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This study examined the prevalence of formal intimate partner violence (IPV) education during basic and advanced practice programs and its effect on the likelihood of screening for IPV. A national, random sample of 553 nurse practitioners... more
This study examined the prevalence of formal intimate partner violence (IPV) education during basic and advanced practice programs and its effect on the likelihood of screening for IPV. A national, random sample of 553 nurse practitioners completed a written survey documenting their IPV educational experiences in both their basic and advanced practice programs. Although 77.9% had received IPV education at some point in their nursing education, this education had a far greater effect on their subjective feelings of competence and comfort in working with IPV patients than it had on the likelihood of their screening or identifying IPV victims in their practice. Nurse educators must provide students with the words, body language, and screening measures to use to screen effectively. Study implications for nursing education, limitations, and recommendations are discussed.
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Electronic access to standards of care is viewed as a promising strategy for increasing evidence-based practice. Before determining whether electronic access to standards will increase nurses' use of standards of care, data on their... more
Electronic access to standards of care is viewed as a promising strategy for increasing evidence-based practice. Before determining whether electronic access to standards will increase nurses' use of standards of care, data on their current rate of utilization are needed. Using 2 standards of care, Fluid Volume Excess and Manic Behavior, we used retrospective chart reviews to gather baseline information. Insights from these findings are presented.
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If the health of children is to be improved, systems of care for youth must organize and collaborate around an emphasis toward promotion of health and prevention of mental illness. This approach demands an understanding of the complex... more
If the health of children is to be improved, systems of care for youth must organize and collaborate around an emphasis toward promotion of health and prevention of mental illness. This approach demands an understanding of the complex interplay of genes, environment, risk, and protective factors that influence the manifestation of behavior problems. The focus of this article is prevention efforts aimed at processes thought to be involved in the development of mental illnesses. A particular emphasis is on prevention strategies that reduce risk prior to the onset of an identifiable mental disorder. Included are interventions appropriate to nurses who deal with children in schools, pediatric primary care, and specialty mental health care.
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Restraint and seclusion of children has great potential for harm. Since the mid-1980s, psychiatric inpatient personnel for children and adolescents have put considerable energy in reducing the use of extreme measures of aggression... more
Restraint and seclusion of children has great potential for harm. Since the mid-1980s, psychiatric inpatient personnel for children and adolescents have put considerable energy in reducing the use of extreme measures of aggression management. While the use of restraints is a particular problem in the United States, aggression management and means of control in psychiatric settings is an international issue. The core question of this review was: What is the current state of the evidence supporting restraint reduction efforts with children and adolescents? Studies were reviewed and critiqued that related to programs of restraint reduction, restraint reduction methods, and aggression management. Internationally, there seems to be more emphasis on reducing coercive measures by understanding the context of their use. Thus, studies exploring staff perceptions and decisions concerning coercive measures were also examined. The evidence supporting restraint reduction methods in the United States comes mainly from case study reports of clinical sites' quality improvement projects. Consequently, a collection of studies is accumulating that supports a multi-strategy approach to restraint reduction. Limited evidence exists for aggression management measures and training in de-escalation techniques. Controversial aggression management techniques such as the use of pro re nata medication and holding continue to be used with very little support for their efficacy. Recommendations include taking a view of restraint and seclusion as emergency measures to address dangerous aggression, not interventions examined in controlled studies. As such it is suggested that sites pool data on restraint use and reduction efforts to create a database for benchmarking and studying variations among hospitals. Furthermore, attention should also be given to developing additional means for addressing aggressive behaviors.
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The confusion over, and ultimate demise of, milieu therapy. Literature review. To chronicle the conceptual problems and other events leading to the decline in the use of milieu therapy. Inpatient nurses would do best to leave the concept... more
The confusion over, and ultimate demise of, milieu therapy. Literature review. To chronicle the conceptual problems and other events leading to the decline in the use of milieu therapy. Inpatient nurses would do best to leave the concept of milieu therapy behind and focus on clarifying how specific nursing interventions are operationalized and tied to patient outcomes.
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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... more
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."
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Inpatient nurses work to engineer an environment in which patients and staff are physically and psychologically safe. A recent research study on an adult psychiatric unit examined the dimensions involved in keeping the unit safe. The four... more
Inpatient nurses work to engineer an environment in which patients and staff are physically and psychologically safe. A recent research study on an adult psychiatric unit examined the dimensions involved in keeping the unit safe. The four dimensions included ideology, people (staff and patients), space, and time. In this article, we discuss how these dimensions apply to real-world efforts to keep child and adolescent inpatient units safe. We also discuss the challenges nurses face within each of these safety dimensions, including those arising from fluctuating acuity, staffing formulas, surveillance of physical space, and entrenched unit cultures.
Research Interests: Psychology, Nursing, Organizational Culture, Adolescent, Philosophy of Nursing, and 14 moreHumans, Child, Time Management, Child Psychiatry, Psychiatric Nursing, Total Quality Management, Safety Management, Clinical Competence, Adolescent Psychiatry, Personal space, Inpatients, Physical Restraint, Health Facility Environment, and personnel staffing and scheduling
Lowering the incidence of reactive aggression on inpatient child/adolescent psychiatric units by creating a milieu that reduces coping demands and augments... more
Lowering the incidence of reactive aggression on inpatient child/adolescent psychiatric units by creating a milieu that reduces coping demands and augments children's self- regulation capabilities. This article elaborates on specific staff approaches that have the potential to reduce occurrences of reactive aggression and behavioral eruptions frequently displayed by children and adolescents during inpatient psychiatric treatment. Identified are key staff behaviors along with explanations on how they dampen the kindling of reactive aggression and create an enhanced milieu. Accompanying each staff behavior is an explanation of the neuroscience and theory that supports the intervention. Published literature and clinical examples. Children hospitalized on inpatient psychiatric units frequently have poor self-regulation skills and diffuse the negative affects they experience via behaviors such as tantrums, venting, and aggression. Staff can reduce this reactive aggression by tempering the way they set expectations, by providing structure, and by decreasing threat via sensible rules that encourage choice. Staff must also create and maintain relationships with the patients that set a particular tone, thereby creating an enhanced milieu populated with adults who are positive and able to attune to a child's changing affect level.
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In this interview, Gayle Bluebird, RN, Director of the Office of Technical Assistance (OTA) Center for Peer Networking, discusses the history and progress of the peer specialist movement. For the past 40 years, Gayle Bluebird has... more
In this interview, Gayle Bluebird, RN, Director of the Office of Technical Assistance (OTA) Center for Peer Networking, discusses the history and progress of the peer specialist movement. For the past 40 years, Gayle Bluebird has advocated for persons with psychiatric disabilities in service sectors, policy arenas, and with federal/state agencies. She has helped produce several important films and monographs on reducing seclusion and restraint. Currently her focus is on building a broader understanding of peer support services. This interview focuses on the peer specialist and the strides of peer support specialists in improving mental health services.
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Why Nursing Leadership is essential for Integrated Care A quickly evolving idea within health care reform is integrated care where a person would have both their medical and behavioral health needs addressed within the primary care... more
Why Nursing Leadership is essential for Integrated Care A quickly evolving idea within health care reform is integrated care where a person would have both their medical and behavioral health needs addressed within the primary care structure. Given the prevalence of mental health issues in the general population and common medical co-morbities in the seriously mentally ill population, the federal government, consumers and mental health advocates have rallied significant support for integrated care. While models for system integration and templates for care coordination are rapidly emerging, plans for the work force needed to enact integrated care have not moved forward with the same clarity and vision. Integrated primary care will demand a work force with improved mental health assessment skills and require clinicians capable of matching the intensity of services with the intensity of need around both medical and behavioral issues. Integrated care will also require clinicians with s...
Individuals who require psychiatric hospitalization need a safe environment that supports stabilization and service planning that promotes a meaningful life in the community. Both processes require a recovery-oriented, patient-centered... more
Individuals who require psychiatric hospitalization need a safe environment that supports stabilization and service planning that promotes a meaningful life in the community. Both processes require a recovery-oriented, patient-centered treatment environment where care reflects the patient's needs, values, and choices. It also requires a nursing staff that builds a unit culture which instills hope, self-direction, and empowerment. Currently there is no method to assess the delivery of recovery oriented, patient-centered care in the psychiatric inpatient environment. The focus of this study was development of an instrument (Combined Assessment of Psychiatric Environments- the CAPE) that assesses quality of care by gauging the extent patients have experiences during inpatient treatment that promote recovery and patient-centered care; i.e., ones marked by safety, engagement, respect, choice, achievement, and significance. A staff-form of the tool gauges the extent the environment su...
Developing and evaluating core clinical competencies of nurse practitioner students at distant clinical sites requires dialog among the student, the clinical preceptor and University faculty. Students enter our program with diverse... more
Developing and evaluating core clinical competencies of nurse practitioner students at distant clinical sites requires dialog among the student, the clinical preceptor and University faculty. Students enter our program with diverse backgrounds, experience and interests. Here we demonstrate an innovative online Clinical Development Scale (CDS) that gathers self assessment data from each student, analyzes, organizes and prioritizes competencies to be accomplished in a clinical practicum, produces midterm and final evaluation summaries from data contributed by both student and preceptor and displays action plans developed by students, for meeting deficient competencies for preceptor and faculty approval.
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Currently the United States health care system is responding to the Patient Protection and Affordable Care Act (PPACA) and the vision it contains for health care transformation. Along with sweeping changes in service delivery and payment... more
Currently the United States health care system is responding to the Patient Protection and Affordable Care Act (PPACA) and the vision it contains for health care transformation. Along with sweeping changes in service delivery and payment structures, health care reform has championed concepts such as patient-centered care, integrated care, and wellness. Although these are not new ideas, their adaptation, in both ideology and service design has been accelerated in the context for reform. Indeed they are reaching a tipping point; the point where ideas gain wide acceptance and become influential trends. Although psychiatric mental health (PMH) nurses have been active in wellness, patient-centered care, and integrated care, at the current time they seem to be situated peripheral to these national trends. Increased presence of PMH nurses will facilitate their contribution to the development of these concepts within service structures and interventions. To increase knowledge and appreciation of PMH nurses' practice and unique perspective on these issues, leaders are needed who will connect and effectively communicate PMH nursing efforts to the broader health care arena. This article outlines the events that created a context for these three concepts (patient-centered care, wellness, and integrated care), and I suggest why they have reached a tipping point and discuss the need for greater PMH nursing presence in the American national dialog and the role of nursing leaders in facilitating these connections.
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Approximately 300,000 youth are at risk of being sexually exploited in the United States each year. The commercial sexual exploitation of children is defined as any sexual act performed by a minor for an adult in exchange for anything of... more
Approximately 300,000 youth are at risk of being sexually exploited in the United States each year. The commercial sexual exploitation of children is defined as any sexual act performed by a minor for an adult in exchange for anything of value. Studies conducted in Chicago, identify as many as 16,000 girls and women engaged in prostitution, with many having engaged in prostitution before the age of 15. The internet plays an integral role in sex trafficking that has yet to be fully examined or understood. Three out of 4 victims are trafficked online. In a Chicago study with men who buy sex, over 1/3 reported using the internet to buy sex. In addition, the USA Sex Guide, a large free website used to educate men on how to buy sex with women, serves as a training ground. Over 800 men visit the USA Sex Guide at any given moment. The anonymity that is provided by the internet allows men to read and post explicit descriptions of sexual exploitation and violence without fear of repercussion...
The American Psychiatric Nurses Association (APNA) Institute for Safe Environments (ISE) has focused on key elements that affect safety in psychiatric treatment environments; one of these key elements is patient engagement. An ISE... more
The American Psychiatric Nurses Association (APNA) Institute for Safe Environments (ISE) has focused on key elements that affect safety in psychiatric treatment environments; one of these key elements is patient engagement. An ISE workgroup discussed and reviewed the literature on engagement and safety in inpatient psychiatric settings. This article presents what we have learned about the role that engagement plays in inpatient treatment of severely mentally ill individuals and evidence that links nurse-patient engagement to safety. To describe, using supporting literature, the role that nurse-patient engagement plays in creating safe, therapeutic environments for individuals with severe mental illness. (1) Define engagement and describe why it is an important element of safe treatment environments; (2) identify what helps and what hinders patients in their engagement with nurses, and nurses in their engagement with patients; (3) describe how engagement may improve unit safety; and ...
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Inpatient psychiatric treatment satisfaction measures are not constructed from patients' perspective of hospitalization experiences that they deem meaningful and important. To develop and conduct psychometric testing of a measure that... more
Inpatient psychiatric treatment satisfaction measures are not constructed from patients' perspective of hospitalization experiences that they deem meaningful and important. To develop and conduct psychometric testing of a measure that evaluates person-centered care on inpatient psychiatric units, the Combined Assessment of Psychiatric Environments (CAPE). The measure is built on a theoretical framework holding that if optimal care is to be achieved, all major stakeholders (patients and staff) need to experience a positive environment. An instrument development design was used to create the patient/staff nurse versions of the CAPE and to test their dimensions. The pilot versions of the CAPE were tested on six inpatient psychiatric units to determine the psychometrics of the staff/patient versions. The overall reliability of both versions of the CAPE (staff/patient) was .91. The test-retest reliability for both versions was significant at the .01 level. Construct validity was esta...
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ABSTRACT Nearly 75% of adolescent morbidity and mortality is a result of risky behaviors. In this study we aimed to determine the effectiveness of an adolescent-focused motivational interviewing training in improving health professionals’... more
ABSTRACT Nearly 75% of adolescent morbidity and mortality is a result of risky behaviors. In this study we aimed to determine the effectiveness of an adolescent-focused motivational interviewing training in improving health professionals’ knowledge, skills, and confidence in risk reduction counseling with adolescents. Paired t-tests and Spearman’s correlation coefficients for pre- and posttraining showed significant improvements in knowledge, skills, and confidence, with P < .05. Slightly positive correlations between intention and use of strategies at 1 and 3 months posttraining were noted. The findings show that there was an improvement in health professionals’ knowledge, skills, and confidence in counseling adolescents on risky behaviors.
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In several states, commercial sexual exploitation of children (CSEC) is now a reportable child abuse offense. Illinois has taken the lead in tackling the issue and the Illinois experience illuminates valuable lessons. This article... more
In several states, commercial sexual exploitation of children (CSEC) is now a reportable child abuse offense. Illinois has taken the lead in tackling the issue and the Illinois experience illuminates valuable lessons. This article delineates the protection, practice, and policy implications that evolve when CSEC falls under a state child welfare system. The specific aims are to (a) discuss CSEC, its victims, risks, harms, and challenges inherent in providing effective care; (b) use Illinois as an exemplar to explicate the consequences and implementation challenges of establishing a state reporting system that frames CSEC as a child welfare issue; (c) recommend strategies for developing effective state reporting models, and (d) demonstrate how nurses are well poised to advocate for victims of human trafficking on both state and national levels. Recommendations for improving the identification of CSEC victims and overcoming challenges to state implementation are offered.
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Half of all youth hospitalized in inpatient psychiatric facilities manifest aggressive behavior. When aggression escalates to the point of danger, measures must be employed to guarantee safety of both patients and staff. In this paper,... more
Half of all youth hospitalized in inpatient psychiatric facilities manifest aggressive behavior. When aggression escalates to the point of danger, measures must be employed to guarantee safety of both patients and staff. In this paper, the current empirical evidence for intervention models to reduce restriction and restraint utilization in children and adolescents is reviewed. PubMed and PsycINFO were searched for English-language articles published between 2006 and 2013. Included were empirical studies of child or adolescent inpatient populations using a pretest and posttest design. Included in this review are three empirical papers describing two different intervention models that met the inclusion criteria. The review indicates there are two empirical supported intervention models that are helpful in reducing seclusion and restraint utilization in children and adolescents. The promising empirical findings support evidence and application to the child/adolescent population for at ...