Use of music therapy and other ITNIs in acute care.

The purpose of this descriptive study was to examine the clinical use of music therapy as an independent therapeutic nursing intervention (ITNI) in acute inpatient settings. This study identified the frequency, rationale, and perceived effectiveness of its use as an ITNI. In addition, barriers and facilitators to nurses' use of music therapy were identified. Frequency of use of other ITNIs also were investigated. An author-designed questionnaire, based on the literature and reviewed by a panel of experts, was used to survey a convenience sample (N = 321) of RNs at an acute inpatient facility with more than 50 beds, located in the midwestern United States. One hundred thirty-five RNs (42%) participated in the study. Findings indicated that 85.2% (n = 115) of respondents knew of music therapy, with 69.6% (n = 94) of them reporting using it in practice. Of the other listed ITNIs, deep breathing was used most frequently, followed by therapeutic touch and massage. Music therapy was used most commonly to reduce anxiety and was ranked as the ITNI used most often to enhance sleep and decrease distraction, agitation, aggression, and depression. Psychiatry/chemical dependency and intensive care units had the highest incidence of use of music therapy. The ranking of barriers and facilitators identified the strongest barrier as not having time to help patients with music therapy, whereas the strongest facilitator was nurses' comfort with the idea of using music therapy. This research begins to fill an information gap about the frequency, purpose, and perceived effectiveness of use of ITNIs. The use of ITNIs can increase patient comfort and facilitate conservation of energy, which aids healing processes, as described in Levine's Conservation Model. Use of ITNIs also can empower nurses and facilitate their control over nursing practice. This study indicates that nurses need further education on the use of music therapy and other ITNIs.

Working with American Indians toward educational success.

Past research has focused on identifying barriers that American Indian college students experience in attempting to complete programs in higher educational systems. Recommendations to reduce these barriers have not significantly decreased attrition rates or increased the completion rates of this minority group. Nationally, nursing professionals recognize the shortage of minorities in the field of nursing. Likewise, the need for American Indian health care providers is growing in direct proportion to the number of health care issues facing this population. This grounded theory study focused on the enablers that supported educational success of American Indian baccalaureate nursing graduates between the years 1986 and 1995 in a western university. Through constant comparative analysis of 18 interviews, four core variables emerged. The interactive core variables are individual American Indian student, instructor, institutions (university and college of nursing), and external influences. This article focuses on the core variable individual American Indian student and the following seven properties that support success: focuses on goal, adjusts to dominant cultural, invests in self-assessment, develops assertive skills, establishes support community, socializes into roles of student and nurse, and masters content. This central core variable and properties create a gestalt that promotes educational success. The implications are that faculty, in their roles as advisor and instructor, can assist in the development and maintenance of these seven properties. This can be achieved through proactive culturally responsive advisement, creation of a culturally relevant environment, and use of humanistic andragogical approaches to teaching-learning processes.

Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison.

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.

Maintaining health: proactive client-oriented community day treatment centres for the chronic mentally ill.

This grounded theory study compared the definition of health by clients of two rural mental health day treatment centres, Big Sky Centre and Montana Centre. Based on an original grounded theory study of seven chronic mentally ill/disabled clients in Big Sky Centre (Yurkovich et al. 1997), the core variable, 'preventing loss of control' and related properties, were validated with nine residents of Montana Centre. While establishing a 'fit' with previous research findings, differences emerged between these two centres. These differences related to the staffs' philosophical approaches in providing treatment to the chronic mentally ill. Big Sky Centre care providers empowered their clients to learn new behaviours from their peers and assume new roles such as newcomer, member and leader. They also encouraged a prosocial attitude, and created a sense of belonging through valued involvement in their treatment. Montana Centre clients were not empowered to try out new behaviours in the treatment environment, or seek social support networks among their peers at the centre, which would foster a sense of belonging. The result was that clients from Montana Centre relied on the formal healthcare system more often than clients from the Big Sky Centre. The competing forces in healthcare today--family members, mental health providers, and insurance or managed care providers--make it easy to lose sight of or fail to gain the client's perspective about their health status and maintenance, particularly as it concerns day treatment centres. The importance of the day treatment centre as a therapeutic community which requires educational processes, innovative nursing practice, and client-centred interventions will be discussed.

Shift report: a time for learning.

Shift report provides an opportunity for professional communication that supports role socialization and development of a cohesive group process in the health care system. In this learning project, nursing students were able to practice professional behaviors, prioritize information, and reduce material to the boundaries of a work setting without relinquishing the holistic approach to the client. Critical thinking, direct application, self-analysis, peer critiques, and problem-solving processes were used by the student groups which will assist in their role transition to professional nursing practice.

Strategies for maintaining optimal wellness in the chronic mentally ill.

TOPIC: Ways the chronic mentally ill avoid loss of control and the importance of both the therapeutic environment and the nurse-patient relationship in helping them do this. PURPOSE: To examine the strategies people with chronic mental illness use to prevent loss of control and maintain health, and ways nurses can help with this process. SOURCE: Findings from a previously published study of seven chronically mentally ill clients in a rural day-treatment center. CONCLUSIONS: Four properties related to the core variable of "preventing loss of control" are relationships, feelings, good attitude, and functional activity. These properties must be examined within the context of the therapeutic environment as well as the nurse-patient relationship.

Loss of control and the chronic mentally ill in a rural day-treatment center.

PROBLEM: What do chronically mentally ill clients consider to be the core variable in maintaining health, and how do they go about doing this? METHODS: A grounded theory design with analysis of interviews of seven chronically mentally ill clients in a rural day-treatment center. FINDINGS: The core variable in maintaining health according to chronic mentally ill clients is preventing loss of control. A process was discovered that clients used to do this. CONCLUSIONS: Chronic mentally ill clients prevent loss of control by using informal relationships to adapt behaviors, attitudes, and feelings within a supportive environment. If this fails, they turn to formal sources of control such as therapists, case workers, or other mental health providers.

Elective preceptorship: a cooperative opportunity for baccalaureate nursing education and nursing service.

The elective summer preceptorship described in this article has been successful in facilitating socialization into professional nursing. The professional socialization process for students is described as "a sense of identity and commitment to the profession by internalizing the norms, values, knowledge, skills, and behaviors shared by members of that profession" (American Association of Colleges of Nursing, 1986, p. 3). Review of the evaluative data from students and preceptors has validated that the preceptorship contributes to the professional socialization of students. Preceptors have also indicated that they experienced personal growth and satisfaction in their educational role with students. The experience has served to enhance their own professional development. Clinical agency staff and the students have been involved in a collaborative learning opportunity which fostered interagency relationships and has taken a step in improving health care.

Patient and nurse roles in the therapeutic community.

A therapeutic community consists of an interdisciplinary team working collaboratively with the patient to maximize the patient's potential health. This process requires nursing facilitation of the patient's movement towards and assumption of behaviors inherent in the roles of newcomer, member, and leader. The nurse contributes to the therapeutic milieu in many ways: as a change agent of human behavior, as a manipulator of the dynamic environment, as a confronter of discrepancies, as a role model of interpersonal skills, and as an identified leader with diversified functional skills. The nurse enhances her utilization of the therapeutic community by knowledge of roles enacted by staff, patients, and self.