[Coercive stress in psychiatric intensive care unit: What link with insight?] / Stress coercitif en unité de soins intensifs psychiatrique : quel lien avec l'insight ?

The aim of this work was to study the correlations between the coercive experience level in patients in a psychiatric intensive care unit and clinical insight. We included 40 patients without specific diagnosis criteria at the end of their hospitalization in the intensive care unit. We assessed patients with the Coercion Experience Scale (CES) to measure their coercive stress level, and the Scale to Assess Unawareness of Mental Disorder (SUMD) which measures clinical insight. A total of 42.5 % of our sample suffered from mood disorders, 50 % suffered from psychotic disorders and 7.5 % from other disorders. On the one hand, we found that patients' coercive stress level was neither correlated with the awareness of their mental disorder nor with the awareness of social consequences of their mental disorder. On the other hand, we found that coercive stress level was significantly correlated with patients' awareness of treatment efficacy and that the specific CES factor measuring coercion showed a strong trend to significantly correlate with patients' awareness of treatment efficacy. These results seem to show that education about benefits of treatment is a key point to improve patients' coercive stress in a psychiatric intensive care unit, more than an education about awareness of the mental disorder itself.

Clinical insights for office practice management.

This manual is intended to be an easily used reference tool for office nurses who are involved with orthopaedic practice management. The manual can be enhanced with personal annotation, creating a working desk reference. While it is beyond the scope of this publication to be a textbook of ambulatory nursing, concepts will be introduced, ideas shared, and resources listed without pretense of attempting to instruct nurses in the science of ambulatory nursing. Some sections are in question and answer format. This will guide the reader through situations commonly encountered and provide possible solutions applicable to individual settings. Because office/clinic nursing is diversified in setting and clinical focus, it is beyond the scope of this manual to provide answers applicable for all situations. Sections have been included regarding office setup, equipment issues, space requirements, regulations, certification, and accreditation. Contributing authors have provided expert information on managed care issues, CPT/ICD9 coding, risk management, and OSHA regulations. By outlining common areas of concern and pitfalls to avoid, nurses can develop a workbook specific to their own setting.

Guiding patient interaction with insurance carriers.

It is becoming essential for ambulatory care nurses to develop systems to help both themselves and their patients cope with increasingly complicated insurance issues. Nurses need to decide how involved to be, how much responsibility to assume, and how to help the patients understand their own role in dealing with their insurance carriers. Guidelines for involvement and for developing teaching tools and documentation are presented in the article.