Barbara Caldwell

Sleep and trauma: an overview.

Sleep disturbance is common after traumatic events of various types, such as combat, physical trauma, and sexual abuse, and closely intertwined with Posttraumatic Stress Disorder (PTSD), a common outcome of severe and prolonged trauma. This paper reviews the current literature on the significance and characteristics of sleep disturbance occurring in the context of trauma, examines the relationship between sleep disturbance and PTSD, identifies gaps in knowledge relative to the role of sleep disturbance in trauma and PTSD, and discusses the implications of this body of knowledge for clinical practice.

Psychiatric Nursing Practice & the Recovery Model of Care

This article provides an overview of the national actions by key groups on recovery from psychiatric disability and how a shift is needed to transform health care service delivery in mental health. Fundamental components of recovery are outlined, and examples are provided from the literature in nursing and related disciplines that reflect similar research and evidence-based practice interventions. It is recommended that professional nursing include consumers as active participants in the design of evidence-based practices in all settings.

Sleep patterns and psychological distress in women living in an inner city

Psychological distress, including symptoms of anxiety, depression, and psychological trauma, is common in women living in inner cities and can be associated with disturbed sleep. The purposes of the study of 115 women were to examine: (a) objective and subjective sleep patterns; (b) extent of psychological distress; and (c) the relationship between objective and subjective sleep patterns and psychological distress. Wrist actigraphs were worn. High levels of life stress, sleep pattern disturbance, and psychological distress were common. Self-reported sleep patterns, but not objective sleep pattern variables, explained 12.5% to 44% of the variance in psychological distress, suggesting the importance of screening for sleep and psychological distress. These findings suggest that interventions focusing on sleep or psychological distress may reduce symptoms.

Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

Purpose: The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospitals administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. Description of the Project: The quality improvement project team instituted a new model to promote the hospitals vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Outcome: Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Conclusions: Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staffs attention to work with clients on their recovery. Implications: The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

PRESENCING: CHANNELING THERAPEUTIC EFFECTIVENESS WITH THE MENTALLY ILL IN A STATE PSYCHIATRIC HOSPITAL

Twenty-three nursing staff in a state psychiatric hospital in the eastern United States narrated their experiences in establishing meaningful presence with seriously and persistently mentally ill clients. Interviews were audiotaped, transcribed, and then interpreted using a phenomenological hermeneutic method. The results of interpretation point to clarifying or illustrating that presence is established and maintained in the context of anxiety and uncertainty. Six themes were constructed to describe staff presencing: knowing the uniqueness of individual clients; listening actively with intense focus on the client; engaging several potential channels for change; caring with confidence, creativity, and perceived respect; involving clients optimally; and encountering mutually defined effective change.

The Association of Ward Atmosphere with Burnout and Attitudes of Treatment Team Members in a State Psychiatric Hospital

As part of a Clinical Affiliation Agreement between a major state psychiatric facility and a state university, it was agreed that the hospitals staff would be assessed in terms of: burnout, nursing functioning, and ward atmosphere. The assessment data would be used to examine hospital characteristics as they relate to the strategies necessary to transform an approach of custodial care to a culture of recovery. In order to address the baseline levels of attitudes for various disciplines the survey was conducted with all advanced practice nurses (APNs), assistant directors of nursing (ADNs), registered nurses (RNs), licensed practical nurses (LPNs), psychologist, social workers, and psychiatrists. The results indicated that nursing staff had the highest burnout levels among the disciplines. Even though the nurse autonomy, relationship with MD, control over practice, and organization support was related to favorable traits on the ward atmosphere, this did not influence burnout rates of nurses. One hospital complex was distinctly different than the other four complexes of the hospital and had higher levels of Ward Atmosphere Support, Autonomy, and Order and Organization and lowest burnout levels. This assessment provides valuable data to understand the current organizational culture and consider design elements to improve collaboration and treatment team functioning.

The evolution of the advanced practice role in psychiatric mental health in New Jersey: 1960-2010.

This historical perspective is focused on the contribution of Hildegard E. Peplau in laying the foundation for Advanced Practice Nursing and the development of the roles of Clinical Nurse Specialists and Psychiatric Nurse Practitioners. An overview is provided of legal developments within the state that enabled Advanced Practice Nurses to provide mental health services. A description of a recent specialized state-funded initiative is outlined, focused on the development and contributions of Psychiatric Advanced Practice Nurses in community settings in New Jersey. Implications for the Advanced Practice Nursing role in New Jersey are presented based on national and state initiatives.

Working Together to Improve Care: Collaboration Between a State Psychiatric Hospital and an Academic Institution

This article describes a collaboration between state mental health services division and a state university that focuses on the improvement of patient care services in state psychiatric hospitals. The collaboration is different from other initiatives linking state institutions and academia as it is composed of a team of psychiatrists, advanced practice nurses, and masters prepared psychiatric rehabilitation practitioners. The historical development and accomplishments are described and the process of working with a state psychiatric hospital is explored.

Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers: Implications for Early Intervention Professionals.

This study used a survey approach to investigate current developmental surveillance and developmental screening practices by pediatric primary care providers in a diverse New Jersey county. A total of 217 providers were contacted with a final sample size of 57 pediatric primary care respondents from 13 different municipalities. Most providers (73.7%) began developmental surveillance at the first nonhospital health supervision visit, usually at 3–5 days of life. About half of responding providers (51.8%) did surveillance and/or screening at all health encounters, whereas the remaining providers (48.2%) did surveillance and/or screening at only well child visits. The majority of providers (63.6%) report using a formal tool for developmental screening. There was variation in the particular developmental tool used for screening that included the use of both standardized formal and nonstandardized informal tools. Disparities in practice were associated with the patients type of insurance, age at surveillance and/or screening initiation, and the time frame of surveillance and screening. Implications for early intervention practice are discussed.

Moving evidence to practice: reflections on a multisite academic-practice partnership.

ABSTRACTThis paper describes the challenges encountered by an academic team when working with clinical teams to translated knowledge for the purposes of quality improvement in multiple sites. The sites were four differing health care settings in a Northeastern US state: two acute care hospital sites (one rural, one urban), one visiting nurse service and one psychiatric specialty hospital were purposively chosen for the action research study. In conducting this study at these diverse sites the importance of developing relationships and trust, understanding the context and dealing with real world complexities were evident. We conclude with observations and recommendations on important elements for effective knowledge translation work.