Training consumers to collect data in mental health service system evaluation research.

Consumer satisfaction with services is an outcome measure. This report describes The Consumer Satisfaction Research Associate Training Program, which was designed for the education and supervision of recovered consumers who collected data during four studies at three psychiatric hospitals. The educational program had didactic and laboratory components. Consumer research associates collected quantitative and qualitative data using a survey tool for face-to-face interviews. Participant recruitment and management of confidential records were included in the role. Data collected by research associates from consumers who are in treatment can enhance the validity and trustworthiness of satisfaction surveys. Nurses can play an important role in the research process by serving as staff resources for consumers who collect data in various service system settings.

Consumer satisfaction with services in a regional psychiatric hospital: a collaborative research project in Kentucky.

Consumer satisfaction with mental health services is a dimension of outcome. This report is on a university and state mental health department research project that involved development of the Kentucky Consumer Satisfaction Instrument (KY-CSI) and a retrospective, cross-sectional study designed to measure consumer satisfaction with services at a regional psychiatric hospital. Triangulation of methods guided the survey of participants (N = 189) near discharge from the hospital during a 6-month period. Research associates, who were former consumers of mental health services, collected data during face-to-face interviews. Most participants were unemployed White men. Factor analysis indicated the 19-item instrument was unidimensional; Cronbach's alpha was 0.90. Multiple regression indicated predictors of satisfaction were levels of education and diagnosis. As education increased, satisfaction decreased; participants with a diagnosis of bipolar disorder tended to be more satisfied than those with other diagnoses. Analysis of qualitative data combined with standardized summary of KY-CSI items indicated participants were most satisfied with opportunities to talk with other patients and least satisfied about lack of involvement of people with whom they lived in discharge planning. Study findings guided recommendations for quality of care and additional studies at other hospital sites.

Evidence-based practice and the advanced practice nurse: a curriculum for the future.

The concept of evidence-based practice has gained increased attention throughout the 1990s as a strategy for linking the best scientific findings with clinical judgment to improve health outcomes. Because the concept implies finding, evaluating, summarizing, and using research results, a high level of clinical reasoning skills is required. Effective evidence-based practice also requires the incorporation of new practices into clinical and organizational settings, thereby demanding advanced leadership skills. Competencies in clinical reasoning, leadership, and clinical practice are critical for advanced practice nurses. This article describes a master's-level curriculum supportive of evidence-based practice and includes recommendations for developing curricula of this type.

The experience of fathers of adult children with schizophrenia.

The purpose of this study was to describe the lived experience of fathers of adult children with schizophrenia by exploring the extent to which they engaged in caregiving. Cross-sectional data were gathered from 12 fathers over a 2-year period using naturalistic inquiry. Two instruments guided in-depth explorations of caregiving experiences, theme extrapolation, and theme refinement. Data were collected during taped interviews using the constant-comparative method. Findings indicated that the caregiving event was prolonged. Three themes explained the extent to which these fathers engaged in caregiving: involvement in care, unresolved issues, and severity of the event. Recommendations include similar studies with ethnic groups and use of chronic sorrow as a framework for studies about parental care for adult children with severe mental illness. practice implications include immediate assessment of fathers, supportive listening, and brief therapy.

Keratometry, ultrasonic biometry, and prediction of intraocular lens power in the feline eye.

OBJECTIVE: To determine ocular dimensions (using A-scan ultrasound biometry) and corneal curvature (using keratometry) in the feline eye and to calculate the appropriate dioptric power for a prototype posterior chamber intraocular lens (IOL) necessary to achieve emmetropia in the eyes of cats undergoing lens extraction. ANIMALS: 25 clinically normal adult mixed-breed cats and 10 eyes from 10 clinically normal adult mixed-breed cat cadavers. PROCEDURE: A-scan ultrasonic biometry was performed on both eyes of each live cat. Cats were tranquilized, and keratometry was performed on each eye. Biometry was performed on the cadaver eyes. Five of the cadaver eyes had the lens extracted and an IOL, designed for use in dogs, was implanted. Biometry was repeated to estimate postoperative IOL position. Using 3 theoretical IOL formulas, data from biometry, keratometry, and postoperative IOL position were used to predict IOL strength required to achieve emmetropia after lens extraction in cats. RESULTS: Mean axial length of eyes in live cats was 20.91 +/- 0.53 mm. Mean preoperative anterior chamber depth (ACD) was 5.07 +/- 0.36 mm, and mean lens thickness was 7.77 +/- 0.23 mm. Predicted postoperative ACD was calculated to be 10.84 mm. Measured postoperative ACD in the 5 cadaver eyes was 8.28 mm. Required IOL strength calculated, using the predicted postoperative ACD, was 73 to 76 diopters. The required IOL strength calculated, using the measured postoperative ACD, was 53 to 55 diopters. CONCLUSIONS AND CLINICAL RELEVANCE: An IOL of substantially higher diopter strength than that needed in dogs is required to achieve emmetropia after lens extraction in average cats; an IOL strength of approximately 53 to 55 diopters will likely be required.

Quality indicators for primary mental health within managed care: a public health focus.

Primary mental health is an orientation to care that addresses mental health needs of consumers on point of first contact with caregivers. Core values, and principles drawn from a public health perspective serve as the foundation for indicators of quality within managed primary mental health. A model, illustrating the key components for quality indicators, includes stakeholder groups (consumers, families, providers, and payers), quality concerns (access, appropriateness, outcomes, and prevention), and the spectrum of clinical processes (assessment, treatment, rehabilitation, and support). Responsibility for monitoring quality is vested in these stakeholder groups. To enable them to fulfill their responsibilities, indicators are proposed in the form of checklists. The checklists assist stakeholders in evaluating the plans and services offered by managed care entities.

Advanced practice psychiatric nursing: a national profile.

The results of a national survey of Advanced Practice Psychiatric Nurses (APPN) are presented. Results are based on the Society for Education and Research in Psychiatric/Mental Health Nursing's (SERPN) Primary Mental Health and Advanced Practice Psychiatric Nursing monograph. Characteristics of the nurses, the clients they serve, and their practice patterns are described. Documenting the cost-effectiveness of these practitioners and increasing the number of younger APPNs is recommended.

Constraints to advanced psychiatric-mental health nursing practice.

Constraints and barriers to advanced practice psychiatric nursing were reported by respondents of the Primary Mental Health and Advanced Practice Psychiatric Nursing survey of certified psychiatric clinical nurse specialists. Primary data (N = 507) were the qualitative responses to a survey item about constraints and secondary data were the literature and theoretical memos. Methodology was based on principles of qualitative data analysis and procedures for manifest and latent content analysis. Findings resulted in eight themes that explained both constraints and barriers to advanced practice: (1) reimbursement, (2) prescriptive authority, (3) admitting privileges, (4) bureaucracy, (5) practice environment, (6) colleagues, (7) image, and (8) personal. Themes were interpreted within the context of regulatory, market-based, and inter/intraprofessional constraints and barriers that led to suggestions for organizational and individual strategies for action. The survey was funded by the Society for Education and Research in Psychiatric-Mental Health Nursing with technical support from the Center for Mental Health Services.

Reservoir competence of the rice rat (Rodentia: Cricetidae) for Borrelia burgdorferi.

The reservoir competence of the rice rat, Oryzomys palustris, for Borrelia burgdorferi is described. Infected Ixodes scapularis Say (I. dammini, Spielman, Clifford, Piesman & Corwin) nymphs were used to infect animals. Borrelia infection was diagnosed by xenodiagnostic feeding of noninfected I. scapularis larvae and by reisolation of the spirochetes from blood and other tissues. Rice rats acquired B. burgdorferi and maintained spirochete infection for 5-9 wk. B. burgdorferi were cultured from samples of skin and urinary bladders from all animals killed on day 21 (three rats), 35 (three rats), or 56 (three rats) after infection. The spirochetes were also detected in blood samples obtained 1 and 2 wk after exposure. Spirochetes that persisted for 5 wk in rice rats did not lose their infectivity for golden Syrian hamsters. The prepatent period for infecting xenodiagnostic ticks was 1 wk. Overall, 75.6% of I. scapularis larvae (n = 694) that fed on infected rice rats acquired B. burgdorferi. Prevalence of infection reached 83% in ticks that fed on tick-exposed animals during the 2nd-4th wk, 68% during the 5th wk, and 17.4% during the 9th wk. The duration of rice rat infectivity for ticks exceeded 2 mo. I. scapularis nymphs infected as larvae on rice rats transmitted B. burgdorferi. Taken together, these studies confirm the reservoir competence of the rice rat for B. burgdorferi.

Lifelong maternal caregiving for children with schizophrenia.

Maternal caregiving for adult children with schizophrenia is described using a lifespan perspective. Principles of naturalistic inquiry and a grounded-theory design guided field work methods. Nineteen in-depth interviews with ten participants averaged 4 hours each. Data analysis involved coding and classifying themes, constant comparison, and saturating theme categories. A model depicts findings including stages of learning in the experience. The stages are as follows: (1) perceiving a problem; (2) searching for solutions; (3) enduring the situation; and (4) surviving the experience. Implications include use of the model in developing intervention and education models.

An anti-EnaTS detected in the serum of an MiI homozygote.

The serum of EH reacted with all red cells (RBCs) except her own, ficin- or trypsin-treated red cells, and En(a-) red cells. This reactivity defined an anti-EnaTS specificity. The red cells of the proposita typed as M-N+S-S+, Vw+Mur-Hil-Hut-Anek-Lane-, Wr(a-b+), EnaKT+. Red cells of five relatives were Vw+ and positive with her serum. Titration studies suggest that EH is genetically an MiI homozygote and that her Vw+ relatives are MiI heterozygotes. There is no history of consanguinity. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting studies have agreed with the serologic observations. A variant sialoglycoprotein of faster mobility than normal glycoprotein A, but no normal glycoprotein A, was detected on her red cells. Treatment with N-glycanase did not alter the mobility, which indicated that there was no N-glycosylation of residue 26. These findings are in agreement with the reported properties of the Mi.I-specific glycoprotein A. The relatives' Vw+ red cells showed the variant sialoglycoprotein and normal glycoprotein A. EH appears to be the first reported MiI homozygote.