Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support.

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.

La recuperación centrada en la persona y sus implicaciones en salud mental / Person-centered recovery and its implications in mental health

Una fuente importante de la confusión que rodea el uso del término recuperación deriva de la falta de claridad sobre las funciones respectivas de los profesionales de la atención a la salud y de las personas con problemas de salud mental. En este artículo se ofrecen dos definiciones para distinguir entre el proceso de recuperación y la provisión de atención orientada a la recuperación. La recuperación se refiere a las formas en que una persona maneja un problema de salud mental tratando de restaurar o desarrollar un sentido significativo de pertenencia y un sentido positivo de identidad independiente de este problema. La recuperación es un proceso de cambio mediante el cual los individuos mejoran su salud y bienestar, conducen sus vidas de forma autónoma y se esfuerzan por alcanzar su máximo potencial. La atención orientada a la recuperación es lo que los profesionales del tratamiento y rehabilitación en salud mental ofrecen para apoyar los esfuerzos de recuperación de la persona a largo plazo. La promoción del bienestar mediante el autocuidado y la intervención temprana, tanto mental como física, es un componente importante de la misma. La atención orientada a la recuperación requiere que las personas en recuperación se impliquen en todos los aspectos y fases del proceso de la atención. En este artículo se clarifica la terminología y se discuten algunas de las maneras en que la recuperación y la atención orientada a la recuperación se ven comúnmente desde las perspectivas de la política y de la práctica. Así, defendemos que la persona «en recuperación» ha de permanecer en el centro de todas las conceptualizaciones y debates, así como la necesidad de considerar la cultura en la configuración de cómo se ve la recuperación y se promueve en diferentes sociedades. Creemos necesario promover este enfoque con adaptaciones culturales e incluirlo en las escuelas de salud y en los programas de residencia. Así, los estudiantes y futuros profesionales de la salud conocerán el modelo y podrán decidir sobre su integración en la práctica diaria (AU)

One major source of confusion surrounding the use of the term recovery derives from a lack of clarity about the respective roles of health care practitioners and people with mental health problems. We offer two definitions of recovery in order to distinguish between the process of recovery and the provision of recovery-oriented care. Recovery refers to the ways in which a person manages a mental health condition trying to restore or develop a meaningful sense of belonging and a positive sense of identity apart from this condition. Recovery is a process of change through which individuals improve their health and wellness, conduct self-directed lives, and strive to reach their full potential. Recovery-oriented care is what mental health treatment and rehabilitation practitioners offer in support of the person’s own long-term recovery efforts. The promotion of wellness through self-care and early intervention, both mental and physical, is an important component of it. Recovery-oriented care requires that people in recovery be involved in all aspects and phases of the care delivery process. In this article we clarify the terminology and provide a discussion of some of the ways in which recovery and recovery-oriented practice are commonly viewed from the perspectives of policy and practice. In contrast, we argue for a paradigm shift in which the role of the person «in recovery» remains at the center of all conceptualizations and debates while considering the role of culture in shaping how recovery is viewed and best promoted in different societies. We propose to promote this approach with cultural adaptations and to include this model in health schools and residency programs. Students and future professionals of health will thus have information about this model and will be able to decide on its integration in their daily practice (AU)

El grupo y la recuperación / Group and recovery

En el presente trabajo se presentan las aportaciones realizadas por la atención grupal a los pacientes graves y su contribución a la comprensión de la complejidad de los procesos de recuperación. Para ello se señalan los intentos de confluencia de dos disciplinas históricamente separadas como la psicoterapia y la rehabilitación y se plantea que el campo de la recuperación puede servir como un espacio de integración de ambas. Asimismo, se describen resumidamente las tareas-guía del proceso de recuperación, subrayando su carácter relacional o vincular y cómo los enfoques terapéuticos grupales (no solo psicoterapéuticos) pueden potenciar dicho proceso. Teniendo en cuenta el contexto, se muestra que el proceso grupal es acorde con los principios-guía de la recuperación en cuanto al fomento de la autonomía y de una autoestima realista. Por último, se diferencian esquemática y didácticamente dos modos de intervención grupal útiles en una intervención rehabilitadora orientada hacia la recuperación (AU)

The aim of the present article is to discuss contributions made by group therapy for severely ill patients and its usefulness for understanding the complexity of recovery processes. To this end, we describe attempts made to achieve some sort of confluence between two historically separated disciplines, psychotherapy and rehabilitation, and we approach recovery as an area that can provide a framework for their integration. We summarize the tasks that guide the recovery process, emphasizing their binding or relational character and the fact that group therapeutic approaches (and not only psychotherapeutic ones) can enhance this process. Taking into account the context of the patient, group processes are in full agreement with the guiding principles of recovery, aiming at greater autonomy and a realistic self-esteem. Finally, we differentiate in a schematic and didactical way between two useful forms of group intervention in a recovery-oriented rehabilitation work (AU)

A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial.

BACKGROUND: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. AIM: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. DESIGN: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument. SETTING/PARTICIPANTS: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. RESULTS: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. CONCLUSION: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.

Narrative change in emotion-focused therapy: how is change constructed through the lens of the innovative moments coding system?

The aim of this study was to advance understanding of how clients construct their own process of change in effective therapy sessions. Toward this end, the authors applied a narrative methodological tool for the study of the change process in emotion-focused therapy (EFT), replicating a previous study done with narrative therapy (NT). The Innovative Moments Coding System (IMCS) was applied to three good-outcome and three poor-outcome cases in EFT for depression to track the innovative moments (IMs), or exceptions to the problematic self-narrative, in the therapeutic conversation. IMCS allows tracking of five types of IMs events: action, reflection, protest, reconceptualization, and performing change. The analysis revealed significant differences between the good-outcome and poor-outcome groups regarding reconceptualization and performing change IMs, replicating the findings from a previous study. Reconceptualization and performing change IMs seem to be vital in the change process.

The Therapy Process Observational Coding System for Child Psychotherapy-Strategies Scale.

Most everyday child and adolescent psychotherapy does not follow manuals that document the procedures. Consequently, usual clinical care has remained poorly understood and rarely studied. The Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) is an observational measure of youth psychotherapy procedures designed to support the study of usual clinical care by providing a means of characterizing it. Coders independently rated usual care therapy sessions conducted with 43 children (aged 8-15 years) diagnosed with anxiety and depressive disorders. The TPOCS-S showed good interrater reliability, its 5 subscales (e.g., Behavioral, Cognitive, Psychodynamic, Client-Centered, Family) showed good internal consistency, and analyses supported TPOCS-S validity.

The Kansas Excellence in Client-Centered Supervision Program: design and initial results.

Supervisors in community support services are perceived as important to the performance of their teams or programs. Research on training as a means of improving skills has been discouraging. This paper describes a program designed to improve outcomes by providing multiple supports, including training, to CSS supervisors. Results after one year of operation are reported.

Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression.

OBJECTIVE: To assess the predictors of treatment outcome across treatments, as well as those associated with differential treatment response. METHOD: One hundred seven adolescent outpatients, aged 13 to 18 years, with DSM-III-R major depression were randomly assigned to one of three manual-based, brief (12 to 16 sessions) psychosocial treatments: cognitive-behavioral therapy (CBT), systemic-behavioral family therapy, or nondirective supportive therapy. Those with good and poor outcomes were compared. RESULTS: Continued depression was predicted by clinical referral (versus via advertisement) and was in part mediated by hopelessness. Other predictors of depression were comorbid anxiety disorder and higher levels of cognitive distortion and hopelessness at intake. Achievement of clinical remission was predicted by a higher level of self-reported depression. Poorer functional status was predicted by a higher level of initial interviewer-rated depression. Comorbid anxiety and maternal depressive symptoms predicted differential treatment efficacy. CBT's performance continued to be robust with respect to nondirective supportive therapy, even in the presence of the above-noted adverse predictors. CONCLUSION: Predictors of poor outcome may give clues as to how to boost treatment response. Subjects who come to treatment for clinical trials via advertisement (versus clinical referral) may show more favorable treatment responses. CBT is likely to be a robust intervention even in more complex and difficult-to-treat patients.

A comparison of adjuvant psychological therapy and supportive counselling in patients with cancer.

This study compared the effectiveness of two psychological treatments in a group of 57 patients with various types of cancer attending the Royal Marsden Hospital. Patients referred for psychiatric assessment who met criteria for an abnormal adjustment reaction were randomly allocated to either 8 weeks of Adjuvant Psychological Therapy (APT), a problem-focused, cognitive behavioural treatment programme, or 8 weeks of a comparison treatment of supportive counselling. At 8 weeks from the baseline assessment, APT had produced a significantly greater change than the counselling intervention on fighting spirit, helplessness, coping with cancer, anxiety, and self-defined problems. At 4 months from baseline, APT had produced a significantly greater change than counselling on fighting spirit, coping with cancer, anxiety and self defined problems. It is concluded that APT produces greater change in anxiety, adjustment to cancer and use of coping strategies than a non-directive, supportive intervention over an 8 week period of treatment. This difference persists at follow up 4 months after baseline assessment.

Factors that mediate treatment outcome of sexually abused preschool children: six- and 12-month follow-up.

OBJECTIVE: The role of familial, demographic, developmental, and treatment-mediating factors on treatment outcome of sexually abused preschool children was evaluated 6 and 12 months after treatment. METHOD: Forty-three sexually abused preschool children and their parents who were evaluated shortly after disclosure of sexual abuse and then were provided with one of two treatment interventions were reevaluated at the completion of treatment and 6 and 12 months after treatment. Parents completed the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the Weekly Behavior Report to measure a variety of emotional and behavioral symptoms in children. Parents also completed the Beck Depression Inventory, the Family Adaptability and Cohesion Evaluation Scales-III, the Parent Emotional Reaction Questionnaire, the Parental Support Questionnaire, and the Maternal Social Support Index. Children completed the Battelle Developmental Inventory and the Peabody Picture Vocabulary Test at pretreatment to assess developmental levels. RESULTS: Correlational and stepwise multiple regression analyses were conducted to analyze the role of the hypothesized mediating variables in predicting scores on outcome measures across the two treatment groups. While the Parent Emotional Reaction Questionnaire was the strongest familial predictor of treatment outcome at posttreatment, parental support became a stronger predictor of outcome at the 6- and 12-month follow-up points. Treatment group was the strongest overall predictor of outcome at posttreatment and at 12-month follow-up. Demographic and developmental factors did not strongly predict outcome. CONCLUSIONS: Findings indicate the strong impact of parental support on treatment outcome in sexually abused preschool children over the course of a 12-month follow-up and emphasize the importance of including parental interventions in treating sexually abused preschool children. They also support the superior effectiveness of cognitive-behavioral therapy over supportive counseling for this population.

A treatment study for sexually abused preschool children: outcome during a one-year follow-up.

OBJECTIVE: Treatment outcome in sexually abused preschool children was evaluated 6 and 12 months after treatment. METHOD: Forty-three sexually abused preschool children and their parents were evaluated 6 and 12 months after completion of either Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) or nondirective supportive therapy (NST). Parents completed the Child Behavior Checklist, Child Sexual Behavior inventory, and Weekly Behavior Report to measure a variety of symptoms in their children. RESULTS: Repeated-measures analyses indicated that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior. CONCLUSIONS: Findings support the superior efficacy of CBT-SAP over NST in maintaining symptom reduction in the year after treatment completion. The importance of using cognitive-behavioral interventions for sexually inappropriate behaviors and including nonoffending parents in the treatment of sexually abused preschool children is discussed.

Nondirective prompting and noncontingent reinforcement in the treatment of destructive behavior during hygiene routines.

The escape-maintained destructive behavior of a girl with mental retardation persisted during hygiene routines with directive prompting, differential reinforcement for compliance, and extinction as treatment. Using nondirective prompting and noncontingent reinforcement, destructive behavior was reduced to near-zero levels during the hygiene routine.