Models of care delivery in mental health nursing practice: a mixed method study.

The aim of this study was to identify the conceptual models that underpin mental health nursing care in clinical settings. This study is a modification of a previous study which evaluated the influence of implicit models of mental disorder on processes of decision making within community-based teams. Participants completed questionnaires in response to a scenario. A range of explanatory conceptual models were identified in respect to aetiology, treatment and recovery. In a forced choice the participants ranked a medical model of care above other models as underpinning care delivery. The content analysis found that the participants used a psychodynamic framework for understanding the causes of mental distress but described the nursing interventions in terms of supporting a medical model of care. Nursing care is dominated by a medical model which constrains mental health nursing. This potentially creates tension between what nurses believe to be the problem and the responses available for nurses in their clinical setting. A range of psychosocial approaches to mental health care delivery have been developed, but there seems to be problems with their implementation in practice. Further research is required to explore how broader therapeutic interventions can be implemented by nurses within multidisciplinary systems of mental health care delivery.

Clinician beliefs and practices related to increasing responsivity to the needs of Maori with alcohol and drug problems.

Culturally responsive treatments are often cited as essential for successfully addressing substance use-associated problems in indigenous and other ethnic groups. However, there has been little investigation of the support for this assertion among alcohol and drug-user treatment workers, or how it might translate into clinical practice. The current paper reports on the results of a survey of the New Zealand alcohol and drug-user treatment field, which canvassed these issues. Eighty-six percent of respondents advocated adjustment of clinical practice when working with Maori. Two key strategies were referral to specialist Maori groups or individuals and/or contacting/meeting with whanau (family). Comparisons were made between respondents who referred clients on and those who provided intervention themselves. Implications of results, limitations and future research are discussed.

A profile of alcohol and drug clients in New Zealand: results from the 1998 national telephone survey.

AIMS: To describe the profile of clients seen across the broad spectrum of dedicated alcohol and drug treatment services in New Zealand. METHODS: 217 randomly selected alcohol and drug treatment workers in New Zealand were interviewed by telephone, yielding a randomly selected sample of 291 clients. Workers were asked to identify the age, gender, ethnicity, main substance use problem and geographical location of clients. RESULTS: 60% of clients were male, 28% were Maori, the mean age was 31 years and the largest group of clients were seen for alcohol related issues (45%), followed by cannabis (27%) and opioids (17%). None of these variables differed significantly across residential/non-residential services. Significant trends to emerge were: that Maori clients were more likely to live rurally and to be in treatment for cannabis use, women were more likely to be in treatment for benzodiazepine use and less likely for cannabis use, opioid users were more likely to be seen at Crown Health Enterprise funded services, and cannabis users were (on average) younger than other clients, while alcohol users were older. CONCLUSIONS: Alcohol and drug treatment services are dominated by clients seeking assistance with alcohol and cannabis use problems. Women are not under-represented in this population. Maori are over-represented. This contrasts with the absence of Asian clients and an under-representation of Pacific Island clients. There are some significant variations in the types of drugs used by different demographic treatment seeking populations. In contrast, client differences across treatment settings are minimal.

Increasing diagnosis of nicotine dependence in adolescent mental health patients.

OBJECTIVE: The aim of this study was to investigate the routine recording patterns of patients' smoking by clinical staff of an adolescent mental health service over a 3-year period. METHOD: A systematic examination of the clinical files of all patients who underwent an initial assessment or reassessment at the Youth Specialty Service (Mental Health; YSS) over a 2-month period (1 April-31 May) was carried out in 1996, 1997 and 1998. A range of data were collected including: demographics; diagnoses; amount of total information recorded and history of nicotine dependence. RESULTS: A stable historical record of cigarette smoking in the region of 30-40% across the 3 years sampled was found, but the rate of formal diagnosis of nicotine dependence rose from 3.6% in 1996 to 26.3% in 1998. This rise was in the context of relative stability over this time period of: size of reports and relevant sections (alcohol and drug history, cigarette smoking history); three other key diagnoses, major depression, conduct disorder and alcohol dependence; and demographic data. The rise in rate of diagnosis proceeded specific discussion within the clinical team about nicotine dependence. CONCLUSIONS: Adolescent mental health settings are a key venue to address heavy and potentially chronic cigarette smoking, but nicotine dependence has been traditionally a neglected diagnosis in mental health patients. The rate of diagnosis is likely to rise when specific discussion is undertaken within clinical teams.

Neuropsychologic impact of facial deformities in children. Neurodevelopmental role of the face in communication and bonding.

The face is the primary tool of human communication. In early childhood, the face plays a crucial role in bonding and attachment. Severe craniofacial problems may alter bonding and attachment, thereby resulting in future risk for emotional, behavioral, and social problems. Clinical and research findings, while incomplete, suggest that this is the case. This conceptual understanding of the key role of face-to-face communication in early childhood provides a compelling rationale for early repair of craniofacial deformations.

Cultural linkage: treating Maori with alcohol and drug problems in dedicated Maori treatment programs.

Maori are the indigenous people of New Zealand and suffer more health problems, including alcohol and drug-related problems, per head of population compared with the Pakeha (non-Maori) population. An initiative to develop dedicated Maori alcohol and drug user treatment programs, which offer "cultural linkage," is currently being undertaken. This initiative is based on the premise that addressing cultural needs makes alcohol and drug treatment more effective for Maori than mainstream programs which do not specifically address these special needs issues. As yet, there are no data from controlled studies which address this proposition. Key problems related to the development of "cultural linkage" programs in New Zealand are identified and solutions suggested along with future direction for research in this area.

The effects of maternal alcohol consumption and cigarette smoking during pregnancy on acoustic cry analysis.

During the last trimester of pregnancy, 127 primiparous Irish mothers were interviewed to ascertain their history of alcohol and tobacco use. Confounding effects due to other drugs were not a factor in this sample. Mothers consumed an average of .21 ounces absolute alcohol (AA) per day, with 62% classified as moderate drinkers, 10.6% as heavy drinkers, and 26% as nondrinkers. Neurobehavioral status was measured using acoustic characteristics of the infant's cry, collected on the third day of life. Multiple regression analysis showed that more ounces AA per day was related to more dysphonation and higher first formant, while more cigarette smoking was related to higher pitch, higher second formant, and more variability in the second formant. Analysis of variance comparisons of these 3 alcohol groups demonstrated significant cry effects on infants of heavy drinking mothers.

An inter-rater reliability study of the Opiate Treatment Index.

The development of standardized instruments to evaluate treatment outcome fo opioid dependence is necessary to determine individual patients' progress within a particular treatment programme and to compare treatment outcomes across programmes. This paper reports the results of an inter-rater reliability study utilizing the Opiate Treatment Index (OTI). The OTI questionnaire is a standardized opiate treatment evaluation tool developed within a research setting. The main aim of this study was to determine within the clinical setting of a Methadone Treatment Programme (MTP), whether information given by patients differed significantly according to whether the OTI questionnaire was administered by clinicians working within the service, or by an unknown research assistant. Results indicated that overall there were few differences between the information given to clinicians compared with that given to the research assistant and that in general, inter-rater reliability was good. A number of issues related to the development and use of treatment outcome measures in clinical settings are highlighted and it is proposed that for MTPs a shorter questionnaire, based on the OTI, be developed.

Profiles of difficult psychiatric hospital patients.

In a study of 127 long-term psychiatric hospital patients perceived as difficult to treat, investigators used hierarchical grouping analysis to differentiate ten profile groups of patients. The groups are based on four dimensions or clusters of characteristics previously derived by factor analysis: withdrawn psychoticism, severe character pathology, suicidal-depressed behavior, and violence-agitation. The ten profile groups are described and are related to staff ratings of overall treatment difficulty, prognosis, sex, diagnosis, and other variables. The main conclusion is that treatment difficulty stems in large part from the compounding of different dimensions of severe psychopathology. Thus a pan-symptomatic group, with high scores on all four dimensions, ranks highest in overall treatment difficulty.

Patterns of staff perception of difficult patients in a long-term psychiatric hospital.

In a study to determine which psychiatric patients are perceived by staff as most difficult to treat, clinical staff from several disciplines rated problem behaviors of 127 long-term inpatients in a private psychiatric hospital; staff also rated overall treatment difficulty, progress, and prognosis. No single patient characteristic determined staff's perception of patients as difficult to treat. Instead, four clusters of patient characteristics contributed to this perception; in decreasing order of influence, they are withdrawn psychoticism, severe character pathology, suicidal-depressed behavior, and violence-agitation. The study also showed that the patients who are considered particularly difficult are perceived as improving less and as having a poor prognosis.

Simple radiative transfer model for relationships between canopy biomass and reflectance.

A modified Kubelka-Munk model has been utilized to derive useful equations for the analysis of apparent canopy reflectance. Based on the solution to the model simple working equations were formulated by employing reflectance characteristic parameters. The relationships derived show the asymptotic nature of reflectance data that is typically observed in remote sensing studies of plant biomass. They also establish the range of expected apparent canopy reflectance values for specific plant canopy types. The usefulness of the simplified equations was demonstrated by the exceptionally close fit of the theoretical curves to two separately acquired data sets for alfalfa and shortgrass prairie canopies.