Douglas P. Olsen

A Review of Ecological Factors Affecting Inpatient Psychiatric Unit Violence: Implications for Relational and Unit Cultural Improvements

This review examines the research on ecologic factors that may contribute to or lessen the likelihood of inpatient unit violence. Understanding these factors can provide psychiatric inpatient unit staff with valuable therapeutic relational and cultural strategies to decrease violence. International and US studies from OVID Medline, CINAHL, and PsycInfo that evaluated aggression and violence on psychiatric inpatient units between 1983 and 2008 were included in this review. The review revealed that violence results from the complex interactions among the patient, staff, and culture of the specific unit. Inpatient psychiatric staff can decrease the potential for violence by using therapeutic relationship strategies such as using good communication skills, advocating for clients, being available, having strong clinical assessment skills, providing patient education, and collaborating with patients in treatment planning. Cultural improvements include providing meaningful patient activities and appropriate levels of stimulation and unit staffing.

A Comparative Study of Chinese, American and Japanese Nurses’ Perceptions of Ethical Role Responsibilities

This article reports a survey of nurses in different cultural settings to reveal their perceptions of ethical role responsibilities relevant to nursing practice. Drawing on the Confucian theory of ethics, the first section attempts to understand nursing ethics in the context of multiple role relationships. The second section reports the administration of the Role Responsibilities Questionnaire (RRQ) to a sample of nurses in China (n = 413), the USA (n = 163), and Japan (n = 667). Multidimensional preference analysis revealed the patterns of rankings given by the nurses to the statements they considered as important ethical responsibilities. The Chinese nurses were more virtue based in their perception of ethical responsibilities, the American nurses were more principle based, and the Japanese nurses were more care based. The findings indicate that the RRQ is a sensitive instrument for outlining the embedded sociocultural factors that influence nurses’ perceptions of ethical responsibilities in the realities of nursing practice. This study could be important in the fostering of partnerships in international nursing ethics.

Presynaptic activity and CaMKII modulate retrograde semaphorin signaling and synaptic refinement.

Establishing synaptic connections often involves the activity-dependent withdrawal of off-target contacts. We describe an in vivo role for temporally patterned electrical activity, voltage-gated calcium channels, and CaMKII in modulating the response of Drosophila motoneurons to the chemorepellent Sema-2a during synaptic refinement. Mutations affecting the Sema-2a ligand, the plexin B receptor (plexB), the voltage-gated Ca(v)2.1 calcium channel (cac), or the voltage-gated Na(v)1 sodium channel (mle(nap-ts);tipE) each result in ectopic neuromuscular contacts. Sema-2a interacts genetically with both of the channel mutations. The cac phenotype is enhanced by the Sema-2a mutation and is suppressed by either plexB overexpression or patterned, low-frequency (0.01 Hz) bouts of electrical activity in the embryo. The calcium-dependent suppression of ectopic contacts also depends on the downstream activation of CaMKII. These results indicate a role for patterned electrical activity and presynaptic calcium signaling, acting through CaMKII, in modulating a retrograde signal during the refinement of synaptic connections.

Empathy as an ethical and philosophical basis for nursing.

This article reconstructs the concept of empathy. Current conceptualizations in nursing, psychology, and lay usage and philosophic approaches are examined. Factors of empathetic situations are defined. Key issues of the object, moral implications, and the locus of empathy are discussed using illustrations from fictional and professional literature. In the proposed concept, a common humanity is the object of empathy, and the empathetic process occurs within individuals. Ability to empathize varies with the broadness of the base with which each individual is able to perceive the common humanity within another. Moral implications include a duty to base actions in empathy.

Empathetic Maturity: Theory of Moral Point of View in Clinical Relations

The article describes a cognitive structural theory of how nurses conceive or understand the personhood of patients. The theory postulates three levels that have the properties of cognitive structures. The third and highest level is held to be a meta-ethical theory of the moral structure of care. For nurses operating with level-III understanding, critiques of justice and care-based ethics are further held to be synthesized within.

Privacy and Confidentiality Issues in Primary Care: views of advanced practice nurses and their patients

Various aspects of the concepts of privacy and confidentiality are discussed in relation to health care information in primary health care settings. In addition, findings are presented from patient and nurse practitioner focus groups held to elicit concerns that these two groups have in relation to privacy and confidentiality in their respective primary care settings. The focus groups were held prior to the implementation of the Health Insurance Portability and Accessibility Act in the USA. Implications for advanced practice registered nurses in primary care practices are provided.

HIPAA privacy regulations and nursing research

BackgroundThe Health Insurance Portability and Accountability Act (HIPAA) privacy regulations, which became effective on April 14, 2003, should have a significant impact on the conduct of nursing research. ApproachThe requirements of the regulations are discussed in three key areas of the research process, accessing data (including recruitment and using medical records), creating data (including intervention studies, survey, and interview research), and disclosing data to others such as colleagues at other institutions. ResultsN/A. DiscussionHIPAA will certainly impact nurses’ ability to conduct research but to an unknown degree.

DEVELOPMENT OF AN INSTRUMENT TO MEASURE THE COGNITIVE STRUCTURE USED TO UNDERSTAND PERSONHOOD IN PATIENTS

Based on a theory of moral regard for personhood, a criterion-related instrument was developed to measure variations in the cognitive structure used to give meaning to personhood in patients. The cognitive structure, called empathetic maturity, has three hierarchical levels. It is measured indirectly through analysis of thought structure. Psychometrics were established in a sample of 41 nurses. Cronbachs alpha was .68. Construct validity was established by correlation with the Defining Issues Test at r = .51. p < .01; with age and education controlled, r = .44, p < .01.

Privacy Concerns of Patients and Nurse Practitioners in Primary Care—An APRNet Study

Purpose This study explores and compares the privacy concerns of primary care nurse practitioners (NPs) and their patients. Data sources Privacy concerns were identified in separate focus groups of NPs and patients, and then parallel survey instruments were designed and administered to 27 NPs and 185 of their patients. All subjects were recruited through APRNet, a regional practice‐based research network of NPs in southern New England encompassing 58 practices. Conclusions Both groups demonstrated high levels of concern regarding privacy. While NPs and patients had similar levels of concern about most issues, there were some notable differences regarding breeches because of carelessness, disclosures for research, and which disorders require the most care in maintaining privacy. Implications for practice These results allow NPs to anticipate patient privacy concerns and to enhance trust in the clinical relationship. These results also indicate the need to educate patients regarding privacy rights and expectations.

Ethical considerations of video monitoring psychiatric patients in seclusion and restraint

Video monitoring of psychiatric patients in seclusion and restraint is reviewed from ethical and legal perspectives. Video monitoring invades privacy beyond patient expectations for routine hospital care and has the potential to harm personal dignity. The potential benefit of patient safety through monitoring must be balanced with the potential harm of monitoring to provide ethical justification. Because involuntary monitoring places patients in a position of extreme vulnerability to personal exposure, clinicians are obligated to protect these patients. A case illustrating problems with video monitoring along with recommendations for ethical use of video monitoring are presented in this article.