Carol A. Williams

EMOTION PROCESSING IN BORDERLINE PERSONALITY DISORDERS

This study examined relationships between the ability to recognize facial affect and affective intensity in women with Borderline Personality Disorder. Women hospitalized with borderline personality disorder and community women without psychiatric disorder (n s = 35/group) were recruited via convenience sampling. The Pictures of Facial Affect and the Affect Intensity Measure were administered to consenting women. Hypotheses related to differences in recognizing facial affect were supported, but further exploration indicated that selected negative emotions accounted for the statistical significance. Implications for practice and research are explored.

Biopsychosocial Elements of Empathy: a Multidimensional Model

Empathy is a topic of growing concern in a variety of disciplines. Although considerable empathy research is reported, often single dimensions of a multidimensional and multiphasic construct are actually being studied. Empathy is a unitary construct involving biopsychosocial components and is particularly well suited for nursing study because of its theoretical congruence with nursing philosophy and concerns. Empathys importance goes beyond the usual emphasis on helper empathy. Although commonly associated with prosocial behavior, empathy involves underlying processes which may be used for either positive or negative social purposes. Recent technological improvements in research methodology, concerns regarding social violence, and conceptual shifts have led to greatly increased interest in the phenomenon of empathy and an expanded research thrust. One major recent change in empathy research is the tendency to view the phenomenon as multidimensional and consequently to include a variety of measures to capture different elements of the construct. This paper reviews the major approaches to measurement of empathy and classifies these approaches according to the dimensions of empathy that they measure. Physiological change in association with empathy is less frequently measured, but because empathy is commonly assumed to include an emotional response to another, concomitant physiological changes should accompany the emotional aspect of empathy and indicators of physiological response may be appropriate measures to include in nursing studies of empathy. A conceptualization of empathy is presented that considers empathy to be a multidimensional phenomenon, with emotional, cognitive, communicative, and relational components. Because empirical approaches can only examine the most easily measured aspects of empathy, phenomenological approaches are also needed to begin to capture the total construct.

The nature of clinical supervision in psychiatric nursing: A survey of clinical specialists

There is a growing body of theory and research on clinical supervision within other mental health disciplines; however, there has been little study of clinical supervision within psychiatric mental health nursing. This article reports the results of a survey of 61 psychiatric mental health specialists to determine their attitudes toward selected supervisory issues. Two-thirds of the respondents had received further supervision beyond the masters degree, one-half reported a personal psychotherapy experience, and one-half were certified in psychiatric mental health nursing. There were significant differences of opinion between clinical nurse specialists who were certified and those who were not and between those who reported a personal therapy experience and those who did not. The authors suggest that more attention be paid to the development of curriculum content regarding clinical supervision in graduate nursing programs. In addition, they recommend further research on the topic of clinical supervision in psychiatric mental health nursing.

Toward an Integration of Competencies for Advanced Practice Mental Health Nursing

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of bound aries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic pro grams. The purposes of this article are to discuss the need for a blended clinical spe cialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners. (J Am Psychiatr Nurses Assoc [1998]. 4, 48-56)

Mental health consultation in a nursing home.

As the worlds population ages, increasing numbers of people can anticipate spending their latter years in long-term care settings. Many of these nursing home residents will also present psychiatric illnesses as primary or secondary diagnoses. The resulting behavioral problems may present challenges to nursing staff that they are ill-prepared to meet. This article illustrates the application of the Blake and Mouton consultation model to a Veterans Administration (VA) nursing home situation by a team of psychiatric mental health nurse specialists. The consultation is described and interpreted in terms of the Blake and Mouton model. The focal conflicts addressed in the consultation included issues of morale/cohesion, power/authority, and norms/standards. Interventions used were acceptant, prescriptive, confrontation, and theories/principles. The model provided a useful structure for conceptualizing and organizing assessment and intervention in the consultation situation.

Nursing Model of Psychoeducation for the Seriously Mentally Ill Patient

The purposes of this paper are to describe a nursing model for psychoeducation that is being implemented in the psychiatric unit of a Veterans Administration (V.A.) Hospital and to report baseline descriptive data for 19 seriously mentally ill patients. The data were collected as part of a larger study of patient, family, and treatment variables associated with community adjustment of seriously ill psychiatric patients. A convenience sample of 19 consenting patients with DSM-III-R diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder were interviewed and assessed by a clinical nurse specialist. Nine consenting family members, identified by the patient as a key family member, were also interviewed. The baseline data reported here were generated in these interviews. These data were also used to develop psychoeducational plans to meet individual patient/family needs. The patients had had an average of 12 prior hospitalizations. Their mean age was 38 years; 74% were African-American and 89% were male. Patients reported a variety of understandings of the reason for their hospitalization and techniques for management of their symptoms. The most common ways of managing symptoms were categorized as physical activity, decreasing stimuli, and use of alcohol/drugs/smoking. Practical problems arising in association with the conduct of clinical research in a V.A. psychiatric setting by a research team are also discussed.

Perspectives on the hallucinatory process.

Hallucinations are common psychiatric symptoms and the hallucinating patient presents a number of nursing problems. Although psychiatric nurses have written fairly extensively about hallucinations as a clinical problem, little nursing research has tested commonly recommended nursing interventions. This paper presents a review of interdisciplinary research on hallucinations and synthesizes findings with clinical observations to suggest a number of areas needing greater stress in nursing practice and research. Aspects of a model proposed by Peplau (1963), Rector (1982), and Field (1985) are questioned. Improved assessments of hallucinating patients are recommended, with exploration of subtleties in the hallucinatory experience; and factors needing assessment are identified. Major emphasis is placed on the need to explore patient efforts at controlling hallucinations as a foundation for promoting patient self-monitoring and self-regulation of hallucinatory experience.

Blending Specialist and Practitioner Roles in Psychiatric Nursing: Experiences of Graduates:

BACKGROUND: Blended roles in advanced practice nursing have generated much discussion but little study. As role modifications emerge in nursing, there is a need to explore their implementation. OBJECTIVE: This descriptive study examined the experiences of nurses who were implementing blended roles as psychiatric clinical specialists and adult nurse practitioners. DESIGN: Four master of science in nursing and 10 postmasters nurses who had been practicing in blended roles for 1 to 2 years were interviewed about their experiences in implementing their roles. Interviews were tape recorded, transcribed, and content analyzed. RESULTS: Respondents believed they were practicing holistically, were able to appropriately integrate physical and psychological care of the patient, and found chronic psychiatric patients to have more complex physical illnesses than they had anticipated. In addition, the advanced practice nurses were satisfied with their roles, felt supported by their physician preceptors, and described cross-consultation with physicians and nonpsychiatric nurse practitioners. CONCLUSIONS: There are roles for advanced practice nurses who blend clinical specialist and adult nurse practitioner skills in the care of psychiatric and primary care patients.