Modeling molecular interactions to understand spatial crowding effects on heterodimer formations.

Molecular crowding occurs when the density of interacting molecules in some reaction system is sufficient to create deviations from traditional mass-action models of chemistry in diffusive systems. While there is a great deal of theory on the influence of molecular crowding on biochemistry in vivo, the effects are highly dependent on specific assumptions about the shapes, volumes, and diffusion properties of the components of an individual system and are thus difficult to predict from first principles. In this study, we use lattice Monte Carlo simulations to examine the effects on a reaction system for two limiting cases of the diffusion behavior of inert crowding agents. In cells, inert molecules might diffuse throughout a solute along with the reactant species by passive diffusion or may be anchored at fixed positions within the solute. We investigate the relative contributions of the two models to crowding effects by examining moving inert particles versus stationery inert particles on the kinetics of a heterodimer assembly system. The two models of inert crowding agents resulted in highly divergent effects on the reactant system. Stationary particles exhibited a bimodal response in the reaction rate curve that was a function of copy number and spatial arrangement and which accelerated the process at conditions not unlike those found in cellular environments. On the other hand, moving inert particles created a well mixed background that had no effect on the reaction process even under extremely compacted conditions. These results may have applications in developing more realistic simulations of reaction chemistry in crowded environments such as living cells.

Adolescent research recruitment issues and strategies: application in a rural school setting.

This report discusses adolescent research recruitment strategies in general and specifically, those developed by a research team for a rural school setting. Recruitment of adolescent subjects involves the consideration of several complex issues. These issues include adolescent development, ethical and legal guidelines, and access to school settings. Specific strategies are discussed regarding access and culture of the rural setting, collaboration, and recruitment procedures in relation to their use to recruit adolescent subjects from rural schools.

Optimism and its relationship to depression, coping, anger, and life events in rural adolescents.

Optimism is a stable personality trait that has important implications for behavior, yet little attention has been given to examining optimism in adolescents. This article describes levels of optimism in rural adolescents and the relationship of optimism with depression, coping, anger, and life events. The identification of optimism may be a vulnerability factor when screening adolescent mental health and, as such, has implications for the psychiatric nurse clinician.

Health concerns and risk behaviors of rural adolescents.

Although much has been written about the health status of adolescents, little is known about adolescents' perception of their own health. The purpose of this article is to describe the health concerns of rural adolescents. Two national studies, the Youth Risk Behavior Survey and the National Longitudinal Study of Adolescent Health (Add Health Project), are used as comparisons. Data from the rural survey represent 624 community adolescents attending 4 rural Pennsylvania schools. The students were in the 9th, 10th, and 11th grades. The Adolescent Health Inventory was used to report concerns related to general health, psychosocial issues, and risk behaviors. Overall, rural adolescents in the study reported an average of 6.5 (SD = 3.2) health concerns with frequencies of occurrence being always or often and reported an average involvement in 1 (SD = 1.3) risk behavior. Psychosocial issues were reported by 28%, and 23% worried about their general health. Frequently reported risk behaviors included alcohol use, drug use, and a lack of exercise. There was minimal concern expressed regarding venereal disease or AIDS, whereas 12% expressed concern about the possibility of pregnancy. These results suggest the likelihood that adolescents perceive health from a holistic perspective and that health promotion programs should consider involving adolescents in planning, both (a) to ensure congruence of the plan of care with adolescents' concerns and (b) to clarify the interpretation and meaning of their concerns. We present implications for the community health nurse.

School relocation and stress in teens.

Geographical relocation, with transfer to a new school, is a life transition experienced by many adolescents. The normal developmental tasks of adolescence may complicate the transition for relocated teens, particularly those with inadequate coping skills. This 2-year study, conducted in an upper-middle-income suburban community in the Northeast, with highly mobile students, compared the effects of relocation on 43 teens with matched non-relocated controls. While statistical significance was found in differences between the relocated and non-relocated groups, the relocated teens were only mildly anxious. There were no significant differences between the groups for depression, hostility, life events, or coping. Implications for schools and school nursing regarding health promotion interventions with relocated adolescents are discussed.

Screening and predicting adolescent depressive symptoms in rural settings.

Adolescent depression with related suicidal behavior is a serious health problem. This article describes depressive symptoms, reported life events, and demographic risk factors in 846 rural adolescents. The results indicate that self-reported depressive symptoms in rural adolescents is significantly (p < .05) related to gender, death in the family, and the perceived positive and negative impact of life events, as well as the specific events of losing a close friend, an increase in number of arguments with parents, trouble with classmates, and trouble with police. The type of school program and trouble with siblings was marginally significant (p < .10). These demographic factors and life events may assist health-care professionals in identifying adolescents at risk for depressive symptoms.

School-based intervention to promote coping in rural teens.

PURPOSE: To evaluate a program designed to help high school students with depressive symptomology to effectively cope. DESIGN: Two-phase experimental study. METHODS: Rural high school students (N = 222), ages 14 through 19 years, were surveyed to identify teens with depressive symptomatology, identify stressful life events and coping styles of at-risk subjects, and evaluate a cognitive-behavioral group intervention to enhance students' coping and affect levels of depression. Students with depressive symptomatology were randomized into control (n = 18) or intervention (n = 23) groups. Intervention subjects were treated with a nurse-led, 8-week cognitive skills group, conducted at school. RESULTS: On posttesting, the intervention groups demonstrated reduced depressive symptoms in females and a wider range of coping compared with controls. CLINICAL IMPLICATIONS: School-based nurses are in an ideal position to provide assessment, referral, and intervention programs in the natural setting of the school. Results of this study indicate that such programs can be implemented successfully in schools and have the potential to promote mental health in teenagers.

Teaching kids to cope: a preventive mental health nursing strategy for adolescents.

TOPIC: The theoretical base, implementation, and effectiveness of Teaching Kids to Cope (TKC). PURPOSE: To inform clinicians about the benefits and uses of TKC, a 10-week psychoeducational group intervention designed to enhance the coping repertoire of adolescents. SOURCE: Authors' clinical experience. CONCLUSIONS: Following the TKC intervention, students demonstrated less depressive symptomatology and improved coping behaviors. Further research is needed to test the intervention on a larger group and to determine its effectiveness.

High touch meets high tech. Distance mental health screening for rural youth using Teleform.

This article presents an overview of distance mental health screening using Teleform. This technology provides nurses with the ability to have questionnaires administered in one location then processed and scored rapidly at a location some distance away by using a facsimile system and Teleform. The authors examine the process of using Teleform, cite its advantages and disadvantages, discuss its application with rural youth, and suggest implications for school personnel and health-care providers. Technology has facilitated many changes in health-care delivery and increasingly will be instrumental in creating changes. Computer technology can help nursing deliver services swiftly to larger populations.

Genogram: a useful tool for nurse practitioners.

This paper presents the genogram, originated by family therapists and utilized in the psychosocial field, as a valuable tool to be used by the nurse practitioner. The nurse practitioner from any area of practice, primary care, women's health, paediatrics, geriatrics, psychiatry, in any setting (hospital, clinic, school, industry, community and home), requires a tool that provides a comprehensive assessment of the client and the factors that affect their health. The theoretical background of Bowen's family system theory and of systems theory is reviewed as the genogram evolved from the theories. Two hypothetical case illustrations utilizing the genogram are presented, one presenting only medical problems, the other presenting medical, psychiatric and family relationships. The usefulness of the genogram is not new, but it is reviewed here for its value to the nurse practitioner. Evidence leads to the conclusion that the genogram is an assessment tool that enhances intervention strategy and communication in the client's record. It augments treatment planning, care provision, health promotion and prevention, as well as cost management.

Nursing research in a school setting.

As more nurses are expanding their role and moving beyond traditional staff nursing, it is becoming increasingly common to find nurses conducting research. The utilization of schools as research sites is on the rise. Life events in families, such as divorce, unemployment, and geographic relocation, predispose school-aged children to high levels of stress, and nurse researchers are in a position to examine students' responses to these stressors. The purpose of this article is to discuss four issues inherent to research in schools, and to share some strategies which were effective. The issues include recruitment of subjects, informed consent, interviewing subjects, and coping with the unpredictable.

Adolescent geographic relocation: theoretical perspective.

This article analyzes the literature related to adolescent geographic relocation. A model of transitions developed by Chick & Meleis (1986) is the basis for the analysis. This analysis suggests that adolescent relocation is a type of life transition, and the relocated adolescents constitute an at-risk population for health status alterations. The relocation transition is defined and its dimensions delineated through the literature review. Preventive nursing intervention for future research and theory development related to adolescent geographic relocation are proposed.

Adolescent suicide: behaviors, risk factors, and psychiatric nursing interventions.

Current statistics show a marked increase in suicides among adolescents 15 to 19 years of age. The literature suggests an increase in the use of lethal methods such as firearms by young suicide attempters. Studies show that most adolescent suicide completers have never received mental health treatment, although the majority had exhibited psychiatric symptoms previous to their deaths. This review of the literature identifies the characteristics and precipitants of suicidal behavior among adolescents. The literature clearly indicates a need for suicide awareness and prevention programs and for the early identification of teenagers at risk for suicidal behaviors. The most logical location for suicide prevention programs and activities is in the schools where the greatest number of adolescents can be reached. The master's-prepared psychiatric mental health nurse in a consultive and collaborative role can be instrumental in the successful formation and execution of these programs. In a joint effort, school personnel and the psychiatric mental health nurse specialist may be able to decrease significantly the number of suicidal behaviors among adolescents.

Psychiatric mental health nursing in a biopsychosocial era.

Clients in long-term facilities carry a wide array of psychiatric diagnoses, often with equally diverse medical problems. This "back ward" population requires a specialized area of psychiatric mental health nursing practice. The need for comprehensive assessment and adequate interventions, and the various frustrations of nursing staff, are discussed using a case example.

Examining the common stressors and coping methods of rural adolescents.

The major objective of this study was to explore and examine common stressors and coping strategies of rural adolescents. Coping was defined as a cognitive and transactional process between a person and the person's environment. A survey of 222 normal adolescents attending a rural southwestern Pennsylvania high school reported experiencing stressful events related to school, family, friendship, health, and transportation. The coping strategy reported as being the most commonly used was optimistic. However, the coping strategy reported to be most effective in dealing with stressful events was supportant. The results of this study contribute to the limited information on adolescent coping in rural areas. This study should help health care providers further their understanding of this vulnerable population. Clinicians can enhance the effective coping and overall health of the rural adolescent by screening for and discussing coping strategies.

Tots and teens: similarities in behavior and interventions for pediatric and psychiatric nurses.

The separation-individuation process is played out in similar ways by toddlers and teenagers. Child and adolescent psychiatric nurses may have a better appreciation of the subtleties and complexities in dealing with behaviors of these patients with a comparison of the two groups. This paper discusses similarities in behaviors of toddlers and teens and presents theory-based guidelines for interventions with clients in these age groups.

Difficulties with teens: can nursing consultation help?

Child/youth problems and psychiatric hospitalizations are increasing. A literature review suggests that there is an increased need for more nurses with the knowledge and skills necessary to work in this specialty area. The review also suggests that providing psychiatric nursing consultation services is one way to help direct care staff to strengthen or develop these skills. The authors describe a consultation project that took place on a newly developed 15-bed adolescent program in a 30-bed private psychiatric hospital. They examine the effectiveness of consultation sessions, ascertained through both verbal and written evaluations of staff members. The outcome suggests that psychiatric nursing consultation services can be an important contribution in expanding the knowledge base of direct care staff (child care specialists and nurses) who work with the hospitalized adolescent psychiatric patient.

Suicidal and nonsuicidal coping methods of adolescents.

The authors investigated the coping methods used by adolescents hospitalized for suicidal behaviors and adolescents hospitalized for nonsuicidal behaviors. The authors' purpose was to determine if a significant difference between the two groups existed. The findings suggested that adolescents with suicidal thoughts and behaviors use affective-oriented coping methods to a more significant degree than they use problem-solving strategies. The nonsuicidal group was found to use both affective and problem-oriented coping methods.

Life events, problems, stresses, and coping methods of adolescents.

The purpose of this pilot study is to explore the life events, problems, stressful situations, and coping methods used by adolescents. A sample of 69 volunteer adolescents age 16-18 was obtained from a rural western Pennsylvania high school. The following instruments were administered: The Life Event Scale, senior high version (Coddington, 1972); Mooney Problem Checklist (1951); Stress Questionnaire (Lazarus & Folkman, 1984); and the Ways of Coping Questionnaire (Folkman & Lazarus, 1988). Descriptive statistics revealed the most frequent life event listed was breaking up with a boyfriend/girlfriend; most frequent problems were related to adjustment to school; and most common stress situations related to family. Coping methods were delineated with a few gender differences noted. The most common method of coping was self-control. The adolescent population has many issues to deal with during a time of psychosocial and physiological change and vulnerability. The psychiatric-mental health nurse specialist could be a valuable asset to help school systems teach health promotion and prevention concepts about mental health, identify students at high risk for mental health disorders, and offer counseling and guidance for students and consultative services for both teachers and parents.