A recovery-oriented alternative to hospital emergency departments for persons in emotional distress: "the living room".

Persons with severe mental illness experience episodic crises, resulting in frequent visits to hospital emergency departments (EDs). EDs, however, are not the most effective treatment environments for these individuals who might better be served elsewhere in an environment based on recovery-oriented framework. The purpose of this study is to describe the lived experience of guests (persons in emotional distress) and staff (counselors, psychiatric nurses, and peer counselors) of a community, recovery-oriented, alternative crisis intervention environment-The Living Room (TLR). The total sample is comprised of 18 participants. An existential phenomenological approach was used for this qualitative, descriptive, study. Through non-directive in-depth interviews, participants were asked to describe what stands out to them about The Living Room. Interviews were audio-recorded, transcribed verbatim, and systematically analyzed using descriptive phenomenological methods of analysis by an interdisciplinary and community-based participatory research team. Participants' experiences in hospital EDs and inpatient psychiatric units contextualized the phenomenological experience of TLR environment. The final thematic structure of the experience of TLR included the following predominant themes: A Safe Harbor, At Home with Uncomfortable Feelings, and It's a Helping, No Judging Zone. Findings from this qualitative study of a recovery-based alternative to hospital EDs for persons in emotional distress are supported by anecdotal and empirical evidence that suggests that non-clinical care settings are perceived as helpful and positive.

Culturally competent practice in a pre-licensure baccalaureate nursing program in the United States: a mixed-methods study.

AIM: This study examined how one pre-licensure baccalaureate nursing program at a public university in the southeastern United States integrated concepts and issues of culture and culturally competent practice into its curriculum. BACKGROUND: Teaching and learning about culturally competent practice in pre-licensure nursing programs are essential to ensure a culturally competent health care workforce. METHOD: A mixed-methods case study approach was used. Data were collected from student surveys (n = 111), student focus groups (three groups, n = 9), faculty interviews (n = 14), and school of nursing documents, including the mission statement, faculty and student handbooks, and course syllabi. Data were analyzed using descriptive statistics and content analysis. RESULTS: Findings provide evidence of cultural competence, barriers to deeper engagement with cultural issues, and suggestions for improvement. CONCLUSION: These findings suggest teaching/learning strategies and curricular design issues that may lead to greater student and faculty member cultural understandings.

Consumers' perceptions of transitions from assertive community treatment to less intensive services.

When first conceptualized, it was thought that individuals with severe mental illness who needed assertive community treatment (ACT) would need ACT for life. Today, ACT-for-life is contrary to recovery-based principles, and teams routinely transition consumers to less intensive services. However, there is little qualitative information about the experiences of consumers who transition from ACT. To address this gap in our knowledge, we conducted semi-structured interviews with 11 consumers who had transitioned from ACT to case management services. Consumers expressed feelings of loss and frustration about transitioning from ACT to case management services. Findings underscore the importance of facilitating open dialogue about transitions with consumers, managing consumers' expectations of post-transition services, and facilitating consumer independence prior to transition. ACT teams should be deliberate about preparing consumers for transitions from ACT. More research is needed about facilitating successful transitions from ACT.

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.

Review: Community-based participatory research approach to address mental health in minority populations.

In this review, a synthesis of studies employing community-based participatory research (CBPR) to address mental health problems of minorities, strengths and challenges of the CBPR approach with minority populations are highlighted. Despite the fact that minority community members voiced a need for innovative approaches to address culturally unique issues, findings revealed that most researchers continued to use the traditional methods in which they were trained. Moreover, researchers continued to view mental health treatment from a health service perspective.

Assertive community treatment and the physical health needs of persons with severe mental illness: issues around integration of mental health and physical health.

BACKGROUND: Assertive community treatment (ACT) is characterized as a service delivery platform and represents an ideal setting in which mental health and physical health care can be integrated. OBJECTIVE: Little is known about the extent to which ACT integrates physical health care with mental health care or the challenges ACT teams experience. To address this gap, focus groups were conducted with five ACT teams in a Midwestern US state to explore how ACT teams address the physical health care needs of persons with severe mental illness. DESIGN: A qualitative study design was used. RESULTS: Three major themes emerged: ACT teams recognize serious and chronic physical health problems, ACT teams take on a variety of roles to address physical health problems, and there are challenges to integrating primary and mental health care within an ACT setting. CONCLUSIONS: ACT needs to be adapted to incorporate promising practices designed to better integrate physical health care and mental health care.

Authors' and editors' perspectives on peer review quality in three scholarly nursing journals.

PURPOSE: This study examined the quality of peer review in three scholarly nursing journals from the perspectives of authors and editors. Specifically, the study examined the extent to which manuscript reviews provided constructive guidance for authors to further develop their work for publication, and for editors to make informed and sound decisions on the disposition of manuscripts. METHODS: Corresponding authors who had submitted manuscripts to the study journals in 2005-2007 were invited via email to complete an online survey about the quality of the peer review process; 320 authors responded. In addition, one third of the reviews of manuscripts submitted in 2005-2007 (a total of 528) were selected for rating by journal editors on level of detail, bias, and constructive tone; usefulness to authors in revising/developing the manuscript; and usefulness to the editor in making a decision. RESULTS: A majority (73.8%) of authors agreed that peer reviews provided constructive guidance, and 75.6% agreed that reviews provided adequate rationale for editors' decisions. New authors generally reported less satisfaction with reviews than more experienced authors. Ratings of reviews by the editors revealed some problem areas, including inconsistency, insufficient feedback to the author, reviewer bias, and disrespectful tone. CONCLUSIONS: Given the inexperience of many nurse authors, it is incumbent upon editors and reviewers to provide guidance and support. Manuscript reviews could be improved by increasing the consistency of numeric ratings, narrative comments, and recommendations regarding disposition of the manuscripts. Nevertheless, the results of this study reaffirm the worth of the peer review approach. CLINICAL RELEVANCE: Publication of research and other forms of scholarly work is critical to the development of nursing knowledge that can be used in clinical practice. Authors with a variety of backgrounds, knowledge, and skills have important work to share that can serve healthcare providers and their clients. Thus, ensuring the quality of the peer review process is essential.

Older adults with bipolar disorder: guidelines for primary care providers.

The purpose of this article is to present evidence-based guidelines to facilitate early diagnosis and appropriate treatment of older adults with symptoms of bipolar disorder. Assessment criteria, diagnostic tools, and interventions to optimize care of older adults with bipolar disorder--with a focus on implications for primary care providers--are described.

Worksite-induced morbidities among truck drivers in the United States.

A critical review was conducted of social, psychological, and health science literature on the array of health risks and morbidities of truckers. Multilevel worksite-induced strains (e.g., long work hours and fatigue, shift work and sleep deprivation, postural fatigue and exposure to noise and vibration, sedentary lifestyle and unhealthy diet, exposure to diesel exhaust fumes, and other occupational stressors) were categorized into six primary morbidities for truckers: (1) psychological and psychiatric disorders; (2) detriments resulting from disrupted biological cycles; (3) musculoskeletal disorders; (4) cancer and respiratory morbidities; (5) cardiovascular disease; and (6) risk-laden substance use and sexual practices. Elevated morbidity risks suggest the need for the design and implementation of systematic epidemiological research and environmental interventions in the transport sector.

Advocates' Experiences With Media and the Impact of Media on Human Trafficking Advocacy.

The present qualitative study explores advocates' opinions of misinformation about human trafficking in the media and describes advocates' strategies to counter the misinformation presented by the media. Thus, 15 advocates who work against human trafficking in Chicago-based nonprofit organizations participated in semistructured interviews about their opinions and strategies. Data were analyzed using thematic content analysis. The present study identifies specific misperceptions of human trafficking in the media, highlights advocates' opinions of this misinformation, and discusses advocates' strategies to counteract inaccurate media, adding support to the role of media advocacy. Advocates note how media images shape and perpetuate stereotypes of trafficking through glamorizing sex work and sensationalizing stories that are most often international depictions of trafficking. Advocates report media generally shares only a piece of the story, simplifying the stories of survivors and the issue of human trafficking. Advocates critique media perpetuating these misperceptions for how they may contribute to policies and programs which fail to address structural factors that create vulnerabilities to be trafficked and the multisystem needs of survivors. However, advocates also note misperceptions can be counteracted by producing sensitive, informed media through social platforms. Advocates share their strategies counteracting misinformation through engaging in informative conversations, utilizing social media to educate, and promoting media messages of survivor agency. Research, clinical, and policy implications are also discussed. The present study emphasizes the importance of decision makers and service providers being critical consumers of media and to assess how media portrayals may (or may not) inform their understanding and response to the issue.

How patients and nurses experience the acute care psychiatric environment.

The concept of the therapeutic milieu was developed when patients' hospitalizations were long, medications were few, and one-to-one nurse-patient interactions were the norm. However, it is not clear how the notion of 'therapeutic milieu' is experienced in American acute psychiatric environments today. This phenomenological study explored the experience of patients and nurses in an acute care psychiatric unit in the USA, by asking them, 'What stands out to you about this psychiatric hospital environment?' Three figural themes emerged, contextualized by time, which was a source of stress to both groups: for patients there was boredom, and for nurses, pressure and chaos. Although they shared some themes, nurses and patients experienced them differently. For instance, nurses felt caged-in by the Plexiglas-enclosed nursing station, and patients felt caged-in by the locked doors of the unit. The findings from this US study do not support the existence of the therapeutic milieu as described in the literature. Furthermore, although the nurse-patient relationship was yearned for by nurses, it was nearly absent from patients' descriptions. The caring experienced by patients was mainly derived from interactions with other patients.

Visual tracking strategies to move scholarship forward.

Moving from the doctoral student role to the faculty member role is a challenging transition. Strategies that motivate and help keep scholarship moving forward can be invaluable in helping make the transition successful. The authors discuss 2 visual tracking strategies to promote the forward movement of scholarship. A whiteboard (dry erase) and a publication trajectory table to track manuscript and research ideas through grant proposal and manuscript submission to publication are described.

Mental health service needs of a Latino population: a community-based participatory research project.

Community-based participatory research bridges the gap between academic researchers and the real-life issues of communities and offers promise for addressing racial and ethnic disparities in mental health care. The purpose of this community-based participatory research was to identify factors that affect access, use, and perception of mental health services by a Latino population at individual, organizational, and community levels. Individual level factors included health beliefs about mental illness and care, suspicions of providers, financial concerns, and culturally determined gender roles. Organizational factors included problems with access to care related to cost, lack of bilingual providers, and culturally competent care; and community level factors included distance between resources and the need for services to be provided in community sites. Immigration status and acculturation were identified as factors at all levels.

Healing scents: an overview of clinical aromatherapy for emotional distress.

Individuals in emotional distress are often treated with psychotherapeutic agents, but other treatment options exist. One safe and effective adjunct for the prevention and treatment of emotional distress is aromatherapy. This article describes the physiological effects of scent, reviews the research on aromatherapy, presents practical information on the use of clinical aromatherapy for emotional distress, and suggests resources for additional training and education.

Risk and protection for HIV/AIDS in African-American, Hispanic, and White adolescents.

African-Americans and Hispanics are disproportionately affected by HIV/AIDS in the United States. HIV infection is often acquired during adolescence, a time when risky sexual behaviors are at their peak. This study explored relationships among selected risk factors, protective factors, and risky sexual behaviors among African-American, Hispanic, and White adolescents, from a sample of adolescents from the National Longitudinal Study of Adolescent Health. African-Americans and Hispanics were more likely to have sexual intercourse without the use of birth control than were Whites. African-Americans were more likely to have sexual behavior with multiple sexual partners than either Hispanics or Whites were, and African-Americans had higher self-esteem than did Hispanics and Whites. In order to develop culturally sensitive, effective interventions to prevent HIV/AIDS in adolescents, racial differences in risk and protective factors must be examined.

Engaging students and faculty with diverse first-person experiences: use of an interpretive research group.

This article is about a teaching strategy that operationalizes an aspect of the National League for Nurses' position statement "Transforming Nursing Education" and the Institute of Medicine's report "Crossing the Quality Chasm." Engaging students with patients' first-person experiences related to health and illness and their experiences with health care can help students learn about the multiplicity of views on experience, help them focus on the patient as an individual, and heed the call for more patient-centered care. This article describes how an interpretive research group can be used to develop these skills by teaching undergraduate nursing students, in a caring, open environment, what life is like from the patient's perspective.

'Take my hand, help me out': mental health service recipients' experience of the therapeutic relationship.

The purpose of this study was to describe mental health service recipients' experience of the therapeutic relationship. The research question was 'what is therapeutic about the therapeutic relationship?' This study was a secondary analysis of qualitative interviews conducted with persons with mental illness as part of a study of the experience of being understood. This secondary analysis used data from 20 interviews with community-dwelling adults with mental illness, who were asked to talk about the experience of being understood by a health-care provider. Data were analysed using an existential phenomenological approach. Individuals experienced therapeutic relationships against a backdrop of challenges, including mental illness, domestic violence, substance abuse, and homelessness. They had therapeutic relationships with nurses (psychiatric/mental health nurses and dialysis nurses), physicians (psychiatrists and general practitioners), psychologists, social workers, and counsellors. Experiences of the therapeutic relationship were expressed in three figural themes, titled using participants' own words: 'relate to me', 'know me as a person', and 'get to the solution'. The ways in which these participants described therapeutic relationships challenge some long-held beliefs, such as the use of touch, self-disclosure, and blunt feedback. A therapeutic relationship for persons with mental illness requires in-depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient, is key for practising nurses and nurse educators interested in enhancing the therapeutic potential of relationships.