A statewide consortium's adoption of a unified nursing curriculum: evaluation of the first two years.

AIM: This article provides an evaluation of the first two years of implementation of a statewide nursing consortium (SNC) curriculum on nursing faculty work life, teaching productivity, and quality of education. BACKGROUND: In response to the call for nursing education reform, the SNC incorporated new approaches to competency-based, student-centered learning and clinical education. METHOD: Faculty and two cohorts of students were measured at three points over the first two years of the curriculum implementation. RESULTS: The expected positive impact of the SNC was documented at the start of the first year, but not sustained. Students reported having more confidence in their clinical skills at the start of the first year, yet demonstrated significantly less confidence in their ability after two years. CONCLUSION: Faculty indicated that the SNC allowed greater opportunity for collaboration, but that the experience did not alter their classroom performance or satisfaction beyond the first year.

Prevalence and correlates of criminal victimization among new admissions to outpatient mental health services in Hawaii.

Adults with serious mental illness (SMI) experience criminal victimization at rates higher than the general population whether they reside in the community or correctional settings. This study examines the past-six month prevalence and correlates of criminal victimization among a large community sample (N = 2,209) of consumers with SMI newly admitted to outpatient mental health services during 2005 through 2008. A cross-sectional design was used with self-report and clinical data collected from administrative records. Victimization was determined by responses to direct questions about experiences in the previous 6 months with respect to victimization of a non-violent and/or violent crime. Socio-demographic, clinical and criminal correlates of victimization were abstracted from a quality of life survey and clinical assessment interview conducted at admission. Overall, 25.4 % of consumers reported being a victim of any crime (violent or non-violent) in the past 6 months, with 20.3 % reporting non-violent and 12.3 % violent victimization. The risk of victimization was elevated for those who were female, White, not taking atypical psychotropic medication, not feeling safe in their living arrangement, and were arrested or homeless in the six-months prior to engaging in mental health outpatient treatment. Policy and practice implications of these findings are discussed.

The effects of working alliance and client-clinician ethnic match on recovery status.

Sixty-seven clients with severe and persistent mental illnesses (SPMI) recruited from community mental health centers were interviewed to assess their subjective quality of life, self-efficacy, importance of ethnic matching and level of working alliance (WA) with their clinicians. Results revealed that clients in the ethnically matched group reported significantly higher WA compared to the non-matched group. Clients who reported a higher level of WA also reported better recovery status. Results suggest that, in a multicultural community, ethnic matching may help augment WA and address potential barriers to treatment engagement, and identifying strategies to promote WA may enhance treatment effectiveness in programs for SPMI.

Cognitive motivational systems and life satisfaction in serious and persistent mental illness.

PURPOSE: Levels of life satisfaction are commonly used to measure attainment of recovery in serious and persistent mental illness (SPMI). There is some controversy about what constitutes life satisfaction and its measurement. This study explored the influence of cognitive motivational systems upon estimations of life satisfaction using structural equation modeling (SEM). METHODS: One hundred and ninety participants diagnosed with SPMI from Hawai'i's public mental health system completed instruments measuring cognitive motivational systems (e.g., behavioral activation and inhibition), psychological distress, and life satisfaction (e.g., quality of life and subjective well-being). RESULTS: Exploratory models indicated that higher behavioral inhibition or psychological distress predicts lower levels of life satisfaction. However, higher levels of behavioral activation predict higher levels of life satisfaction. There was no support for psychological distress as a mediator between cognitive motivational systems and life satisfaction. CONCLUSIONS: Overall, cognitive motivational systems accounted for 15% of the variance in life satisfaction while psychological distress accounted for 29%. This suggests the importance of considering cognitive schemas and motivation beyond symptomatology when examining life satisfaction.

The recovery promotion fidelity scale: assessing the organizational promotion of recovery.

The Recovery Promotion Fidelity Scale (RPFS) was developed to evaluate the extent to which public mental health agencies in Hawai'i incorporate recovery principles into their services and operations. The project progressed through two phases using concept mapping and expert review methods to generate scale items and identify dimensions of recovery that were used as scale domains. The resultant measure consists of 12 items organized around five recovery domains. This paper describes the development of the RPFS, illustrating how public mental health stakeholders, particularly persons in recovery, can be involved in efforts toward making a system of care more recovery oriented.

The relationship between cognitive dysfunction and coping abilities in schizophrenia.

Cognitive dysfunction is a core feature of schizophrenia [Psychiatr. Clin. North Am., 16 (1993) 295; Psychopharmacology: The fourth generation of progress, Raven Press, New York (1995) 1171; Clinical Neuropsychology, Oxford University Press, New York (1993) 449] and is related to psychosocial functioning in this population [Am. J. Psychiatry, 153 (1996) 321]. It is unclear whether cognitive dysfunction is related to specific areas of functioning in schizophrenia, such as coping abilities. Individuals with schizophrenia have deficient coping skills, which may contribute to their difficulties dealing with stressors [Am. J. Orthopsychiatry, 62 (1992) 117; J. Abnorm. Psychol., 82 (1986) 189]. The current study examined the relationship between coping abilities and cognitive dysfunction in a community sample of individuals with schizophrenia. It was hypothesized that executive dysfunction and mnemonic impairments would be positively related to deficiencies in active coping efforts involving problem solving and self-initiation (e.g. advocating for oneself and others with mental illness and becoming involved in meaningful activities, such as work), independent of the contributions of the general intellectual deficits associated with the disorder and psychiatric symptoms. The results indicated that both executive dysfunction and mnemonic impairments were related to decreased usage of active coping mechanisms after controlling for general intellectual deficits. Further, recognition memory made independent contributions to the prediction of coping involving action and help seeking after controlling for the effects of negative symptoms. These findings suggest that individuals with schizophrenia may be less flexible in their use of coping strategies, which may in turn contribute to their difficulties in coping with mental illness and its consequences.

Health care experiences and preferences of uninsured workers.

An exploratory study of the experiences, beliefs, and preferences of uninsured workers found that uninsured workers are active in seeking solutions to their health care needs and have decided opinions about health care. They use a cost-benefit analysis in deciding which health problems warrant professional attention. However, uninsured workers also exhibit a contradictory pattern of behaviors and beliefs. They say their health is good, yet many have illnesses that they neglect. They are satisfied with the health care services they use, yet they want health insurance because they believe it provides more choice and ensures better care and treatment. They express few negative feelings about Medicaid, yet even among the poorest of these workers, few have recently used Medicaid. These findings can inform policy options being considered.

Exercise and eating disorders in college-aged women: profiling excessive exercisers.

This study examined associations among excessive exercise, eating disorders, and selected psychological characteristics in college women (N = 586). Participants were recruited from university classes and administered the Obligatory Exercise Questionnaire, Eating Disorders Inventory-2, Bulimia Test-Revised, and other psychosocial measures. Results indicated that obligatory exercise is best viewed as multidimensional. These dimensions were used, through cluster analysis, to generate a typology of exercisers. One identified group clearly manifested eating disorder traits and behaviors, as well as signs of psychological disturbance. Another group who exercised with equal intensity but less emotional fixation showed the fewest signs of eating disorders and psychological distress.