A student-directed community project to support sexually abused women veterans suffering from post-traumatic stress disorder.

While awareness of post-traumatic stress disorder (PTSD) and sexual abuse continues to grow, it has only been during the past few years that the military has realized the prevalence and impact of sexual abuse inflicted upon women while on active military duty. Though Veteran Administration (VA) agencies throughout the United States have given concerted attention to this problem, published resources specific to PTSD and military sexual abuse have been limited. In this article the authors present the results of a 2(1/2)-year endeavor to address the problem of PTSD and military sexual abuse at the Tulsa VA Outpatient Clinic. The project started with a research study and the subsequent initiation of a PTSD women veterans support group, and culminated in the development of resource manuals for both professional staff and women veterans.

The process of transforming self in women veterans with post-traumatic stress disorder resulting from sexual abuse.

In recent years increasing attention has been given to the prevalence and impact of military sexual abuse. Symptoms of post-traumatic stress disorder (PTSD), a diagnostic entity originally restricted to those who had experienced wartime trauma, have been observed in women veterans who reported that they were sexually abused during military service. However, little research has been conducted in this area. The purpose of this study was to determine the recovery process in women veterans suffering from PTSD resulting from sexual abuse. Using grounded theory methods, the researchers interviewed 16 women veterans who were in active recovery. Constant comparison data analysis revealed the emerging basic social process of "transforming self." The findings indicate that participants transformed self by progressing through five stages: reacting to triggers; seeking validation; sorting through confusion; becoming intentional; and affirming self. The authors compare these findings to other research on recovery from sexual abuse.

A comparison of traditional folk healing concepts with contemporary healing concepts.

Health professional interest in folk healing concepts as a means of complementing contemporary health care has flourished within recent years. Yet, despite this seemingly new area of study, many basic tenets of folk healing are consistent with principles ascribed to by modern health professionals. In this article, I elucidate several concepts shared by traditional folk healing systems and the contemporary health care system. These concepts include origin of illness, harmony and balance, motion, colors, symbols, and family and community involvement. The analysis of these concepts should enable nurses to have an advanced understanding of transcultural healing practices, as well as a heightened perspective on the shared dimensions of folk and contemporary health care systems.

The business management preceptorship within the nurse practitioner program.

Changes in health care reimbursement practices have affected the way in which primary health care is provided. To be successful, nurse practitioners must have a proficient understanding of basic business functions, including accounting, finance, economics, marketing, and reimbursement practices. Yet, many graduates of nurse practitioner programs are not adequately prepared to make fundamental business decisions. Therefore, it is essential that nurse practitioner faculty provide learning experiences on primary practice business. Because the preceptor experience is an integral aspect of nurse practitioner education, a business preceptorship provides students with pragmatic knowledge of the clinical practice within a business framework. The University of Indianapolis School of Nursing offers a nurse practitioner business preceptorship. The implementation, challenges, and positive outcomes of the course are discussed in this article.

The process of transforming self in women veterans with post-traumatic stress disorder resulting from sexual abuse.

In recent years increasing attention has been given to the prevalence and impact of military sexual abuse. Symptoms of post-traumatic stress disorder (PTSD), a diagnostic entity originally restricted to those who had experienced wartime trauma, have been observed in women veterans who reported that they were sexually abused during military service. However, little research has been conducted in this area. The purpose of this study was to determine the recovery process in women veterans suffering from PTSD resulting from sexual abuse. Using grounded theory methods, the researchers interviewed 16 women veterans who were in active recovery. Constant comparison data analysis revealed the emerging basic social process of "transforming self." The finding indicate that participants transformed self by progressing through five stages: reacting to triggers; seeking validation; sorting through confusion; becoming intentional; and affirming self. The authors compare these findings to other research on recovery from sexual abuse.

Caring for alcoholic patients with dissociative identity disorder.

Nursing care of the alcoholic patient becomes multifaceted and complex with the presence of a psychiatric-mental health disorder. Although issues surrounding dual-diagnosis patients have been addressed in the literature, there is a paucity of research and theory regarding care of the patient who has both alcoholism and dissociative identity disorder. This article presents a synthesis of the nursing literature with the author's experience to elucidate factors that enhance healing. Nursing interventions that are unique and sensitive for the alcoholic patient with dissociative identity disorder are discussed.

A concept analysis of alcoholic denial and cultural accounts.

Accounts are statements offered by individuals when explaining questionable behavior. Cultures vary in the kinds of accounts they honor, and individuals who deny a problem with alcohol may be attempting to maintain congruence between self and culture. Within this context, health care professionals who challenge a patient's denial may be causing unnecessary harm. The author presents a concept analysis of alcoholic denial in relation to the concept of accounts to explicate cultural variations in the manifestation of denial. The author integrates findings of her own and others' research to advance an understanding of alcoholic denial and cultural accounts.

The meaning of alcohol to traditional Muscogee Creek Indians.

The purpose of this study was to learn the meaning of alcohol to the traditional Muscogee Creek Indians of eastern Oklahoma. Using Leininger's theory of culture care diversity and universality as the theoretical base, the authors conducted interviews of 24 traditional people to elicit both emic and etic meanings of alcohol. The conceptualization of alcohol as a dichotomy of power to do both good and evil emerged as the central theme. Other meanings of alcohol were explicated in relation to five social structure dimensions. The findings suggest culturally competent nursing implications for preserving, accommodating, and repatterning the meaning of alcohol.

Causes of alcoholism: a qualitative study of traditional Muscogee (Creek) Indians.

Traditional Native American people are experiencing serious health, economic, and social problems resulting from alcoholism. Native Americans maintain a worldview of health and illness that conflicts with the dominant culture's approach to treatment. The purposes of this study were to describe the health beliefs of traditional Muscogee (Creek) Indians concerning the causes of illness and learn how these beliefs relate to alcoholism. The researchers conducted in-depth interviews of 55 traditional Muscogee (Creek) participants to learn traditional beliefs about illness and alcoholism. Data were analyzed using content analysis. Results indicate that both illness and alcoholism are perceived as having natural and unnatural (supernatural) causes. A challenge facing nurses is how to provide culturally sensitive care when clients' and nurses' beliefs about the cause of alcoholism may be in conflict. The authors discuss preservation, accommodation, and repatterning of health care beliefs as a basis for planning culturally sensitive nursing care.

Transcending alcoholic denial.

Denial is a characteristic of alcoholism and other drug addictions that must be appreciated in order to understand the recovery process. The purpose of this field study was to describe the internal processes that alcoholics experience as they transcend denial. Grounded theory methods guided data collection and analysis. The author observed and interviewed 42 patients in an inpatient alcoholism treatment facility, then followed 30 participants over a 3-year period. Using the constant comparison method of data analysis, a basic social process theory of transcending alcoholic denial emerged. The theory has five progressive stages: reacting to the critical event; role disaffiliation; ambiguous anticipation; peer affiliation; and acceptance. The theory also elucidates consequences of unresolved stages.

The Alcoholism Denial Assessment Tool (ADAT): a study of interrater reliability.

The purpose of this study was to develop and test a tool for assessing alcoholic denial. The primary author devised the Alcoholism Denial Assessment Tool (ADAT) based on 2 years of experience. The tool was tested for interrater reliability using chart data of 42 recently discharged alcoholism patients. The test for significance of a proportion, using z scores, indicated significance at the .001 level. Item analysis showed strong interrater reliability on all but 1 of the 16 tool items. The ADAT provides nurses with a practical assessment tool that can be used daily to monitor progress. Recognition that a patient is in denial can allow meaningful and appropriately planned treatment.

Understanding alcoholism relapse. A case study illustrating the integration of two theories.

The potential for relapse is a continuous threat for recovering alcoholics, most of whom will relapse within the first few years following treatment. Although relapse prevention is a challenge to nurse practitioners and clinical specialists, having an understanding of the factors leading to relapse can assist nurses in planning individualized care. This article presents a unique perspective on alcoholism relapse by integrating two theories--the interactional approach theory and the theory of recovery and goal setting. Case studies illustrate this perspective.

Applying the "Model of recovering alcoholics' behavior stages and goal setting" to nursing practice.

In 1990, the author developed the Model of Recovering Alcoholics' Behavior Stages and Goal Setting as a result of grounded theory research. The model explains the natural progression of recovery through four behavior stages. Each stage is characterized by specific patient goals. Application of the model provides a framework for nursing care planning that is both stage-focused and patient-centered. In this article, the author discusses nursing intervention in relation to the model.

Determinants of denial: a study of alcoholics.

1. Although denial may at times operate as a coping mechanism used by alcoholics in an attempt to adapt to a perceived threatening environment, it can be a detriment to recovery. 2. The assessment of denial can be laborious because of the various aspects of denial and the obscure manner in which it can manifest itself. 3. To facilitate the assessment process, the authors have undertaken a study to operationalize denial by its observable behaviors.

A field study of couples recovering from alcoholism.

Effective recovery from alcoholism demands commitment from both partners in a marriage. The focus of this qualitative study was to learn how couples progressed through recovery and how they achieved their goals conjointly. The Model of Recovering Alcoholics' Behavior Stages and Goal Setting was used as the theoretical base. Twenty-eight couples participated in the study. The author used analytic fieldwork to learn if spouses of alcoholics conformed to the same stages as indicated by the model and to learn the interactive effects of alcoholics' and spouses' stages. As a result, the author developed the Model of Alcoholic Spouses' Behavior Stages and Goal Setting. The research has implications for planning nursing care, determining when to intervene individually versus conjointly, and identifying indicators of relapse.

Involuntary chemical addiction treatment. EAP implications for occupational health nurses.

1. Measuring treatment effectiveness is problematic when a substance abuser does not enter treatment voluntarily. Furthermore, clients' goals and EAPs' goals for recovery may be in conflict. 2. It is preferable to determine treatment effectiveness by those changes in behavior, lifestyle, and quality of life that each substance abuser considers important for recovery. 3. The author found that substance abusers' goals progress through four stages: denial, dependence, behavior change, and life planning. 4. The recovering substance abuser who returns to work requires continuous follow up by the occupational health nurse. Client stage needs to be assessed and care must be planned accordingly.