Living in the fallout: parents' experiences when their child becomes mentally ill.

Parental loss of a child to mental illness and the resulting grief is a relatively unacknowledged phenomenon. This study aimed to capture the process through which parents journey in the face of their child's mental illness. Conducting a series of focus groups, the authors sought to further the understanding and the needs of these families. They identify seven themes from initial awareness to the formation of a new stability. Identification of this grief process is an important step that can heighten practitioners' awareness so that future interventions and support systems can be developed to help these families deal with their pain and burden.

The DSM and child psychiatric nursing: a cautionary reflection.

The DSM is the key reference guide for clinicians and it continues to be the way in which practitioners apply discrete categories to behaviors that are sufficiently disruptive to social institutions to have come to the attention of tertiary care systems. As a way to classify and diagnose mental disorders, the DSM has been a source of controversy in the psychiatric community since its development. This article reviews some of the limitations of the DSM approach to psychiatric nosology with respect to practice with children. Alternative conceptualizations and approaches to childhood psychopathology are proposed and implications for child psychiatric nurses are discussed.

The psychiatric-primary care nurse practitioner: a futuristic model for advanced practice psychiatric-mental health nursing.

A new paradigm for delivering comprehensive mental and general health services has been born out of the necessity to integrate all aspects of health care. Because of issues of cost-effectiveness and capitation, fragmentation of services is no longer viable. Graduate programs in nursing will need to: (1) effectively prepare its practitioners to manage the complexity of both medical and psychiatric problems of clients, (2) promote health and prevent disease, and (3) counsel and refer clients. The psychiatric nurse practitioner is uniquely suited to provide comprehensive health care to both clients in psychiatric settings as well as primary care environments. An overview of the Psychiatric-Primary Care Nurse Practitioner program at the University of Pittsburgh is described.

Problem-focused coping in HIV-infected mothers in relation to self-efficacy, uncertainty, social support, and psychological distress.

A preliminary investigation of relationships among perceived self-efficacy, uncertainty, social support, psychological distress, and problem-focused coping was conducted in a convenience sample of 41 HIV-infected mothers. The mothers represented 93% of the clients in a large HIV clinic in 1992 who met the study criteria. Support was found for using Lazarus and Folkman's stress, appraisal, and coping framework to understand the health-related needs of HIV-infected mothers. Maternal coping was related to living with one's children and their HIV-status. The feasibility of studying this population of women was demonstrated. Findings suggest the need for exploration of family-focused interventions.

Illness cognition of HIV-infected mothers.

Despite the increasing prevalence of human immunodeficiency virus (HIV) infection in the female population the responses of women to their HIV-positive status and their resultant needs remain largely unexplored. This investigation explored the needs, choices, and decisions faced by 38 mothers since becoming HIV-positive. Participants were recruited from an infectious disease clinic in a large mid-Atlantic urban area. The results are based on data from taped, semistructured interviews with participants. Themes that emerged from these verbal reports illustrated that decisions and choices, uncertainty, their relationship to their children, and a renewed spirituality influenced the actions that they took in response to their HIV-positive status. Themes are discussed in relation to needs for further research and health-related interventions.

Judgment tasks in clinical psychiatric mental health nursing.

PROBLEM: What are the cognitive tasks involved in making judgments in psychiatric nursing? METHODS: Fifteen nurses with varied educational preparation provided 36 in-depth interviews. A comparative content analysis was done to determine the underlying structure of judgment tasks. FINDINGS: Nurses use clients' presenting behaviors as a basis for making judgments, with judgments being multiple multidimensional, overlapping, and holistic. CONCLUSIONS: Understanding judgment tasks delineates the kind of information needed to provide the best possible care.

Adult survivors of childhood sexual abuse: survivor's disclosure and nurse therapist's response.

Recent literature pertinent to adult survivors suggests that childhood sexual abuse is a serious problem, and that disclosure is on the rise. The aftereffects of childhood sexual abuse can cause dysfunction in various aspects of the survivor's physical and mental health. Understanding the traumagenic dynamics of childhood sexual abuse and its aftereffects provides direction for the nurse therapist during both the client's disclosure and intervention planning. This knowledge assists the therapist in promoting mental health and healing, as well as providing comfort for the therapist. The nurse therapist's reactions to the client's disclosure can affect the way the client feels about disclosure and the therapeutic relationship. If a negative message is conveyed to the survivor at the time of disclosure, the feelings of betrayal, stigmatization, and powerlessness that the survivor experienced as a child will be replicated. This can damage the therapeutic relationship and delay the healing process. When disclosure is received and acted upon in a sensitive, therapeutic manner, the survivor is empowered and can enter with the nurse therapist into an effective therapeutic alliance. Nurse therapists should gain awareness of the types of emotional responses that can be engendered in the health professional during disclosure. Awareness of these emotional reactions can lead to the identification of coping strategies useful to both the therapist and the adult survivor. Coping strategies useful to the therapist include maintaining adequate boundaries, understanding oneself and one's responses to sexual-abuse issues, utilizing ongoing consultation or supervision, and preventing burnout.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV-infected woman. Illness cognition assessment.

1. Special attention is particularly important in addressing the mental health needs of HIV-infected women. These needs may involve issues such as concerns about present or future pregnancy; child-rearing, often as single parents; poverty, illicit drug use or addiction; and the potential lack of support services. 2. Diagnosis of HIV infection in women may be overlooked, as the clinical signs that routinely trigger the suspicion of HIV illness in men are often interpreted to reflect depression or psychological factors, such as stress or overwork, rather than raise the suspicion of HIV infection in women. 3. Understanding a woman's illness cognition is an important component of designing strategies that can enhance coping. The picture a woman generates regarding her illness is a composite of her experiences and responses, and determines to a large extent what she will do in response to her illness.

A model of clinical judgment processes in psychiatric nursing.

This study addressed judgment processes in psychiatric nursing by analyzing reported use of clinical cues cited as being relevant in the process of making a nursing judgment. Using an exploratory, qualitative approach, data were collected by interviewing 15 subjects who provided 36 in-depth interviews upon completion of an intake interview. Comparative content analysis was used to determine the underlying structure in subject reports. A model depicting judgment processes is presented and discussed. Results suggest that although judgments were highly context-dependent, all subjects assessed data labeled as universals in the psychiatric nursing assessment: suicidality, depression, drug and alcohol use, and patient functional abilities. Similarities among subjects were noted in that presenting behaviors were most salient, a categorization process occurs within the judgment process, and patients are included in the judgment process. Finally, nursing judgments uncovered an action orientation rather than a labeling function.