Facilitating Social Integration for People With Severe Mental Illness Served by Assertive Community Treatment.

PURPOSE: This article explores the experience of workers on Assertive Community Treatment (ACT) teams surrounding their efforts to facilitate social integration for their clients. DESIGN AND METHODS: Sixteen workers were individually interviewed and eight additional workers participated in two focus groups. FINDINGS: The formation of caring relationships between worker and client was an important first step towards social integration for ACT clients. Community activities offer opportunities for social interaction. PRACTICE IMPLICATIONS: The frequency of community based activities should be increased. Social integration should be a targeted focus of service by structurally embedding a social integration specialist onto the ACT model.

Exploring nurses' personal dignity, global self-esteem and work satisfaction.

BACKGROUND: This study examines nurses' perceptions of dignity in themselves and their work. Nurses commonly assert concern for human dignity as a component of the patients' experience rather than as necessary in the nurses' own lives or in the lives of others in the workplace. This study is exploratory and generates potential relationships for further study and theory generation in nursing. RESEARCH QUESTIONS: What is the relationship between the construct nurses' sense of dignity and global self-esteem, work satisfaction, and identified personal traits? PARTICIPANTS AND RESEARCH CONTEXT: This cross-sectional correlation study used a stratified random sample of nurses which was obtained from a US University alumni list from 1965 to 2009 (N = 133). ETHICAL CONSIDERATIONS: University Institutional Review Board approval was achieved prior to mailing research questionnaire packets to participants. Participation was optional and numerical codes preserved confidentiality. FINDINGS: Statistical results indicated a moderately strong association between the nurse's sense of personal dignity and self-esteem (rx = .62, p = .000) with areas of difference clarified and discussed. A positive but moderate association between nurses' personal dignity and nurses' work satisfaction (rx = .37, p = .000) and a similar association between self-esteem and nurses' work satisfaction (rs = .29, p = .001) were found. A statistically significant difference was found (F = 3.49 (df = 4), p = .01) for dignity and categories of spiritual commitment and for nurses' personal dignity when ratings of health status were compared (F = 21.24 (df = 4), p = .000). DISCUSSION: Personal sense of dignity is discussed in relation to conceptual understandings of dignity (such as professional dignity) and suggests continued research in multiple cultural contexts. CONCLUSION: The relationships measured show that nurses' sense of dignity has commonalities with self-esteem, workplace satisfaction, spiritual commitment, and health status; the meaning of the findings has ramifications for the welfare of nurses internationally.

Relationships among health promotion behaviors, patient engagement, and the nurse practitioner-patient partnership.

BACKGROUND: Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion. PURPOSE: This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting. METHODOLOGY: A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index). RESULTS: Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors (R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors. CONCLUSIONS: Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients. IMPLICATIONS: Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.

Celebrate Birth!-Amazing Grace: Remembering Pregnancy and Birth.

Our daughter and son were born at the Maternity Center in NYC in 1986 and 1989, respectively. I am grateful to the exceptional care and freedom the nurse midwives were able to provide to our family. What follows is the expression of that deeply personal and profound experience, which will hopefully remind and inspire women of the truly individual and extraordinary gift of birth.

Articulating the value of psychiatric community health nurse interventions: a secondary analysis.

The purpose of this secondary analysis of qualitative data was to discover and articulate the nature and value of therapeutic nursing interventions (TNIs) utilized by psychiatric community health nurses (PCHNs). PCHNs encounter ethical conflict when faced with increasingly strict payment limitations on nursing practice (Sturm, 2004). This new analysis provides evidence of how TNIs, executed with a high level of sensitivity and skill, enable the PCHN to address and effectively manage the complex healthcare needs of patients with chronic mental illness. The author/researcher specifically analyzed qualitative data from two broad thematic categories of an ethnographic study of PCHN practice to explicate the nature and impact of TNIs employed by PCHNs in efforts to provide high-quality care. Specific TNIs were observed to be an integral part of the nurse-patient relationship and were executed by the PCHN, influencing patient self-esteem, socialization, and the capacity for autonomy.

Albutropin: a growth hormone-albumin fusion with improved pharmacokinetics and pharmacodynamics in rats and monkeys.

Growth hormone (GH) replacement therapy is used to treat GH deficiency. Treatment requires daily administration because of the short plasma t(1/2) of GH. Albutropin, human GH fused at its N-terminus with human serum albumin, should be cleared from the circulation more slowly than GH. Pharmacokinetic and pharmacodynamic studies of albutropin were conducted in rats and monkeys. After subcutaneous (s.c.) dosing in rats, a twofold decrease in clearance and a fourfold increase in plasma half-life were seen with albutropin compared to GH. In monkeys, s.c. administered albutropin (0.3 mg/kg) had a sixfold longer terminal half-life and an eightfold slower clearance than GH (0.3 mg/kg). A single subcutaneous administration of albutropin (0.3, 1.5 and 4 mg/kg) increased plasma insulin-like growth factor 1 (IGF-1) levels for up to 7 days. Seven consecutive daily s.c. injections of GH at 0.3 mg/kg resulted in an increase in IGF-1 equivalent to that induced by a single administration of albutropin at 4 mg/kg. Albutropin (1-20 microg/kg) dosed daily, every other day or every 4 days significantly increased cumulative body weight gain and tibial epiphyseal growth plate width in hypophysectomized rats compared to equimolar doses of GH. These results suggest that albutropin could be given less frequently than GH and achieve therapeutic effects in patients.

The phenomenon of social isolation in the severely mentally ill.

PURPOSE: The phenomenon of social isolation is closely linked with the experience of having a severe mental illness (SMI). This paper offers scholarly perspectives and analyses of the phenomenon of social isolation as it applies to people with SMI by highlighting relevant definitional, historical, theoretical, and conceptual understanding surrounding this phenomenon. CONCLUSIONS: Stigma, alienation, and existential loneliness when taken together provide an understanding of the multidimensional problem of social isolation for people with SMI. PRACTICE IMPLICATIONS: Mental health services should be provided which take into account the importance of human contact and social connection for people who live with SMI. Services can be offered which are designed to develop social skills, as well as to create opportunities for social connection and community involvement.

Ethics and care: an ethnographic study of psychiatric community health nursing practice.

The purpose of this ethnographic study was to explore, describe, and document the practice of a group of psychiatric community health nurses (CHNs), and to provide a forum through which their voices could be heard. Discovery of the nature of issues CHNs experience in an effort to meet the needs of patients with mental illness was the focus. The paper describes the ethical conflict experienced by many of these nurses who wanted to provide beneficial, high-quality care to patients with mental illness but encountered obstacles in practice. Insight into the difficulties nurses experience in applying an ethic of care in the context of administrative constraints, resulting from the strict regulatory mechanisms imposed by third party insurance payers is provided. The negative impact of increasingly stricter payment restrictions on nursing practice and on quality of care is exposed.

Generation and characterization of LymphoStat-B, a human monoclonal antibody that antagonizes the bioactivities of B lymphocyte stimulator.

OBJECTIVE: To identify and characterize a fully human antibody directed against B lymphocyte stimulator (BLyS), a tumor necrosis factor-related cytokine that plays a critical role in the regulation of B cell maturation and development. Elevated levels of BLyS have been implicated in the pathogenesis of autoimmune diseases. METHODS: A human phage display library was screened for antibodies against human BLyS. A human monoclonal antibody, LymphoStat-B, specific for human BLyS was obtained from the library screening and subsequent affinity optimization mutagenesis. The antibody was tested for inhibition of human BLyS in vitro and in an in vivo murine model. Additionally, the consequences of BLyS inhibition were tested in vivo by administration of LymphoStat-B to cynomolgus monkeys. RESULTS: LymphoStat-B bound with high affinity to human BLyS and inhibited the binding of BLyS to its 3 receptors, TACI, BCMA, and BLyS receptor 3/BAFF-R. LymphoStat-B potently inhibited BLyS-induced proliferation of B cells in vitro, and administration of LymphoStat-B to mice prevented human BLyS-induced increases in splenic B cell numbers and IgA titers. In cynomolgus monkeys, administration of LymphoStat-B resulted in decreased B cell representation in both spleen and mesenteric lymph nodes. CONCLUSION: A fully human monoclonal antibody has been isolated that binds to BLyS with high affinity and neutralizes human BLyS bioactivity in vitro and in vivo. Administration of this antibody to cynomolgus monkeys resulted in B cell depletion in spleen and lymph node. This antibody may prove therapeutically useful in the treatment of autoimmune diseases in humans.