Critical incident stress debriefing: a health promotion model for workplace violence.

PURPOSE: To view the global impact of violence as a critical incident. DATA SOURCES: Published literature, author's experience. CONCLUSIONS: Psychiatric nurses can use the critical incident stress debriefing protocol to minimize adverse outcomes after a traumatic event. Workplace violence threatens the safety and well-being of nurses. Psychiatric nurses are more likely to encounter workplace violence than nurses in other settings and must prepare themselves using proactive health-promoting activities, for example the critical incident stress debriefing (CISD) model. This health-promotion model provides immediate emotional support and education about normal stress reactions, and may reduce the risk of chronic and disabling emotional and physical consequences.

Creative stress-management techniques for self-renewal.

The daily stress and pressure of today's nurses are profound. As workloads escalate and staffing declines, nurses must be proactive and develop healthier lifestyles. Creative stress management techniques offer health-promoting strategies to manage stress in nurses' lives.

The neurobiology of anxiety disorders: implications for psychiatric nursing practice.

This era of neurobiological advances challenges psychiatric nurses to develop innovative practice models that address the needs of clients with anxiety disorders. Technological discoveries and molecular and genetic research provide a wealth of evidence-based data that serve as the basis of symptom management, prevention, and health promotion and maintenance in clients experiencing anxiety disorders. This article provides an overview of current data-based studies and conceptual models of various anxiety disorders and their key components. Underpinnings include the interrelationship among neurotransmitter systems, neuroendocrinological processes, and neuroanatomical structures and their role in mediating stress, normal anxiety, and various anxiety disorders. Treatment considerations are also an integral part of this article. The discussion of pharmacologic and nonpharmacological interventions reflect dysregulation of intricate neurobiologic processes and concurrent behaviors and individual client needs.

Adrenergic receptor function in panic disorder. II. Neutrophil beta 2 receptors: Gs protein coupling, effects of imipramine treatment and relationship to treatment outcome.

Panic attacks are associated with increased autonomic symptoms, suggesting increased beta 2-adrenergic receptor (beta 2AR) function in PD. Tricyclic antidepressants downregulate beta AR function. Previous studies on beta AR function in PD, however, are inconsistent. We recently found increased beta AR coupling and density in neutrophils of symptomatic drug-free PD patients. This study evaluated beta AR coupling to Gs protein in 28 controls, 25 drug-free PD patients and 8 PD imipramine-treated patients. PD patients had significantly higher coupling and receptor density, particularly in the high-conformational state. Differences were more pronounced in patients with less depressive symptomatology. Treatment with imipramine was associated with decreased beta AR coupling and density in the high-conformational state. Several beta AR binding parameters were related to severity of anxiety symptoms and treatment outcome. Antidepressants downregulate beta AR density and induce uncoupling from Gs protein in PD. Future studies may investigate beta AR coupling in relationship to treatment outcome and the role of beta AR kinase in PD.

Neutrophil beta2-adrenergic receptor coupling efficiency to Gs protein in subjects with post-traumatic stress disorder and normal controls.

The symptomatology of post-traumatic stress disorder (PTSD) involves sympathetic hyperarousal. Several of these sympathetic symptoms are mediated through end-organ beta2-adrenergic receptors (beta2AR). Increased sympathetic activity in PTSD could therefore be due to increased betaAR function. This study investigated betaAR function in 30 healthy controls and 20 drug-free PTSD patients. BetaAR binding studies were conducted using antagonist-saturation and agonist-displacement experiments. Measures of beta2AR coupling to Gs protein were derived from agonist-displacement experiments. PTSD patients had significantly higher beta2AR density particularly in the high-conformational state and higher beta2AR coupling than controls, as reflected in a higher percentage of receptors in the high conformational state and a higher ratio of the agonist dissociaton constant from the receptor in the low/high-conformational state. Increased betaAR function in PTSD is consistent with the symptomatology of this disorder. Increased betaAR density and coupling may be consistent with downregulation of betaAR density and uncoupling by antidepressants and may underlie their partial efficacy in PTSD. Dysregulation in Gs protein function is postulated and, agonist-mediated regulation of betaAR expression and/or betaAR kinase activity in PTSD should be investigated in future studies.

Platelet alpha2-adrenergic receptor coupling efficiency to Gi protein in subjects with post-traumatic stress disorder and normal controls.

Low platelet membrane alpha2-adrenergic receptor (alpha2AR) density and low basal and forskolin-stimulated cyclic adenosine monophosphate responses, which have been reported in post-traumatic stress disorder (PTSD), suggest either abnormal alpha2AR coupling to G(i) protein or dysregulation in post-receptor signal transduction mechanisms. alpha2AR density in the high- and low-conformational states, agonist affinity in both states and coupling to G(i) protein were investigated in 23 drug-free combat PTSD patients and 25 normal controls. alpha2AR coupling measures were not different between PTSD patients and controls. Total alpha2AR density was higher in PTSD patients than controls, due to a higher density of the receptor in the high-conformational state. There were no differences in agonist affinity to the receptor in either conformational state. Results rule out dysregulation in alpha2AR coupling to G(i) protein. Studies of post-receptor signal transduction mechanisms are warranted.

Adrenergic receptor function in panic disorder. I. Platelet alpha 2 receptors: Gi protein coupling, effects of imipramine, and relationship to treatment outcome.

Various studies suggest alpha 2-adrenergic receptor (alpha 2AR) dysregulation in panic disorder (PD). Platelet alpha 2-AR exist in high- and low-conformational states as a function of their coupling to Gi protein. alpha 2AR coupling is important in signal transduction and is modulated by antidepressants. alpha 2AR density in the high- and low-conformational states, agonist affinity, and coupling efficiency were investigated in 21 healthy controls, 21 drug-free PD patients, and eight imipramine-treated patients using norepinephrine displacement of 3H-yohimbine binding. Percentage of receptors in the high-conformational state (%RH) and the ratio of the agonist dissociation constant to the receptor in the low-/high-conformational state (KL/KH), calculated from displacement experiments, were used as coupling indices. Patients had high alpha 2AR density in both conformational states. %RH and KL/KH ratio were significantly different, particularly in patients with Hamilton scale for depression (HAMD) scores > or = 15. Imipramine treatment (29 weeks) had no effect on alpha 2AR density or coupling, despite improvement in anxiety ratings. High pretreatment alpha 2AR density and coupling predicted low severity of anxiety after treatment. Increased alpha 2AR density and abnormal coupling may represent an adaptive mechanism or trait marker in PD.

Helping the alcoholic patient recover.

The patient may come to your unit because of any of the numerous possible health consequences of alcoholism. Or his dependence may surface after he's admitted for some unrelated problem. In either case, your challenge is to see him through withdrawal and set him on the path to long-term recovery.

Cognitive and affective assessment of the geriatric patient.

Assessing patients' cognitive function requires astute observational skills and a willingness to put aside stereotypes about aging. History taking is an essential aspect of this process and requires nurses to gather information from patients, family members, and significant others. Nurses must assess and distinguish age-related changes from those precipitated by cognitive and mood disorders. In addition, they must be familiar with presenting symptoms of organic disorders such as dementias, and mood disorders such as depression in order to assess older adults for cognitive impairment and collaborate in planning care for these patients.

The patient with schizophrenia: helping you stay in touch with reality.

Patients with schizophrenia can be found in all clinical settings--including medical surgical areas. Hospitalization is an extremely stressful event for most patients, especially those suffering from schizophrenia. It forces them into unfamiliar settings and daily routines that often exaggerate their fears and anxieties, increasing the risk of exacerbation of psychosis. Nurses can take simple steps in dealing with these patients by recognizing increased feelings of helplessness and loss of control related to separation from significant others and fears of the unknown. Nurses can begin by establishing rapport as soon as possible and approaching the patient in a calm and reassuring manner. In addition, they need to identify individual needs, provide safety, and promote a sense of mental and physical well being.

Concerns of the hospitalized and community psychiatric client.

Teaching is an essential aspect of the client's treatment plan. The high incidence of noncompliance and subsequent relapse in the psychiatric client have forced nurses to develop creative teaching strategies embedded with therapy to address these issues. Nurses must involve clients and their families actively in the teaching process and provide ongoing evaluation of the client's response to treatment. Teaching strategies for clients in the hospital and community settings are similar and must be modified by an ongoing assessment based on the client's needs.