Effects of psychological distress on blood pressure in adolescents.

This cross-sectional survey measured relationships among blood pressure and measures of psychologic distress, family structure, and economic status in a sample of adolescents exposed to Hurricane Hugo. Spielberger's Anger Scale and Derogatis' Brief Symptom Inventory were used. Data analysis revealed 5% of the 1079 adolescents were hypertensive. Multiple regression analyses revealed the following predictors of higher diastolic blood pressure: African-American race, recipient of subsidized lunch, exposure to Hurricane Hugo, and higher anger-in scores in males. The effects of a catastrophic event such as a hurricane on blood pressure and the effects of introjected anger have implications for both health care consumers and providers.

OPT: transformation of nursing process for contemporary practice.

Over time, clinical, educational, and social forces have influenced the development of three generations of traditional nursing process. The first generation was concerned with problems and process. Analysis of second-generation models revealed interest in understanding the nature of diagnosis and diagnostic reasoning. We have proposed a third generation model that underscores the importance of critical, metacognitive, and thinking skills that support outcome specification and testing in clinical reasoning. Clinicians, educators, managers, and administrators are invited to consider the OPT model as an alternative to traditional nursing process. The OPT model may be one of many transitional reasoning models needed for contemporary nursing practice.

Psychological evaluations, referrals, and follow-up of adolescents after their exposure to Hurricane Hugo.

PROBLEM: There is little understanding of adolescent appraisal of stress and crisis intervention for adolescents who are exposed to major stress such as that of a natural disaster. METHODS: A description of the psychological evaluations, referrals, and follow-up assessments made by nurse practitioners (NPs) and a nurse psychotherapist (NPT) of adolescents (N = 507) in two South Carolina high schools who experienced Hurricane Hugo. FINDINGS: The NPs' evaluations concluded that 63 adolescents (12%) exhibited symptoms of psychological distress. The NPs referred 36 of these adolescents to high school counselors for minor distress or school-related problems and 27 for more intensive clinical evaluation by an NPT. Of the 27 adolescents who were referred to the NPT, 10 had symptoms associated with adolescent adjustment reaction, 8 showed symptoms of depression, 5 revealed symptoms of posttraumatic stress disorder, and 4 complained of serious family problems. CONCLUSIONS: Based on these data and the mental processes described by these adolescents, the authors propose a model and suggest adolescent appraisal of stress and crisis is a critical issue to consider when intervening with adolescents who are exposed to major stressors, including those associated with a disaster.

Hallucinatory experiences of psychiatric patients in seclusion.

Seclusion is a common treatment method in psychiatry. However, there are contradictory reports about the effects of the sensory deprivation involved in seclusion on the distortions of perceptions seen in some psychiatric patients. This descriptive study explored the seclusion experiences of seriously ill psychiatric patients; described the hallucinatory experiences of these patients during seclusion; and examined the relationship between hallucinations and sensory stimulation, as reflected in staff visits and length of time secluded. Consenting adult male and female psychiatric inpatients (n = 25), with DSM III-R diagnoses of schizophrenia or schizoaffective disorder were interviewed within 5 days after a seclusion experience, using a modification of Richardson's structured interview guide. Approximately half of the patients hallucinated in seclusion; however, 70% of these had also hallucinated before seclusion. There were no significant relationships between hallucinating in seclusion and frequency of staff visits or length of time secluded; however, patients who hallucinated received significantly more "as needed" (PRN) medications and had more therapeutic visits than patients who did not hallucinate.

Using metacognitive skills: the quality audit tool.

The authors describe a strategy used to teach clinical reasoning skills to novice diagnosticians. The strategy proposed is the Quality Audit Tool, an instrument designed to help novices use metacognitive skills to critique diagnostic statements and care plans. The Quality Audit Tool has eight frames (Diagnostic Statement, Diagnostic Cues, Functional Relationship, Outcome, Etiology, Nursing Orders, Evaluation, and Clinical Judgment); each frame has a content and process focus. Conducting a Quality Audit enables the novice diagnostician to understand relationships among the parts of a nursing diagnosis, recognize the metacognitive skills used in clinical reasoning, and evaluate knowledge and clinical reasoning against a set of standards.

Metacognitive skills in diagnostic reasoning: making the implicit explicit.

The metacognitive skills of monitoring, analyzing, predicting, planning, evaluating, regulating, and revising frame the nursing process and support clinical reasoning. Nurse educators who encourage metacognitive skill acquisition are likely to accelerate student comprehension, understanding, and mastery of nursing diagnosis, nursing process, and clinical reasoning. The models presented in this article have implications for teaching and learning clinical/diagnostic reasoning.

Self-management of recovery: implications for nursing practice.

This article describes and discusses differences in responses to a 60-item survey instrument, the Carolina Self-Regulation Inventory (CSRI) from a selected sample of university faculty and staff. The CSRI was designed to measure the types of self-regulation strategies (SRS) individuals use to facilitate their recovery from illness episodes. When the CSRI was developed, 1,306 university employees participated in the survey. Four hundred eighty (36%) employees classified themselves as faculty; 346 (26%), staff; 418 (32%), midlevel administrators; and 62 (6%), blue-collar workers. This report focuses on the differences between the faculty and staff groups in the survey. Analysis revealed that the staff used a variety of strategies and had higher statistically significant means on the following CSRI subscales: visualization (t = 2.53, P less than .01), self-talk (t = 6.801, P less than .001), and external attention deployment strategies (t = 4.08, P less than .001). No significant differences were found between faculty and staff in the use of exercise and physical activity or interactive self-regulation strategies. Higher-educated faculty women tended to use fewer SRS when compared with female staff (F = 4.70; df = 8.819; P = .0009). Faculty women were similar to faculty men in their use of SRS. Female staff used significantly more SRS when compared with faculty of both genders and male staff (t = 2.81, P = .05). Nursing implications of self-regulation nursing assessments are discussed in terms of nursing interventions and need for more research.