudinal advanced pharmacy practice experience (APPE). Methods. A 3-part survey was administered to students enrolled between January 1, 2010, and December 31, 2013. The sections of the survey evaluated respondents' baseline characteristics, satisfaction, and career path. Results. Majority of the respondents had a GPA above 3.0 (91%), pharmacy school honors (84%), work experience in retail (16%) or multiple pharmacy sites (38%), and were members of at least one professional organization (76%). Sixty-nine percent reported that the program exceeded their expectations. Strengths included practice site consistency, rotation diversity, preceptors, presentations, and collaboration with health care professionals. Students gained approximately 76 hours of additional clinical experience, compared to if they completed rotations at individual sites. After graduation, more than half of the respondents accepted a pharmacy practice residency (67%). Conclusion. The results of this study support the need for APPE programs that prepare students to deliver advanced patient care, while providing them with professional development.

  11. Efficient and effective models for integrating advanced practice professionals into oncology practice.

    PubMed

    Shulman, Lawrence N

    2013-01-01

    Advanced practice professionals (APP), primarily nurse practitioners and physician assistants, are increasingly being integrated into oncology practices. The reasons are numerous, and models of care options are numerous as well. Models of care have developed without much forethought and are often the result of the relative interests of the physician, the APP, and the mutual "comfort" of practice style. The increasing complexity of oncology care, the pressures of the health care crisis and health care reform mean that it is necessary that we examine models of collaborative care in terms of both quality of care and productivity.

  12. An Academic-Practice Partnership to Advance DNP Education and Practice.

    PubMed

    Howard, Patricia B; Williams, Tracy E

    During the past decade, the growth of doctor of nursing practice (DNP) programs in the United States has been phenomenal, with most focusing on the preparation of advanced practice registered nurses. Simultaneously, academic-practice partnerships have been a frequent subject of discussion for nursing's leading academic, administrative, and practice organizations. Numerous reports about academic-practice partnerships concerning aspects of baccalaureate nursing education exist, but partnership accounts for DNP programs are essentially nonexistent. The purpose of this article is to describe the initial phase of an academic-practice partnership between a multisystem health care organization and a college of nursing in a public land-grant university in the southeastern United States. The 7-year partnership agreement between Norton Healthcare and the University of Kentucky College of Nursing was designed to prepare 5 cohorts of 20 to 30 baccalaureate-prepared staff nurses as DNP graduates for advanced practice registered nurse eligibility. The description of partnering institution characteristics frames an emphasis on elements of the partnership proposal, contractual agreement, and partner responsibilities along with the logic model evaluation plan. Lessons learned include the importance of proposals and contracts to sustain the partnership, frequent communication to build trust, and strategic analysis for rapid response to challenging situations. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Current Status of Fellowship Programs for Advanced Practice Registered Nurses in the Nurse Practitioner Role.

    PubMed

    Camal Sanchez, Carlos Alberto

    2017-05-31

    Students completing an advanced practice RN program for practice as a nurse practitioner may seek options for further advancement. Although postgraduate clinical fellowship programs exist, information about such programs is not readily available. This article offers a resource for faculty to assist graduate students in finding advanced practice RN nurse practitioner fellowship programs in the United States.

  14. E-mails in a Psychiatric Practice: Why Patients Send Them and How Psychiatrists Respond.

    PubMed

    Moldawsky, Richard J; Shah, Pranav V

    2016-01-01

    Little is known about what prompts patients to use e-mail with their physicians and how physicians respond to these e-mails. To identify the main reasons why patients e-mail and to learn how psychiatrists manage these e-mails as part of these patients' overall care. One hundred patient-initiated e-mails to each of two psychiatrists in a group practice were studied retrospectively for primary reason for the e-mail and for psychiatrists' handling of each e-mail. Other data were collected to assess how representative the e-mailing patients were of the psychiatrists' patient panels. Age, sex, and diagnoses of the e-mailers were similar to our overall panels. The most common reasons for e-mailing were refill requests (19.5%), questions about prescribed medication (16.5%), and worsening of symptoms (11.5%). The modal e-mail was a patient with attention-deficit/hyperactivity disorder requesting a refill. The psychiatrists' most common responses were authorizing a refill (25%), reassurance (22%), and making or moving up a scheduled appointment (16%). For all patients who reported a worsening of symptoms, responses, communicated by e-mail or telephone, included a combination of an earlier appointment and/or change in medication or dose and/or referral for psychotherapy. Both psychiatrists found e-mail to be an efficient enhancement of their practice, and it was inferred that this was also a satisfying mechanism for patients. Physician-patient communication via e-mail is timesaving for both, and the benefits to patient care should reassure physicians who are wary of using e-mail in their practice. Potential risks to patients without face-to-face or telephone contact appear to be minimal.

  15. E-mails in a Psychiatric Practice: Why Patients Send Them and How Psychiatrists Respond

    PubMed Central

    Moldawsky, Richard J; Shah, Pranav V

    2016-01-01

    Context: Little is known about what prompts patients to use e-mail with their physicians and how physicians respond to these e-mails. Objective: To identify the main reasons why patients e-mail and to learn how psychiatrists manage these e-mails as part of these patients’ overall care. Design: One hundred patient-initiated e-mails to each of two psychiatrists in a group practice were studied retrospectively for primary reason for the e-mail and for psychiatrists’ handling of each e-mail. Other data were collected to assess how representative the e-mailing patients were of the psychiatrists’ patient panels. Results: Age, sex, and diagnoses of the e-mailers were similar to our overall panels. The most common reasons for e-mailing were refill requests (19.5%), questions about prescribed medication (16.5%), and worsening of symptoms (11.5%). The modal e-mail was a patient with attention-deficit/hyperactivity disorder requesting a refill. The psychiatrists’ most common responses were authorizing a refill (25%), reassurance (22%), and making or moving up a scheduled appointment (16%). For all patients who reported a worsening of symptoms, responses, communicated by e-mail or telephone, included a combination of an earlier appointment and/or change in medication or dose and/or referral for psychotherapy. Both psychiatrists found e-mail to be an efficient enhancement of their practice, and it was inferred that this was also a satisfying mechanism for patients. Conclusion: Physician-patient communication via e-mail is timesaving for both, and the benefits to patient care should reassure physicians who are wary of using e-mail in their practice. Potential risks to patients without face-to-face or telephone contact appear to be minimal. PMID:26562306

  16. Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana.

    PubMed

    Olashore, Anthony; Ayugi, James; Opondo, Philip

    2017-01-01

    There is a growing preference for psycho-pharmacological therapy over non-pharmacological care. The prescription pattern and the choice of psychotropic medications vary in different settings. Whilst newer agents and rational prescribing are favored in the more specialized settings, the pattern remains unclear in less specialized units, largely due to lack of data. The aims were to conduct a treatment audit in the only mental referral hospital in Botswana, which is a non-specialized child and adolescent care setting and see how it conforms to best practice. A retrospective audit which involved the extraction of socio-demographic and clinical information from the records of patients who were ≤ 17 years and seen from January 1, 2012-July 31, 2016. A total of 238 files were used for this report. Mean age (SD) was 12.41 (4.1) years. Of the 120 (50.4%) patients who had pharmacological intervention, only 85(70.8%) had monotherapy. The most commonly prescribed psychotropic agents were antipsychotics (40%). Off-label use of antipsychotics and polypharmacy were 31.2% and 29.2% respectively. The level of conformity to standard practice in terms of psychotropic prescribing in our setting is consistent with the reports from developed countries where more specialized care ostensibly exists. Further studies will be necessary to determine the scope of psychotropic use.

  17. Overcoming the problem of diagnostic heterogeneity in applying measurement-based care in clinical practice: the concept of psychiatric vital signs.

    PubMed

    Zimmerman, Mark; Young, Diane; Chelminski, Iwona; Dalrymple, Kristy; Galione, Janine N

    2012-02-01

    Measurement-based care refers to the use of standardized scales to measure the outcome of psychiatric treatment. Diagnostic heterogeneity poses a challenge toward the adoption of a measurement-based care approach toward outcome evaluation in clinical practice. In the present article, we propose adopting the concept of psychiatric vital signs to facilitate measurement-based care. Medical vital signs are measures of basic physiologic functions that are routinely determined in medical settings. Vital signs are often a primary outcome measure, and they are also often adjunctive measurements. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the frequency of depression and anxiety in a diagnostically heterogeneous group of psychiatric outpatients to determine the appropriateness of considering their measurement as psychiatric vital signs. Three thousand psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV supplemented with items from the Schedule for Affective Disorders and Schizophrenia. We determined the frequency of depression and anxiety evaluated according to the Schedule for Affective Disorders and Schizophrenia items. In the entire sample of 3000 patients, 79.3% (n = 2378) reported clinically significant depression of at least mild severity, 64.4% (n = 1932) reported anxiety of at least mild severity, and 87.4% (n = 2621) reported either anxiety or depression. In all 10 diagnostic categories examined, most patients had clinically significant anxiety or depression of at least mild severity. These findings support the routine assessment of anxiety and depression in clinical practice because almost all patients will have these problems as part of their initial presentation. Even for those patients without depression or anxiety, the case could be made that the measurement of depression and anxiety is relevant and analogous to measuring certain physiologic

  18. [The practical application of the International Classification of Functioning, Disability and Health (ICF) in medical rehabilitation of psychiatric patients].

    PubMed

    Grundmann, J; Keller, K; Bräuning-Edelmann, M

    2005-12-01

    The WHO Classification of Functioning, Disability and Health enables the description of functional health, disability and impairment on an international and interdisciplinary level in a common language. The fundamental underlying assumption of this Classification, which is orientated around a bio-psycho-social model of health and impairment, has been accepted by rehabilitation scientists in general. Unfortunately, the WHO does not make any recommendations as to how this classification could be applied in practice. In this article, various problems are outlined which could occur when the ICF is applied. Furthermore an example from a psychiatric rehabilitation institution illustrates the way the ICF could serve as an instrument for an extensive rehabilitation management programme. Here, Stucki's use will be made of Rehab-Cycle model. This describes a comprehensive sequence of steps which help analyse the patients problems from a patient-centred standpoint, to set up a schedule for treatment and to evaluate the results. Within Stucki's model the ICF is used as a system to analyse problems upon which intervention can be set. This method is illustrated with an example from a rehabilitation case. Summarizing, it is pointed out that through easier communication (as a result of the ICF) interdisciplinary productivity and efficiency will increase. On this basis it is possible to achieve a more comprehensive multimodal approach in the treatment of people suffering from psychic impairments or disability.

  19. Pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'.

    PubMed

    Ali, A S; Fejzic, J; Grant, G D; Nissen, L M

    2016-01-01

    The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30-40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the

  20. Mindfulness-Based Stress Reduction in Advanced Nursing Practice

    PubMed Central

    Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

    2015-01-01

    The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. PMID:25673578

  1. Levine's Conservation Model: A Framework for Advanced Gerontology Nursing Practice.

    PubMed

    Abumaria, Ibrahim Mahmoud; Hastings-Tolsma, Marie; Sakraida, Teresa J

    2015-01-01

    Growing numbers of older adults place increased demands on already burdened healthcare systems. The cost of managing chronic illnesses mandates greater emphasis on management and prevention. This article explores the adaptation of Levine's Conservation Model as a structure for providing care to the older adult by the adult-gerontology primary care nurse practitioner (AGNP). The AGNP role, designed to provide quality care to adult and older adult populations, offers the opportunity to not only manage health care of the elderly, but to also advocate, lead in collaborative care efforts, conduct advanced planning, and manage and negotiate health delivery systems. The use of nursing models can foster the design of effective interventions that promote health of the older adult, particularly in the long-term care environment. Levine's Conservation Model provides a useful structure for older adult care in the long-term care setting. As an ideal care manager, the AGNP would be well served to consider use of the model to guide advanced nursing practice. Recommendations for clinical practice, research, and health policy. © 2014 Wiley Periodicals, Inc.

  2. Advanced Practice Nursing Competency Assessment Instrument (APNCAI): clinimetric validation

    PubMed Central

    Sastre-Fullana, Pedro; Morales-Asencio, Jose Miguel; Sesé-Abad, Albert; Fernández-Domínguez, Juan Carlos; De Pedro-Gómez, Joan

    2017-01-01

    Objective To describe the development and clinimetric validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) through several evidence sources about reliability and validity in the Spanish context. Design and setting APNCAI development was based on a multisequential and systematic process: literature review, instrument content consensus through qualitative Delphi method approach (a panel of 51 Advanced Practice in Nursing –APN– experts was selected) and the clinimetric validation process based on a sample of 600 nurses from the Balearic Islands public healthcare setting. Methods An initial step for tool's content development process based on Delphi method approach of expert consensus was implemented. A subsequent phase of tool validation started from the analysis of APN core competencies latent measurement model, including exploratory and confirmatory techniques. Reliability evidence for each latent factor was also obtained. Items' scores were submitted to descriptive analysis, plus univariate and multivariate normality tests. Results An eight-factor competency assessment latent model obtained adequate fit, and it was composed by ‘Research and Evidence-Based Practice’, ‘Clinical and Professional Leadership’, ‘Interprofessional Relationship and Mentoring’, ‘Professional Autonomy’, ‘Quality Management’, ‘Care Management’, ‘Professional Teaching and Education’ and ‘Health Promotion’. Conclusions Adequate empirical evidence of reliability and validity for APNCAI makes it useful for application in healthcare policy programmes for APN competency assessment in Spain. PMID:28235968

  3. Educating advanced level practice within complex health care workplace environments through transformational practice development.

    PubMed

    Hardy, Sally; Jackson, Carrie; Webster, Jonathan; Manley, Kim

    2013-10-01

    Over the past 20 years health care reform has influenced the development of advanced level practitioner roles and expectations. How advanced level practitioners work to survive the highly stimulating, yet sometimes overwhelming aspects of balancing high quality provision with political reform agendas, amidst economic constraint is considered. Transformational approaches (encompassing education and practice led service development) can provide, promote and 'provoke' a harnessing of complex issues workplace environment to produce creative solutions. Transformational Practice Development provides a structured, rigorous, systematic approach that practitioners, teams and health care consumers alike can utilise to achieve skills and attributes needed for successful innovation. The authors present case study materials from action orientated locally delivered Practice Development, as a complex strategic intervention approach to influence and promote advanced level practice expertise. Initiated through facilitation of transformational leadership, and resultant team based improvements, we present how strategic collaborative processes can harness work chaos and complexity to provide sustainable and productive workplace cultures of effectiveness. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Partner for Promotion: An Innovative Advanced Community Pharmacy Practice Experience

    PubMed Central

    Legg, Julie E.; Casper, Kristin A.

    2008-01-01

    Objectives To implement the Partner for Promotion (PFP) program which was designed to enhance the skills and confidence of students and community pharmacy preceptors to deliver and expand advanced patient care services in community pharmacies and also to assess the program's impact. Design A 10-month longitudinal community advanced pharmacy practice experience was implemented that included faculty mentoring of students and preceptors via formal orientation; face-to-face training sessions; online monthly meetings; feedback on service development materials; and a web site offering resources and a discussion board. Pre- and post-APPE surveys of students and preceptors were used to evaluate perceptions of knowledge and skills. Assessment The skills survey results for the first 2 years of the PFP program suggest positive changes occurring from pre- to post-APPE survey in most areas for both students and preceptors. Four of the 7 pharmacies in 2005-2006 and 8 of the 14 pharmacies in 2006-2007 were able to develop an advanced patient care service and begin seeing patients prior to the conclusion of the APPE. As a result of the PFP program from 2005-2007, 14 new experiential sites entered into affiliation agreements with The Ohio State University College of Pharmacy. Conclusion The PFP program offers an innovative method for community pharmacy faculty members to work with students and preceptors in community pharmacies in developing patient care services. PMID:19325954

  5. Integration of advanced practice providers into the Israeli healthcare system.

    PubMed

    Aaron, Eliana Marcus; Andrews, Caryn Scheinberg

    2016-01-01

    Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence

  6. A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

    PubMed

    Hanley, Mary Anne; Coppa, Denise; Shields, Deborah

    2017-08-01

    For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

  7. Complete-block scheduling for advanced pharmacy practice experiences.

    PubMed

    Hatton, Randy C; Weitzel, Kristin W

    2013-12-01

    An innovative approach to meeting increased student demand for advanced pharmacy practice experiences (APPEs) is described, including lessons learned during a two-year pilot project. To achieve more efficient allocation of preceptor resources, the University of Florida College of Pharmacy (UFCOP) adopted a new APPE rotation model in which 20 pharmacy students per year complete all required and elective APPEs at one practice site, an affiliated academic medical center. Relative to the prevailing model of experiential training for Pharm.D. students, the "complete-block scheduling" model offers a number of potential benefits to students, preceptors, and the pharmacy school. In addition to potentially reduced student housing expenses and associated conveniences, complete-block scheduling may enable (1) more efficient use of teaching resources, (2) increased collaboration among preceptors, (3) greater continuity and standardization of educational experiences, and (4) enhanced opportunities for students to engage in longer and more complex research projects. The single-site APPE rotation model also can provide value to the training site by enabling the extension of clinical pharmacy services; for example, UFCOP students perform anticoagulation monitoring and discharge medication counseling at the host institution. Despite logistical and other challenges encountered during pilot testing of the new scheduling model, the program has been well received by students and preceptors alike. Complete-block APPE scheduling is a viable model for some health systems to consider as a means of streamlining experiential education practices and helping to ensure high-quality clinical rotations for Pharm.D. students.

  8. Framework for Evaluating the Impact of Advanced Practice Nursing Roles.

    PubMed

    Bryant-Lukosius, Denise; Spichiger, Elisabeth; Martin, Jacqueline; Stoll, Hansruedi; Kellerhals, Sabine Degen; Fliedner, Monica; Grossmann, Florian; Henry, Morag; Herrmann, Luzia; Koller, Antje; Schwendimann, René; Ulrich, Anja; Weibel, Lukas; Callens, Betty; De Geest, Sabina

    2016-03-01

    To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes. © 2016 Sigma Theta Tau International.

  9. Educational Changes to Support Advanced Practice Nursing Education

    PubMed Central

    LeFlore, Judy L.; Thomas, Patricia E.

    2016-01-01

    Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system. PMID:27465446

  10. Advancing the practice of systems engineering at JPL

    NASA Technical Reports Server (NTRS)

    Jansma, Patti A.; Jones, Ross M.

    2006-01-01

    In FY 2004, JPL launched an initiative to improve the way it practices systems engineering. The Lab's senior management formed the Systems Engineering Advancement (SEA) Project in order to "significantly advance the practice and organizational capabilities of systems engineering at JPL on flight projects and ground support tasks." The scope of the SEA Project includes the systems engineering work performed in all three dimensions of a program, project, or task: 1. the full life-cycle, i.e., concept through end of operations 2. the full depth, i.e., Program, Project, System, Subsystem, Element (SE Levels 1 to 5) 3. the full technical scope, e.g., the flight, ground and launch systems, avionics, power, propulsion, telecommunications, thermal, etc. The initial focus of their efforts defined the following basic systems engineering functions at JPL: systems architecture, requirements management, interface definition, technical resource management, system design and analysis, system verification and validation, risk management, technical peer reviews, design process management and systems engineering task management, They also developed a list of highly valued personal behaviors of systems engineers, and are working to inculcate those behaviors into members of their systems engineering community. The SEA Project is developing products, services, and training to support managers and practitioners throughout the entire system lifecycle. As these are developed, each one needs to be systematically deployed. Hence, the SEA Project developed a deployment process that includes four aspects: infrastructure and operations, communication and outreach, education and training, and consulting support. In addition, the SEA Project has taken a proactive approach to organizational change management and customer relationship management - both concepts and approaches not usually invoked in an engineering environment. This paper'3 describes JPL's approach to advancing the practice of

  11. Association between stigmatisation and experiences of evidence-based practice by psychiatric rehabilitation staff in Japan: a cross-sectional survey.

    PubMed

    Yamaguchi, Sosei; Niekawa, Nobuyuki; Maida, Keiko; Chiba, Rie; Umeda, Maki; Uddin, Shahir; Taneda, Ayano; Ito, Junichiro

    2015-04-01

    Mental health professionals are one of the groups holding harmful stigmatisation towards people with mental illness. To investigate the association between the performance of evidence-based practice (EBP) and the staff's level of stigmatisation in Japan. The study enrolled 179 staff members in psychiatric day-care, psychiatric community outreach teams, and psychiatric rehabilitation teams at 14 psychiatric hospitals. The Positive Attitudes Scale (PAS), the Japanese-language version of the Social Distance Scale (SDSJ) and the Recovery Attitude Questionnaire (RAQ) were employed as outcome measures. Scores on each scale were compared between participants who performed EBPs and those who had never performed EBPs. Approximately 40% of the staff engaged in at least assertive community treatment, supported employment or family psychoeducation. The staff who performed EBPs had significantly higher scores on PAS (MD, 7.09; 95% CIs, 4.09-10.09) and RAQ (MD, 1.30; 95% CIs, 0.36-2.25) but lower scores on SDSJ (MD, -2.41; 95% CIs, -3.50 to -1.32) than those who never performed EBPs. Multivariate analyses found that EBP experience was associated with a low level of staff stigmatisation after controlling for confounders. The findings suggest that an individual EBP experience is associated with their reduced stigmatisation.

  12. [THE MATTER: NO PSYCHIATRIZATION].

    PubMed

    Pisa, Hugo

    2015-01-01

    Anxiety, sadness, worries, fears, irritability, fatigue, tedium, are situations that life confront us with. They don't qualify as psy- chiatric disorders, but nevertheless they are treated as though. We refer to the psychiatrization of daily life. The aim of this article is to prevent such psychiatrization. To support this assertion, we are going to develop different aspects tending to explain the origins of the patient's demands and the answers given by the psychiatrist. A critical reflection of our practice is proposed.

  13. Collaborating across services to advance evidence-based nursing practice.

    PubMed

    Kenny, Deborah J; Richard, Maggie L; Ceniceros, Xochitl; Blaize, Kelli

    2010-01-01

    Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a

  14. Advancing practice through prescribing: is there a better way?

    PubMed

    Harding, Stephen; Gardner, Andrew

    2006-07-01

    The literature demonstrates a clear relationship between the rate of adverse effects and the number of prescribers that a service consumer may consult. This brings into question the benefits, for the service consumer, of nurses prescribing. Given the complexities of care for certain population groups, for example older people, it is suggested that there is greater benefit in professionals working collaboratively toward the best outcome for the person in care, with nurses offering more informed advice to their partners in service delivery. Nurses who advance their practice through the development of an expert knowledge base relevant to their area of expertise can contribute to the diagnosis and management of particular client groups by providing specialist advice to primary and direct care professionals. It is proposed that this could be achieved using an 'academic detailing' approach rather than becoming another prescriber of pharmacotherapy.

  15. A Quality Improvement Course Review of Advanced Pharmacy Practice Experiences

    PubMed Central

    Hornsby, Lori B.; Phillippe, Haley M.; Kelley, Kristi; McDonough, Sharon

    2011-01-01

    Objectives. To determine strengths of and quality improvements needed in advanced pharmacy practice experiences (APPE) through a systematic course review process. Design. Following the “developing a curriculum” (DACUM) format, course materials and assessments were reviewed by the curricular subcommittee responsible for experiential education and by key stakeholders. Course sequence overview and data were presented and discussed. A course review worksheet was completed, outlining strengths and areas for improvement. Assessment. Student feedback was positive. Strengths and areas for improvement were identified. The committee found reviewing the sequence of 8 APPE courses to be challenging. Conclusions. Course reviews are a necessary process in curricular quality improvement but can be difficult to accomplish. We found overall feedback about APPEs was positive and student performance was high. Areas identified as needing improvement will be the focus of continuous quality improvement of the APPE sequence. PMID:21931454

  16. Comprehensive nursing case management. An advanced practice model.

    PubMed

    Taylor, P

    1999-01-01

    Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.

  17. A collaborative and reflective academic advanced pharmacy practice experience.

    PubMed

    Roche, Victoria F; Limpach, Aimee L

    2011-08-10

    To implement a co-precepted advanced pharmacy practice experience (APPE) focused on traditional pharmacy faculty and administrative responsibilities and reflection opportunities. A multi-faceted, reflection-infused academic APPE was designed that exposed students to activities related to teaching, curriculum revision, scholarly writing, committee service, faculty role-modeling, mentorship and development, and school-level administrative decision-making. Two students completed the APPE in the first 2 semesters it was offered (1 in spring 2010 and 1 in fall 2010). Formative and summative evaluations confirmed that the students achieved the APPE goals and viewed the experience as valuable, informative, and enjoyable as expressed both in reflective journal submissions and survey comments. Co-precepting by pharmacy faculty members primarily engaged in traditional faculty- and administration-related responsibilities can provide students with a robust learning experience that surpasses that which could be achieved by a single mentor.

  18. Advanced nursing practice and Newton's three laws of motion.

    PubMed

    Sturgeon, David

    This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.

  19. Barriers to advanced practice registered nurse scope of practice: issue analysis.

    PubMed

    Villegas, Whitney J; Allen, Patricia E

    2012-09-01

    Advanced practice registered nurses (APRNs) have the unique potential to affect the changing needs of health care in the United States, but are restricted in care provision by varying state regulations and reimbursement policies. Although research shows APRN care to be safe, cost-effective, and of high quality, most medical professional organizations continue to oppose the removal of scope-of-practice barriers, citing patient safety concerns. Nursing organizations at the state and national levels have already begun to invest the time and resources needed for policy change. However, empirical evidence of APRN quality of care must be shared with policymakers, funding entities, and the public. Additionally, support must be garnered from the public and other health care disciplines. Scope-of-practice policy change will occur through the emergence of strong individuals within nursing professional organizations and the joining together of organizations to form one voice.

  20. A Strategy to Develop Advanced Pharmacy Practice Experiences

    PubMed Central

    Ellis, Sam; Giles, Joel; Maffeo, Carrie; Hansen, Laura; Saseen, Joseph J.; Ulrich, Heather; Valdez, Connie; Altiere, Ralph; Bainbridge, Jacquelyn; Page, Robert; Sintek, Charles; Vondracek, Sheryl; Zadvorny, Emily; Fish, Douglas

    2007-01-01

    Objective To establish statewide medication, disease management, and other clinical programs to serve as advanced pharmacy practice experience (APPE) training sites for the University of Colorado at Denver and Health Sciences Center School of Pharmacy, and to guarantee year-round support for the programs by providing pharmacy students with the necessary competencies to carry a significant proportion of each program's workload. Methods Partnerships with pharmacies willing to use students to expand their scope of clinical practice or support existing programs were established. Partners were asked to choose the clinical program(s) they wished implemented or supported and were guaranteed that APPE students would contribute to carrying each program's clinical service workload for 48 week/year under the supervision of the partners' pharmacists. In addition, partners implementing new programs were offered other support, including equipment, supplies, and training and mentoring for their pharmacists. Evaluation Twenty-two partnerships involving anticoagulation, diabetes, immunization, medication reconciliation, and other clinical programs were established with hospital, community, and community health center pharmacies. The partnerships provided 213 APPE placements in the 2006-2007 academic year. Conclusion This work demonstrates that by using innovative approaches, a pharmacy school can form new partnerships with hospital, community health center, and community pharmacies, as well as work with existing clinical programs, to create a variety of medication, disease management, and other APPEs to meet its increasing placement needs and evolving accreditation standards. PMID:17619646

  1. An Advanced Pharmacy Practice Experience in Sports Pharmacy

    PubMed Central

    2008-01-01

    Objective To establish and evaluate an advanced pharmacy practice experience (APPE) in sports pharmacy. Design Students actively participated in a variety of activities for this new 6-week elective APPE, including drug-testing collections, delivering presentations, and providing drug information. Students also learned about assays, compounding, and dispensing medications specifically for athletes, and visited various athletic medical facilities. Student were given written and practical certification examinations for drug-testing collections, and their specimen measurements were compared to those obtained by the testing laboratory for validation; satisfaction surveys were obtained from testing sites; and presentation evaluations were obtained from audience participants. Assessment Students were able to accurately measure pH and specific gravity of urine samples and all students passed the certification examination. Students rated the APPE very high. Also, students received high satisfaction ratings on surveys administered to the officials of the schools where they tested and members of the groups to whom they gave presentations. Conclusion Students gained experience and insight into the various roles of pharmacists in sports pharmacy and developed confidence in their ability to conduct drug-testing collections. PMID:18322580

  2. A strategy to develop advanced pharmacy practice experiences.

    PubMed

    Turner, Christopher J; Ellis, Sam; Giles, Joel; Maffeo, Carrie; Hansen, Laura; Saseen, Joseph J; Ulrich, Heather; Valdez, Connie; Altiere, Ralph; Bainbridge, Jacquelyn; Page, Robert; Sintek, Charles; Vondracek, Sheryl; Zadvorny, Emily; Fish, Douglas

    2007-06-15

    To establish statewide medication, disease management, and other clinical programs to serve as advanced pharmacy practice experience (APPE) training sites for the University of Colorado at Denver and Health Sciences Center School of Pharmacy, and to guarantee year-round support for the programs by providing pharmacy students with the necessary competencies to carry a significant proportion of each program's workload. Partnerships with pharmacies willing to use students to expand their scope of clinical practice or support existing programs were established. Partners were asked to choose the clinical program(s) they wished implemented or supported and were guaranteed that APPE students would contribute to carrying each program's clinical service workload for 48 week/year under the supervision of the partners' pharmacists. In addition, partners implementing new programs were offered other support, including equipment, supplies, and training and mentoring for their pharmacists. Twenty-two partnerships involving anticoagulation, diabetes, immunization, medication reconciliation, and other clinical programs were established with hospital, community, and community health center pharmacies. The partnerships provided 213 APPE placements in the 2006-2007 academic year. This work demonstrates that by using innovative approaches, a pharmacy school can form new partnerships with hospital, community health center, and community pharmacies, as well as work with existing clinical programs, to create a variety of medication, disease management, and other APPEs to meet its increasing placement needs and evolving accreditation standards.

  3. Advancing technician practice: Deliberations of a regulatory board.

    PubMed

    Adams, Alex J

    2017-02-16

    In 2016, the Idaho State Board of Pharmacy (U.S.) undertook a major rulemaking initiative to advance pharmacy practice by broadening the ability of pharmacists to delegate tasks to pharmacy technicians. The new rules of the Board thus moved the locus of control in technician scope of practice from law to pharmacist delegation. Pharmacist delegation is individualistic and takes into account the individual technician's capabilities, the pharmacist's comfort level, facility policies, and the risk mitigation strategies present at the facility, among other factors. State law limits, by contrast, are rigid and can mean that pharmacists are unable to delegate tasks that are or could otherwise be within the abilities of their technicians. The expanded technician duties are in two domains: 1) medication dispensing support (e.g., tech-check-tech, accepting verbal prescriptions, transferring prescriptions, and performing remote data entry); and 2) technical support for pharmacist clinical services (e.g., administering immunizations). This commentary reviews the evidence behind these expanded duties, as well as the key regulatory decision points for each task. The Board's rules and approach may prove useful to other states and even other governing bodies outside the U.S. as they consider similar issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Use of information technology by advanced practice nurses.

    PubMed

    Gaumer, Gary L; Koeniger-Donohue, Rebecca; Friel, Christina; Sudbay, Mary Beth

    2007-01-01

    The purpose of this study is to describe the use of information technology by advance practice nurses. A survey of 519 graduates of the Simmons College nurse practitioner program was conducted. Areas of investigation included the nurse practitioner's use of informatics technology, perception of information technology competence, adequacy of information technology training and support in the workplace, specific information technology health functions used in the workplace, and perceived benefits of using information technology. The data on the 249 usable responses were analyzed using descriptive statistics. These analyses compare the use of information technology by type of job, specialty, years of practice, and setting of work. Results indicate that more than 90% of nurse practitioners utilize computers at work, yet a large fraction of them still have low self-perception of information technology competence, believe initial training at the work site was inadequate, and believe that academic preparation for information technology was also inadequate. There is considerable variation in these measures across nurse practitioner specialties, settings of care, job characteristics, and experience.

  5. Advance Care Discussions: Pediatric Clinician Preparedness and Practices.

    PubMed

    Sanderson, Amy; Hall, Amber M; Wolfe, Joanne

    2016-03-01

    Few data exist regarding clinician preparedness to participate in advance care discussions (ACD) and the practices surrounding these discussions for children with life-threatening conditions. We sought to understand pediatric clinician preparedness to participate in ACD and the practices surrounding these discussions. A survey was administered to assess clinician attitudes and behaviors regarding ACD. Two hundred sixty-six clinicians (107 physicians and 159 nurses) responded to the survey (response rate 53.6%). Seventy-five percent of clinicians felt prepared to participate in ACD. Most clinicians believed they were prepared to express empathy (98.8%), discuss goals of care for an adolescent patient (90.3%), and elicit a parent's hopes (90.3%). Conversely, several felt unprepared to discuss resuscitation status with school-aged (59.7%) and adolescent (48.5%) patients and to conduct a family conference (39.5%). The most frequent topics addressed were: parents' understanding of the patient's illness (75.5%), primary goals of the parent (75.1%), and the parents' understanding of prognosis (71.1%). Conversely, the topics least commonly discussed were as follows: belief system of the patient/family (22.0%), patient's hopes (21.2%), and the patient's perceptions of his/her quality of life (19.8%). Notably, 40% of clinicians believe that caring for patients with poor prognoses is depressing, and this was more common among less-experienced clinicians (P = 0.048). Many clinicians believe they are prepared to participate in ACD, but practices are not consistent with expert recommendations for optimal ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and behavior, and greater clinician support may enhance health care provider ACD preparedness and skills. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  6. Psychiatric comorbidities in movement disorders.

    PubMed

    Miguel-Puga, Adán; Villafuerte, Gabriel; Arias-Carrión, Oscar

    2017-07-06

    Psychiatric comorbidities are common in movement disorders. This review provides a practical approach to help clinicians to recognize psychiatric disorders in the most frequent movement disorders. However, the extent of neurodegeneration, as well as the impact of medications with considerable CNS effects, influences the diverse psychiatric presentations that, in turn, are influenced by the stress of living with a movement disorder. Depression, anxiety, and psychosis are the most common psychiatric comorbidities in movement disorders and of the medications used to treat the motor disturbances. These psychiatric problems impair patients' functioning throughout the course of the chronic neurodegenerative diseases. Due to the direct connection between brain dysfunction and psychiatric symptoms, there is hope that understanding the psychiatric comorbidities in movement disorders will lead to a better quality-of-life.

  7. [Prevalence of psychiatric disorders in French general practice using the patient health questionnaire: comparison with GP case-recognition and psychotropic medication prescription].

    PubMed

    Norton, J; de Roquefeuil, G; David, M; Boulenger, J-P; Ritchie, K; Mann, A

    2009-12-01

    Psychiatric disorders, mainly depression and anxiety, are frequently encountered in primary care and are a major cause of distress and disability. Nearly half of cases go unnoticed and among those that are recognised, many do not receive adequate treatment. In France, there is limited research concerning the prevalence, detection and management of these conditions in primary care. To estimate the prevalence of psychiatric disorders, overall and for the main psychiatric diagnostic categories, encountered in primary care; to describe general practitioners' (GPs') case identification rate; to examine psychotropic medication prescription according to diagnosis, in a regionally representative sample of GP attenders. GP practicing standard general practice in an urban area of the city of Montpellier and a nearby semi-rural region were recruited to participate. The response rate was 32.8% (n=41). Five additional GP almost exclusively offering homeopathy and acupuncture were recruited nonrandomly for convenience purposes. In each GP surgery, consecutive patients entering the waiting room were invited by a research assistant to participate until 25 patients per GP were recruited. Each participant completed self-report questionnaires in the waiting time, including the patient health questionnaire (PHQ), which yields provisional DSM-IV diagnoses. The GP completed a brief questionnaire during the consultation, giving his/her rating of the severity of any psychiatric disorder present and action taken. The patient response rate was 89.8%. In all, 14.9% of patients reached DSM-IV criteria for major depression or anxiety disorder on the PHQ (9.1% for major depression, 7.5% for panic disorder; 6% for other anxiety disorders). For the subthreshold categories, 7.4% met criteria for other depressive disorders, 11.8% for somatoform disorders and 10.9% for probable alcohol abuse or dependence. 66.3% of patients with DSM-IV diagnoses of major depression or anxiety disorder were

  8. Psychiatric Aide II. Instructor's Guide.

    ERIC Educational Resources Information Center

    Heimericks, Belinda K.

    This instructor's guide is for a Psychiatric Aide II course intended to provide Psychiatric Aids Is who have demonstrated expertise in giving basic nursing care to the mentally ill with more advanced nursing interventions and techniques. (It is assumed that all nursing care the aides provide is under the direction of a Registered Nurse.)…

  9. Correlates of Stress and Coping among Jordanian Nursing Students during Clinical Practice in Psychiatric/Mental Health Course.

    PubMed

    Alzayyat, Abdulkarim; Al-Gamal, Ekhlas

    2016-10-01

    Training in psychiatric settings is stressful for nursing students. The purpose of this study was to examine the correlations between the students' characteristics, their stress degrees, stressors and types of coping strategies they experience during training in psychiatric course. A descriptive, correlational, longitudinal design was used. Sixty-five undergraduate nursing students were recruited randomly from five Jordanian universities. Self-report questionnaires were administered at the second semester of the 2012-2013 academic year. The findings showed that students who utilized avoidance or transference strategies reported high stress degrees. Moreover, the results showed that those students who were in the fourth year, with a low family income, who avoid extracurricular activities, with a low academic grade or who registered in other clinical course(s) reported high stress degrees. These findings present a worthy data for the clinical instructors that facilitate students training in psychiatric settings and promote their psychosocial well-being. Copyright © 2014 John Wiley & Sons, Ltd.

  10. Providing a navigable route for acute medicine nurses to advance their practice: a framework of ascending levels of practice.

    PubMed

    Lees-Deutsch, Liz; Christian, Jan; Setchfield, Ian

    2016-01-01

    This article conveys concerns raised by delegates at the International SAM Conference (Manchester, 2015) regarding how to advance nursing practice in acute medicine. It endeavors to capture the essence of 'how to advance practice' and 'how to integrate advanced practice' within the workforce structures of an acute medicine unit (AMU). It addresses the production of tacit knowledge and the recognition and integration of this to developing the nursing workforce. The current context of NHS efficiencies and recruitment issues emphasize the value of retaining tacit knowledge. Uniquely, this article offers an early conceptual framework through which levels of advancement and potential transition points to advance nursing practice in acute medicine are articulated. Determining how to advance requires identification of prior accomplishments such as, tacit knowledge, experiential learning, CPD, specialist courses and management experience. This requires nurses to make judicious decisions to advance their practice and the distinction between 'amassing experience' and 'career progression'. It aims to stimulate thinking around the practicalities of advancement, the value of tacit knowledge and potential realization through the framework trajectory.

  11. Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue

    PubMed

    Rudner Lugo, Nancy

    2016-05-04

    In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.

  12. 28th Annual APRN Legislative Update: Advancements continue for APRN practice.

    PubMed

    Phillips, Susanne J

    2016-01-16

    The Annual Legislative Update discusses the legislative accomplishments in the areas of practice authority, reimbursement, and prescriptive authority that have the most impact on nurse practitioners and other advanced practice nurses across the country.

  13. Commentary: Leveraging discovery science to advance child and adolescent psychiatric research--a commentary on Zhao and Castellanos 2016.

    PubMed

    Mennes, Maarten

    2016-03-01

    'Big Data' and 'Population Imaging' are becoming integral parts of inspiring research aimed at delineating the biological underpinnings of psychiatric disorders. The scientific strategies currently associated with big data and population imaging are typically embedded in so-called discovery science, thereby pointing to the hypothesis-generating rather than hypothesis-testing nature of discovery science. In this issue, Yihong Zhao and F. Xavier Castellanos provide a compelling overview of strategies for discovery science aimed at progressing our understanding of neuropsychiatric disorders. In particular, they focus on efforts in genetic and neuroimaging research, which, together with extended behavioural testing, form the main pillars of psychopathology research. © 2016 Association for Child and Adolescent Mental Health.

  14. Critical analysis of the theories advanced to explain short REM sleep latencies and other sleep anomalies in several psychiatric conditions.

    PubMed

    Le Bon, O; Staner, L; Murphy, J R; Hoffmann, G; Pull, C H; Pelc, I

    1997-01-01

    One of the most consistent and most studied sleep modifications in several psychiatric conditions is the shortening of the rapid eye movement (REM) sleep latency. While its clinical usefulness is still to be proven and its meaning relatively obscure, the appearance of a short REM latency continues to be a daily fact in sleep laboratories. Many theories compete to explain what is observed, the most important being the circadian rhythm hypotheses, the homeostatic model and the reciprocal interaction model. These three are summarised and their pros and cons are exposed in a systematic manner. Points of conflict, possible convergences and limitations are discussed in the light of recent developments on the general theories of sleep regulation.

  15. Impact of an Introductory Pharmacy Practice Experience on Students' Performance in an Advanced Practice Experience

    PubMed Central

    Johnson, Thomas J.; Hedge, Dennis D.

    2010-01-01

    Objective To determine the impact of an introductory pharmacy practice experience (IPPE) on students' clinical skills during their initial advanced pharmacy practice experience (APPE). Design A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs. Assessment During the third week of the first APPE, faculty members rated students' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01). Conclusion Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE. PMID:20221362

  16. Critical Behaviors in Psychiatric-Mental Health Nursing. Volume 1: A Survey of Mental Health Nursing Practices.

    ERIC Educational Resources Information Center

    Jacobs, Angeline Marchese; And Others

    This document describes the methodology followed in obtaining abstracts (see volumes 2 and 3) of more than 8,000 critical behaviors of nurses and attendants in delivering care in 50 psychiatric and mental health facilities throughout the country. The abstracts were derived from reports of actual observations by 1,785 mental health practitioners in…

  17. The role of advanced practice providers in pediatric otolaryngology academic practices.

    PubMed

    Reilly, Brian K; Brandon, Gretchen; Shah, Rahul; Preciado, Diego; Zalzal, George

    2013-01-01

    The goal of this study was to examine the roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) in pediatric academic otolaryngology programs to provide a better understanding of their scope of practice, levels of autonomy, clinical duties, teaching opportunities and research participation. An anonymous web-based electronic survey tool was sent to all pediatric otolaryngology fellowship program directors in the United States. Nurse Practitioners and Physician Assistants are utilized in approximately 3 out of every 4 pediatric otolaryngology practices. The top three job activities of both the PA and NP were: (1) seeing patients independently, (2) working alongside doctors in clinic, and (3) answering phone lines/parental calls. A higher percentage of PAs (83%), worked alongside doctors in clinic, as compared to NPs, where only 55% work alongside MDs. Over half of PAs round with the in-patient team and see consults as compared to just over one third of NPs who participate in such activities. Twenty-five percent of practices reported that PAs cover call and assist in the OR. Most PAs/NPs saw between 11 and 15 patients per clinic which provides a clear productivity advantage when looking to screen patients, provide medical care, generate surgical cases, and maximize billings. NPs and PAs have complimentary skill sets ideal for the pediatric otolaryngology workplace, although job activities and "best fit" are hospital and practice dependent. Our study suggests that the use of PAs and NPs will continue to grow to meet increased demand for services in the field of pediatric otolaryngology. Employing advanced practice providers enables academic centers to improve access, provide additional financial remuneration, reduce wait times for new patients, and allow attending physicians to meet increased practice demands. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Infusing gerontological nursing content into advanced practice nursing education.

    PubMed

    Kohlenberg, Eileen; Kennedy-Malone, Laurie; Crane, Patricia; Letvak, Susan

    2007-01-01

    The inclusion of gerontology content in the nursing curriculum is paramount as our population of older adults grows. As one of 10 recipients of the John A. Hartford Foundation/AACN awards for Enhancing Gerontological and Geriatric Nursing Education for Advanced Practice Nursing Programs, we successfully integrated gerontological/ geriatric content throughout core courses for all concentrations taught at the master's level. The Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care were used as a guide to integrate gerontological nursing content across the core courses. We present examples of content, strategies, and evaluation methods that demonstrate infusion of gerontology in a nursing theory course, research course, and healthcare law and policy course. Twenty-two of the competencies are addressed in these core courses and provide a foundation for further development in the support and specialty courses for the nurse practitioner, clinical nurse specialist, nursing administrator, nurse educator, and nurse anesthetist. We also present helpful Web-based resources for older adult care.

  19. Psychiatric rehabilitation interventions: a review.

    PubMed

    Farkas, Marianne; Anthony, William A

    2010-01-01

    Psychiatric rehabilitation has become accepted by the mental health field as a legitimate field of study and practice. Over the last several decades various psychiatric rehabilitation programme models and procedures have been developed, evaluated and disseminated. At the same time the process of psychiatric rehabilitation has been specified and its underlying values and practitioner technology articulated. This review describes the psychiatric rehabilitation process and in so doing differentiates psychosocial interventions that can be classified as psychiatric rehabilitation interventions from other psychosocial interventions. Furthermore, the major psychiatric rehabilitation interventions are examined within a framework of the psychiatric rehabilitation process with a review of their evidence. The review concludes that psychiatric rehabilitation interventions are currently a mixture of evidence-based practices, promising practices and emerging methods that can be effectively tied together using the psychiatric rehabilitation process framework of helping individuals with serious mental illnesses choose, get and keep valued roles, and together with complementary treatment orientated psychosocial interventions, provide a broad strategy for facilitating recovery.

  20. Purinergic system in psychiatric diseases.

    PubMed

    Cheffer, A; Castillo, A R G; Corrêa-Velloso, J; Gonçalves, M C B; Naaldijk, Y; Nascimento, I C; Burnstock, G; Ulrich, H

    2017-09-26

    Psychiatric disorders are debilitating diseases, affecting >80 million people worldwide. There are no causal cures for psychiatric disorders and available therapies only treat the symptoms. The etiology of psychiatric disorders is unknown, although it has been speculated to be a combination of environmental, stress and genetic factors. One of the neurotransmitter systems implicated in the biology of psychiatric disorders is the purinergic system. In this review, we performed a comprehensive search of the literature about the role and function of the purinergic system in the development and predisposition to psychiatric disorders, with a focus on depression, schizophrenia, bipolar disorder, autism, anxiety and attention deficit/hyperactivity disorder. We also describe how therapeutics used for psychiatric disorders act on the purinergic system.Molecular Psychiatry advance online publication, 26 September 2017; doi:10.1038/mp.2017.188.

  1. Liver Illness and Psychiatric Patients

    PubMed Central

    Carrier, Paul; Debette-Gratien, Marilyne; Girard, Murielle; Jacques, Jérémie; Nubukpo, Philippe; Loustaud-Ratti, Véronique

    2016-01-01

    Patients with psychiatric disorders are usually more exposed to multiple somatic illnesses, including liver diseases. Specific links are established between psychiatric disorders and alcohol hepatitis, hepatitis B, and hepatitis C in the population as a whole, and specifically in drug abusers. Metabolic syndrome criteria, and associated steatosis or non-alcoholic steato-hepatitis (NASH) are frequent in patients with chronic psychiatric disorders under psychotropic drugs, and should be screened. Some psychiatric medications, such as neuroleptics, mood stabilizers, and a few antidepressants, are often associated with drug-induced liver injury (DILI). In patients with advanced chronic liver diseases, the prescription of some specific psychiatric treatments should be avoided. Psychiatric disorders can be a limiting factor in the decision-making and following up for liver transplantation. PMID:28123443

  2. Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice.

    PubMed

    Mahaffey, Lisa; Burson, Kathrine A; Januszewski, Celeste; Pitts, Deborah B; Preissner, Katharine

    2015-01-01

    Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.

  3. Energy Therapies in Advanced Practice Oncology: An Evidence-Informed Practice Approach

    PubMed Central

    Potter, Pamela J.

    2013-01-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author’s professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting. PMID:25031994

  4. Energy therapies in advanced practice oncology: an evidence-informed practice approach.

    PubMed

    Potter, Pamela J

    2013-05-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author's professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting.

  5. Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice.

    PubMed

    Zug, Keri Elizabeth; Cassiani, Silvia Helena De Bortoli; Pulcini, Joyce; Garcia, Alessandra Bassalobre; Aguirre-Boza, Francisca; Park, Jeongyoung

    2016-08-08

    to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. identificar o estado atual da regulação, educação e prática do enfermeiro de prática avançada na América Latina e no Caribe e a percepção de líderes de enfermagem na região quanto ao papel da enfermagem de prática avançada na atenção primaria à saúde em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde. o estudo descritivo transversal utilizou um survey online com 173 líderes de enfermagem questionando suas percepções sobre o estado atual da pr

  6. Advancing Mathematical Activity: A Practice-Oriented View of Advanced Mathematical Thinking

    ERIC Educational Resources Information Center

    Rasmussen, Chris; Zandieh, Michelle; King, Karen; Teppo, Anne

    2005-01-01

    The purpose of this article is to contribute to the dialogue about the notion of advanced mathematical thinking by offering an alternative characterization for this idea, namely advancing mathematical activity. We use the term advancing (versus advanced) because we emphasize the progression and evolution of students' reasoning in relation to their…

  7. Scheduling of advanced practice providers at Level 1 trauma centers.

    PubMed

    Myers, Robert A; Parikh, Pratik J; Ekeh, Akpofure Peter; Denlinger, Elizabeth; McCarthy, Mary C

    2014-07-01

    Advanced practice providers (APPs) are essential to the provision of trauma care services, particularly in the wake of residency hour restrictions. Demand for these APPs fluctuates with cyclic patient arrivals; however, most trauma teams continue to staff APPs in a linear fashion. Failure to plan for variable arrivals may contribute to excessive patient wait times and emergency department overcrowding. This study used both qualitative and quantitative approaches to evaluate the impact of APP scheduling on patient wait time and to find schedules minimizing delays in reaching the needed care at the right time. A retrospective observation of the availability of APPs and the flow of 2,249 trauma patients at a Level 1 trauma center, using both visual overlays and computer modeling, allowed us to evaluate the baseline condition, two what-if schedules, and two model-generated schedules minimizing patient time without any additional APP hours. A visual overlay of APP staffing on 2010 patient arrivals indicated substantial times of mismatch. Trauma managers considered adding an APP during weekday evenings that would have resulted in a 14.8% increase in APP hours and yielded a 27% reduction in patient wait times according to our model. An alternate schedule was developed and implemented in 2012 with a 10.5% increase in APP hours and yielding a 73% reduction in wait times. We also delineated two schedule options with 57% and 78% reductions in wait time and no increase in APP work hours. Evaluating alternate shift times and assignments using visual overlays and computer modeling can provide APP staffing solutions with up to 78% reduction in trauma patient wait time without additional APP labor. Knowing that care at the right time is crucial to arriving patients, making sure APP staffing is synchronized with arriving patients is something trauma center managers cannot ignore. Care management study, level IV.

  8. Outsourcing mental health care services? The practice and potential of community-based farms in psychiatric rehabilitation.

    PubMed

    Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

    2015-02-01

    Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by analysing care farm services in the Netherlands. Service characteristics were analysed across 214 care farms retrieved from a national database. Qualitative insights were provided by five case descriptions, selected from 34 interviews. Institutional care farms were significantly larger and older than private care farms (comprising 88.8% of all care farms). Private, independent care farms provide real-life work conditions to users who are relatively less impaired. Private, contracted care farms tailor the work activities to their capacities and employ professional supervisors. Institutional care farms accommodate for the most vulnerable users. We conclude that collaborations with independent, contracted and institutional care farms would provide mental health care organizations with a diversity in services, enhanced community integration and a better match with users' rehabilitation needs.

  9. Advances in endodontics: Potential applications in clinical practice

    PubMed Central

    Kishen, Anil; Peters, Ove A.; Zehnder, Matthias; Diogenes, Anibal R.; Nair, Madhu K.

    2016-01-01

    Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment. PMID:27217630

  10. Advances in endodontics: Potential applications in clinical practice.

    PubMed

    Kishen, Anil; Peters, Ove A; Zehnder, Matthias; Diogenes, Anibal R; Nair, Madhu K

    2016-01-01

    Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment.

  11. The Role of the Advanced Practice Nurse in the Academic Setting.

    PubMed

    Gosselin, Tracy K; Dalton, Kerri A; Penne, Kara

    2015-11-01

    To explore how advanced practice nurses implement practice change in academic medical centers to support optimal patient and staff outcomes. Published peer reviewed literature, web-based resources, and professional society materials. Cancer care is rapidly evolving and advanced practice nurses can shape the future of how care is delivered as well as the setting it is delivered in. Advanced practice oncology nurses (Nurse Practitioners and Clinical Nurse Specialists) have an opportunity to significantly shape the patient experience by implementing programmatic changes across the continuum of care by engaging stakeholders in project design. Knowledge of change management and implementation science is critical to success. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Implementation of Advanced Access in a Family Medicine Residency Practice.

    PubMed

    Tseng, Ann; Wiser, Eric; Barclay, Emily; Aiello, Karen

    2015-01-01

    Several models of scheduling have been documented in the literature, including the traditional model, the carve-out model, and the advanced access model. We describe the implementation of the advanced access model in our clinic, which has been very successful. Advanced access has decreased third next available appointments to less than seven days for many of our providers and has increased individual primary care physician continuity for 40% of our providers. Interestingly, we had no gains in patient satisfaction, which is consistent with other previously published studies on advanced access.

  13. Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

    PubMed Central

    Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna

    2016-01-01

    Objective: To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods: Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. Results: 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusion: Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge: This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. PMID:27008104

  14. Computers and information technologies in psychiatric nursing.

    PubMed

    Repique, Renee John R

    2007-04-01

    There is an assumption that psychiatric nurses are late adopters of technology because psychiatric nursing has been traditionally viewed as a nontechnological nursing specialty. This article will review current nursing literature to outline the value and significance of computers and information technologies to psychiatric nursing. Existing bodies of research literature related to computers and information technology for psychiatric nurses. Three areas of psychiatric nursing are identified and the specific advantages and benefits of computers and information technologies in each of these areas are discussed. In addition, the importance of informatics competencies for psychiatric nursing practice is reiterated in order to accelerate its acquisition.

  15. Evolution: Advancing Communities of Practice in Naval Intelligence

    DTIC Science & Technology

    2003-06-01

    and determine which ones will be included in the overall lessons learned message to other units. A certain amount of self -censorship takes place...Communities of Practice will be examined. The self - organizing Community of Practice is found at one end of the spectrum and the sponsored Community of...Practice is located at the other. Successful Communities of Practice exist at both ends and many places in between. a) Self Organizing 32 Self

  16. Listening Instruction and Practice for Advanced ESL Students.

    ERIC Educational Resources Information Center

    Godfrey, Dennis

    This paper attempts to enact Rivers' (1971 and 1972) urgings to base ESL listening instruction on both psychological and linguistic findings and contends that advanced ESL students' listening needs call for improvement in processing spoken English discourse. Psychological data on memory span is cited to demonstrate that advanced ESL students…

  17. Practical use of advanced mouse models for lung cancer.

    PubMed

    Safari, Roghaiyeh; Meuwissen, Ralph

    2015-01-01

    To date a variety of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) mouse models have been developed that mimic human lung cancer. Chemically induced or spontaneous lung cancer in susceptible inbred strains has been widely used, but the more recent genetically engineered somatic mouse models recapitulate much better the genotype-phenotype correlations found in human lung cancer. Additionally, improved orthotopic transplantation of primary human cancer tissue fragments or cells into lungs of immune-compromised mice can be valuable tools for preclinical research such as antitumor drug tests. Here we give a short overview of most somatic mouse models for lung cancer that are currently in use. We accompany each different model with a description of its practical use and application for all major lung tumor types, as well as the intratracheal injection or direct injection of fresh or freeze-thawed tumor cells or tumor cell lines into lung parenchyma of recipient mice. All here presented somatic mouse models are based on the ability to (in) activate specific alleles at a time, and in a tissue-specific cell type, of choice. This spatial-temporal controlled induction of genetic lesions allows the selective introduction of main genetic lesions in an adult mouse lung as found in human lung cancer. The resulting conditional somatic mouse models can be used as versatile powerful tools in basic lung cancer research and preclinical translational studies alike. These distinctively advanced lung cancer models permit us to investigate initiation (cell of origin) and progression of lung cancer, along with response and resistance to drug therapy. Cre/lox or FLP/frt recombinase-mediated methods are now well-used techniques to develop tissue-restricted lung cancer in mice with tumor-suppressor gene and/or oncogene (in)activation. Intranasal or intratracheal administration of engineered adenovirus-Cre or lentivirus-Cre has been optimized for introducing Cre

  18. Factors influencing advanced practice nurses' ability to promote evidence-based practice among frontline nurses.

    PubMed

    Gerrish, Kate; Nolan, Mike; McDonnell, Ann; Tod, Angela; Kirshbaum, Marilyn; Guillaume, Louise

    2012-02-01

    Advanced practice nurses (APNs) have an important role in promoting evidence-based practice (EBP) among frontline nurses (FLNs). Factors influencing FLNs' engagement with EBP are well documented but little is known about factors that affect APNs' ability to facilitate evidence in practice. To identify factors that influence APNs' ability to promote EBP among FLNs. A multiple case study of 23 APNs from hospital and primary care settings across seven English health authorities was undertaken. Data collection comprised interviews and observation of APNs and interviews with FLNs and other healthcare professionals. Data were analysed using the Framework approach. Four groups of influencing factors were identified: (1) Personal attributes of APNs included knowledge and skills in EBP, clinical credibility with frontline staff and leadership style. (2) Relationships with stakeholders included APNs' interactions with FLNs and the level of support from managers and medical colleagues. (3) Aspects of the APN role included their sphere of responsibility and workload. (4) Organisational context included the organisational culture, FLNs' workload, professional networks and available resources. Educational preparation for APNs should enable them to develop expertise in EBP plus interpersonal and leadership skills to manage relational dynamics in clinical settings. APN role specifications should provide the opportunity to promote EBP. The organisational culture should be conducive to enabling EBP with managers supportive of this aspect of the APNs' role. APNs need to be supported to address the individual, interpersonal and organisational factors, which influence their ability to promote EBP. Organisational commitment at the highest level is key to APNs' ability to fulfil this aspect of their role. ©2011 Sigma Theta Tau International.

  19. Documenting Student Engagement Using an Intention/Reflection Exercise during an Advanced Pharmacy Practice Experience

    ERIC Educational Resources Information Center

    Fierke, Kerry K.; Lepp, Gardner A.

    2015-01-01

    The article shares the outcomes of a practice called Intention/Reflection (I/R) when applied to a group of ten students in a five-week course involving an international advanced pharmacy practice experience. Developed by the authors and founded on a combination of theoretical principles, this practice is unique because of the blend of formative…

  20. Documenting Student Engagement Using an Intention/Reflection Exercise during an Advanced Pharmacy Practice Experience

    ERIC Educational Resources Information Center

    Fierke, Kerry K.; Lepp, Gardner A.

    2015-01-01

    The article shares the outcomes of a practice called Intention/Reflection (I/R) when applied to a group of ten students in a five-week course involving an international advanced pharmacy practice experience. Developed by the authors and founded on a combination of theoretical principles, this practice is unique because of the blend of formative…

  1. Assuring Quality and Access in Advanced Practice Nursing: A Challenge to Nurse Educators.

    ERIC Educational Resources Information Center

    Mundinger, Mary O.; Cook, Sarah Sheets; Lenz, Elizabeth R.; Piacentini, Karen; Auerhahn, Carolyn; Smith, Jennifer

    2000-01-01

    Advanced practice nurses are assuming increasingly accountable roles in primary health care. A doctor of nursing practice degree would signify the high level of competency they achieve. Columbia University's training model is an example of the preparation needed for this level of professional practice. (SK)

  2. Does radiography advanced practice improve patient outcomes and health service quality? A systematic review.

    PubMed

    Hardy, Maryann; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna

    2016-06-01

    To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

  3. Advanced practice in maternal/child nursing: history, current status, and thoughts about the future.

    PubMed

    Lewis, J A

    2000-01-01

    Advanced practice nursing has undergone dramatic growth and change in during the past quarter century. Specialization in maternal/child health started with hospital-developed postlicensure programs which evolved into formal master's level programs. The first nurse-practitioner program in pediatrics was begun in 1965 at the University of Colorado. The last 25 years has seen an increase in clinical specialization and in advanced practice roles within the specialties. The growth of credentials and types of certification available have provided opportunities for nurses, but have also created confusion for consumers and other health care professionals. Current challenges facing advanced practice nurses include issues related to legal authority for scope of practice, direct reimbursement for services, and prescriptive authority. The current health care climate provides challenges and opportunities for nurses in advanced practice.

  4. Telemedicine: benefits to advanced practice nursing and the communities they serve.

    PubMed

    Reed, Kirby

    2005-05-01

    To review the use of telemedicine in a variety of advanced nursing practice settings, its contribution in expanding the service and role of the nurse practitioner, and the regulatory issues of reimbursement and licensure. Literature review of relevant journals, research articles, case examples, and web searches. Although telemedicine has been utilized for many years, it has historically been used primarily by physicians. In recent years, telemedicine has been demonstrating its growing potential in advanced nursing practice in terms of economy, efficacy, and quality of care. When used appropriately, telemedicine complements advanced nursing practice in cost-effective ways and improves healthcare access to the populations served. Incorporating telemedicine into the advanced nursing practice can be rewarding for both clinicians and their patients. Because of the high variability that exists among state regulations and payer reimbursements, clinicians are advised to verify their respective Board of Nursing Examiners, State, and payers' policies prior to investing in the establishment of telemedicine in practice.

  5. Identifying components of advanced-level clinical nutrition practice: a Delphi study.

    PubMed

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; O'Sullivan Maillet, Julie

    2012-06-01

    The dietetics profession lacks a comprehensive definition of advanced-level practice. Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions of advanced-level practice that define advanced practice registered dietitians (RDs) in clinical nutrition was explored. Purposive sampling identified 117 RDs who met advanced-level practice criteria. In round 1, experts rated the essentiality of statements on a 7-point ordinal scale and generated open-ended practice activity statements regarding the following four dimensions of advanced-level practice: professional knowledge, abilities and skills, approaches to practice, roles and relationships, and practice behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral, and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not reaching consensus by evaluating their previous responses, group median rating, and comments. Consensus was reached when the interquartile range of responses to a statement was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were essential to advanced practice RD clinical practice. Having a master's degree; completing an advanced practice residency; research coursework; and advanced continuing education were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise; specialization; participation in research activities; and skills in technology and communication. Highly essential approaches to practice were systematic yet adaptable and used critical thinking and intuition and highly essential values encompassed professional growth and service to patients. Roles emphasized patient care and leadership. Essential practice activities within the nutrition care process included provision of complex patient-centered nutrition care using application of advanced knowledge/expertise and

  6. Reducing transfers of psychiatric inpatients to emergency rooms of general hospitals in Singapore: a clinical practice improvement project.

    PubMed

    Low, Tchern Kuang Lambert; Tay, Kai Hong; Fang, Tina; Fung, Daniel Shuen Sheng

    2017-03-01

    Patients admitted to a psychiatric hospital commonly suffer from comorbid medical problems which sometimes require urgent medical attention. Twenty-two percent of emergency medical transfers from the Institute of Mental Health (IMH) to the emergency rooms of general hospitals were preventable and could be managed at IMH itself. We undertook a quality improvement project to understand the reasons behind such preventable referrals and implemented changes to address this. Using the model for improvement, we deconstructed our processes and analysed root causes for such preventable referrals. Thereafter changes were implemented with Plan-Do-Study-Act (PDSA) cycles to analyse their outcomes. During the 6-month study period, we achieved a 100% reduction in preventable referrals through strategies aimed at reducing pressure on our on-call physicians in the making of medical decisions, maximising usage of our medical resources, constant education and raising awareness of this issue. Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.

  7. Substance abuse as a risk factor for violence in mental illness: some implications for forensic psychiatric practice and clinical ethics.

    PubMed

    Pickard, Hanna; Fazel, Seena

    2013-07-01

    To review recent research on the relationship between substance abuse, crime, violence and mental illness, and suggest how this research could aid forensic psychiatrists, psychologists and other mental health professionals in assessing and managing risk, and balancing patient care and public protection. Substance abuse in mentally ill forensic psychiatric patients should be considered an important risk factor for violence and re-offending. Improved treatment for substance abuse in forensic psychiatric patients and other mentally disordered offenders together with the offer of monitored abstinence as a condition of leave or discharge could be usefully considered as a means of reducing and managing risk. This may improve patient care by addressing mental health needs and increasing opportunity and likelihood of successful re-integration into the community and better life prospects; protect the public by reducing risk of re-offending and offering real time monitoring and potential intervention when risk is heightened; and help forensic psychiatrists strike a balance between patient care and public protection, potentially alleviating some of the difficulty and anxiety that decisions to grant leave or discharge can create.

  8. Substance abuse as a risk factor for violence in mental illness: some implications for forensic psychiatric practice and clinical ethics

    PubMed Central

    Pickard, Hanna; Fazel, Seena

    2014-01-01

    Purpose of review To review recent research on the relationship between substance abuse, crime, violence and mental illness, and suggest how this research could aid forensic psychiatrists, psychologists and other mental health professionals in assessing and managing risk, and balancing patient care and public protection. Recent findings Substance abuse in mentally ill forensic psychiatric patients should be considered an important risk factor for violence and re-offending. Summary Improved treatment for substance abuse in forensic psychiatric patients and other mentally disordered offenders together with the offer of monitored abstinence as a condition of leave or discharge could be usefully considered as a means of reducing and managing risk. This may improve patient care by addressing mental health needs and increasing opportunity and likelihood of successful re-integration into the community and better life prospects; protect the public by reducing risk of re-offending and offering real time monitoring and potential intervention when risk is heightened; and help forensic psychiatrists strike a balance between patient care and public protection, potentially alleviating some of the difficulty and anxiety that decisions to grant leave or discharge can create. PMID:23722099

  9. Forensic psychiatric/mental health nursing: responsive to social need.

    PubMed

    Kent-Wilkinson, Arlene E

    2010-06-01

    Forensic nursing is an emerging global nursing specialty, with subspecialties that focus on nursing practice at the clinical-legal interface of tending to victims and offenders, living and deceased. An integrated review of the literature provides an overview of the role development of forensic nursing subspecialties. The subspecialties of forensic nursing that deal with the mental health care of victims and offenders are the focus of this paper. Forensic nursing, like all forensic specialties, developed from a need in society for a medico-legal role. This paper discusses the global role of forensic nursing and argues that role development has been both proactive and responsive to vital needs of victims and offenders in society. Advanced practice forensic nurses have taken leadership roles in the role development of this nursing specialty. A future challenge for forensic psychiatric/mental health nurses with advanced education is to take leadership roles in all areas of psychiatric assessment, intervention, and evaluation of clients.

  10. A System Approach to Advanced Practice Clinician Standardization and High Reliability.

    PubMed

    Okuno-Jones, Susan; Siehoff, Alice; Law, Jennifer; Juarez, Patricia

    Advanced practice clinicians (APCs) are an integral part of the health care team. Opportunities exist within Advocate Health Care to standardize and optimize APC practice across the system. To enhance the role and talents of APCs, an approach to role definition and optimization of practice and a structured approach to orientation and evaluation are shared. Although in the early stages of development, definition and standardization of accountabilities in a framework to support system changes are transforming the practice of APCs.

  11. Prevalence of self-medication practice with herbal products among non-psychotic psychiatric patients from southeastern Serbia: A cross-sectional study.

    PubMed

    Stojanović, Nikola M; Samardžić, Ljiljana; Randjelović, Pavle J; Radulović, Niko S

    2017-09-01

    The aim of this study was to evaluate the usage prevalence of herbal products (HP) and to ascertain the identity, mode and adverse effects of plant taxa used in self-medication practice for anxiety, depression and insomnia in patients with non-psychotic disorders originating from southeastern Serbia. Also, we compared HP users and non-users on the variables of socio-demographic characteristics, information source and origin of HP. The study was done by a face-to-face interview with a trained psychiatrist using a structured questionnaire administered to 136 adult patients suffering from non-psychotic mental disorders. A typical herbal-product user among non-psychotic psychiatric patients from southeastern Serbia is a middle-aged married woman, with a secondary level of education, unemployed and living in an urban area. Non-psychotic psychiatric patients, although not living predominantly in rural areas, were familiar with a variety of ethno-medicines and were often using HP primarily without the consultation of their psychiatrists/physicians. HP stated to be most frequently used for psychiatry-related symptoms included: Melissa officinalis, Mentha × piperita, Hypericum perforatum and Valeriana officinalis. The interviewees rarely stated adverse reactions related to the HP usage; however, this should not be generalized, since HP are known to vary in the content of their adverse reaction-causing constituents.

  12. Advance directive communications practices:social worker's contributions to the interdisciplinary health care team.

    PubMed

    Black, Kathy

    2005-01-01

    This article presents a comparative study about social workers' interdisciplinary advance directive communication practices with patients at several hospitals located in upstate New York. The sample consisted of physicians (n=32), nurses (n=74), and social workers (n=29). The research surveyed advance directive communication practices by discipline utilizing a self-administered questionnaire. Advance directive communication was operationalized as a cumulative process incorporating the following phases that were measured as scales: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Results suggest that social workers offer distinct skills in their advance directive communication practices and discuss advance directives more frequently than either physicians or nurses.

  13. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

    PubMed

    Dornblaser, Emily K; Ratka, Anna; Gleason, Shaun E; Ombengi, David N; Tofade, Toyin; Wigle, Patricia R; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J; Ochs, Leslie; Jungnickel, Paul W; Abrons, Jeanine P; Alsharif, Naser Z

    2016-04-25

    The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

  14. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations

    PubMed Central

    Ratka, Anna; Gleason, Shaun E.; Ombengi, David N.; Tofade, Toyin; Wigle, Patricia R.; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J.; Ochs, Leslie; Jungnickel, Paul W.; Abrons, Jeanine P.; Alsharif, Naser Z.

    2016-01-01

    The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students. PMID:27170810

  15. From challenges to advanced practice registered nursing role development: Qualitative interview study.

    PubMed

    Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija

    2015-12-01

    The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.

  16. Neuroscience critical care: the role of the advanced practice nurse in patient safety.

    PubMed

    Phillips, JoAnne

    2005-01-01

    The Institute of Medicine report published in 1999 described a healthcare system in which 44,000 to 98,000 patients die each year from preventable medical errors. The healthcare industry has been charged with identifying and ameliorating risks to patients. The advanced practice nurse is in the optimal position to influence the patient care environment and contribute to a culture of patient safety. This article will review the role of the advanced practice nurse in the care of the neuroscience patient in identifying risks unique to this at-risk population. There will be a discussion of risk factors that contribute to errors, with advanced practice nurse-driven, evidence-based solutions. A case presentation of the role of the advanced practice nurse in reducing the incidence of deep vein thrombosis in the craniotomy patients with malignant tumors will be discussed.

  17. [Psychiatric Emergencies in the Preclinical Emergency Medicine Service in Ulm, Germany in 2000 and 2010, and Practical Consequences].

    PubMed

    Schönfeldt-Lecuona, Carlos; Gahr, Maximilian; Schütz, Stefan; Lang, Dirk; Pajonk, Frank Gerald Bernhard; Connemann, Bernhard J; Muth, Claus-Martin; Freudenmann, Roland W

    2017-07-01

    Background Psychiatric emergencies (PE) in preclinical emergency medical services are about 5 - 10 % of all emergencies and represent often a source of difficulties in handling for the non-psychiatric professional helpers that deal with them. Studies informing about quantitative and qualitative changes of PEs in preclinical emergency medicine in Germany are scarce. Methods Therefore, we conducted a retrospective cross-sectional study of PE in a preclinical emergency medical service based on the protocols of the emergency ambulance of the Section for Emergency Medicine at the University Hospital Ulm comparing the years 2000 and 2010. Results We observed a significant increase of PEs from 8.8 % in the year 2000 (n = 285, from a total of n = 3227) to 10.3 % in 2010 (n = 454, from a total of n = 4425). In both years intoxications were the most common PE [2000: n = 116 (44.4 %); 2010: n = 171 (37.7 %)], followed by suicide-related behavior [2000: n = 59 (22.6 %); 2010: n = 78 (17.2 %)] and acute anxiety disorders [2000: n = 37 (13 %); 2010: n = 105 (23.1 %)]. The mentioned three conditions accounted for about 80 % of all PE. Most frequently PE occurred at the weekend and with the highest density in the evening and at night (18 - 24 h) in both years. Patients with PE were predominantly men, but the rate of women causing PE increased between 2000 and 2010. Discussion/Conclusion This study provides preliminary data on current trends in PEs in preclinical emergency medicine in Germany and has implications for improving the medical care provided. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Development of a conceptual policy framework for advanced practice nursing: an ethnographic study.

    PubMed

    Schober, Madrean M; Gerrish, Kate; McDonnell, Ann

    2016-06-01

    To report on a study examining policy development for advanced practice nursing from intent of policy to realization in practice. Inclusion of advanced practice nursing roles in the healthcare workforce is a worldwide trend. Optimal advanced nursing practice requires supportive policies. Little is known about how policy is developed and implemented. Ethnography using an instrumental case study approach was selected to give an in-depth understanding of the experiences of one country (Singapore) to contribute to insight into development elsewhere. The four-phase study was conducted from 2008-2012 and included document analysis (n = 47), interviews with key policy decision makers (n = 12), interviews with nursing managers and medical directors (n = 11), interviews and participant observation with advanced practice nurses (n = 15). Key policymakers in positions of authority were able to promote policy development. However, this was characterized by lack of strategic planning for implementation. A vague understanding by nursing managers and medical directors of policies, the role and its position in the healthcare workforce led to indecision and uncertainty in execution. Advanced practice nurses developed their role based on theory acquired in their academic programme but were unsure what role to assume in practice. Lack of clear guidelines led to unanticipated difficulties for institutions and healthcare systems. Strategic planning could facilitate integration of advanced practice nurses into the healthcare workforce. A Conceptual Policy Framework is proposed as a guide for a coordinated approach to policy development and implementation for advanced practice nursing. © 2016 John Wiley & Sons Ltd.

  19. Building foundations for the future: the NHS Scotland advanced practice succession planning development pathway.

    PubMed

    Currie, Kay; Grundy, Maggie

    2011-10-01

    To highlight implications for managers from the implementation of a national advanced practice succession planning development pathway within Scotland. Internationally, advanced practice posts have often developed in an ad-hoc manner, with little organizational attention to succession planning. Evaluation of a pilot national succession planning development pathway identified mechanisms which facilitate or hamper effective planning for advanced practice roles. A responsive evaluation design incorporating semi-structured questionnaires to pathway participants (n = 15) and semi-structured telephone interviews with case-site pathway participants (n = 7) and their line managers. Managers believed the development pathway was worthwhile; however, there was limited strategic planning to match individuals' development to service need. Practitioners generally perceived managers as interested in their development, although levels of practical support varied. There is concern from both managers and practitioners regarding ongoing funding for advanced practice development. The present evaluation study reiterates the need for organizational commitment to succession planning including robust service needs analysis mechanisms and adequate funding for development processes. Nurse managers are viewed as the 'gatekeepers' to opportunities for developing advanced nurse practitioners; scare resources must be targeted effectively to support succession planning through the development of selected individuals for future advanced practice posts, justified by service need. © 2011 Blackwell Publishing Ltd.

  20. Nothing out of the ordinary: advanced fertility nursing practice.

    PubMed

    Allan, Helen; Barber, Debbie

    2004-12-01

    This paper discusses data from a case study of fertility nursing practice. An ethnographic case study approach using participant observation and nine semi-structured interviews with staff and patients was undertaken. The data were analysed thematically and these themes are discussed in this paper. We present the meaning a small group of nurses working in a fertility unit in the UK attach to new roles and the ways in which changes in practice may be influenced. The nurses in this study believed that nature of the task demanded changes to practice and they identified personal, interpersonal and socio-cultural factors which influenced these changes. These new roles facilitated greater continuity of care for patients. This paper discusses the effects of these new roles on knowing and intimacy in nurse - patient relationships. The data suggests that new nursing roles, which are based on "traditional" nursing and "new" technical skills, are fragile and may not be shared across a professional community.

  1. Collagenase Clostridium histolyticum: emerging practice patterns and treatment advances.

    PubMed

    Warwick, David; Arandes-Renú, José M; Pajardi, Giorgio; Witthaut, Jörg; Hurst, Lawrence C

    2016-10-01

    This study aims to provide a comprehensive review of the role of Collagenase Clostridium histolyticum (CCH). This review is based on a literature review and practical experience. This review provides practical management strategies for using collagenase by sharing clinical experiences over the past few years; logistical aspects of in-clinic treatment, lessons learned, and novel approaches to correct traditionally hard-to-treat contractures are discussed. In addition a brief, yet comprehensive overview is provided on the pathophysiology of the disease, the mechanism of collagenase action and results of clinical studies. CCH has an evolving role as one of the tools available for treating Dupuytren's disease.

  2. Time to clarify--the value of advanced practice nursing roles in health care.

    PubMed

    Lowe, Grainne; Plummer, Virginia; O'Brien, Anthony Paul; Boyd, Leanne

    2012-03-01

    This article presents a discussion of the importance of providing meaningful advanced practice nursing role definition and clarity to improve international standards of nursing titles and scopes of practice. A plethora of international literature exists discussing advanced practice nursing roles and their contribution to healthcare delivery in various countries. However, lack of consistency around title, role definition and scope of practice remains. CINAHL and Medline databases were searched using 'nurse practitioner', 'nurse practitioner role', 'nurse practitioner practice', 'nurse practitioner in public health', 'advanced practice nursing roles' and 'development of new nursing roles' with articles limited to years 1995-2010. Citations used in those articles were also explored. All cited articles were in the English language. This article supports the need to strengthen the Nurse Practitioner role in health care and professional clarity is identified as a strategy to enhance this. Themes around role clarity, professional identity, ability to enhance healthcare provision and inter-professional issues are examined. The need to more clearly articulate advanced nursing roles in light of the evolution of the Nurse Practitioner role is highlighted. Much work has already occurred in this domain and a means of adapting and broadening these developments for a wider, more global audience whilst maintaining local context is discussed. Although evidence exists that advanced practice nursing roles are increasing internationally, uncertainty around role clarity remains. This is problematic because the valuable contribution of nursing roles is lost, if the ability to clearly express their function does not exist. © 2011 Blackwell Publishing Ltd.

  3. Psychiatric emergencies.

    PubMed

    Cavanaugh, S V

    1986-09-01

    Psychiatric disorders are common in medical inpatient and outpatient populations. As a result, internists commonly are the first to see psychiatric emergencies. As with all medical problems, a good history, including a collateral history from relatives and friends, physical and mental status examination, and appropriate laboratory tests help establish a preliminary diagnosis and treatment plan. Patients with suicidal ideation usually have multiple stressors in the environment and/or a psychiatric disorder (i.e., a major affective disorder, dysthymic disorder, anxiety or panic disorder, psychotic disorder, alcohol or drug abuse, a personality disorder, and/or an adjustment disorder). Of all patients who commit suicide, 70% have a major depressive disorder, schizophrenia, psychotic organic mental disorder, alcoholism, drug abuse, and borderline personality disorder. Patients who are at great risk have minimal supports, a history of previous suicide attempts, a plan with high lethality, hopelessness, psychosis, paranoia, and/or command self-destructive hallucinations. Treatment is directed toward placing the patient in a protected environment and providing psychotropic medication and/or psychotherapy for the underlying psychiatric problem. Other psychiatric emergencies include psychotic and violent patients. Psychotic disorders fall into two categories etiologically: those that have an identifiable organic factor causing the psychosis and those that have an underlying psychiatric disorder. Initially, it is essential to rule out organic pathology that is life-threatening or could cause irreversible brain damage. After such organic causes are ruled out, neuroleptic medication is indicated. If the patient is not agitated or combative, he or she may be placed on oral divided doses of neuroleptics in the antipsychotic range. Patients who are agitated or psychotic need rapid tranquilization with an intramuscular neuroleptic every half hour to 1 hour until the agitation and

  4. Translating Advances in Reading Comprehension Research to Educational Practice

    ERIC Educational Resources Information Center

    McNamara, Danielle S.; Kendeou, Panayiota

    2011-01-01

    The authors review five major findings in reading comprehension and their implications for educational practice. First, research suggests that comprehension skills are separable from decoding processes and important at early ages, suggesting that comprehension skills should be targeted early, even before the child learns to read. Second, there is…

  5. Advancing Counselor Education in Evidence-Based Practice

    ERIC Educational Resources Information Center

    Morrow, Michael T.; Lee, Hsin-Hua; Bartoli, Eleonora; Gillem, Angela R.

    2017-01-01

    Evidence-based practice (EBP) is a core priority in counselor education. This paper details one United States' counselor education program's self-assessment of its EBP curriculum. Faculty members collaborated to identify challenges and generate solutions to strengthen the EBP emphasis within the program. This paper is intended as a resource for…

  6. A Clinical Workshop in Mental Health and Psychiatric Nursing for Instructors in Schools of Practical Nursing. Final Report.

    ERIC Educational Resources Information Center

    Lamar, Carl F.; And Others

    Twenty directors and instructors in schools of practical nursing in Kentucky and a total of nine directors and instructors from six other states and the District of Columbia attended a 2-week workshop at the University of Kentucky in July 1967. The purpose was to assist participants to integrate mental health concepts into the practical nurse…

  7. Video-confidence: a qualitative exploration of videoconferencing for psychiatric emergencies.

    PubMed

    Trondsen, Marianne Vibeke; Bolle, Stein Roald; Stensland, Geir Øyvind; Tjora, Aksel

    2014-10-31

    In psychiatric emergencies in rural areas the availability of psychiatrists are limited. Therefore, tele-psychiatry, via real-time videoconferencing (VC), has been developed to provide advanced consultative services to areas that lack psychiatrists. However, there is limited research on the use of VC for psychiatric emergencies. The University Hospital of North Norway has been the first hospital in Norway to implement this type of service by developing a new on-call system for psychiatric emergency practice through which psychiatrists are accessible by telephone and VC 24 hours a day for consultations with patients and nurses at three regional psychiatric centres. This study explores patients', psychiatrists' and nurses' experiences of using VC for psychiatric emergencies, as well as how the technology influenced their confidence. In this study, we used a qualitative explorative research design. With a particular focus on users' experiences of VC, we conducted 29 semi-structured interviews with patients, psychiatrists and nurses who had participated in a VC consultation in at least one psychiatric emergency. Our findings show that access to the VC system increased the experience of confidence in challenging psychiatric emergencies in four ways: (1) by strengthening patient involvement during the psychiatric specialist's assessment, (2) by reducing uncertainty, (3) by sharing responsibility for decisions and (4) by functioning as a safety net even when VC was not used. This study has demonstrated that an emergency psychiatric service delivered by VC may improve the confidence of psychiatrists, nurses and patients in challenging psychiatric emergencies. VC can serve as an effective tool for ensuring decentralised high-quality psychiatric services for emergency care.

  8. Integrating Social Neuroscience and Social Work: Innovations for Advancing Practice-Based Research

    ERIC Educational Resources Information Center

    Matto, Holly C.; Strolin-Goltzman, Jessica

    2010-01-01

    Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is…

  9. Cost-effectiveness of a WOC Advanced Practice Nurse in the Acute Care and Outpatient Setting

    PubMed Central

    2014-01-01

    Increasing numbers of advanced practice nurses who practice within the WOC specialty are challenged by the need to justify their role by demonstrating clinical and fiscal benefits to the employing agency. This View From Here column describes the steps I took while completing such an analysis for a position for a nurse practitioner with WOC certification in upstate New York. PMID:24918767

  10. Integrating Social Neuroscience and Social Work: Innovations for Advancing Practice-Based Research

    ERIC Educational Resources Information Center

    Matto, Holly C.; Strolin-Goltzman, Jessica

    2010-01-01

    Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is…

  11. The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

    PubMed

    Schoonover, Heather

    The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

  12. Collagenase Clostridium histolyticum : emerging practice patterns and treatment advances

    PubMed Central

    Warwick, David; Arandes-Renú, José M.; Pajardi, Giorgio; Witthaut, Jörg; Hurst, Lawrence C.

    2016-01-01

    Abstract Objective: This study aims to provide a comprehensive review of the role of Collagenase Clostridium histolyticum (CCH). Methods: This review is based on a literature review and practical experience. Results: This review provides practical management strategies for using collagenase by sharing clinical experiences over the past few years; logistical aspects of in-clinic treatment, lessons learned, and novel approaches to correct traditionally hard-to-treat contractures are discussed. In addition a brief, yet comprehensive overview is provided on the pathophysiology of the disease, the mechanism of collagenase action and results of clinical studies. Conclusion: CCH has an evolving role as one of the tools available for treating Dupuytren's disease. PMID:27050718

  13. Unpacking University-Community Partnerships to Advance Scholarship of Practice.

    PubMed

    Suarez-Balcazar, Yolanda; Mirza, Mansha Parven; Hansen, Anne Marie Witchger

    2015-01-01

    Today, more than ever, occupational therapists are engaged in close partnerships with community organizations and community settings such as service agencies, refugee and immigrant enclaves, and faith-based organizations, to name a few, for the purpose of engaging in scholarship of practice. However, we know little about the views of community partners regarding the development and sustainability of university-community partnerships. The purpose of this article is twofold: First, we will describe a pilot study in which we gathered qualitative data from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships. Second, based on this pilot study and extensive experience of the authors, we propose a revised version of a partnerships model available in the literature. We illustrate the model through examples of the authors' collective experiences developing and sustaining successful university-community partnerships.

  14. [The analysis of a mobile mental health outreach team activity: from psychiatric emergencies on the street to practice of hospitalization at home for homeless people].

    PubMed

    Girard, Vincent; Sarradon-Eck, Aline; Payan, Noura; Bonin, Jean-Pierre; Perrot, Sylvain; Vialars, Vanessa; Boyer, Laurent; Tinland, Aurélie; Simeoni, Marie-Claude

    2012-05-01

    Since their creation in 2005 in France, mobile mental health outreach teams (EMPP) have been working to improve the health of the homeless who, for 30 to 50% of them, present severe mental disorders. Their missions are defined by ministerial circular's specifications. Few studies have been undertaken in France to analyze the practices of these teams' professionals, nor the characteristics of the populations with whom they are involved. The EMPP described in this paper had in 2010 a greater staff than other French EMPPs. It has 15 full-time staff, including four doctors (two psychiatrists, one GP, one house physician), two nurses, two educators, one social worker, three peer-workers, one secretary and two coordinators. The article analyzes the way of support developed within the range of EMPP's missions defined by the ministerial circular. Descriptive statistical analysis was carried out using standardized data from four different sources (round sheet, record of activity, record of hospitalization, housing information, interviews conducted by medical and social professionals with patients). Another source of data consists of records describing the operation of the team (reference framework) and annual activities (annual report). The method of care was developed based on a street working, involving a full medical and its relationship with the hospital and a place to live in a semi-community context. The Mobile Mental Health Outreach team documented 318 rounds in 2010, describing 666 contacts among whom 87.9% were followed regularly thereafter. It focuses to a target population. The team actively followed 198 people including 161 for whom a psychiatric diagnosis was done: 48.5% of the patients followed presented schizophrenic-type disorders, 21.8% bipolar disorders and other mood-linked problems, 13% behavioral disorders and 6.2% substance-use disorders. A percentage of 44.9 presented with a physical disease. Among the 89 hospitalizations, 86.5% were motivated by

  15. Prosthodontics in a general practice program of advanced dental education.

    PubMed

    Plekavich, E J

    1976-01-01

    The problems involved in teaching prosthodontics in a general practice program outwardly appear to be due to the lack of sufficient basic prosthodontic training dispensed by the dental schools. This lack of sufficient training is not the fault of dental school faculties. The students are not learning what they are taught. What they need is more repetition, which means more time. The problems are not insurmountable. We just must find the route.

  16. Simulation training in neurosurgery: advances in education and practice

    PubMed Central

    Konakondla, Sanjay; Fong, Reginald; Schirmer, Clemens M

    2017-01-01

    The current simulation technology used for neurosurgical training leaves much to be desired. Significant efforts are thoroughly exhausted in hopes of developing simulations that translate to give learners the “real-life” feel. Though a respectable goal, this may not be necessary as the application for simulation in neurosurgical training may be most useful in early learners. The ultimate uniformly agreeable endpoint of improved outcome and patient safety drives these investments. We explore the development, availability, educational taskforces, cost burdens and the simulation advancements in neurosurgical training. The technologies can be directed at achieving early resident milestones placed by the Accreditation Council for Graduate Medical Education. We discuss various aspects of neurosurgery disciplines with specific technologic advances of simulation software. An overview of the scholarly landscape of the recent publications in the realm of medical simulation and virtual reality pertaining to neurologic surgery is provided. We analyze concurrent concept overlap between PubMed headings and provide a graphical overview of the associations between these terms. PMID:28765716

  17. Using advanced mobile devices in nursing practice--the views of nurses and nursing students.

    PubMed

    Johansson, Pauline; Petersson, Göran; Saveman, Britt-Inger; Nilsson, Gunilla

    2014-09-01

    Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses' and nursing students' views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research. © The Author(s) 2013.

  18. Monitoring for opioid-induced advancing sedation and respiratory depression: ASPMN membership survey of current practice.

    PubMed

    Jungquist, Carla R; Willens, Joyce S; Dunwoody, Danielle R; Klingman, Karen J; Polomano, Rosemary C

    2014-09-01

    Adverse events secondary to opioid-induced advancing sedation and respiratory depression continue to occur during hospitalizations despite efforts to increase awareness and clinical practice guidelines to address prevention strategies. In 2009, ASPMN surveyed membership on current practices surrounding this topic. ASPMN clinical practice guidelines were then published in 2011. In winter of 2013, ASPMN membership was again surveyed to assess progress in preventing adverse events. This is a report of the follow-up membership survey. In general, monitoring practices are slowly improving over time, but there are many facilities that have not instituted best practices for avoiding adverse events.

  19. Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer

    PubMed Central

    Rhondali, Wadih; Freyer, Gilles; Adam, Virginie; Filbet, Marilène; Derzelle, Martine; Abgrall-Barbry, Gaelle; Bourcelot, Sophie; Machavoine, Jean-Louis; Chomat-Neyraud, Muriel; Gisserot, Olivier; Largillier, Rémi; Le Rol, Annick; Priou, Frank; Saltel, Pierre; Falandry, Claire

    2015-01-01

    Background Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC). Methods This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard. Results Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=−0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively). Conclusion The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC. PMID:26203235

  20. Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer.

    PubMed

    Rhondali, Wadih; Freyer, Gilles; Adam, Virginie; Filbet, Marilène; Derzelle, Martine; Abgrall-Barbry, Gaelle; Bourcelot, Sophie; Machavoine, Jean-Louis; Chomat-Neyraud, Muriel; Gisserot, Olivier; Largillier, Rémi; Le Rol, Annick; Priou, Frank; Saltel, Pierre; Falandry, Claire

    2015-01-01

    Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC). This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard. Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=-0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively). The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.

  1. Meeting report: advancing practical applications of biodiversity ontologies

    PubMed Central

    2014-01-01

    We describe the outcomes of three recent workshops aimed at advancing development of the Biological Collections Ontology (BCO), the Population and Community Ontology (PCO), and tools to annotate data using those and other ontologies. The first workshop gathered use cases to help grow the PCO, agreed upon a format for modeling challenging concepts such as ecological niche, and developed ontology design patterns for defining collections of organisms and population-level phenotypes. The second focused on mapping datasets to ontology terms and converting them to Resource Description Framework (RDF), using the BCO. To follow-up, a BCO hackathon was held concurrently with the 16th Genomics Standards Consortium Meeting, during which we converted additional datasets to RDF, developed a Material Sample Core for the Global Biodiversity Information Framework, created a Web Ontology Language (OWL) file for importing Darwin Core classes and properties into BCO, and developed a workflow for converting biodiversity data among formats.

  2. Impact of advanced manufacturing technology on prosthetic and orthotic practice.

    PubMed

    Jones, D

    1988-04-01

    Radical changes in the technology applied to prosthetics and orthotics are being proposed. This paper attempts to define the scope and character of advanced manufacturing technology and examines the rehabilitation problems which are or could be tackled. Lower-limb prosthetics has been the major area under investigation so far, but orthopaedic footwear, spinal orthotics and custom seating for the disabled have also been investigated using similar technological approaches. The whole process of patient measurement, device design, and component manufacture is conceived as an integrated system relying upon shape or tissue property sensing, computer based device design and computer-numerically-controlled or robot manufacturing processes. The aim is to retain flexibility for custom design which is necessary to provide for individual patients, and yet improve the rapidity and precision of overall device manufacture and service delivery.

  3. Review: Coastal groundwater optimization—advances, challenges, and practical solutions

    NASA Astrophysics Data System (ADS)

    Ketabchi, Hamed; Ataie-Ashtiani, Behzad

    2015-09-01

    Decision models are essential tools for coastal groundwater management (CGM). A combined simulation-optimization framework is employed to develop these models. One of the main barriers in the widespread application of these models for real-world cases is their large computational burden. Recent advances in efficient computational approaches and robust optimization methods can crack this barrier. This study surveys the scientific basis of CGM to provide an overview on this subject and reviews the-state-of-the-art to clarify recent developments and to outline ideas for improving the computational performance. Key details are presented on the performance and choice of possible robust tools such as efficient evolutionary algorithms (EAs), surrogate models, and parallel processing techniques. Then, the potential challenges remaining in this context are scrutinized, demonstrating open fields for further research, which include issues related to advances in simulating and optimizing phases such as introducing new robust algorithms and considering multi-objective purposes, implementing novel and high-performance tools, considering global concerns (e.g. climate change impacts), enhancing the existing models to fit the real world, and taking into account the complexities of real-world applications (e.g. uncertainties in the modeling parameters, and data acquisition). Finally, the outcomes of the systematic review are applied to solve a real-world CGM problem in Iran, to quantitatively examine the performance of combined implementation of some of the suggested tools. It is revealed that the required computational time is considerably reduced by as much as three orders of magnitude when correct combinations of robust EAs, surrogate model, and parallelization technique are utilized.

  4. Advancing the Practice of Health Coaching: Differentiation From Wellness Coaching.

    PubMed

    Huffman, Melinda H

    2016-09-01

    The increasing demand for health coaches and wellness coaches in worksite health promotion and the marketplace has resulted in a plethora of training programs with wide variations in coaching definitions, content, attributes, and eligibility of those who may train. It is in the interest of public awareness and safety that those in clinical practice take the lead in this discussion and offer a reasonable contrast and comparison focusing on the risks and responsibilities of health coaching in particular. With the endorsement of the American Association of Occupational Health Nurses (AAOHN), the National Society of Health Coaches, whose membership is primarily nurses, discusses the issue and states its position here.

  5. Practical advance in obtaining an emergency airway via cricothyroidotomy.

    PubMed

    Huber, William G; Dahman, Marc H; Thomas, Deanna; Lipschutz, Joshua H

    2007-05-01

    By the time a cricothyroidotomy is deemed necessary, the patient is in critical need of an emergency airway before anoxic damage ensues. Two things are necessary for the delivery of the requisite oxygen. First, an airway must be rapidly established. Second, the airway must be large enough to facilitate ventilation. Present methods for emergency cricothyroidotomy include needle cricothyroidotomy, which suffers from difficulties in both establishment and ventilation. We describe here a practical and widely available method for establishing a timely effective airway that has been used successfully for five patients since 1992.

  6. The lived experience of nurse practitioners practicing within the Transformational Advanced Professional Practice Model: A phenomenological study.

    PubMed

    Elliott, Elizabeth C; Walden, Marlene; Young, Anne; Symes, Lene; Fredland, Nina

    2017-06-01

    The purpose of this study was to describe the lived experiences of nurse practitioners (NPs) practicing within the Transformational Advanced Professional Practice (TAPP) Model, a professional practice model (PPM). A descriptive phenomenological analysis using semistructured interviews of 11 NPs across multiple inpatient and outpatient clinical areas at Texas Children's Hospital. Member checking and theming data occurred using Colaizzi's Method concurrently with Mind Mapping technique. Main themes included: (a) transforming professional practice, (b) cultivating the inner self, and (c) mentoring professional transitions. The findings of this study provide qualitative evidence that the TAPP Model influences role transition and professional development. Transforming NP practice within organizations and within the nursing profession itself will take mindfulness with an intentional approach to design PPMs specifically for NPs. ©2017 American Association of Nurse Practitioners.

  7. Advancing nursing practice through social media: a global perspective.

    PubMed

    Barry, Jean; Hardiker, Nicholas R

    2012-08-14

    Social media has been used globally as a key vehicle for communication. As members of an innovative profession, many nurses have embraced social media and are actively utilizing its potential to enhance practice and improve health. The ubiquity of the Internet provides social media with the potential to improve both access to health information and services and equity in health care. Thus there are a number of successful nurse-led initiatives. However, the open and democratising nature of social media creates a number of potential risks, both individual and organisational. This article considers the use of social media within nursing from a global perspective, including discussion of policy and guidance documents. The impact of social media on both healthcare consumers and nurses is reviewed, followed by discussion of selected risks associated with social media. To help nurses make the most of social media tools and avoid potential pitfalls, the article conclusion suggests implications appropriate for global level practice based on available published guidance.

  8. Advanced materials for magnetic cooling: Fundamentals and practical aspects

    NASA Astrophysics Data System (ADS)

    Balli, M.; Jandl, S.; Fournier, P.; Kedous-Lebouc, A.

    2017-06-01

    Over the last two decades, the research activities on magnetocalorics have been exponentially increased, leading to the discovery of a wide category of materials including intermetallics and oxides. Even though the reported materials were found to show excellent magnetocaloric properties on a laboratory scale, only a restricted family among them could be upscaled toward industrial levels and implemented as refrigerants in magnetic cooling devices. On the other hand, in the most of the reported reviews, the magnetocaloric materials are usually discussed in terms of their adiabatic temperature and entropy changes (ΔTad and ΔS), which is not enough to get more insight about their large scale applicability. In this review, not only the fundamental properties of the recently reported magnetocaloric materials but also their thermodynamic performance in functional devices are discussed. The reviewed families particularly include Gd1-xRx alloys, LaFe13-xSix, MnFeP1-xAsx, and R1-xAxMnO3 (R = lanthanide and A = divalent alkaline earth)-based compounds. Other relevant practical aspects such as mechanical stability, synthesis, and corrosion issues are discussed. In addition, the intrinsic and extrinsic parameters that play a crucial role in the control of magnetic and magnetocaloric properties are regarded. In order to reproduce the needed magnetocaloric parameters, some practical models are proposed. Finally, the concepts of the rotating magnetocaloric effect and multilayered magnetocalorics are introduced.

  9. Circadian Rhythms and Psychiatric Illness

    PubMed Central

    Asarnow, Lauren D.; Soehner, Adriane M.; Harvey, Allison G.

    2014-01-01

    Purpose of review The present review provides a conceptual introduction to sleep and circadian research in psychiatric illness, and discusses recent experimental and intervention findings in this area. Recent Findings In this review, studies published since January 2011 on circadian disturbance and psychiatric illness have been summarized. Summary Exciting new results have increasingly utilized objective and validated instruments to measure the circadian system in experimental studies. Since 2011, treatment research has still predominantly utilized self-report measures as outcome variables. However, research in the treatment domain for sleep/circadian disturbances comorbid with psychiatric illness has advanced the field in its work to broaden the validation of existing sleep treatments to additional patient populations with comorbid sleep/circadian disruptions, address how to increase access to and affordability of treatment for sleep and circadian dysfunction for patients with psychiatric disorders, and how to combine psychosocial treatments with psychopharmacology to optimize treatment outcomes. PMID:24060916

  10. Advanced-practice pharmacists: practice characteristics and reimbursement of pharmacists certified for collaborative clinical practice in New Mexico and North Carolina.

    PubMed

    Murawski, Matthew; Villa, Kristin R; Dole, Ernest J; Ives, Timothy J; Tinker, Dale; Colucci, Vincent J; Perdiew, Jeffrey

    2011-12-15

    PURPOSE The results of a survey assessing the practice settings, clinical activities, and reimbursement experiences of pharmacists with advanced-practice designations are reported. METHODS A questionnaire was sent to all certified Pharmacist Clinicians in New Mexico and all Clinical Pharmacist Practitioners in North Carolina (a total of 189 pharmacists at the time of the survey in late 2008) to elicit information on practice settings, billing and reimbursement methods, collaborative drug therapy management (CDTM) protocols, and other issues. RESULTS Of the 189 targeted pharmacists, 64 (34%) responded to the survey. On average, the reported interval from pharmacist licensure to certification as an advanced practitioner was 11 years. The majority of survey participants were practicing in community or institutional settings, most often hospital clinics or physician offices. About two thirds of the respondents indicated that their employer handled the billing of their services using standard evaluation and management codes, with estimated total monthly billings averaging $6500. At the time of the survey, about 80% of the respondents were engaged in a CDTM protocol. The survey results suggest that pharmacists with advanced-practice designations are perceived favorably by patients and physicians and their services are in high demand, but more than one third of respondents indicated a need to justify their advanced-practice positions to administrators. CONCLUSION Pharmacists with advanced-practice designations are providing clinical services in various settings under collaborative practice arrangements that include prescribing privileges. Despite growing patient and physician acceptance, reimbursement challenges continue to be a barrier to wider use of CDTM programs.

  11. Advanced practice clinicians as abortion providers: current developments in the United States.

    PubMed

    Joffe, Carole; Yanow, Susan

    2004-11-01

    A hopeful note in the contemporary abortion environment in the United States is the expanding role of advanced practice clinicians--nurse practitioners, physician assistants and nurse-midwives--in first trimester abortion provision. A large percentage of primary health care in the U.S. is currently provided by these non-physicians but their involvement in abortion care is promising, especially in light of the shortage of physician providers. Two national symposia in 1990 and 1996 approved the expansion of early abortion care to non-physicians. As of January 2004, trained advanced practice clinicians were providing medical, and in some cases, early surgical abortion in 14 states. This has required not only medical training but also political organising to achieve the necessary legal and regulatory changes, state by state, by groups such as Clinicians for Choice and the Abortion Access Project, described here in examples in two states and the reflections of three advanced practice clinicians. Recent surveys in three states show a substantial interest among advanced practice clinicians in abortion training, leading to cautious optimism about the possibility of increased abortion access for women. Most encouraging, advanced practice clinicians, like their physician counterparts, show a level of passionate commitment to the work that is rare elsewhere in health care in the U.S. today.

  12. Advances and Practices of Bioprocess Scale-up.

    PubMed

    Xia, Jianye; Wang, Guan; Lin, Jihan; Wang, Yonghong; Chu, Ju; Zhuang, Yingping; Zhang, Siliang

    2016-01-01

    : This chapter addresses the update progress in bioprocess engineering. In addition to an overview of the theory of multi-scale analysis for fermentation process, examples of scale-up practice combining microbial physiological parameters with bioreactor fluid dynamics are also described. Furthermore, the methodology for process optimization and bioreactor scale-up by integrating fluid dynamics with biokinetics is highlighted. In addition to a short review of the heterogeneous environment in large-scale bioreactor and its effect, a scale-down strategy for investigating this issue is addressed. Mathematical models and simulation methodology for integrating flow field in the reactor and microbial kinetics response are described. Finally, a comprehensive discussion on the advantages and challenges of the model-driven scale-up method is given at the end of this chapter.

  13. Advances in athlete development: understanding conditions of and constraints on optimal practice.

    PubMed

    Baker, Joseph; Young, Bradley W; Mann, David

    2017-08-01

    The development of elite, high performance athletes reflects the complex interaction of biological and genetic factors with important environmental influences. Over the past two decades, discussions of athlete development have largely focused on the role of 'deliberate' practice, and more recently, researchers have begun exploring the means by which practice can be best used to maximize the rate of talent development across the different stages of athlete development. In this article, we summarize recent developments in understanding how athletes maximize practice including (a) antecedents of practice involvement, (b) environmental constraints of practice involvement, (c) the value of diversification for athlete development, (d) and methodological advancements in this area. Collectively, sustained focus on issues of athlete development and researchers' use of more advanced approaches to novel questions extend our understanding of the nuances associated with this process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Advance market commitment for pneumococcal vaccines: putting theory into practice.

    PubMed

    Cernuschi, Tania; Furrer, Eliane; Schwalbe, Nina; Jones, Andrew; Berndt, Ernst R; McAdams, Susan

    2011-12-01

    Markets for life-saving vaccines do not often generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability for use in the lowest income countries. The perceived risks and uncertainties about sustainably funded demand from developing countries often leads to underinvestment in development and manufacturing of appropriate products. The pilot initiative Advance Market Commitment (AMC) for pneumococcal vaccines, launched in 2009, aims to remove some of these market risks by providing a legally binding forward commitment to purchase vaccines according to predetermined terms. To date, 14 countries have already introduced pneumococcal vaccines through the AMC with a further 39 countries expected to introduce before the end of 2013.This paper describes early lessons learnt on the selection of a target disease and the core design choices for the pilot AMC. It highlights the challenges faced with tailoring the AMC design to the specific supply situation of pneumococcal vaccines. It points to the difficulty - and the AMC's apparent early success - in establishing a long-term, credible commitment in a constantly changing unpredictable environment. It highlights one of the inherent challenges of the AMC: its dependence on continuous donor funding to ensure long-term purchases of products. The paper examines alternative design choices and aims to provide a starting point to inform discussions and encourage debate about the potential application of the AMC concept to other fields.

  15. Advance Care Planning: practicalities, legalities, complexities and controversies.

    PubMed

    Horridge, Karen A

    2015-04-01

    Increasing numbers, complexities and technology dependencies of children and young people with life-limiting conditions require paediatricians to be well prepared to meet their changing needs. Paediatric Advance Care Planning provides a framework for paediatricians, families and their multidisciplinary teams to consider, reflect and record the outcome of their conversations about what might happen in the future in order to optimise quality of clinical care and inform decision-making. For some children and young people this will include discussions about the possibility of death in childhood. This may be unexpected and sudden, in the context of an otherwise active management plan or may be expected and necessitate discussions about the process of dying and attention to symptoms. Decision-making about appropriate levels of intervention must take place within a legal and ethical framework, recognising that the UK Equality Act (2010) protects the rights of disabled children and young people and infants and children of all ages to the same high quality healthcare as anyone else. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. APNA Member Survey Results: Role of Psychiatric Nurses in Hospital Emergency Departments.

    PubMed

    Allen, Diane E

    2016-05-01

    A group of hospital emergency department nurses formed a virtual community within the American Psychiatric Nurses Association (APNA) to explore who and what skills are best suited to provide care for patients with psychiatric disorders in hospital emergency departments. The Emergency Department Nurse work group, under the auspices of APNA's Institute for Safe Environments, developed a survey to help describe the role and function of the psychiatric nurse in hospital emergency departments and to determine needs for training and competencies. The 25-item survey was sent via an email link to all APNA members. Responses from 520 nurses show consensus for the title of "psychiatric emergency department nurse," whose primary role is to provide "crisis management." A need for education in advanced medical assessment was identified. It is critical that we provide a professional practice context to assist nurses working in emergency departments. © The Author(s) 2016.

  17. Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study.

    PubMed

    Canam, Connie

    2005-12-01

    As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.

  18. Psychiatric Treatment

    PubMed Central

    Rudin, Edward; Zimmerman, Rick

    1978-01-01

    The California legislature enacted tight constraints on the use of psychosurgery and electroconvulsive therapy in 1974. In April 1976 a State Court of Appeals declared part of the law to be unconstitutional. In doing so, the court enunciated several principles for regulating medical procedures. It affirmed the inherent police powers which permit the state to safeguard the public, especially incompetent, involuntary or confined persons, with respect to intrusive and hazardous medical procedures and to procedures which affect thought or feeling. Although limited to legislation concerning two psychiatric procedures, the court's decision, and subsequently enacted legislation governing these procedures, has implications for other medical procedures and for other parts of the nation. PMID:664647

  19. Identifying landmark articles for advancing the practice of geriatrics.

    PubMed

    Vaughan, Camille P; Fowler, Rachel; Goodman, Richard A; Graves, Taylor R; Flacker, Jonathan M; Johnson, Theodore M

    2014-11-01

    Landmark articles from the peer-reviewed literature can be used to teach the fundamental principles of geriatric medicine. Three approaches were used in sequential combination to identify landmark articles as a resource for geriatricians and other healthcare practitioners. Candidate articles were identified first through a literature review and expert opinion survey of geriatric medicine faculty. Candidate articles in a winnowed list (n = 30) were then included in a bibliometric analysis that incorporated the journal impact factor and average monthly citation index. Finally, a consensus panel reviewed articles to assess each manuscript's clinical relevance. For each article, a final score was determined by averaging, with equal weight, the opinion survey, bibliometric analysis, and consensus panel review. This process ultimately resulted in the identification of 27 landmark articles. Overall, there was weak correlation between articles that the expert opinion survey and bibliometric analysis both rated highly. This process demonstrates a feasible method combining subjective and objective measures that can be used to identify landmark papers in geriatric medicine for the enhancement of geriatrics education and practice. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  20. Psychological Well-Being Revisited: Advances in Science and Practice

    PubMed Central

    Ryff, Carol D.

    2014-01-01

    This article reviews the research and interventions that have grown up around a model of psychological well-being (Ryff, 1989) generated more than two decades ago to address neglected aspects of positive functioning, such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge. The conceptual origins of this formulation are revisited and scientific products emerging from six thematic areas are examined: (1) how well-being changes across adult development and later life, (2) what are the personality correlates of well-being, (3) how well-being is linked with experiences in family life, (4) how well-being relates to work and other community activities, (5) what are the connections between well-being and health, including biological risk factors, (6) and via clinical and intervention studies, how psychological well-being can be promoted for ever greater segments of society. Together, these topics illustrate flourishing interest across diverse scientific disciplines in understanding adults as striving, meaning-making, proactive organisms who are actively negotiating the challenges of life. A take-home message is that increasing evidence supports the health protective features of psychological well-being in reducing risk for disease and promoting length of life. A recurrent and increasingly important theme is resilience – the capacity to maintain or regain well-being in the face of adversity. Implications for future research and practice are considered. PMID:24281296

  1. The Vanderbilt Professional Nursing Practice Program, part 2: Integrating a professional advancement and performance evaluation system.

    PubMed

    O'Hara, Nancy F; Duvanich, Mary; Foss, Julie; Wells, Nancy

    2003-10-01

    Developing a performance-based advancement system requires evaluation tools that capture essential behaviors and outcomes reflective of key nursing functions. To ensure relevance to clinical practice and enhance buy-in from nursing staff, the behaviors and outcomes were defined by a broad cross-section of nursing staff and administrators. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program under way at Vanderbilt University Medical Center. This second article describes the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the inception of the program. Additionally, the authors present the challenges and lessons we learned in development and implementation of a dynamic evaluation system that supports our career advancement program. The process of advancing within the program will be described in part 3.

  2. Guest Editors' Reflections on Progress in the Development of Advanced Practice Nursing in Canada.

    PubMed

    Martin-Misener, Ruth; Bryant-Lukosius, Denise

    2016-01-01

    This 2016 special edition on advanced practice nursing (APN) roles in Canada builds on earlier role progress reported in the first special edition in 2010. Advancements in role development and innovative models that utilize APN roles are highlighted. The need for further efforts to support health systems integration of APN roles related to funding, research and decision-maker understanding of the roles, and to learn from international experience in APN role implementation are described.

  3. Community Engagement to Drive Best Practices and Scientific Advancement

    NASA Astrophysics Data System (ADS)

    Goring, S. J.; Williams, J. W.; Uhen, M. D.; McClennen, M.; Jenkins, J.; Peters, S. E.; Grimm, E. C.; Anderson, M.; Fils, D.; Lehnert, K.; Carter, M.

    2016-12-01

    The development of databases, data models, and tools around Earth Science data requires constant feedback from user communities. Users must be engaged in all aspects of data upload and access, curation and governance, and, particularly, in highlighting future opportunities for scientific discovery using the data resources. A challenge for data repositories, many of which have evolved organically and independently, is moving from Systems of Record - data silos with only limited input and output options - to Systems of Engagement, that respond to users and interact with other user communities and data repositories across the geosciences and beyond. The Cyber4Paleo Community Development Workshop (http://cyber4paleo.github.io), held June 20 & 21st in Boulder, CO, was organized by the EarthCube Research Coordination Network C4P (Cyber4Paleo) to bring together disciplinary researchers and Principles within data collectives in an effort to drive scientific applications of the collective data resources. C4P focuses on coordinating data and user groups within the allied paleogeoscientific disciplines. Over the course of two days researchers developed research projects that examined standards of 210Pb dating in the published literature, a framework for implementing a common geological time scale across resources, the continued development of underlying data resources, tools to integrate climate and occupation data from paleoecological resources, and the implementation of harmonizing standards across databases. Scientific outcomes of the workshop serve to underpin our understanding of the interrelations between paleoecological data and geophysical components of the Earth System at short and long time scales. These tools enhance our ability to understand connections between and among proxies, across space and time, the serve as outreach tools for training and education, and, importantly, they help to define and improve best practices within the databases, by engaging directly

  4. A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: issues and implications for the future of psychiatric canon and practice.

    PubMed

    Kawa, Shadia; Giordano, James

    2012-01-13

    The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the

  5. A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice

    PubMed Central

    2012-01-01

    The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the

  6. Ethical challenges in developing drugs for psychiatric disorders.

    PubMed

    Carrier, Felix; Banayan, David; Boley, Randy; Karnik, Niranjan

    2017-03-06

    As the classification of mental disorders advances towards a disease model as promoted by the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC), there is hope that a more thorough neurobiological understanding of mental illness may allow clinicians and researchers to determine treatment efficacy with less diagnostic variability. This paradigm shift has presented a variety of ethical issues to be considered in the development of psychiatric drugs. These challenges are not limited to informed consent practices, industry funding, and placebo use. The consideration for alternative research models and quality of research design also present ethical challenges in the development of psychiatric drugs. The imperatives to create valid and sound research that justify the human time, cost, risk and use of limited resources must also be considered. Clinical innovation, and consideration for special populations are also important aspects to take into account. Based on the breadth of these ethical concerns, it is particularly important that scientific questions regarding the development of psychiatric drugs be answered collaboratively by a variety of stakeholders. As the field expands, new ethical considerations will be raised with increased focus on genetic markers, personalized medicine, patient-centered outcomes research, and tension over funding. We suggest that innovation in trial design is necessary to better reflect practices in clinical settings and that there must be an emphasized focus on expanding the transparency of consent processes, regard for suicidality, and care in working with special populations to support the goal of developing sound psychiatric drug therapies.

  7. Psychiatric Genomics and Mental Health Treatment: Setting the Ethical Agenda.

    PubMed

    Kong, Camillia; Dunn, Michael; Parker, Michael

    2017-04-01

    Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health.

  8. Premature rupture of the fetal membranes. An update for advanced practice nurses.

    PubMed

    Weitz, B W

    2001-01-01

    Advanced practice nurses in obstetric settings are frequently required to diagnose premature rupture of fetal membranes; co-management of care with physicians is becoming more common in many health care facilities. Therefore, Advanced practice nurses must have an in-depth understanding of this potentially severe obstetric complication. This article presents a review of the current literature focusing on the epidemiology, physiology, pathophysiology, prevention measures, subjective and objective assessment, diagnostic tests, and management of premature rupture of membranes. Psychosocial aspects of this event, often upsetting for the family, are also discussed.

  9. The Vanderbilt Professional Nursing Practice Program, part 3: managing an advancement process.

    PubMed

    Steaban, Robin; Fudge, Mitzie; Leutgens, Wendy; Wells, Nancy

    2003-11-01

    Consistency of performance standards across multiple clinical settings is an essential component of a credible advancement system. Our advancement process incorporates a central committee, composed of nurses from all clinical settings within the institution, to ensure consistency of performance in inpatient, outpatient, and procedural settings. An analysis of nurses advanced during the first 18 months of the program indicates that performance standards are applicable to nurses in all clinical settings. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program underway at Vanderbilt University Medical Center. Part 2 described the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the program's inception. The purpose of this article is to review the advancement process, review the roles of those involved in the process, and to describe outcomes and lessons learned.

  10. Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership.

    PubMed

    DeCarlo, Linda

    2005-09-01

    CHANGES IN THE HEALTH CARE environment and reimbursement practices are creating opportunities for nurse entrepreneurs to be partners with other professional nurses and physicians. Advanced practice nurses (APNs) who want to step into an entrepreneurial role must have strong clinical expertise, specific personal characteristics, interpersonal skills, and business acumen. ESTABLISHING A MULTIDISCIPLINARY partnership for providing surgical assisting services has many benefits and presents many challenges.

  11. Psychiatric pharmacogenomics in pediatric psychopharmacology.

    PubMed

    Wall, Christopher A; Croarkin, Paul E; Swintak, Cosima; Koplin, Brett A

    2012-10-01

    This article provides an overview of where psychiatric pharmacogenomic testing stands as an emerging clinical tool in modern psychotropic prescribing practice, specifically in the pediatric population. This practical discussion is organized around the state of psychiatric pharmacogenomics research when choosing psychopharmacologic interventions in the most commonly encountered mental illnesses in youth. As with the rest of the topics on psychopharmacology for children and adolescents in this publication, a clinical vignette is presented, this one highlighting a clinical case of a 16 year old genotyped during hospitalization for recalcitrant depression.

  12. Primary Care Advanced Practice RNs' Knowledge of Posttraumatic Stress Disorder and Screening.

    PubMed

    Link, Kimberly A; Smith, Lynette S

    2017-09-01

    Individuals with posttraumatic stress disorder (PTSD) may seek treatment for their symptoms within the primary care setting. Research suggests PTSD often goes undiagnosed in primary care. Primary care providers (PCPs) might have deficiencies in their knowledge of PTSD screening and screening practices. A descriptive cross-sectional study design was used to examine primary care advanced practice RNs' (APRN) knowledge of PTSD screening and screening practices, along with subjective norms, attitudes, and self-efficacy regarding PTSD screening. Deficiencies in knowledge of PTSD screening and screening practices were identified. Discrepancies were found between reported subjective norms and screening practices, and most participants reported low self-efficacy and stated screening was not important. Numerous barriers to screening were identified. Additional education and training may be needed to improve primary care APRNs' PTSD screening knowledge and screening practices. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 23-32.]. Copyright 2017, SLACK Incorporated.

  13. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  14. The emergence of forensic nursing and advanced nursing practice in Switzerland: an innovative case study consultation.

    PubMed

    Romain-Glassey, Nathalie; Ninane, Françoise; de Puy, Jacqueline; Abt, Maryline; Mangin, Patrice; Morin, Diane

    2014-01-01

    The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.

  15. Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?

    PubMed

    Deakin, C D; King, P; Thompson, F

    2009-12-01

    Ambulance paramedics are now trained routinely in advanced airway skills, including tracheal intubation. Initial training in this skill requires the insertion of 25 tracheal tubes, and further ongoing training is attained through clinical practice and manikin-based practice. In contrast, training standards for hospital-based practitioners are considerably greater, requiring approximately 200 tracheal intubations before practice is unsupervised. With debate growing regarding the efficacy of paramedic intubation, there is a need to assess current paramedic airway practice in order to review whether initial training and maintenance of skills provide an acceptable level of competence with which to practice advanced airway skills. All ambulance patient report forms (anonymised) for the period 1 January 2007 to 31 December 2007 were reviewed, and data relating to airway management were collected. Paramedic and technician identification codes were used to determine the number of airway procedures undertaken on an individual basis. Of the 269 paramedics, 128 (47.6%) had undertaken no intubation and 204 (75.8%) had undertaken one or less intubation in the 12-month study period. The median number of intubations per paramedic during the 12-month period was 1.0 (range 0-11). A total of 76 laryngeal mask insertion attempts were recorded by 41 technicians and 30 paramedics. The median number of laryngeal mask insertions per paramedic/technician during the 12-month period was 0 (range 0-2). A survey of ongoing continuing professional development across all ambulance trusts demonstrated no provision for adequate training to compensate for the lack of clinical exposure to advanced airway skills. Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews

  16. Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

    PubMed

    Lane, Riki; Halcomb, Elizabeth; McKenna, Lisa; Zwar, Nicholas; Naccarella, Lucio; Davies, Gawaine Powell; Russell, Grant

    2016-04-21

    Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce.Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territoriesResults Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies.Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices.What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally

  17. Integration of an Introductory Pharmacy Practice Experience With an Advanced Pharmacy Practice Experience in Adult Internal Medicine

    PubMed Central

    Bird, Matthew L.; Vesta, Kimi S.; Harrison, Donald L.; Dennis, Vincent C.

    2012-01-01

    Objective. To describe the development, implementation, and assessment of an internal medicine introductory pharmacy practice experience (IPPE) that was integrated with an existing advanced pharmacy practice experience (APPE) in internal medicine. Design. A structured IPPE was designed for first-, second-, and third-year pharmacy (P1, P2, and P3) students. Activities for the IPPE were based on the established APPE and the individual learner's educational level. Assessment. Students reported a greater understanding of clinical pharmacists’ roles, increased confidence in their clinical skills, and better preparation for APPEs. Peers viewed the approach as innovative and transferable to other practice settings. Participating faculty members provided a greater number of contact hours compared to traditional one-time site visits. Conclusions. Integrating an IPPE with an existing APPE is an effective and efficient way to provide patient care experiences for students in the P1-P3 years in accordance with accreditation standards. PMID:22544969

  18. Delta's Key to the TOEFL iBT[R]: Advanced Skill Practice. Revised Edition

    ERIC Educational Resources Information Center

    Gallagher, Nancy

    2012-01-01

    Delta's Key to the TOEFL iBT: Advanced Skill Practice is a revised and updated edition of Delta's Key to the Next Generation TOEFL Test. Since the introduction of the TOEFL iBT in 2005, there have been significant changes to some of the test questions, particularly the integrated writing and integrated speaking tasks. The new 2011 edition of…

  19. Literacy Agents Online: E-Discussion Forums for Advancing Adults' Literacy Practices

    ERIC Educational Resources Information Center

    Guzzetti, Barbara J.; Foley, Leslie M.

    2014-01-01

    This study explored how adults used a self-selected online forum to advance their own and others' literacy practices. The study was a discourse-centered online ethnography using triangulated methods, including analysis of list archives, semi-structured and informal interviews, and document collection. These data were analyzed by discourse…

  20. Delta's Key to the TOEFL iBT[R]: Advanced Skill Practice. Revised Edition

    ERIC Educational Resources Information Center

    Gallagher, Nancy

    2012-01-01

    Delta's Key to the TOEFL iBT: Advanced Skill Practice is a revised and updated edition of Delta's Key to the Next Generation TOEFL Test. Since the introduction of the TOEFL iBT in 2005, there have been significant changes to some of the test questions, particularly the integrated writing and integrated speaking tasks. The new 2011 edition of…

  1. Addressing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Advanced Practice Nursing Education.

    ERIC Educational Resources Information Center

    Nokes, Kathleen M.; Stein, Gary L.

    1997-01-01

    A survey of 23 advanced practice nursing programs showed only 3 had HIV-specific graduate-level nursing courses. Recommendations were made for HIV-specific courses, integration of HIV content into other courses, use of Centers for Disease Control and Occupational Safety and Health Administration guidelines, and subspecialties in HIV nursing. (SK)

  2. Advances in circulating tumor cells (ACTC): from basic research to clinical practice

    PubMed Central

    2013-01-01

    The first 'Advances in Circulating Tumor Cells (ACTC): from Basic Research to Clinical Practice' meeting was held in Athens, Greece, September 26–29, 2012 (abstracts, presentations and a more detailed meeting report are freely available online: http://www.actc2012.org). We summarize in this report most major findings presented and the main conclusions derived during the expert panel sessions. PMID:24314311

  3. Addressing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Advanced Practice Nursing Education.

    ERIC Educational Resources Information Center

    Nokes, Kathleen M.; Stein, Gary L.

    1997-01-01

    A survey of 23 advanced practice nursing programs showed only 3 had HIV-specific graduate-level nursing courses. Recommendations were made for HIV-specific courses, integration of HIV content into other courses, use of Centers for Disease Control and Occupational Safety and Health Administration guidelines, and subspecialties in HIV nursing. (SK)

  4. A Qualitative Analysis of an Advanced Practice Nurse-Directed Transitional Care Model Intervention

    ERIC Educational Resources Information Center

    Bradway, Christine; Trotta, Rebecca; Bixby, M. Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An…

  5. Enhancing Success in Advanced Practice Nursing: a grant-funded project.

    PubMed

    McNeal, Gloria J; Walker, Donita

    2006-01-01

    The Enhancing Success in Advanced Practice Nursing (ESAPN) Project is designed to improve access to a diverse and culturally competent and sensitive health professions workforce by increasing the number of Hispanic, African-American and Asian nurses recruited, enrolled in and graduated from the MSN program at the University of Medicine and Dentistry of New Jersey-School of Nursing (UMDNJ-SN). In addition, the project plan includes the development and implementation of a comprehensive program that incorporates academic support services, career advisement and mentoring activities to retain and graduate an increased number of culturally, racially and ethnically diverse advanced practice nurses for the State of New Jersey. The project also seeks to improve the quality of care by preparing advanced practice nurses to provide culturally competent and sensitive care by assuring that the MSN curriculum includes content and clinical experiences relevant to the development of cultural competence. Faculty participation in workshops, designed to increase knowledge of cultural competence, is a key component. The success of the project will be evaluated using a variety of measures that track increases in the number of diverse students recruited and enrolled, the number of students accessing services associated with the ESAPN program, and increased retention and graduation of Hispanic, African-American and Asian nurses prepared as advanced practice nurses.

  6. Literacy Agents Online: E-Discussion Forums for Advancing Adults' Literacy Practices

    ERIC Educational Resources Information Center

    Guzzetti, Barbara J.; Foley, Leslie M.

    2014-01-01

    This study explored how adults used a self-selected online forum to advance their own and others' literacy practices. The study was a discourse-centered online ethnography using triangulated methods, including analysis of list archives, semi-structured and informal interviews, and document collection. These data were analyzed by discourse…

  7. 27th Annual APRN legislative update: advancements continue for APRN practice.

    PubMed

    Phillips, Susanne J

    2015-01-16

    As the tides of healthcare in the United States continue to change, advanced practice registered nurses (APRNs) are at the forefront of legislative history. This overview provides a snapshot of legislative and regulatory activity in 2014 as reported by state Boards of Nursing and nursing organizations representing APRNs.

  8. [Psychiatric Emergencies in Psychiatric Hospitals in Germany].

    PubMed

    Schwerthöffer, Dirk; Beuys, David; Hamann, Johannes; Messer, Thomas; Pajonk, Frank-Gerald

    2016-10-01

    Objective: Psychiatric hospitals are confronted with high rates of psychiatric emergencies. There are, however, only few investigations that focus on psychiatric emergency care in German psychiatric hospitals, their supply structures and diagnostic and treatment standards. The aim of the survey was a systematic acquisition of the diagnostic and therapeutic approach in treating psychiatric emergencies in German psychiatric hospitals. Methods: We conducted a survey in psychiatric hospitals throughout Germany. The questionnaire consisted of questions concerning the structures of supply and diagnostic and therapeutic standards treating psychiatric emergencies. Results: 42 % of all admissions to German psychiatric hospitals were emergency admissions. More than 60 % of the patients in psychiatric emergency ambulances had to receive inpatient treatment. As standard procedures for medical clearing in psychiatric emergencies physical examination, measurement of heart rate and blood pressure and conducting certain laboratory tests and breath alcohol were named. The most common psychopharmacological agents for emergency situations were diazepam, lorazepam, haloperidol and zuclopenthixol. Conclusion: Diagnosing and treating psychiatric emergencies need more standardisation. More specific data is required to generate diagnostic and therapeutic standards. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist

    PubMed Central

    Gotlib, Dorothy; Bostwick, Jolene R.; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E.; Fluent, Thomas

    2017-01-01

    Objectives To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Experimental Design Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Principal Observations Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). Conclusions This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery.

  10. Redefining perioperative advanced practice. Scope of practice: measuring impact and sustainability.

    PubMed

    Radford, Mark; Abbassi, Ann; Williamson, Alastair; Johnston, Paul

    2003-12-01

    There are increasing demands placed upon the modern NHS, particularly in emergency care. In combating these demands, new approaches to practice will form an overall strategy for improving care delivered to patients. This is the second in a series by authors from the Good Hope Hospital NHS Trust and explains their experience of developing an innovative approach to the management of surgical emergencies through the specialist nurse role in anaesthesia and emergency surgery. It examines the scope of practice, clinical and operational impact of the role, and future developments.

  11. Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

    PubMed

    Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

    2015-12-01

    Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

  12. Psychiatric consultation of patients with hyperemesis gravidarum.

    PubMed

    Kim, Deborah R; Connolly, K R; Cristancho, Pilar; Zappone, Mark; Weinrieb, Robert M

    2009-04-01

    The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.

  13. Integrating social neuroscience and social work: innovations for advancing practice-based research.

    PubMed

    Matto, Holly C; Strolin-Goltzman, Jessica

    2010-04-01

    Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is enthusiastic discussion of how to ensure that such capacity development helps the profession move forward in ways that make use of the biological sciences and that facilitate social work-specific contributions to the larger interdisciplinary scientific community. This article describes how the social work profession can make use of biomedical knowledge and technological advances from social neuroscience to inform psychosocial treatment development, and it illustrates an application to social work practice by giving an example of a substance abuse treatment development process built on social neuroscientific research.

  14. The Experience of Advanced Practice Nurses in US Emergency Care Settings.

    PubMed

    Wolf, Lisa A; Delao, Altair M; Perhats, Cydne; Moon, Michael D; Carman, Margaret J

    2017-09-01

    Little information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education. An exploratory mixed-methods study was performed incorporating a self-report survey and focus group interviews. The educational path to advanced practice nursing in emergency care settings is not standardized. Few programs incorporate or address the need for APRNs to receive acute care training across the life span, which is the hallmark of emergency nursing practice. Similarly, training is reported as fragmented, and validation of skills for both nurse practitioners and clinical nurse specialists can vary. APRN practice autonomy is affected by the presence of other providers (specifically physicians), institutional culture, and state boards of nursing that regulate practice. Integrated educational and orientation programs are needed that address high-acuity patients across the life span. Additionally, a more nuanced approach to assessing APRN capabilities as a combination of hard (clinical emergency) and soft (communication and organizational) skills may be an appropriate framework within which to examine the advanced practice role. Future research should continue to evaluate training, competency assessment, and outcomes for APRNs in the emergency care setting. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  15. Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

    PubMed

    Choma, Kim; McKeever, Amy E

    2015-02-01

    The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.

  16. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses.

    PubMed

    Leggat, Sandra G; Balding, Cathy; Schiftan, Dan

    2015-06-01

    To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. A pre-postlongitudinal intervention study. Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in

  17. The Role of the Advanced Practice Nurse in Geriatric Oncology Care.

    PubMed

    Morgan, Brianna; Tarbi, Elise

    2016-02-01

    To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. International Society for Advancement of Cytometry (ISAC) flow cytometry shared resource laboratory (SRL) best practices.

    PubMed

    Barsky, Lora W; Black, Michele; Cochran, Matthew; Daniel, Benjamin J; Davies, Derek; DeLay, Monica; Gardner, Rui; Gregory, Michael; Kunkel, Desiree; Lannigan, Joanne; Marvin, James; Salomon, Robert; Torres, Carina; Walker, Rachael

    2016-11-01

    The purpose of this document is to define minimal standards for a flow cytometry shared resource laboratory (SRL) and provide guidance for best practices in several important areas. This effort is driven by the desire of International Society for the Advancement of Cytometry (ISAC) members in SRLs to define and maintain standards of excellence in flow cytometry, and act as a repository for key elements of this information (e.g. example SOPs/training material, etc.). These best practices are not intended to define specifically how to implement these recommendations, but rather to establish minimal goals for an SRL to address in order to achieve excellence. It is hoped that once these best practices are established and implemented they will serve as a template from which similar practices can be defined for other types of SRLs. Identification of the need for best practices first occurred through discussions at the CYTO 2013 SRL Forum, with the most important areas for which best practices should be defined identified through several surveys and SRL track workshops as part of CYTO 2014. © 2016 International Society for Advancement of Cytometry.

  19. Decision making in psychiatric emergencies.

    PubMed

    Murdach, A D

    1987-01-01

    Social workers increasingly are being required to assist clients in emergency situations. Such conditions typically require rapid decision making and quick action. In this article, the processes practitioners use in their interventions in psychiatric emergencies are examined. This examination is based on concepts derived from cognitive psychology and decision-making theory. Implications for practice and training also are discussed.

  20. [Chronic diseases and complexity: new roles in nursing. Advanced practice nurses and chronic patient].

    PubMed

    Sánchez-Martín, C Inmaculada

    2014-01-01

    The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases. In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level. It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients.

  1. Teaching critical reflection skills for advanced mental health nursing practice: a deconstructive-reconstructive approach.

    PubMed

    Crowe, Marie T; O'Malley, Jane

    2006-10-01

    This paper presents a literature review conducted to establish what was already known about critical reflection in the nursing literature and what work had been done on using a critical social theory framework as the basis for critical reflection. Critical thinking emerged as a significant aspect of nursing education and practice in the late 1980s. It has been promoted as a means by which issues in clinical practice can be examined through a systematic process of exploration and reasoning. Traditionally, critical thinking has commonly involved an attempt to link practice with theory using a scenario or exemplar from practice to illustrate a practice dilemma. This process is often constructed as a retrospective narrative of events. This paper provides a deconstructive-reconstructive approach that differs from some traditional approaches by taking a critical social theory perspective with an emphasis on improving practice. The nursing literature reviewed was accessed through Cumulative Index of Nursing and Allied Health Literature (CINAHL). The search was restricted to English language and published between 1995 and 2005. Based on these findings, we developed a postgraduate advanced mental health nursing programme. There were 490 articles related to 'nursing' and 'critical thinking'; 34 articles related to 'nursing' and 'critical reflection'; 23 articles related to 'nursing' and 'critical social theory'; 15 articles related to 'mental health nursing' and 'critical thinking'; and two articles related to 'mental health nursing' and 'critical reflection'. In the programme we developed based on these findings, students were facilitated to deconstruct concepts and knowledge integral to their own practice. In the reconstructive phase, students implement a change project in clinical practice, supported by a mentor. The deconstructive-reconstructive approach to the development of critical thinking skills provides advanced practitioner with the opportunity to integrate

  2. Portfolio use as a tool to demonstrate professional development in advanced nursing practice.

    PubMed

    Hespenheide, Molly; Cottingham, Talisha; Mueller, Gail

    2011-01-01

    A concrete way of recognizing and rewarding clinical leadership, excellence in practice, and personal and professional development of the advanced practice registered nurse (APRN) is lacking in the literature and healthcare institutions in the United States. This article presents the process of developing and evaluating a professional development program designed to address this gap. The program uses APRN Professional Performance Standards, Relationship-Based Care, and the Magnet Forces as a guide and theoretical base. A key tenet of the program is the creation of a professional portfolio. Narrative reflections are included that illustrate the convergence of theories. A crosswalk supports this structure, guides portfolio development, and operationalizes the convergence of theories as they specifically relate to professional development in advanced practice. Implementation of the program has proven to be challenging and rewarding. Feedback from APRNs involved in the program supports program participation as a meaningful method to recognize excellence in advanced practice and a clear means to foster ongoing professional growth and development.

  3. Capacity Ratios to Assess the Solvency of a College’s Advanced Pharmacy Practice Experience Program

    PubMed Central

    McClellan, Nicole H.; Byrd, Debbie C.

    2013-01-01

    Objective. To use the capacity ratio to determine solvency in 10 advanced pharmacy practice experiences (APPEs) offered by a college of pharmacy. Methods. Availability in each APPE was determined based on preceptor responses, and student need was tabulated from 3 preference forms. Capacity ratios were calculated by dividing preceptor availability by the sum of student requests plus 20% of student requests; ratios ≥ 1 indicated solvency. For the 3 required APPEs, minimum capacity ratios were calculated by dividing availability by the sum of student number plus 20% of the student number. When possible, the capacity ratio for the APPE was calculated by geographic zone. Results. The 3 required APPEs had statewide minimum capacity ratios that were consistent with solvency: advanced community (2.8), advanced institutional (1.6), and ambulatory care (2.5). Only 3 of 7 elective APPEs demonstrated solvency. The elective APPEs for which requests exceeded availability were association management (0.8), emergency medicine (0.8), cardiology (0.6), and human immunodeficiency virus (HIV) ambulatory care clinic (0.4). Analysis by zone revealed additional insolvent practice experiences in some locations. Conclusions. The capacity ratio allowed for assessment of 10 APPEs and identification of practice experience areas that need expansion. While the capacity ratio is a proposed standardized assessment, it does have some limitations, such as an inability to account for practice experience quality, scheduling conflicts, and geographic zone issues. PMID:23519687

  4. Caring for Special Populations: Total Pain Theory in Advanced Heart Failure: Applications to Research and Practice

    PubMed Central

    Goebel, Joy R.; Doering, Lynn V.; Lorenz, Karl A.; Maliski, Sally L.; Nyamathi, Adeline M.; Evangelista, Lorraine S.

    2010-01-01

    PURPOSE Describe total pain theory and apply it to research and practice in advanced heart failure (HF). SOURCE OF INFORMATION Total pain theory provides a holistic perspective for improving care, especially at the end of life. In advanced HF, multiple domains of well-being known to influence pain perception are adversely affected by declining health and increasing frailty. A conceptual framework is suggested which addresses domains of well-being identified by total pain theory. CONCLUSION By applying total pain theory, providers may be more effective in mitigating the suffering of individuals with progressive, life-limiting diseases. PMID:19691653

  5. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance.

    PubMed

    Carter, Christine E; Grahn, Jessica A

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the "contextual interference effect." While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  6. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance

    PubMed Central

    Carter, Christine E.; Grahn, Jessica A.

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the “contextual interference effect.” While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  7. The dynamics of psychiatric bed use in general hospitals.

    PubMed

    Slade, Eric P; Goldman, Howard H

    2015-03-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N = 7,831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100 % occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events.

  8. The dynamics of psychiatric bed use in general hospitals

    PubMed Central

    Slade, Eric P; Goldman, Howard H

    2014-01-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N=7831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100% occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events. PMID:24756929

  9. Advancing the practice of health impact assessment in Canada: Obstacles and opportunities

    SciTech Connect

    McCallum, Lindsay C.; Ollson, Christopher A.; Stefanovic, Ingrid L.

    2015-11-15

    Health Impact Assessment (HIA) is recognized as a useful tool that can identify potential health impacts resulting from projects or policy initiatives. Although HIA has become an established practice in some countries, it is not yet an established practice in Canada. In order to enable broader support for HIA, this study provides a comprehensive review and analysis of the peer-reviewed and gray literature on the state of HIA practice. The results of this review revealed that, although there is an abundance of publications relating to HIA, there remains a lack of transparent, consistent and reproducible approaches and methods throughout the process. Findings indicate a need for further research and development on a number of fronts, including: 1) the nature of HIA triggers; 2) consistent scoping and stakeholder engagement approaches; 3) use of evidence and transparency of decision-making; 4) reproducibility of assessment methods; 5) monitoring and evaluation protocols; and, 6) integration within existing regulatory frameworks. Addressing these issues will aid in advancing the more widespread use of HIA in Canada. - Highlights: • Reviewed current state of practice in the field of HIA • Identified key obstacles and opportunities for HIA advancement • Major issues include lack of consistent approach and methodology. • No national regulatory driver hinders opportunity for widespread use of HIA. • Identified research opportunities vital to developing HIA practice in Canada.

  10. Developing a professional poster: four "ps" for advanced practice nurses to consider.

    PubMed

    Bindon, Susan L; Davenport, Joan M

    2013-01-01

    Professional posters play an important role in the dissemination of knowledge and the professional development of advanced practice nurses, graduate students, and clinical faculty. Posters should be considered an integral component in communication of professional work in practice, research, and education. The invitation to submit a poster abstract is an important opportunity for clinicians and faculty alike to consider. Though sometimes misperceived as less prestigious than a podium presentation, posters add a unique element to professional and academic events. The argument is made for posters as an equal among scholarly presentation formats. The poster serves as a tremendous opportunity for collaboration between partners and a way to communicate important findings and advertise the presenters' work. For the advanced practice nurse who is a novice in presenting best practice or evidence from research trials, the poster format may be less intimidating while allowing the invaluable sharing of results. Four critical elements of professional poster development are deciding on a clear Purpose, targeting the right People, outlining key steps in the Process, and delivering a memorable Presentation. Using the "4 Ps" as cornerstones for the work of developing, preparing, and delivering the poster to an audience, the authors aim to help organize the entire process into these essential considerations. The poster, as a means of scholarly work, is a viable and essential activity, as interdisciplinary collaboration and sharing of best practice becomes the expectation for all professional development.

  11. The effect of state laws on the supply of advanced practice nurses.

    PubMed

    Kalist, David E; Spurr, Stephen J

    2004-12-01

    This paper considers how the decision to enter advanced practice nursing (e.g., the occupations of nurse practitioner, certified nurse-midwife, nurse anesthetist, and clinical nurse specialist) is affected by State laws on the scope of practice of APNs. We find that enrollments in APN programs are 30 percent higher in States where APNs have a high level of professional independence. Our work differs from previous studies by estimating a fixed effects model on cross-sectional and time series data, to avoid problems of endogeneity of State laws.

  12. The impact of interprofessional collaboration on the effectiveness, significance, and future of advanced practice registered nurses.

    PubMed

    Brooten, Dorothy; Youngblut, JoAnne M; Hannan, Jean; Guido-Sanz, Frank

    2012-06-01

    Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma

    PubMed Central

    Batra, U; Parikh, PM; Prabhash, K; Tongaonkar, HB; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, SK; Rajappa, S; Rajendranath, R; Rawal, SK; Singh, Manisha; Singh, R; Somashekhar, SP; Sood, R

    2016-01-01

    The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of “Take Home Messages” at the end is a convenient tool for busy practitioners. PMID:28032079

  14. The role of the nurse executive in fostering and empowering the advanced practice registered nurse.

    PubMed

    Talbert, Tukea L

    2012-06-01

    The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders.

  15. [Psychiatric medicine].

    PubMed

    Ibañez Dominguez, J

    1984-06-01

    The author, after a short historical introduction which shows the Medicine, especially the Neurology, as the predecessor of the Psychiatry, intents to relate in a theorico-practical way the anxiety and the depression within a bio-chemical and endocrinological frame. He presents the hipo and hipercalcemia signals and symptoms demonstrating with a casuistic from his clinical practice the similitude between anxiety and depression respectively. Finally he realizes a theorical analysis about the investigations published over the AMP-ciclic and infers about the hormonal interference and the clinical data linked with the manic-depressive disease.

  16. Evidence based practice and advanced competencies in a MHS-CLS program.

    PubMed

    Russell, Barbara; Kraj, Barbara; Pretlow, Lester; Ranne, Anne; Leibach, Elizabeth K

    2011-01-01

    The goals, curriculum, implementation, and immediate impacts of an entry-level Master of Health Science in Clinical Laboratory Science (MHS-CLS) degree are described as compared to the baccalaureate program (BS-CLS) in the same institution. The MHS-CLS program was instituted in fall semester, 2008; the inaugural class graduated in spring semester 2010. To document the need for the MHS-CLS, program statistics, such as the number of students entering the current BS-CLS program with previous baccalaureate degrees, numbers of students graduating with biology and chemistry degrees in the United States, CLS workforce shortages and pending retirement statistics were used. The shortage of CLS practitioners able to perform and publish evidence-based practice research also supported program need. The MHS-CLS curriculum includes advanced courses, advanced competencies incorporated into existing BS-CLS courses, and a capstone research project in evidence based practice.

  17. Donation after cardiac death: ethical dilemmas and implications for advanced practice nurses.

    PubMed

    Everidge, Caryn S

    2012-01-01

    Donation after cardiac death has always presented ethical concerns among health care providers. As advanced practice nurses and critical care nurses, it is our responsibility to ensure that health care providers and families are educated about the process and that we remain advocates for the potential donors. This article reviews the donation after cardiac death process, provides a donation after cardiac death hypothetical case report and its outcome, and addresses the ethical concerns associated with donation after cardiac death from both opponents' and proponents' points of view. It will also discuss the benefits of obtaining a palliative care consult and the roles of the advanced practice nurse in the care of the potential donor.

  18. Advanced practice role characteristics of the community/public health nurse specialist.

    PubMed

    Robertson, Julie Fisher; Baldwin, Karen Brandt

    2007-01-01

    The purpose of this qualitative study was to describe the advanced practice role of nurses with master's degrees in community/public health nursing using their experiences and perspectives. The purposive sample consisted of 10 nurses who had master's degrees in community/public health nursing and were working in a variety of community health settings. Data were collected using audiotaped interviews and 1-day observations of study participants in their workplaces. An editing analysis technique was used to analyze the data. Findings indicated that role characteristics included advocacy and policy setting at the organizational, community, and state levels; a leadership style centered on empowerment; a broad sphere of influence; and high-level skills in large-scale program planning, project management, and building partnerships. Results provide important descriptive data about significant aspects of the advanced practice role of nurses with master's degrees in community/public health nursing.

  19. Infusing informatics into interprofessional education: the iTEAM (Interprofessional Technology Enhanced Advanced practice Model) project.

    PubMed

    Skiba, Diane J; Barton, Amy J; Knapfel, Sarah; Moore, Gina; Trinkley, Katy

    2014-01-01

    The iTEAM goal is to prepare advanced practice nurses, physicians and pharmacists with the interprofessional (IP) core competencies (informatics, patient centric, quality-focused, evidence based care) to provide technology enhanced collaborative care by: offering technology enhanced learning opportunities through a required informatics course, advanced practice courses (team based experiences with both standardized and virtual patients) and team based clinical experiences including e-health experiences. The innovative features of iTEAM project will be achieved through use of social media strategies, a web accessible Electronic Health Records (EHRs) system, a Virtual Clinic/Hospital in Second Life, various e-health applications including traditional telehealth tools and consumer oriented tools such as patient portals, social media consumer groups and mobile health (m-health) applications for health and wellness functions. It builds upon the schools' rich history of IP education and includes clinical partners, such as the VA and other clinical sites focused on care for underserved patient populations.

  20. Implementation of a professional portfolio: a tool to demonstrate professional development for advanced practice.

    PubMed

    Chamblee, Tracy B; Dale, Juanita Conkin; Drews, Barbie; Spahis, Joanna; Hardin, Teri

    2015-01-01

    The literature has a gap related to professional development for APRNs. In the United States, many health care organizations use clinical advancement programs for registered nurses, but APRNs are not often included in these programs. If APRNs are included, advancement opportunities are very limited. At CMC, implementation of a professional portfolio resulted in increased satisfaction among APPs regarding their ability to showcase professional growth and expertise, as well as the uniqueness of their advanced practice. Use of the professional portfolio led to improved recognition by APS and organizational leaders of APP performance excellence during the annual performance evaluation, as well as improved recognition among APP colleagues in terms of nominations for honors and awards.

  1. [Curriculum for additional advanced specialist training in psychotherapy--concept and initial experience in practice].

    PubMed

    Fritzsche, Kurt

    2008-01-01

    The regulations for advanced specialist training passed by the German Medical Council in May 2003 make it possible for any clinical physician to complete advanced training for "specialty-related psychotherapy". Critics see this as a "watering down" of medical psychotherapy. The majority applaud the greater proximity to practice and the possibility of achieving psychosomatic expertise. The new advanced specialist training regulations permit therapeutic interventions by the primary care physician beyond psychosomatic primary care. A curriculum has been developed in the Department of Psychosomatic Medicine and Psychotherapy of the University Hospital Freiburg, which has completed the pilot phase and is now offered in block courses over a period of 2 years. We present here experience with the new concept and the results of the evaluation.

  2. Reflections on ethnocentrism and racism: a challenge for advanced practice nurses.

    PubMed

    Harris, S H; Cummings, S H

    1996-01-01

    As nurses and patient populations increasingly reflect the changing demographics of the United States, it will be necessary for nurses to address the critical issues surrounding a multicultural society. Nurses have been relatively quiet on the topic of ethnocentric and racist behavior. If advanced practice nurses are to be successful in assisting nurses and organizations to embrace cultural diversity, understanding ethnocentric and racist behaviors is key to developing strategies to facilitate the provision of culturally competent care.

  3. Expert googling: best practices and advanced strategies for using google in health sciences libraries.

    PubMed

    Ripple, Ammon S

    2006-01-01

    Google is the search engine of choice for most Internet users. For a variety of reasons, librarians and other expert searchers do not always use Google to its full potential, even though it provides capabilities not possible in traditional bibliographic databases and other search engines. Applying expert searching principles and practices, such as the use of advanced search operators, information retrieval strategies, and search hedges to Google will allow health sciences librarians to find quality information on the Internet more efficiently and effectively.

  4. Implications for Advanced Nursing Practice in the Patient with Heat Stress

    DTIC Science & Technology

    1993-05-01

    systemic vascular resistance), while elderly patients are hypodynamic (increased heart rate, decreased cardiac output and decreased systemic vascular...resistance). By the time elderly patients are seen, massive volume deficits may exist, requiring hemodynamic monitoring to differentiate pump...TITLE AND SUBTITLE 5. FUNDING NUMBERS Implications for Advanced Nursing Practice in the Patient with Heat Stress 6. AUTHOR(S) Patricia A Skelton S 7

  5. Developing Structured-Learning Exercises for a Community Advanced Pharmacy Practice Experience

    PubMed Central

    Thomas, Renee Ahrens

    2006-01-01

    The recent growth in the number of pharmacy schools across the nation has resulted in the need for high-quality community advanced pharmacy practice experience (APPE) sites. A vital part of a student's education, these APPEs should be structured and formalized to provide an environment conducive to student learning. This paper discusses how to use a calendar, structured-learning activities, and scheduled evaluations to develop students' knowledge, skills, and abilities in a community pharmacy setting. PMID:17136164

  6. Teaching transcendental meditation in a psychiatric setting.

    PubMed

    Candelent, T; Candelent, G

    1975-03-01

    For two and a half years the authors have taught Transcendental Meditation (TM) to psychiatric patients at the Institute of Living in Hartford, Connecticut. They have also presented programs to hospital staff to acquaint them with the technique and practice of TM. In this paper they describe briefly the instruction program given to patients at the institute and point out some of the benefits of regular practice of TM for psychiatric patients.

  7. Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety.

    PubMed

    Walker, Evan; McMahan, Ryan; Barnes, Deborah; Katen, Mary; Lamas, Daniela; Sudore, Rebecca

    2017-09-21

    Documenting patients' advance care planning wishes is essential to providing value-aligned care, as is having this documentation readily accessible. Little is known about advance care planning documentation practices in the electronic health record. Describe advance care planning documentation practices and the accessibility of documented discussions in the electronic health record. Participants were primary care patients at the San Francisco VA Medical Center, were ≥60 years old, and had ≥2 chronic/serious health conditions. In this cross-sectional study, we assessed the prevalence of advance care planning documentation, including any legal forms/orders and discussions in the prior five years. We also determined accessibility of discussions (i.e., accessible centralized posting vs. inaccessible free-text in progress notes). The mean age of 414 participants was 71 years (SD ±8), 9% were women, 43% were non-white, and 51% had documented advance care planning including 149 (36%) with forms/orders and 138 (33%) with discussions. Seventy-four participants (50%) with forms/orders lacked accompanying explanatory documentation. Most (55%) discussions were not easily accessible, including 70% of those documenting changes in treatment preferences from prior forms/orders. Half of chronically ill, older participants had documented advance care planning, including one third with documented discussions. However, half of the patients with completed legal forms/orders had no accompanying documented explanatory discussions, and the majority of documented discussions were not easily accessible, even when wishes had changed. Ensuring that patients' preferences are documented and easily accessible is an important patient safety and quality improvement target to ensure patients' wishes are honored. Copyright © 2017. Published by Elsevier Inc.

  8. Advanced practice nursing for enduring health needs management: a global perspective.

    PubMed

    Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D; Richardson, Jim; Savage, Eileen; Schorn, Mavis

    2012-07-01

    Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.

  9. Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

    PubMed

    Johnson, Charisse L; Crawford, Stephanie Y; Lin, Swu-Jane; Salmon, J Warren; Smith, Miriam Mobley

    2009-02-19

    To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

  10. Neighborhood Geographical Factors and the Presence of Advanced Community Pharmacy Practice Sites in Greater Chicago

    PubMed Central

    Crawford, Stephanie Y.; Lin, Swu-Jane; Salmon, J. Warren; Smith, Miriam Mobley

    2009-01-01

    Objectives To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Methods Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Results Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Conclusion Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities. PMID:19513145

  11. An advanced practice nursing program for foreign medical doctors: a practical approach.

    PubMed

    Alpert, Patricia T; Yucha, Carolyn B; Atienza, Manuel

    2013-01-01

    This article articulates lessons learned about an accelerated family nurse practitioner course offered to foreign medical doctors who also held baccalaureate nursing degrees (BSN). In the last decade, many physicians in the Philippines returned to school to obtain BSN degrees and licensure as registered nurses (referred to as nurse-medics) to emigrate to the United States in the hope of a better life. Once in the United States, many remain in nursing even though they prefer the practice of medicine. This fast-track master's degree program began in fall 2006 at a university in the southwestern United States in collaboration with St. Jude College in the Philippines. By the end of this program (2010), 76 students had graduated. All who sat for the FNP national certification exam passed on the first attempt. Due to a decrease in qualified applicants, the program eventually closed, but a number of important lessons were learned. Nursing programs planning to undertake accelerated programs to transition medical doctors to nurse practitioners should consider they retake courses such as physical assessment, pharmacology and pathophysiology.

  12. [Movement disorders is psychiatric diseases].

    PubMed

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva

    2014-12-01

    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

  13. Innovations in performance assessment: a criterion based performance assessment for advanced practice nurses using a synergistic theoretical nursing framework.

    PubMed

    Scarpa, Raymond; Connelly, Patricia E

    2011-01-01

    Health care organizations that employ advanced practice nurses are challenged to evaluate practice at this advanced level. Current evaluation methods tend to inter-mingle basic nursing competencies with competencies found in medical practice and organizational objectives that are typically derived from human resources departments. This article describes the development of a criterion-based job performance assessment for advanced nursing practice using a framework rooted in a nursing theory. A needs analysis; review of the literature, adaptation of nursing's Synergy Model, and input from various stakeholders guided the development of a generic job description. This job description progressed into a criterion-based performance assessment. Construct validity was tested using a questionnaire administered to a convenience sample of 9 practicing advanced practice nurses, 2 nurse executives, 1 PhD nurse educator, and 1 physician. Autonomy, job satisfaction, and quality improvement for advanced practice nurses are fostered by a review process that defines roles and competencies specific to advanced nursing practice. Peer review, a concept contributing to this process is explored as a means to monitor and improve practice.

  14. A descriptive study of point-of-care reference resource use by advanced practice RNs in Texas.

    PubMed

    Bischoff, Whitney Rogers; Hinojosa, Rogelio H

    2013-11-01

    This descriptive study replicates and extends previous research on advanced practice RNs and the (1) reference resources available to them at the point of care, (2) resources they use to inform their clinical practice, and (3) resources they are accessing from handheld electronic devices such as PDAs, smartphones, and tablet computers during practice. These elements formed the purpose of the current study. A sample of advanced practice RNs from Texas Public Health Region 11 was surveyed. Available resources were current journals appropriate to setting and current clinical guidelines. These advanced practice RNs "always or frequently" based their professional practice on personal experience of caring for patients/clients over time, information learned in college/university, and information learned about each patient/client as an individual. Responses for Hispanic respondents as well as electronic device users were similar. Content and features accessed daily by handheld computer devices were reference materials, e-mail, address/phonebook, Internet access other than e-mail, calendar/date book, alarm/reminder, calculator, and memo pad. Software installed on handheld devices and used daily included drug references, medical text/reference book, medical math/formula calculator, practice guidelines, and language translator/dictionary. Respondents who did not report using handheld devices at work were older, had more years in advanced practice nursing, and were more likely to work in a hospital, birthing center, or institution such as a prison, school, or military facility. There was no difference in resource or electronic device use by Hispanic advanced practice RNs. Electronic resources for practice are growing and being used by advanced practice RNs. Consideration should be given to incorporating evaluation and implementation of electronic clinical resources into advanced practice RN educational programs. Future research should include greater detail about the origin of

  15. Cultural Issues in Psychiatric Administration and Leadership

    PubMed Central

    Aggarwal, Neil Krishan

    2016-01-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation’s largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges. PMID:26071640

  16. Cultural Issues in Psychiatric Administration and Leadership.

    PubMed

    Aggarwal, Neil Krishan

    2015-09-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges.

  17. Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice.

    PubMed

    Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

    2017-01-01

    (1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Assessing the Spread and Uptake of a Framework for Introducing and Evaluating Advanced Practice Nursing Roles.

    PubMed

    Boyko, Jennifer A; Carter, Nancy; Bryant-Lukosius, Denise

    2016-08-01

    Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and it is difficult to ascertain their spread into research, practice, and policy using existing methods. The purpose of this article is to report results of a study on the spread and uptake of an evidence-based framework (i.e., the participatory, evidence-based, patient-focused process for advanced practice nursing [PEPPA] framework) into research, practice, and policies relevant to the introduction and evaluation of advanced practice nursing roles. We also reflect on the utility of using a modified citation methodology to evaluate knowledge translation efforts. We searched four databases for literature published between 2004 and 2014 citing the original paper in which the PEPPA framework was published, and carried out an Internet search for grey literature using keywords. Relevant data were extracted from sources and organized using NVivo software. We analysed results descriptively. Our search yielded 164 unique sources of which 69.5% were from published literature and the majority (83.4%) of these were published in nursing journals. Most frequently (71.5%), the framework was used by researchers and students in research studies. A smaller number of citations (11.3%) reflected use of the PEPPA framework in practice settings with a focus on role development, implementation, evaluation, or a combination of these. This study demonstrates that the PEPPA framework has been used to varying degrees as intended, and provides guidance on how to evaluate the spread and uptake of research outputs (e.g., theoretical frameworks). Further research is needed about ways to determine whether evidence-informed research tools such as frameworks have been

  19. Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance.

    PubMed

    Louridas, M; Bonrath, E M; Sinclair, D A; Dedy, N J; Grantcharov, T P

    2015-01-01

    Mental practice, the cognitive rehearsal of a task without physical movement, is known to enhance performance in sports and music. Investigation of this technique in surgery has been limited to basic operations. The purpose of this study was to develop mental practice scripts, and to assess their effect on advanced laparoscopic skills and surgeon stress levels in a crisis scenario. Twenty senior surgical trainees were randomized to either conventional training or mental practice groups, the latter being trained by an expert performance psychologist. Participants' skills were assessed while performing a porcine laparoscopic jejunojejunostomy as part of a crisis scenario in a simulated operating room, using the Objective Structured Assessment of Technical Skill (OSATS) and bariatric OSATS (BOSATS) instruments. Objective and subjective stress parameters were measured, as well as non-technical skills using the Non-Technical Skills for Surgeons rating tool. An improvement in OSATS (P = 0.003) and BOSATS (P = 0.003) scores was seen in the mental practice group compared with the conventional training group. Seven of ten trainees improved their technical performance during the crisis scenario, whereas four of the ten conventionally trained participants deteriorated. Mental imagery ability improved significantly following mental practice training (P = 0.011), but not in the conventional group (P = 0.083). No differences in objective or subjective stress levels or non-technical skills were evident. Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  20. Training Advanced Practice Providers to Collect Functional Outcomes After Fragility Fractures

    PubMed Central

    Wang, Tiffany L.; Ames, Tyler D.; Le, Khoi M.; Wee, Corinne; Phieffer, Laura S.

    2015-01-01

    Objective: The objective of this study was to determine whether advanced practice providers could learn to collect objective functional assessment data accurately and efficiently with commercially available devices that measure kinematics and kinetics (Nintendo Wii Balance Board [WBB] and Level Belt [LB]) to aid in the assessment of fall risk and outcomes after fragility fractures. Methods: Nine advanced practice providers participated in a 1-hour clinical assessment tools (CATs) training session on equipment use, providing standardized instructions, and practice of the testing procedures. Afterward, they participated in a skills demonstration evaluation and completed a postsession survey. Results: Participants successfully achieved a mean of 18.22 (standard deviation 1.56) of 20 performance measures. Of the incomplete or omitted tasks, the majority (10 of 16) occurred within the first of 3 CATs activities. Postsession survey results revealed that 9 of 9 participants reported that the 1 hour provided for training on the CATs was sufficient. All participants reported that after the training, they felt confident they could reliably carry out the tasks to test patients on both the WBB and the LB. The majority of participants reported that they believed that the WBB (7 of 9) and LB (8 out of 9) would be good assets to clinics in assessing patient functionality after fragility fractures. Conclusion: These results indicate that advanced practice providers can confidently learn and effectively test patients with the WBB and LB within 1 hour of training. In the future, adoption of CATs in the clinical setting may allow for objective, easy-to-use, portable, noninvasive, and relatively inexpensive measures to assess functional outcomes in patients with fragility fracture. PMID:26328225