Illness intrusiveness among survivors of autologous blood and marrow transplantation.

BACKGROUND: Illness-induced disruptions to lifestyles, activities, and interests (i.e., illness intrusiveness) compromise subjective well-being. The authors measured illness intrusiveness in autologous blood and bone marrow transplantation (ABMT) survivors and compared the results with survivors of solid organ transplants. METHODS: Forty-four of 64 consecutive ABMT survivors referred to the University of Toronto ABMT long-term follow-up clinic completed the Illness Intrusiveness Ratings Scale (IIRS), the Affect Balance Scale (ABS), the Atkinson Life Happiness Rating (ATKLH), the Beck Hopelessness Scale (BHS), and the Center for Epidemiologic Studies Depression (CES-D) Scale. Mean time from ABMT to evaluation was 4.6 +/- 2.8 years. All patients were in remission or had stable disease at the time of evaluation. Autologous blood and bone marrow transplantation patients' IIRS scores were compared with scores reported by recipients of kidney (n = 357), liver (n = 150), lung (n = 77), and heart (n = 60) transplants. RESULTS: Mean IIRS score for the 44 ABMT patients was 37.2 +/- 17 (maximum possible score, 91; minimum possible score, 13). Higher IIRS scores correlated with lower scores on the ABS (r = -0.54; P < 0.0001), and ATKLH (r = -0.44; P = 0.004), and with higher scores on the BHS (r = 0.58; P < 0.0001) and CES-D (r = 0.48; P < 0.0001). The authors compared IIRS scores from the ABMT survivors with scores from recipients of solid organ transplants. Scores were corrected for age, gender, and time from transplant to evaluation. Corrected mean IIRS scores for the marrow (37.5), kidney (38.9), heart (40.0), lung (30.1), and liver (32.3) transplant recipients differed significantly (P < 0.0001 by analysis of covariance). Higher scores among marrow, kidney, and heart transplant survivors were caused by increased scores in the instrumental domain of the IIRS that measures disruptions in health, work, financial situation, and active recreation. CONCLUSIONS: Despite achieving a remission after ABMT, patients continue to experience illness intrusiveness compromising subjective well-being.

Help-seeking for parents of individuals experiencing a first episode of schizophrenia.

The purpose of this triangulated study was to understand parents' experience of help-seeking in response to their child's first episode of schizophrenia. Twenty participants completed questionnaires related to stigma, parental caregiver burden, uncertainty in illness and help-seeking. Findings indicated: (1) as stigmatized attitudes towards mental illness and feelings of ambiguity increased, so did burden; (2) as parental education increased, uncertainty regarding their child's illness decreased; (3) as the number of symptoms causing distress increased so did burden and lack of clarity regarding their child's illness. A significant amount of time passed before parents were able to access help. No relationships were found between indicators of parental help-seeking and the study variables. A subset of five participants described their help-seeking experience. Three overarching themes emerged: (1) Evolving change: What does it mean? (2) Continuous help-seeking, and (3) The help-seeking experience: Impact on parents.

Culturally competent care for psychiatric clients who have a history of sexual abuse.

Canadian psychiatric nurses (N = 1,701) participated in a survey in which they-assessed their ability to nurse clients with a history of sexual abuse when cultural differences are present. Thirty-nine percent worked at a facility having a significant number of clients from a different culture. Only 4.6% rated themselves as "very competent." Four themes emerged from nurses' assessment of their ability: culture is not the problem, culture is not an issue, culture influences perspective and responses, and culturally specific competence. Only one cultural group, First Nations, was identified by sufficient numbers of nurses to generate themes concerning the challenge of working with clients from a particular culture. These themes (abuse as a cultural norm, concurrent and related health and social problems, reluctance to talk about problems, a need to learn about First Nations culture, and developing culturally competent caregivers), critical areas of concern, and possible solutions suggested by the nurses are discussed.

The experience of hospitalization and restraint of women who have a history of childhood sexual abuse.

Within psychiatric settings, many female clients report experiences of childhood sexual abuse (CSA). In this paper we explore the experience of 10 women who were hospitalized in psychiatric settings, restrained, and given forced medication (FM). All the women have histories that included CSA. Some authors have suggested that the experience of psychiatric hospitalization may represent an event that reenacts the experience of trauma. The results suggest that from the perspective of these women, the experience of restraint engendered traumatic emotional reactions such as fear, anxiety, and rage, and in no way was viewed as therapeutic even years later. Women felt powerless and unheard. The women wanted nurses who were empathic and responsive to their human needs as clients, but they felt nurses did not want to hear about the abuse or their internal distress. We hope that the perspective of these women will help in the consideration of alternatives and modifications to the use of restraint in psychiatric settings.

A scale to measure the impact of a schizophrenic illness on an individual's self-concept.

This study was conducted to assess the reliability and validity of the Modified Engulfment Scale (MES) which measures the impact of schizophrenia on self-concept. The concept of engulfment offers a theoretical framework for understanding how a person's self-concept incorporates the experience of mental illness. In a homogeneous sample of 100 outpatients with a Diagnostic and Statistical Manual of Mental Disorders-III-R diagnosis of schizophrenia or schizoaffective disorder increased engulfment was found to correlate positively with hopelessness and low self-esteem and negatively with self-efficacy. In addition, clinical findings revealed that increased levels of engulfment were associated with an earlier age of onset, a longer illness, a greater number of hospitalizations and decreased social adjustment. These results suggest that individuals with a more severe form of the illness are vulnerable to engulfment. The study results also show substantial evidence for the reliability and validity of the MES.

Sexual abuse comfort scale: a scale to measure nurses' comfort to respond to sexual abuse in psychiatric populations.

The purpose of the present study was to further contribute to the psychometric evaluation of the Sexual Abuse Comfort Scale (SACS) in order to provide a standardized measure that would assess the impact of educational programmes on nurses' comfort to intervene with psychiatric clients regarding sexual abuse. This study was part of a larger multisite study conducted in four Canadian provinces, designed to assess the attitudes, beliefs, competencies and educational needs of psychiatric nurses who may work with clients who have been sexually abused. As part of the larger study, a self-administered survey was sent to 3532 psychiatric nurses employed in Alberta, Saskatchewan, Ontario and Nova Scotia. The SACS, the Sexual Attitudes Scale (SAS), the Questionnaire Measure of Emotional Empathy (QMEE) and the Marlowe-Crowne Social Desirability Scale (M-CDS) were included in the survey. The SACS was submitted for item analysis, factor analysis, hypothesis testing regarding construct validity and assessment of concurrent validity. Item analysis of the SACS resulted in a 30-item scale with a coefficient of 0.91, indicating an excellent level of reliability. Empirical evidence indicates that the SACS is a reliable and valid instrument that may be used for the effective evaluation of intervention programmes directed towards increasing clinical knowledge and competence related to sexual abuse.

Nurses' views regarding False Memory Syndrome.

Knowledge concerning the storage and retrieval of traumatic memories and so-called False Memory Syndrome has not been widely available in nursing journals. Information in the popular media, however, means that nurses are learning about aspects of the memory debate from such sources. This article reports on 1,701 nurses' views of False Memory Syndrome (FMS). As background, this report reviews briefly current issues and research on traumatic memory retrieval. The majority of participants believed that FMS, although rare, could occur. For these nurses, FMS was a consequence of incompetent and unethical therapists. They worried that attention to FMS would silence or revictimize survivors of abuse.

Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients.

The purpose of this study was to examine personality differences among three different Axis I disorders-recovered patients with unipolar depression (n = 62), euthymic patients with bipolar disorder (n = 34), and patients with schizophrenia in the residual phase of their illness (n = 41) using the five-factor model of personality (FFM). The dimensions of the FFM-Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A), and Conscientiousness (C)-were measured with composite scores derived from the NEO Personality Inventory (NEO PI) and the Revised NEO Personality Inventory (NEO PI-R). While no group differences emerged on N or C, the bipolar patients scored significantly higher on the Positive Emotion facet (subscale) of E than the unipolar patients. The schizophrenic patients scored lower on the Feelings, Values and Actions facets of O than did the unipolar and bipolar patients. The unipolar patients scored higher on A than the schizophrenic patients.

Mitigating engulfment: recovering from a first episode of psychosis.

1. Schizophrenia, and the challenge of coping with the ongoing stigma of mental illness, profoundly affects an individual's self-concept. 2. Individuals in the early phases of schizophrenia are at risk of becoming engulfed by their illness, such that all aspects of self become defined by the illness. 3. A group intervention enabled individuals to construct a positive self-concept through interacting with others, exploring the meaning of illness, developing an acceptable understanding of the illness, and developing diverse coping strategies.

The relationship between nurses' limit-setting styles and anger in psychiatric inpatients.

OBJECTIVE: Violence by patients in psychiatric settings is frequently associated with the quality of staff-patient interactions. Impulsivity has been identified as a high risk factor for anger and aggression. This study was designed to test the influence of nurses' limit-setting styles on anger among psychiatric inpatients grouped by high or low levels of impulsivity. METHODS: Ninety-seven patients with various diagnoses and either high or low levels of impulsivity participated in role-play scenarios in which nurse actors played out six limit-setting styles, ranging from belittlement to explanations of rules to empathy linked with a presentation of an alternative course of action. Patients' level of anger in response to the acted scenario was assessed using the Spielberger State-Trait Anger Scale. RESULTS: Patients' level of anger was highest in response to unempathic limit-setting styles, moderate for explanations, and lowest for empathic styles. Impulsive subjects were more likely to respond with anger than nonimpulsive patients, regardless of the limit-setting style. CONCLUSIONS: Although many current intervention programs focus on reducing patients' anger after it occurs, the study results suggest that it may be possible to prevent some of patients' anger by improving nurses' limit-setting styles.

The conceptualization of impulsivity for psychiatric nursing practice.

This article conceptualizes impulsivity from the perspective of psychiatric nurses in the inpatient setting. A theoretical model of the nature and the process of impulsivity is developed phenomenologically from information obtained from psychiatric nurses and patient chart reviews. The impulsive event is characterized by three elements: (1) precipitants of the behavior, (2) characteristics of the impulsive event, and (3) staff response. The expression of these elements differentiates impulsivity according to patient domains of psychotic and nonpsychotic illnesses. The emerging differentiation provides the opportunity to develop distinct nursing interventions that target the impulsivity within each of these domains.

The Patient Learning Needs Scale: reliability and validity.

The article describes the development and initial psychometric evaluation of an instrument to measure patients' perceptions of learning needs at time of discharge from hospital to home. Evaluation of the Patient Learning Needs Scale was based on responses of 301 adults hospitalized with a medical or surgical illness. Factor analysis isolated seven subscales: medications, activities of living, feelings related to condition, community and follow-up, treatment and complications, enhancing quality of life and skin care. These seven factors accounted for 56.1% of the variance. Cronbach's alpha for the 50-item scale was 0.95.

Factors influencing patients' informational needs at time of hospital discharge.

The relationship between patients' perceived informational needs and selected sociodemographic and illness-related variables were examined in a sample of 301 adult medical and surgical patients preparing for discharge from an acute care setting. Marital status, living arrangements and chronicity of illness had no influence on the importance of informational needs as measured by the Patient Learning Need Scale (PLNS). More informational needs were identified by females than males, and those with malignant as opposed to benign disease. Length of time spent in the hospital, number of discharge medications, and patient perception of the influence of the illness on life were positively correlated with informational needs at the time of discharge.