Case-based teaching and learning experiences.

Case-based teaching and learning strategies can be utilized to assist advanced practice psychiatric nursing students in both obtaining requisite knowledge and enhancing clinical reasoning skills. We discuss the benefits of case-based learning in terms of how it (1) contributes to students' appropriate organization of information to be recalled later for use in clinical reasoning situations; (2) generates experiences that students would not otherwise have; (3) increases the visibility of students' clinical reasoning processes; and (4) enhances students' confidence. This article also explores three examples of case-based teaching and learning: use of written cases in a seminar; use of standardized patients in an assessment course; and utilization of web-based cases for learning assessment and intervention skills. Finally, we compare and contrast each of these methods in terms of their relative effectiveness in achieving each of the benefits.

Symptom self-management and relapse in schizophrenia.

The purpose of this descriptive study was to examine the relationships among 4 variables that are hypothesized to be associated with relapse in schizophrenia; insight, symptom recognition, symptom self-management, and perceived effectiveness of symptom self-management. The theoretical framework was derived from self-management theory and the vulnerability-stress model of schizophrenia. Pearson's correlation coefficients for the variables in the model detected 2 significant relationships; between symptom recognition and symptom self-management and between symptom self-management and perceived effectiveness of symptom self-management. Insight was not found to be significantly related to the other variables. Results of the study indicate that individuals with schizophrenia do recognize symptoms associated with relapse and use a wide range of management methods, regardless of the degree of insight present.

Preparing psychosocial nurse practitioners for health care delivery.

A central task for faculty in programs preparing health care practitioners is to remain timely in educating for the prevailing and future social and health services context. Current considerations in preparing advanced practice psychiatric nurses include the need for greater recognition of comorbidity, concerns about health care access and utilization for vulnerable populations, and changing patterns of practice. In addition, there is a great need to expand the cultural competence and diversity of the population of advanced practice nurses who deliver care to recipients in an increasingly multicultural society. This article describes the educational program developed at the University of Washington to prepare expanded role Psychosocial Nurse Practitioners and sets forth the rationale for major decisions and current directions.

Incorporating standardized patients into a psychosocial nurse practitioner program.

Interactions with standardized patients (SPs) provide customized, immediate clinical learning for graduate nursing students. SPs are lay persons trained to portray a role in a faculty-designed health care scenario for a series of students. Student learning results from the experience of the encounter, performance feedback from the SP, subsequent classroom discussion with peers, faculty critique, and review of the videotaped interaction. Design and implementation of an SP experience involves clarification of goals for the encounter, development of the clinical scenario, recruitment and training of SPs, preparation of students, and management of the logistics of the exercise. Although the process is labor-intensive, we have found SP experiences versatile, valuable, and popular with students.

Psychosocial assessment for treatment planning and evaluation.

1. Use of standardized measures to document a client's psychosocial status and circumstances yields readily interpretable data. These data can provide a basis for treatment selection and make possible reliable documentation of change. 2. Identification of the best measure(s) for a particular purpose requires consideration of the reason for the assessment, intended use of the data, characteristics of instruments, capabilities of respondents, and available resources. 3. Increased use of measures can advance efforts to obtain rigorous and comparative data in psychosocial nursing research and practice. Such information advances science, develops clinical acumen, and documents the results of interventions.

A vulnerability-stress framework for evaluating clinical interventions in schizophrenia.

Symptom management and prevention of psychotic relapse are major treatment concerns in schizophrenia. Research shows a relationship between psychotic symptom levels and several intrapersonal, interpersonal, and environmental factors. These determinants are incorporated into an etiologic causal model of psychotic symptoms based on a vulnerability-stress framework. Then a multifaceted intervention model to influence symptom determinants is advanced, and examples of intervention elements are specified. Finally, a research agenda to evaluate the effectiveness of the intervention model is described, and related methodologic issues are considered.

A clozapine treatment program for patients living in the community.

Clozapine treatment for schizophrenic patients living in the community requires strategies to ensure safe use of the medication and to foster patients' emerging social and living skills. The authors describe a clozapine treatment program in a community mental health center that includes a weekly clozapine support group meeting followed by drawing of blood for monitoring of side effects. Case managers and other program staff remind patients to take clozapine as prescribed and help them comply with hematological monitoring requirements, manage side effects, deal with the emotional aspects of improvement, and benefit from emerging capabilities. About 75 percent of the center's patients who have been offered clozapine have decided to take the medication, and almost all patients in the clozapine treatment program have experienced significant symptom relief and functional development with manageable side effects.

Enhancing surgical nurses' patient education: development and evaluation of an intervention.

This research tested whether staff nurses could provide enhanced patient education and whether increases in education improved surgical patient outcomes. A protocol for patient education was developed from earlier research. Then a multifocal intervention was implemented to motivate and teach staff nurses and to increase structural support for patient education. Following the intervention, patients reported receiving more preoperative information and psychosocial support, but not skills training. These increases occurred without measurable opportunity costs in other areas of nurses' work and generalized to nontargeted patient groups. Concomitantly, patients experienced shortened postoperative hospital stays and decreased use of anti-emetics/sedatives and hypnotics, demonstrating the clinical effectiveness of the increased education.

Clinical and financial effects of psychoeducational care provided by staff nurses to adult surgical patients in the post-DRG environment.

A three-hour, two-stage workshop for staff nurses on providing patient education and psychosocial support was evaluated in terms of its effects on patient welfare and recovery. Subjects were 148 persons who had either a cholecystectomy, other abdominal surgery, or transurethral resection of the prostate (TURP). Two hundred and six additional control subjects were obtained from a nearby hospital. Both hospitals were owned by the same corporation and had many of the same surgeons. After the workshop, experimental subjects used fewer sedatives or antiemetics, fewer hypnotics, and were discharged from the hospital on the average half a day sooner.