Turning danger into opportunity: teaching psychiatric nursing in the aftermath of a disaster.

In the wake of a devastating flood that destroyed the ecology of a small town, undergraduates taking their first clinical course in psychiatric mental health nursing formed AGAST (Awesome Guerillas Against Situational Trauma) and, with their instructor, performed individual and group crisis intervention over an intensive 90-hour clinical rotation. Three theories were used to help guide the students assessments and interventions with survivors. The clinical experience required innovation, close connection with the host community, and multi-level support from the educational institution. Students rose to the occasion and blossomed in the rich clinical matrix of the experience. The example can be applied to the use of other naturally-occurring events as theaters for innovative clinical teaching.

Testing an explanatory model of the development of depressive symptoms in young women during a life transition.

Factors to explain the rising incidence of depressive symptoms among young women making the transition from home to university life were investigated. A path analysis of data from 213 18- and 19-year-old women entering a large university indicated that negative life events, interpersonally derived social support, self-esteem, and depressive symptoms were significantly related. Negative life events that affected the women's self-esteem (drawn from the women's performance in interpersonal relationships) were most strongly associated with depressive symptoms, and self-esteem derived through efficacy (i.e., taking control and acting assertively) was not associated with negative events. The women in the sample appeared to derive efficacy self-esteem from relationships. An analysis of the data supported developing interventions to improve interpersonal relationships rather than focusing on competence in gaining access to resources.

The concept of interpersonal pattern in Peplau's theory of nursing.

Interpersonal pattern, defined as the category in which separate interpersonal acts are linked by similar, defining characteristics, is a critical, data-rich concept that is used in the therapeutic nurse-client relationship. If this concept is studied within the framework of aesthetic knowing in nursing, the processes of deliberate involvement that form the crux of the nurse-client relationship become illuminated. An illustrative case study brings this concept to life by demonstrating the use of interpersonal pattern as the focus of intervention with a frail, elderly woman. In this case study, the nurse practices aesthetic knowing to assess and respond to the woman, and ultimately assist in her forward movement towards optimum function and health. Linkages of this type of intervention to all of nursing practice are made by integrating the use of interpersonal pattern with aesthetic knowing in nursing.

Depressive symptom reversal for women in a primary care setting: a pilot study.

Cognizant that only 20% of depressed individuals seek treatment, Healthy People 2000 has recommended a goal of increasing this figure to 45%. This flows from a recognition of depression as a serious and costly problem, with women carrying twice the risk of men. Primary care settings are the first contact a depressed woman may make with the health care system. This study piloted a collaborative model in which a Psychiatric Mental Health Advanced Practice Nurse (PMH-APN) was available on site to assist providers to recognize women with depressive symptoms and to provide intervention. Thirty three women were identified by primary care providers and referred for screening to the PMH-APN. Assessment and intervention based on the interpersonal theory of Peplau were accomplished in an average of eight sessions with the PMH-APN. Pre and postintervention descriptive data on the primary outcome (depressive symptoms) and three theoretically congruent mediating variables (performance and social self-esteem and satisfaction with interpersonal relations) were consistent with the expected outcomes of the intervention.

Treating depression through the therapeutic nurse-client relationship.

This article provides a blueprint to guide the nurse's work with the client whose depression interferes with his or her health. It is based on an expanded version of Peplau's interpersonal theory and illustrates systematic assessment and intervention through the therapeutic nurse-client relationship. Differentiation of depression from related health problems and criteria for referral to a mental health professional such as a psychiatric-mental health advanced practice nurse are outlined. Practical interventions through the therapeutic relationship are illustrated to guide the nurse in working directly with the depressed client.

Pattern integrations in young depressed women: Part I.

The enduring patterns of interpersonal relations between young depressed women and their significant others create a theater for early interventions. As noted by Hildegard Peplau, interpersonal relations include patterns that are organized around appraisals from significant others, ultimately forming the internal sense of self-regard that is deeply disrupted in depression. Pattern integrations, or the "fit" of the woman and her significant others become maintained as a way of avoiding anxiety and negative appraisals. Complementary, mutual, alternating, and antagonistic patterns have been identified by Peplau, and the relationship to anxiety, the maintenance of self-worth, and the therapeutic use of these patterns by the nurse are explored.

Pattern integrations in young depressed women: Part II.

Using Hildegard Peplau's theoretical model and focusing on the concept of pattern integrations, clinical data from a pilot intervention program for depressed women were analyzed. The program consisted of a collaborative relationship between primary-care providers and two Psychiatric-Mental Health Clinical Nurse Specialists in which women experiencing symptoms of depression were identified and referred to the research program. Data derived from clinical intervention done over a 4-month period with 6 women (42 hours of clinical tapes) was used for analysis. Clusters of behaviors constituting pattern integrations were analyzed for the reciprocal interactions of the nurses and the clients. Four pattern integrations common to the women in the sample were identified. Clinical examples and a framework for intervention using the patterns integrations is presented.

To be one of the boys: aftershocks of the World War I nursing experience.

The mass deployment of nurses during World War I removed them from their structured professional culture and thrust them into the unfamiliar world of men at war. Analysis of personal accounts indicates that for some nurses, this event increased awareness of conflicts between autonomous professional practice and the "good woman" image. It led them to examine the disparity between healing and participation in war and to experience sex-based inequality in the face of equal danger. The emerging dialectic provoked personal and professional change. The value of confrontation with differentness as an impetus to growth is examined.

Update on medications for the treatment of anxiety.

It is interesting to note that antidepressants are widely represented in the medications used to treat the anxiety disorders. This has led to speculation about the role of depression, particularly subclinical forms being manifested as anxiety disorders. The specificity of diagnostic categories suggests that, at least for the moment, medications have a very specific and circumscribed role in the treatment of anxiety. This suggests that the difficulties of many anxious patients are not effectively treated with medication or that medication has only a short-term role at best. The next column will review health problems associated with psychotropic treatments for anxiety and discuss strategies for creating a "wedge," ie, introducing adjunct learning experiences along the anxiety gradient in conjunction with pharmacotherapy.

Enacting corrective interpersonal experiences with the depressed client: an intervention model.

In an attempt to protect the self from anxiety associated with the need for tenderness, the depressed patient enacts particular interpersonal phenomena designed to create distance and control intimacy. A theoretical framework using Sullivan and Peplau explains these phenomena in the context of the therapeutic nurse-patient relationship and guides specific responses by the nurse to create a corrective interpersonal experience. Case material illustrates these processes.

Cohesiveness in groups: a concept in search of a definition.

Cohesiveness in groups has been studied intensively since the 1950s. It is viewed as a central property of all groups and a "curative factor" in therapy groups. Literature on group work in nursing incorporates discussion of group cohesiveness. Its "positive valence" has invited broad application without critical examination of its meanings and limitations. Progress in thinking about cohesiveness in groups, as well as the lack of generally accepted theoretical and operational definitions, suggests the relevance of a reexamination of the concept with a view toward recognizing its limitations or moving toward greater specification of the meaning and improved measurement of the concept.