Instrument that purports to assess "codependency".
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Codependency, Psychological↗
Biomedical subjects
W K Mohr
Publications and source records attributed to W K Mohr.
Deconstructing the language of psychiatric hospitalization.
The purpose of this study was to deconstruct the language of psychiatric nurses' documentation and charting. Employing concepts developed by post-modern theorists, everyday professional activities can be examined in unique ways that uncover how they conceal or skew rather than reveal and illumine patient conditions. The study design and sample was exploratory; content analysis with first and second level analyses. Nine major categories of charting entry were found. Deconstruction of the language and discourse of nursing through a Foucaultian lens goes beyond what is manifest to what is not said. Professional assumptions about patients and the social construction of patients and patient problems are exposed.
Hospitalization↗
Thank you Luther Christman.
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Education, Nursing↗
Breaking through the hegemony of homogeneity: revitalizing curriculum and students.
Undergraduate programs provide fertile ground from which future practitioners, researchers, and teachers of psychiatric mental health nursing will emerge. Health care has changed dramatically, offering opportunities for new and innovative roles and prompting faculty to develop novel ways of thinking about the future role of psychiatric nurses. Nursing faculty are challenged to devise new and creative approaches to teaching psychiatric nursing at the undergraduate level in ways that will instill enthusiasm for the field. In this article, the efforts of the University of Pennsylvania to approach psychiatric mental health courses in new ways will be described. These innovations are designed to stimulate passion for what the authors see as a complex and exciting field that requires revitalization.
Career Choice↗
The DSM and child psychiatric nursing: a cautionary reflection.
The DSM is the key reference guide for clinicians and it continues to be the way in which practitioners apply discrete categories to behaviors that are sufficiently disruptive to social institutions to have come to the attention of tertiary care systems. As a way to classify and diagnose mental disorders, the DSM has been a source of controversy in the psychiatric community since its development. This article reviews some of the limitations of the DSM approach to psychiatric nosology with respect to practice with children. Alternative conceptualizations and approaches to childhood psychopathology are proposed and implications for child psychiatric nurses are discussed.
Child↗
The challenge of creating thoughtful research agendas.
This article is an affirmative rejoinder to a recent editorial calling for revitalizing psychiatric research and education. It reviews the shortcomings of our present knowledge- and research-base using the state of child psychiatry as an exemplar. It concludes that we, as a specialty, must be cautious in setting a course for a research agenda in the new millenium and posits that the most informative research and intervention will occur by using multiple measures and sources of information. As understanding of patients and their problems in development and in context grows, intervention research that will be useful, timely, and cost-effective must include cross-discipline teams of researchers and practitioners who will speak to these complexities.
Adolescent↗
A tale of two centuries: voices of the past and present.
This article compares the reported experiences of children and adolescents receiving inpatient treatment in contemporary psychiatric hospital settings with those of women institutionalized in mental hospitals from 1840 to 1945. Qualitative data include case study material from former psychiatrically hospitalized patients and archival narratives. Analysis includes matching themes from in-depth interviews with archival narratives. Nine representative experiences emerged and are presented in a typology under broader themes of structure, process, and outcome. Similarity of patient experiences over two centuries leads to questions about the meaning of advances in understanding mental illnesses in the context of attitudes, biases, and staff behavior toward patients that remains disturbingly unchanged.
Adolescent↗
A restraint on restraints: the need to reconsider the use of restrictive interventions.
Children with behavior problems are put in units with milieu therapy for the support and guidance of a specialized health care team, supposedly experts in the care of children with these unique and urgent needs. The reality of such units, however, is that those with the most contact with the children are often inadequately prepared, both in terms of knowledge and skills, to manage disruptive behaviors. As a result, the milieu that is supposed to provide support and structure can actually exacerbate the trauma for the vulnerable child. Preliminary data are presented from an ongoing study that is investigating the experiences and memories of formerly hospitalized children. Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force. There was a marked lack of understanding by the children of why given interventions were used. Although coercive interventions are sometimes necessary, ethical, legal, and other professional considerations make it clear that more work is needed. Research to identify the patterns of lack of knowledge and skills, as well as to develop appropriate interventions are recommended.
Adolescent↗
Cross-ethnic variations in the care of psychiatric patients: a review of contributing factors and practice considerations.
The number of ethnic minority persons in the United States is increasing faster than that of the Caucasian population. This means that nurses will be caring for an increasingly diverse patient pool. Ethnic differences have been discovered to play a role in the efficacy of psychoactive medication. These differences result from a number of biological as well as non biological factors. Nurses have a professional obligation to be aware and sensitive to differential response to treatment.
Communication Barriers↗
Updating what we know about depression in adolescents.
1. Despite an 80% increase in prescriptions written for antidepressants for the treatment of pediatric depression, little empirical research has been done on the effects of antidepressant therapy on children and adolescents. 2. What little research has been done does not support the efficacy of antidepressants use in children. Moreover, some antidepressants may actually be harmful to pediatric populations. 3. Nurses have an obligation to keep abreast of the latest research findings in the literature because the knowledge base changes daily.
Adolescent↗
Deconstructing progress notes in psychiatric settings.
The purpose of this article is to examine the language by which nursing staff described these patients in their medical records. Charts of former psychiatric patients were studied for the quality of the words used to communicate about patient behaviors. More than 4,000 entries were examined and descriptive words that appeared with most regularity were presented to a panel of expert psychiatric nurses who were asked to Q sort them as to connotation. Results show that nurses entries focus on patients in judgemental and unflattering ways. Recommendations are made to replace the use of negatively laden language and labels with descriptions in more behavioral and operational terms.
Humans↗
Outcomes of corporate greed.
OBJECTIVE: This study is the context portion of a larger study that described the experience of 30 nurses in Texas, USA who worked in for-profit psychiatric hospitals during a documented period of corporate deviance. The objective of the contextual portion was to describe the major findings in 1991-1992 of investigating agencies that probed the scandal. DESIGN: Exploratory descriptive. SAMPLE: Over 1,240 pages and 40 hours of corporate records obtained under subpoena, and written and oral testimony before the USA House Select Committee on Children, Youth, and Families. METHODS: Content analysis, triangulating sources, and comparing as well as cross-checking themes. FINDINGS: Four themes: insurance games, dumping patients, patient abuse, and playing with language. CONCLUSIONS: Organizational deviance may become more widespread in profit-driven systems of care. Lobbying for whistleblower protection, collective advocacy, and creative educational reforms are used.
Ethics, Institutional↗
Psychiatric nursing in troubled environmental contexts.
During 1985-1991 state, federal and media investigations uncovered widespread fraud, patient abuse, and unethical conduct in investor-owned psychiatric hospitals. The purpose of this research study was to determine how nurses who were employed in these settings during this time experienced their work situations. Inquiry centered on ethical misgivings, sensemaking, and patient advocacy. The experiences discussed in this article are the results of interviews with a theoretical sample of 30 Texas nurses. Their experiences have research, policy, education, and practice implications in that health care settings are becoming increasingly corporatized and are under great pressures to maximize profits to increase returns on investors' equity.
Adult↗
Dirty hands: the underside of marketplace health care.
The ethos of the corporation and the urgency for profit maximization place pressures on health care corporations to act in a way that may be incompatible with ethical practice. Profit-driven incentives often result in corporate deviance and criminal behavior. Nurses may be pressured to go along with schemes that may be unethical or illegal and because of shaky job markets may be unable to adhere to professional ethical guidelines. Recent events in health care are drawn on to argue that ethical theory and research must begin to consider the issue of moral compromise of professionals as a result of deviant organizational environments.
Decision Making↗
A critical reappraisal of a social form in psychiatric care settings: the multidisciplinary team meeting as a paradigm case.
Critical analysis can be used to examine potential inequalities and interferences with freedom in psychiatric nursing contexts. Multidisciplinary team meetings (MDTM) evoke a sense of egalitarian multiparty cooperation, when underlying philosophical, ideological assumptions and realities can operate to contradict consciously held beliefs. Traditional approaches toward structural aspects of organizations are built on several conventional and taken-for-granted assumptions. Deconstruction and critical analysis can create alternate ways of thinking about fixed aspects of practice. The MDTM can be analyzed through different images. Underlying realities about the disempowerment of nurses and patients in the team structure can be shown through such analysis.
Culture↗
Integrating esthetics into nursing: literature as a suggested modality.
In this article the author argues for the importance of reintegrating the neglected pattern of esthetics into the teaching and practice of nursing. Approaching art as both a means and end, the essay illustrates, how art can inform the specialty. By exposure to selected literary works, nurses can vicariously achieve understanding of human conditions that they could not otherwise experience. Through the art act, nurses can examine the depths of their interventions, identify them, and creatively center themselves. Integrating esthetics into nursing education and collaborating with colleagues in the field of humanities can invigorate a discipline in search of identity and justification during a time of professional turbulence.
Curriculum↗
Values, ideologies, and dilemmas: professional and occupational contradictions.
Developments in many "for-profit" psychiatric hospitals over the past decade raise concerns about the nature of values in proprietary health care. These developments raise questions of whether nursing values and ideologies can coexist with those of the current health care environment. There are two influences that are important in considering the issue of nursing within the for-profit context: the commercial motivation of the present health care system and the possible subordination of nursing values to the objectives of lay (business) persons. It is imperative to initiate dialogues of the problematic ideological and ethical dilemmas confronting nurses in the work setting.
Conflict of Interest↗
The private psychiatric hospital scandal: a critical social approach.
The recent events that transpired in the for-profit psychiatric hospital industry in which hospitals were alleged to engage in practices which ranged from unethical to illegal underscore the importance of examining the contexts of nursing practice. A wide range of environmental factors and unchallenged assumptions may influence the care of clients and may become obstacles to effective and ethical nursing practice. Critical social theory offers nursing a potentially valuable tool from which to illuminate and examine otherwise unexamined aspects of the environment.
Authoritarianism↗