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[The model of clinical assistance and possibilities of doing it in a different way].

Nursing, in a clinical assistential model, and the daily practices in an in-patient psychiatric unit, are approached. It seems to have a discordance between the health system and clients problems. The nurses seem to plan actions that accomplish institutional goals instead of reaching out for clients' individual needs. In mental health, to include the client on planning his care is fundamental to reach therapeutical goals. Even in the actual model, there are initiatives incorporating these approaches, rescuing concepts that bring clients and workers closer. By recognizing the subjectivity of professionals and clients, we can understand that they are both singular, bringing up interdisciplinarity, and also a process of hierarchy happens, giving autonomy to the working teams and enlarging the space of work.

Clinical Competence↗

Alcohol use in Hawaii.

This article provides a review of the existing literature on alcohol use in Hawaii (i.e., epidemiology, reasons for use, associated problems, and intervention) and offers clinical implications of the findings and suggestions for further areas of research. In general, Caucasians, Hawaiians, younger Filipinos, males, adolescents, young adults, and those with lower educational attainment were found to be at higher risk. Overall, Hawaii's rates were either comparable or lower than those for the entire United States. Factors associated with different rates of alcohol use included accessibility, ability to resist offers, parent use and sanctions, peer influence and use, attitudes and beliefs (e.g., perceived normal drinking, dangerousness), religious affiliation, social occasions, and school intervention. Variable rates and trends in help-seeking behaviors, treatment admissions, and treatment utilization reflected the socio-cultural diversity in Hawaii. Perceived effectiveness of different treatments were generally consistent across ethnic groups, but did not necessarily represent actual efficacy. There is a clear need for additional prevention, screening, and intervention programs in Hawaii, including socio-culturally appropriate ones, as well as a need for further research.

Adolescent↗

Finding meaning in illness. Can nurses help?

They are common comments from people facing a life-threatening or chronic illness: "Why did this happen to me? I don't deserve this." "Am I being punished for something? Why do I have to go through this?"

Adaptation, Psychological↗

Private LTC insurance. The home care claimant experience.

An understanding of claimants and their behavior should help consumers make more informed choices about financing their potential LTC needs, help the private insurance industry better meet those needs, and inform public policies designed to support and regulate the market. To this end, LifePlans, Inc. and the Center for Health and Long-Term Care Research conducted in-person interviews with more than 1,000 private long-term care insurance claimants residing both in the community and in institutions.

Aged↗

Double take.

Explore the source record for details and available documents.

Adult↗

The relationship between access and stage at diagnosis of breast cancer in African American and Caucasian women.

PURPOSE/OBJECTIVES: To identify the relationships among potential access, realized access, and stage at diagnosis of breast cancer in African American and Caucasian women receiving care within an equal economic access healthcare system. DESIGN: Descriptive-comparative design. SETTING: Department of Defense Military Health System. SAMPLE: 62 African American and 573 Caucasian women (ages 25-97) diagnosed with breast cancer over a 10-year period. METHODS: Secondary analysis using tumor registry records data. MAIN RESEARCH VARIABLES: Economic, potential, and realized access and stage at diagnosis of breast cancer. FINDINGS: When compared to Caucasian women, African American women were diagnosed at later stages, were younger when diagnosed, were from a lower socioeconomic status, had a higher percentage of incidental breast self-examination-discovered abnormalities, and had a lower percentage of mammogram-discovered abnormalities. CONCLUSIONS: Economic access to care did not always result in early diagnosis. Other factors such as age, race, socioeconomic status, and means of discovery influenced diagnosis outcomes. IMPLICATIONS FOR NURSING PRACTICE: Interventions aimed at increasing participation in breast health programs also should focus on noneconomic aspects of access such as help-seeking behaviors and perceptions of access to care. Additional studies should be conducted to evaluate adherence to breast cancer screening guidelines by women receiving care within equal economic access healthcare systems.

Adult↗

Recognizing and responding to a suicide crisis.

Data from therapists who were treating 26 patients when they committed suicide were utilized to identify signs that warned of a suicide crisis. Three factors were identified as markers of the suicide crisis: a precipitating event; one or more intense affective stats other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Problems in communication between patient and therapist, often originating in therapeutic anxiety over the patient's possible suicide, were identified as factors interfering with crisis recognition. Evaluation of the identified affects and behaviors may help therapists recognize a suicide crisis.

Adolescent↗

Social reactions to sexual assault victims from various support sources.

This study examined positive and negative social reactions received by 323 victims disclosing sexual assaults to informal and formal support providers. Analyses of both quantitative and qualitative data indicated that both positive and negative reactions are commonly received by victims disclosing their assaults to others, but that victims seeking help from formal support sources are more commonly faced with negative reactions of victim blame, stigmatizing responses, and controlling reactions from others. Qualitative analysis of written responses provided by respondents also revealed other less common but unhelpful reactions of assault disclosure such as rape myths, violations of the victim's confidential disclosures, and revictimization. Preliminary analyses of the effects of specific reactions on adjustment from different types of support providers suggested that reactions of friends are particularly important for recovery. Positive reactions from friends appear to be more helpful, whereas negative reactions appear to be harmful from both informal and formal support sources. Implications for research and treatment of sexual assault victims are discussed.

Adaptation, Psychological↗

"Super" presencing nurse healers' stories of healing.

This article describes the experience for nurse healers of being a channel for healing. In particular this was explored by revealing "super" presencing--an essential theme of the lived experience of nurse healers, described in a recent research study. "Super" presencing not only enhances our knowledge but gives inspiration in an otherwise undernourished area of the healing profession of nursing.

Adult↗