Mentoring state hospital nurses to write.

There is a shortage of clinical nurses, particularly in the area of psychiatric nursing, who feel competent and comfortable writing for publication. This is unfortunate since clinical nurses have valuable experiences to share, to promote and advance the nursing profession. This manuscript describes the work of one Director of Nursing at a state hospital who mentored the nursing staff to write for publication. Over a period of five years some 28 articles have been published by nurses at this hospital. This success in publication has led to an increase in self-esteem among nurses, an increased willingness to share their writing experiences with others, and increased numbers of workshop presentations on clinical subjects. This article describes how the mentoring process can be used to promote authorship, and specifically, how it was used at this one hospital.

Knowledge and attitudes of chronic mentally ill patients before and after medication education.

This study compares the knowledge and attitudes of 60 patients in a state hospital about medication, before and after structured and unstructured medication education. The purpose was to determine which type of education has more positive effects. A pre- and post-test two-group experimental design was used. The results of this study were not statistically significant in supporting the literature that education has some effect on knowledge or on attitude about taking medication. The study showed similar effects of the method (structured versus unstructured) on increasing knowledge and attitude toward medication. Demographic data from the study suggest a variety of other factors may relate to attitudes and knowledge about medication in the hospital. This study suggests medication education should address demographic factors, incorporate multi-dimensional approaches, include more active patient participation, and utilize one-to-one teaching whenever possible.

A program for water-intoxicated patients at a state hospital.

During normal circumstances, individuals have a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. If fluid intake continues uncurbed, an extreme condition may result known as self-induced water intoxication and psychoses. If untreated, complications may develop, including dilated and hypotonic bowel and bladder, hydronephrosis, renal failure, congestive heart failure, mild confusion, acute delirium, seizures, coma, and death. The ongoing problem of water intoxication presents a modern day nursing challenge to psychiatric nurses. The present study monitors nine chronically ill patients in a special program for water intoxication involving control and monitoring and a psychoeducational group approach in a closed unit of a state hospital. At the end of 3 months serum electrolytes, serum osmolality, and urine specific gravity were within normal limits since the start of the program. Anxiety, as evidenced by restlessness, pacing, increased talking, demanding behavior, hyperactivity, yelling, and irritability, had lessened. This improvement was accompanied by a stabilization of psychotic behavior. The use of restraints dropped from 1303 hr in the 3 months before the program to 20 hr and 55 min for the nine patients in the first 3 months of the program. Progress in relation to the study hypothesis will be evaluated every 3 months.

Physiological causes of depression in the elderly.

Depression represents the most common psychiatric disorder in the elderly. Physiological processes can often cause depressive symptoms. The psychiatric nurse provides an important role in assisting the depressed elderly client through interventions, such as talking, exercise, touch, and relaxation.

Being an effective speaker.

Communication in a group is an essential quality for success in nursing. Despite this, many nurses who must have communication skills to advance have little training in public speaking. Some nurses seek to correct such deficiencies in their education by taking courses in the evenings or on weekends to improve their understanding of the elements of effective speaking. Other nurses learn by self-reflection, study, and ongoing practice. This article has presented guidelines for speaking in a group that can offer assistance in mastering this important nursing skill. Elements of nonverbal communication are crucial for effective communication. However, despite the importance of non-verbal communication to the message, language is what makes communication possible. It is language that allows people to communicate new ideas and thoughts and to solve problems.

Death from auto-erotic asphyxiation in a long-term psychiatric setting.

Death from auto-erotic asphyxiation is a startling phenomenon that is on the rise both in the general population and within psychiatric facilities. While these auto-erotic behaviors may lead to death, it is seldom the client's intention to do harm; rather, the intent is to heighten masturbatory sensations. After describing this phenomenon, the authors discuss implications for nursing care.

Comparison of three rating scales used with psychiatric patients.

Many instruments are available to augment assessment of psychiatric patients. There is little comparative information regarding reliability and validity of these tools on assessing treatment needs, in predicting future behavior, and in classifying psychiatric patients. The purpose of the descriptive study was to provide comparative information on the Nosie-30, Pardue-Dick and the Revised Allen Cognitive Level Test. A significant correlation was found between the total Nosie-30 and the Pardue-Dick and between the Revised ACL and the Nosie-30. The scores on the Pardue-Dick and the R-ACL were not related.

A day in the life of an inpatient: an experiential game to promote empathy for individuals in a psychiatric hospital.

The attitudes of hospital staff toward individuals with mental illness have been investigated, described in the literature, and discussed at national conferences. It has been suggested that attitudes are the precursors or determinants of behavior. Although the precise effect of staff attitude on patients is unclear, attitudes of the staff do appear to be related to their behavior and to have an impact on patients and their subsequent recovery. There are few precise answers on how to promote positive attitudes. While hospital policies and procedures can prescribe behaviors of staff, attitude cannot be dictated. Some studies have evaluated the effect of training and participation in milieu programs on the attitude of psychiatric staff. Simulation games recently have been explored as a possible way to influence the attitude of staff toward those with mental illness. This article describes an attempt at one state psychiatric hospital to influence in a positive way the attitude of the staff by using a simulation game called, A Day in the Life of an Inpatient. Adapted from Into Aging by Hoffman and Reif (1978), the game used by the authors provides a microcosmic experience for staff of a hospitalized patient's ward experience.

The water-intoxicated patient.

In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation. In some cases, the symptoms of water intoxication mimic schizophrenia and thus, are disguised as a part of the psychoses. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (Ripley, Millson, & Koczapski, 1989). Under normal circumstances there is a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. The recognition of water intoxication or self-induced water intoxication and psychosis among chronic, institutionalized patients may prevent their death or the development of neurological damage (Arieff, 1985). Because self-induced water intoxication often goes unrecognized in its early stages and may have irreversible or fatal complications, early detection is crucial. This article will discuss the etiology, nursing assessment, and interventions associated with patients suffering from self-induced water intoxication.

The use of Orem's model in psychiatric rehabilitation assessment.

Nurses in service, rehabilitation, and education have found that Orem's self-care model provides a useful framework for assessing the patient's needs and organizing care. The model has been found to be useful in assessing the long-term-care psychiatric patient.

Could it be Ganser's syndrome?

The term, "Ganser's syndrome," was identified by Sigbert J. Ganser, a German psychiatrist, near the turn of the century. Ganser's syndrome, defined as an hysterical reaction, was often used to describe prisoners who appeared to be trying to escape prosecution. Today, Ganser's syndrome is debated by both psychiatric and judicial systems. This paper addresses these issues by identifying guidelines for assessment and recognition of common malingering behaviors displayed by Ganser's syndrome patients. Psychiatric nurses who practice in both psychiatric and legal systems need an understanding of Ganser's syndrome to adequately assess the patient, plan effective treatment, and complete an evaluation of care. This understanding will enable the nurse to answer the important question, "Could it be Ganser's syndrome?" With the increase of crime and the prison population, the use of "Insufficient Comprehension to Stand Trial" may be a legal option for defendants. If they are exhibiting inappropriate behavior and are a danger to themselves or others, a psychiatric evaluation may be ordered by the court. It is then the responsibility of a psychiatric facility to assess, treat, and evaluate Ganser's syndrome patients in an attempt to return them to competency. The patients may return to court following the psychiatric evaluation if they are found competent to stand trial.

Developing a privileging process for the psychiatric nurse.

A privileging process for nurses has the potential for improving nurses' professional performance and increasing the quality of patient care. At Logansport State Hospital, a psychiatric hospital in Logansport, Indiana, a privileging process was developed in which advanced psychiatric nursing skills and areas of expertise are delineated as privileges. Twelve privileging areas were established along with specific educational and performance criteria. By requiring nurses to reapply for privileges on an ongoing basis, the hospital assures the continued education and competency of its nursing staff.