Eileen K. Rossen

Clinical supervision of nurses working with patients with borderline personality disorder.

Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (34). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.

Outcomes of an intervention to reduce uncertainty among African American women with diabetes.

Poor adjustment to diabetes in older African American women may result from uncertainty, stemming from a lack of information about self-care activities, a complexity of self-care activities, comorbid conditions, and a lack of resources. This study evaluated a telephone intervention to reduce uncertainty (through problem-solving strategies, information, cognitive reframing, and improved patient—provider communication)—namely, to measure its effects on diabetes self-care and psychosocial adjustment. Sixty-eight older African American women were randomly assigned to an experimental group and a control group. The experimental group received the intervention for 4 weeks, and the control group received usual care. Psychosocial adjustment and self-care were measured in all participants at baseline and 6 weeks postbaseline. The experimental group reported increased participation in exercise (self-care component; p < .001) and improvement in psychosocial adjustment (p < .001). Thus, reducing the uncertainty related to diabetes self-care improves self-care exercise, as well as psychosocial adjustment.

Women’s Well-Being After Relocation to Independent Living Communities

Late-life relocation to independent living communities is increasing, especially among women. This study described the impact of relocation on the health and well-being of 31 older women who moved from a private residence to an independent living community. Schumacher and Meleis’ (1994) nursing model of transition guided the study. Health status, social activity, self-esteem, depression, and quality of life were measured pre- and postmove. Post-move women reported a significant increase in engagement in social activities and higher quality of life. Participants’ levels of self-esteem, depression, and quality of life were found to correspond with three relocation transition styles: full integration, partial integration, and minimal integration. These preliminary findings suggest that nurses who identify older women with low self-esteem, high depressive symptoms, and low quality of life pre-move may be at risk for poor relocation outcomes. Interventions to ease the transition process and improve relocation adjustment are needed.

Older Women's Perceptions of Successful Aging

ABSTRACT Little is known about the ways in which older adults view or define successful aging. This qualitative study, therefore, examined older womens perceptions of the characteristics and components of successful aging. Transitions are complex person–environment interactions that include the disruption of the individuals life and their responses to the disruption. Older adults experience many life transitions or changes in life situations, such as relocation or loss of spouse, that result in new life patterns and perhaps even changes in well-being. Because transition is theoretically a time of change that involves introspection and self-examination, older adults who are experiencing transition, such as the study sample, are expected to be able to express their views on successful aging. Acceptance of change, engagement, and comportment emerged as key components of successful aging. Findings from this study can contribute to the development of interventions for older women, in particular, and their families to promote and reinforce personal, social, and behavioral factors that lead to successful aging.

Interdisciplinary Collaboration: The Need to Revisit

Given the complexity of the health care system and the prevalence of acute and chronic mental illnesses, multi-system interventions from an interdisciplinary team of health care providers are necessary to address the needs of individuals in psychiatric and mental health treatment venues. Despite claims that interdisciplinary practice is the norm, in reality it is difficult to accomplish (18). Students must be taught the principles and elements of this way of providing care in order to succeed. This paper describes strategies for educating undergraduate nursing students to engage in interdisciplinary collaborative practice. Two case studies are used to illustrate how teaching collaborative skills can be integrated into a psychiatric undergraduate nursing course.

Media as a teaching tool in psychiatric nursing education.

The authors describe a course in psychiatric nursing where media in the form of literature, film, and music were used as teaching strategies. The purpose was to enhance students’ sensitivity to the personal experiences of psychiatric patients while also broadening students’ understanding of mental illness and the institutions developed to treat it. Students’ critical reading, thinking, and analytic skills were cultivated, along with introspection and self-reflection.

The relationships among health functioning indicators and depression in older adults with diabetes.

A common health problem among the elderly with diabetes is the onset of depressive symptoms that can adversely affect self-care and control of diabetes. The study examined the relationships of gender, race, comorbid conditions, symptom distress, and functional status with depression in a sample (N = 55) of older adults with diabetes. Most participants were female and black; mean age was 73 years. Gender and symptom distress were the strongest predictors of depression, accounting for 53% of the variance in depression. Although the sample was reasonably high functioning with only moderate levels of symptom distress, these findings serve as an important reminder for nurses that even moderate levels of symptom distress may be an indicator of depressive symptomatology among older diabetic adults.

IMPLEMENTATION AND TESTING of the OPT MODEL as a Teaching Strategy in an Undergraduate Psychiatric Nursing Course

ABSTRACT Teaching undergraduate nursing students to think critically and reason clinically is a challenge for nurse educators, yet these skills are essential for the professional nurse.The Outcome‐Present State‐Test (OPT) Model of Reflective Clinical Reasoning (Pesut & Herman, 1999) provides a framework for teaching clinical reasoning skills to nursing students.This article describes how the model can be used in clinical teaching of undergraduate students in psychiatric and mental health settings and presents some findings from an evaluation of the model. Strategies employed in the model implementation are described, along with the benefits and limitations of this teaching method in a psychiatric clinical setting.

Visual tracking strategies to move scholarship forward.

Moving from the doctoral student role to the faculty member role is a challenging transition. Strategies that motivate and help keep scholarship moving forward can be invaluable in helping make the transition successful. The authors discuss 2 visual tracking strategies to promote the forward movement of scholarship. A whiteboard (dry erase) and a publication trajectory table to track manuscript and research ideas through grant proposal and manuscript submission to publication are described.

Commentary on "The influence of positive experiences on depression and quality of life in persons with multiple sclerosis".

The purpose of Phillips and Stuifbergen’s (2008) study was to examine the use of self-initiated activities that can improve mental or physical health by persons with multiple sclerosis (MS) and to determine the relationships between self-initiated positive activities and depressive symptoms and their impact on quality of life. Cross-sectional quantitative data collected during the 7th year of an ongoing longitudinal community-based study of health promotion and quality of life of persons with MS were used. The majority of the participants were White/non-Hispanic (92%) married (70%) women (84%) who had been diagnosed with MS for 19 years (on average). It was reported that the sample characteristics are similar to the U.S. population of persons with MS. Phillips and Stuifbergen’s synthesis of literature gave strong evidence that stress is associated with exacerbation of MS, higher levels of depression, and lower quality of life. Furthermore, it was reported that coping strategies and other psychosocial factors (e.g., social support) may mediate or moderate the effect of stress and thereby reduce depression and exacerbation of MS and improve quality of life. A new measure of Positive Experiences, a scale developed from a participant’s list of positive experiences, was used as well as measures of functional limitations, depressive symptoms, and quality of life to answer the study questions. This study makes an important contribution to holistic nursing practice by demonstrating the value of listening to study participants and incorporating their ideas when feasible and scientifically worthwhile. The new Positive Experiences scale is such an example. This scale, based on a study participant’s suggestions, was developed not only to gain information on which positive activities were being used by individuals with MS but also to give study participants “ideas to make their day better” (Phillips & Stuifbergen, 2008, p. 44). The items in the scale, which can be found in Table 1, are self-initiated activities that represent a holistic approach to positive selfcare activities and, if carried out, will promote health and well-being. In fact, the study findings support the utility of the scale as 58% of the variance in quality of life was explained by functional limitations, positive experiences, and depressive symptoms. Additionally, the positive experiences endorsed by the sample are categorized as activities that promote physical and mental health or that include socialization with other people. Holistic nurses can easily translate these positive activities from the scale by teaching their clients the activities and encouraging their clients to include them in their daily life. It is important for nurses in all roles (e.g., care deliverer, researcher) to contribute to a holistic idea of health, health care, and self-care.