A review and application of suicide prevention programs in high school settings.

Teen suicide is a terrible tragedy and is the third leading cause of death among high school children aged 14 to 19. School based intervention programs have been regarded as an effective and essential means of addressing this problem. A comprehensive review of the extant literature provides examination of the risk and protective factors of suicide in this age group, the development of these programs, the current state of the science and recommendations for enhanced assessment and intervention.

Patterns of knowing: proposing a theory for nursing leadership.

In a time of chaotic and unpredictable health care, it is vital for nursing to employ a nursing leadership theory that is specifically applicable to nurses and will holistically, and comprehensively address and support both the science and art of this honored profession. The authors propose that Nursing Leadership Knowing can address and impact the myriad issues confronting managers and administrators within the turbulent health care industry, with the ultimate goals of quality comprehensive patient care and improved employee satisfaction. They believe that Nursing Leadership Knowing, grounded in the realties of nursing experience, is a logical theoretical extension that can be translated into nursing leadership practice particular and specific focus on empirics and evidence-based practice will not attend to the robust and multidimensional underpinnings of the lived experience that is so vital to nursing as a caring profession. The ideal of nursing leadership theory is not a single-focused shadow of its history, but a rich, inclusive, multi-faceted network of knowing. As such, Nursing Leadership Knowing provides a forum for leaders to enhance their practice, as well as their relationship with their employees, which ultimately translates into optimal care for the patients we serve.

Integrating intimate partner violence content across curricula: Developing a new generation of nurse educators.

Abuse between intimate partners can take many forms. Prevalence data analyses confirm that intimate partner violence (IPV) is a widespread problem. Meeting the objectives of World Health Organization's "Global Campaign on Violence Prevention" will involve many organizations and institutions within and beyond the health care community. Educating prospective Nurse Educators about IPV does, however, present challenges, as most nurses lack awareness of IPV as a public health problem, have limited knowledge and erroneous beliefs about IPV, and are inexperienced in caring for survivors of IPV. Thus providing formal education and training in a supportive environment will enhance Nurse Educators' knowledge and skills about IPV while helping them to examine the benefits and limitations of various pedagogical approaches for teaching this critical content to students. Hence targeting educational efforts at nurses who are pursuing the academic role is an important first step toward raising the collective consciousness of nurses to the point that IPV education becomes an integral component of the nursing curriculum, and competence in caring for IPV survivors becomes the standard rather than the exception.

Persons with developmental disability exposed to interpersonal violence and crime: approaches for intervention.

PURPOSE: Psychoeducational and psychotherapeutic interventions, by psychiatric advanced practice registered nurses and caregivers working with people with developmental disabilities exposed to interpersonal violence and crime, are recommended to help the individual resolve the intrapsychic trauma. CONCLUSIONS: Persons with developmental disabilities experience the full affective range of the effects of trauma and may benefit from a variety of interventions. What may be different in comparison to other survivors are the ways psychotherapeutic and psychoeducational interventions are adapted so that emotions, resultant actions, and ongoing concerns can be effectively expressed and addressed. PRACTICE IMPLICATIONS: Advanced practice registered nurses have an important role in addressing the sequelae of trauma by employing flexible, creative, and direct therapy with individuals. Additionally significant is provision of educational and supportive measures for the caregivers, who have the potential to generate an ongoing socially therapeutic environment.

Persons with developmental disabilities exposed to interpersonal violence and crime: strategies and guidance for assessment.

PURPOSE: Persons with developmental disabilities are frequently exposed to interpersonal violence and crime, directed at themselves and others, and are in need of specific interventions tailored to their unique needs. CONCLUSIONS: What may be different in comparison to other survivors are the:ways therapeutic interventions are adapted so that fears and ongoing concerns can be effectively expressed and addressed. PRACTICE IMPLICATIONS: Persons with developmental disabilities may benefit from a variety of interventions in the treatment of intrapsychic trauma after exposure to interpersonal violence and crime.

Patterns of knowing as a foundation for action-sensitive pedagogy.

Graduate students in the health sciences often juggle full-time careers, demanding programs of study, and family responsibilities. Frustration, a perception of limited caring on the part of role models, and a sense of disengagement, or even despair, are common features of postbaccalaureate study for many of them. Nursing has long recognized the value of multiple perspectives in knowledge development. Previous work involving patterns of knowing not only has advanced the disciplinary knowledge base but has also encouraged innovative applications of the patterns to philosophy, evidence-based practice, and research aimed at reducing health disparities. In an effort to both extend the dialogue about ways of knowing and humanize the experience of graduate education for nursing students, the authors propose six patterns of knowing as a foundation for effective, action-sensitive pedagogy.

Caring for the future: strategies for promoting violence prevention in pediatric primary care.

PURPOSE: To identify strategies that will assist nurse practitioners (NPs) to incorporate universal youth violence screening and prevention strategies into their practices. DATA SOURCES: Extensive reviews of the extant literature, clinical and anecdotal information, and professional experiences and encounters were utilized to explore and identify current practice recommendations related to youth violence prevention. CONCLUSIONS: NPs' expertise in health promotion makes them an important member of interdisciplinary team efforts to prevent youth violence. Knowledge of risk factors, appropriately focused assessment, and relevant intervention strategies can assist NPs to fulfill a valuable role in this critical endeavor. IMPLICATIONS FOR PRACTICE: Recently, there has been an increased recognition of the role that healthcare providers at all levels can play in decreasing youth violence. A greater emphasis on strategies already employed by NPs to promote the development of healthy families can contribute greatly to reducing the problem of youth violence. Universal screening for warning signs and level of violence risk in youth, as well as utilizing appropriate interventions and referrals will provide NPs with the opportunity to contribute to this important goal.

The impact of stress management on nurse productivity and retention.

Throughout the history of nursing there is a seeming legacy of personnel shortage, lack of funds, and, based on the nature of the role and related services, heightened levels of stress involved in patient care. The future of the profession, and more imminently, patient care and the health of nurses, may be significantly impacted by repeated challenges where current levels of stress and burnout are contributing to organizational problems, burnout, and attrition. Employee stress and burnout commonly lead to myriad health-related problems that result in significant organizational consequences. There are many methods of stress management, and sometimes the best and most effective begin with simple recognition, validation, and visible and committed efforts by the nurse executive. Regardless of the technique or approach, what is clear is that there is a need for nurse executives to include the development and enhancement of comprehensive stress-management programming for employees as a priority item to avoid burnout and attrition.

Survivors' guilt following sudden traumatic loss: promoting early intervention in the critical care setting.

Survivors' guilt is a pervasive mental health issue that is often initially manifested by family members in the critical care unit. With increased awareness and enhanced targeted assessment, critical care nurses are in a unique position to begin the initial processes of adaptive coping and functional grief and bereavement in surviving family members. Because the trajectory of grief and bereavement are often complex and long term, the additional complication of survivors' guilt can lead to many psychosocial and physical manifestations and sequelae. However, with early identification and intervention relative to the underlying factors of survivors' guilt, including appropriate referral and psychoeducational intervention and resources, critical care nurses can enhance and extend their care to families in the throes of significant and sudden loss and intrapsychic trauma.

Gay-male couples who adopt: challenging historical and contemporary social trends toward becoming a family.

TOPIC: Gay-male couples who adopt children face ongoing challenges that stem from both historical and contemporary social issues. PURPOSE: To examine and identify key points and guidance for advanced practice psychiatric mental health nurses regarding multicultural awareness involved in counseling gay-male couples who explore or exercise their right to adopt and raise children. SOURCES: A comprehensive review of the extant scientific literature and public media, clinical anecdotes, therapeutic experiences, and an examination of Healthy People 2010 as it relates to how community health is profoundly affected by the collective beliefs, attitudes, and behaviors of everyone who lives in the community. CONCLUSIONS: Heterosexism, homophobic fears, oppression, and the general stigma that surround gay-male couples who choose to adopt children are a few of the relevant contemporary issues and community beliefs for which advanced practice psychiatric mental health nurses need to assess, explore, and intervene.

Workplace violence and corporate policy for health care settings.

Incidents of workplace violence have been of significant concern to health care employers and the public at large. Many employers now find themselves confronted with sentinel events in the workplace, such as assault; property damage; racially, ethnically, or religiously motivated violence; sexual assault; employee suicide; or homicide. Regardless of a health care agency's size or mission, when employees are unexpectedly confronted with workplace violence, they are typically overwhelmed with shock and multiple questions surrounding how the event could have occurred in the safety of the workplace. It is difficult to imagine returning to work only minutes after hearing such news and, yet, in this modern era of corporate health care, this is what usually happens. Awareness of the dynamics and issues related to workplace violence can guide policy development and related interventions to promote safety, stability, and provide a platform for adapting to the devastation of such a disturbing event.

Psychological response to disasters: focus on adolescents.

The effects of disasters may predispose many adolescents to psychological stress, which can interfere with their growth and development and disrupt their intrapsychic homeostasis. This may lead to negative long-term health outcomes and hamper normal development. Many nurses view traumatic events involving children, including adolescents, as the most frequent and stressful critical incidents. There is a need to address psychological emergency preparedness for mass disasters with the development of protocols and practice guidelines. Assessing and managing physical injuries may take priority in emergencies, but incorporating rapid, cost-effective mental health assessments for children and adolescents is essential.

Students' self-identified learning needs: a case study of baccalaureate students designing their own death and dying course curriculum.

The knowledge needed to provide competent care to dying clients and their families and to meet the established criteria for effective death and dying curricula was explored by junior-level and senior-level baccalaureate honors students, who identified their own learning needs and resources. After completing the self-designed curriculum, student-identified learning needs were compared to the American Association of Colleges of Nursing competencies for providing high-quality end-of-life care. Analysis of the student-identified objectives revealed a high level of congruity with the nationally established competencies.

Issues and dynamics of sexually assaulted adolescents and their families.

Interpersonal violence such as sexual assault creates a variety of traumatic responses. Adolescents encounter a significantly high rate of exposure to sexual assault. In the aftermath of sexual assault, issues and dynamics related to traumatic responses include ongoing fear and threats to personal safety, stability, and structure of the family and environment. Each issue is of concern for community and health care practitioners. Sexual assault has a detrimental effect on adolescent intrapsychic development and interpersonal relationships. Symptoms are disturbing and disruptive to daily routines, negatively affect adolescent normal growth and development, and can result in post-traumatic stress disorder. Issues and dynamics regarding sexual assault are explored, with suggestions on how to help adolescents avoid developing a negative world view and long-term negative health consequences.

Cries from the morgue.

TOPIC: Family member homicide. PURPOSE: To explore the unique facets of bereavement for a family member of a homicide victim in order to assist clinicians during assessment, evaluation, and intervention with children. SOURCES: The authors' experience in working with children at a child grief center and published literature. CONCLUSIONS: Children experience grief uniquely and use differing methods of coping and adaptation. Knowledge of these differences can assist clinicians with promotion of adaptive coping and grieving in children who have been exposed to murder.

Child and adolescent homicide survivors. Complicated grief and altered worldviews.

The act of homicide may influence the worldviews of children and adolescents. Problematic beliefs of uncertainty, inadequacy, perceiving the world as dangerous, self-denial, and lack of control can contribute to complicated grief in children and adolescents, and can potentially disrupt their normal psychosocial growth and development. Mental health professionals' understanding of grief after the homicide of a family member enhances their ability to intervene with and support young people struggling to cope with and adapt to a sudden loss.

Shaken baby syndrome: assessment, intervention, & prevention.

Child abuse and neglect continue to be parts of a disturbing reality in both the United States and the world. Despite significant advances in the identification and treatment of child abuse, health care professionals are still attempting to grasp the extent of the physiological and psychological effects of child maltreatment and injury. Child abuse, in all of its forms, is preventable, and more must be done to decrease its incidence. Shaken baby syndrome is one of the most deadly and devastating forms of child abuse and is characterized by a traumatic brain injury caused by the violent shaking of an infant. Recognition of high-risk families, combined with education of parents and other caregivers are key to prevention of shaken baby syndrome.

Dying patients' thoughts of ending their lives: a pilot study of rural New Mexico.

Forty-nine hospice patients in rural New Mexico were directly interviewed concerning their thoughts about ending their lives. Thirty-one patients (63%) did not have thoughts of ending their lives, whereas 18 patients (37%) reported having suicidal thoughts. There were no differences between patients with and without thoughts of suicide related to gender; ethnicity; age; education; disease; religion; importance of religion; location of hospice agency; remaining financial, family, or spiritual issues; satisfaction with hospice care; sum of hospice personnel seen; or sum of medical equipment used. There were significant differences between patients with and without thoughts of suicide related to the number of household members (p = .02); the symptoms of trouble sleeping (p = .04) and nervousness (p =.03); and Medicare insurance coverage for hospice care (p =.01). No other symptom, including pain and hopelessness, was significant. Seven (39%) of the 18 patients who thought of ending their lives told someone about these thoughts. There were no variable differences between patients who did and did not tell someone about these thoughts.

When, catastrophe happens. Assessment and intervention after sudden traumatic death.

The goals of grief after sudden traumatic death is to acknowledge the loss, identify the changes the loss will have in the co-victim's life, and reinvest in life within the new structure. Although these goals seem simple, there is no definitive timeline for when these tasks will be engaged and completed by each of the family members. The pathway and time frame for each co-victim may differ.

Benefits of community meetings in the corporate setting after the suicide of a coworker.

When an employee commits suicide, his or her coworkers are confronted unexpectedly with issues related to the sudden traumatic death. Being inundated with questions, grappling with acceptance of the loss, and exploring how this could have happened are factors that can complicate the bereavement process and delay a return to workplace homeostasis. Understanding the dynamics and issues related to grief and bereavement after sudden traumatic death potentially can accelerate the recovery process and promote restoration of workforce normalcy for employees and organizations. This can be significantly important to corporate managers and administrators who must maintain ongoing productivity despite such disruption, while promoting adaptive coping for their employees.