Beverly Hogan

Psychiatric clinical nurse specialists, nurse practitioners, or the new practice doctorate: Meeting patients’ needs?

Psychiatric clinical nurse specialists (CNSs) were first introduced in 1954 by Hildegard Peplau as valuable contributors to the care of the chronically mentally ill (Spray, 1999; Wheeler, 2004). Peplau demonstrated that the therapeutic nurse-patient relationship shaped treatment outcomes. Then, during the years following mental health reform and deinstitutionalization, a golden opportunity arose for psychiatric CNSs to further their contribution in the community care of these patients.

Caring as a Scripted Discourse versus Caring as an Expression of an Authentic Relationship between Self and Other

As health care has become increasingly complex, the human caring associated with nursing has become eclipsed by financial bottom lines and managed care initiatives. Because patients and others expect a caring health care system, hospitals have responded in varying ways to re-infuse caring into the patients experience. This article examines two approaches (the Jean Watson Caring Science Approach and the Studer Group Approach) and considers the effect of each on the authenticity of the nurse patient relationship.

Interactional influence of fatigue and task difficulty on cardiovascular response: Demonstrations involving an aerobic exercise challenge

Experiments were executed to provide new evidence relevant to the recent suggestion that fatigue should augment or retard cardiovascular response depending on the difficulty of the challenge at hand. Participants walked on a treadmill while wearing a vest fitted with 5 or 25 pounds of weight. Later, they mounted a recumbent stationary bicycle and were asked to pedal with the chance to earn a modest incentive if they attained a low or high cycling standard (i.e., if they met an easy or difficult cycling challenge). Analysis of CV responses during the cycling period indicated expected interactions for systolic blood pressure and heart rate. Whereas responses were stronger for the Heavy-Vest (i.e., high-fatigue) group when the standard was low, they were weaker for this group when the standard was high. Experiments 2 and 3 evaluated a nonfatigue interpretation of the main results and yielded findings that supported the fatigue interpretation.

The interpretive research group as an alternative to the interpersonal process recording.

In the spirit of trying something new, we abandoned the traditional interpersonal process recording for an entirely new way to teach students about communication-an interpretive research group. We propose the interpretive research group as a strategy for teaching communication and analysis that encourages active student-faculty participation, provides for more egalitarian student-teacher relationships, and creates a liberating learning environment.

FALLOUT FROM THE BIOLOGICAL MODEL: IMPLICATIONS FOR PSYCHIATRIC MENTAL HEALTH NURSES

In the biological, disease-oriented model of psychiatric illness, psychotropic medications are the frontline treatment. These medications have enabled many consumers of psychiatric mental health care to obtain relief from severe and disabling symptoms. Allegiance to the model continues as both consumers and psychiatric mental health professionals anxiously await approval of newer medications promising even greater benefits.

Expanding the scope of psychiatric nursing practice: devaluing the essence of psychiatric nursing?

Psychiatric Nurse Practitioners are quickly becoming sought after employees, especially in public mental health systems where a shrinking number of psychiatrists necessitate alternate access to prescribers. In addition, new guidelines necessitate greater attention to the follow up and monitoring of the medical problems of psychiatric patients. These events are occurring in the midst of declining reimbursement and rising litigation concerns in psychiatry. At the same time there is an increased focus on a recovery orientation to psychiatry alongside the primacy of psychotropic medicine as the most cost effective treatment, which can become competing aims for practitioners. It is important for psychiatric nurses and psychiatric nurse practitioners to consider how these opportunities might also have a negative impact on the core foundation of psychiatric nursing.