"No Right Place to Die": Nursing Attitudes and Needs in Caring for People With Serious Mental Illness at End-of-Life.

BACKGROUND: Approximately 6% of the U.S. population suffer from a serious mental illness (SMI). People with SMI reportedly die 20 to 25 years earlier than the general population. OBJECTIVES: To explore both hospice/palliative care nurses' and psychiatric/mental health nurses' attitudes and needs toward people with SMI at the end-of-life. DESIGN: A qualitative study following a phenomenological approach was used to interview hospice/palliative care nurses and psychiatric nurses about the experience of caring for people with SMI at the end-of-life; a total of 20 nurses were interviewed. Interviews were analyzed and coded, and themes were identified. RESULTS: Six themes were identified: stigma of mental illness, effect of SMI symptoms on communication and trust, chaotic family systems, advocacy issues around pain and comfort, need for formal support, no right place to die. CONCLUSIONS: Participants discussed the need for better education and collaboration between psychiatric and palliative care nurses as well as the need for ongoing support.

Nursing attitudes toward patients with substance use disorders in pain.

The problem of inadequate pain management in hospitals is well documented. Patients who have substance use disorders (SUD) have many medical problems and are often in pain as a result of these problems. Nurses often lack knowledge of appropriate treatment of both pain and SUD, and have been identified as having negative attitudes toward patients with SUD. The negative attitudes may affect the quality of care delivered to patients with problems of pain and SUD. The purpose of this study was to identify and explore nurses' attitudes toward hospitalized patients with SUD who are in pain, to expand the knowledge about nurses' attitudes and interactions with patients with SUD in pain, and to generate theory that will contribute to a greater understanding of the problem. Grounded theory methodology was used to interview hospital-based nurses who work with patients with SUD who are in pain. Individual interviews, using a semistructured interview guide, were conducted with 14 nurses who worked with this population. Additionally, an expert addictions nurse was interviewed at the end of the study to validate the findings. Interviews were analyzed and coded with the use of grounded theory concepts. A model illustrating the categories and their relationships was developed based on the theory generated as a result of the study. The implications for nursing practice, education, research, and policy are discussed.

Behind closed doors: school nurses and sexual education.

School nurses can play a key role in providing sexual education in schools. However, they often face barriers from the school administration and concerned parents. Additionally, school nurses may have limited formal preparation in managing sexual health issues. This study used a descriptive qualitative method to explore the school nurses' experiences with facilitators and barriers to providing sexual education. Eighteen nurses from 12 Massachusetts high schools were interviewed. Results showed that the school nurses do not provide formal sexual education at their schools but frequently conduct informal sessions. School nurses reported that students needed more sexual health information, yet there was no collaboration with the school health teachers. Common barriers included lack of privacy and time, confidentiality issues, and fear of conflict. Nurses working in communities with high teen pregnancy rates reported more barriers. The findings can inform the development of policies and practices for sexual education by school nurses.

DSM-5 changes on the horizon: substance use disorders.

The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952. This publication was the first formal attempt to provide a nosology to guide the diagnosis of mental disorders, including substance use disorders (SUD). There have been four iterations of the nosology since 1952, and the sequential publication of each new edition has provided the foundation for a more enlightened perspective on diagnosing the range of psychiatric conditions. This article reviews the literature specific to the past revisions of the DSM up to and including the proposed changes on substance abuse/use for the DSM-5, the significance of substance use pathology, associated behaviors, as well as the social and political influences that impact substance use. Nosological changes will be reviewed as they relate to shifts in the conceptualization of substance-related diagnosis.

Difficult-to-manage HIV/AIDS clients with psychiatric illness and substance abuse problems: a collaborative practice with psychiatric advanced practice nurses.

Complex clients with comorbid HIV disease, other medical illness, psychiatric illness, and substance abuse problems present tremendous challenges to providers. Medication adherence and case management become vital issues in providing comprehensive care to this population. This report describes the practice of two advanced practice psychiatric registered nurses who worked collaboratively with each other and with nurse practitioners to provide care to such complex clients. Description of collaborative practices and the model of collaboration used by the two practitioners are highlighted through three case studies. Conclusions about the practice and its use with complex clients are provided.

Peer consultation: a unique experiential model for P/MHNP students.

TOPIC: Peer consultation: A unique experiential model for P/MHNP students. PURPOSE: The purpose of this paper is to describe the consultation component of the Adult Psychiatric Mental Health Graduate Program at UMASS Lowell. The consultation requirement is described in the Professional Role competency as "provides consultation to healthcare providers and others to enhance quality and cost-effective services for patients and to effect change in organizational systems" (NONPF, 2003, p. 10). The activity described in this paper also includes demonstration of components of the competencies for assessment, diagnosis, plan of care, and teaching/coaching (NONPF, 2003). SOURCES: This paper is based on review of the literature and the author's clinical and teaching experience. CONCLUSIONS: Form of classroom instruction is a unique way of assisting students in the development of the professional role as a consultant.

Knowing how to play the game: hospitalized substance abusers' strategies for obtaining pain relief.

This study explored hospitalized substance abusers' perspectives about getting their pain adequately addressed in the hospital setting and their interactions with nurses about pain-management issues. The aim of the study was to generate theory that can contribute to a greater understanding of the problem of pain management with this population. A grounded theory approach was used to interview participants with a substance abuse problem who were hospitalized with a medical/surgical problem. Interviews were conducted using an interview guide; interviews were audiotaped and transcribed. In addition, a focus group of nurses who worked with this population met twice, once midway through the study, and before the final participant interview. The nurses commented on the fit of the developing model according to their experiences of working with the population described. Eighteen participants were interviewed for a total of 20 interviews (two participants were interviewed twice). All participants were polysubstance abusers and had a painful medical/surgical problem for which they were hospitalized. The Model of "Knowing How to Play the Game" was developed on the basis of participants' descriptions of their experiences and consisted of two core action categories "Feeling Respected/Not Respected" and " Strategizing to Get Pain Relief." Participants had many suggestions about nursing actions that were helpful or not helpful in assisting them to obtain pain relief. Nursing practice, education, research, and policy implications were discussed.

From chronic pain patient to peer: benefits and risks of volunteering.

Peer volunteers have been used as cost-effective adjuncts to professional services in other settings and populations, but not a heterogeneous sample of patients with chronic pain. This study evaluated the transition from "patient" to "peer," identifying possible benefits or harm associated with volunteering. Peers provided descriptive data and questionnaires, including measures of pain, disability, self-efficacy, and depression before and after three periods: as a patient, during training, and while volunteering. Average pain intensity scores declined while participants were patients (7.1 to 4.2), rose slightly (5.8) before training, and dropped again after training and volunteering (4.3 and 3.6, respectively). A similar pattern was noted for disability. Depression scores continued to decline after initially dropping, and self-efficacy scores remained stable after the initial 40% rise as a patient. Two themes, "making a connection" and "a sense of purpose," emerged from the narrative data. Descriptive data provided further support that volunteering benefited both patients and peers. This study supports the viability of using peer volunteers for clinical or research endeavors. Improvements in pain, disability, and depression were reported immediately after training and after volunteering for several months without evidence of harm. Despite encountering challenges, the rewards of this altruistic endeavor outweighed any frustrations experienced by volunteers with chronic pain.