Evelyn Parrish

Clinical Outcomes of Depressed Clients: A Review of Current Literature

The purpose of this paper is to review current literature reporting clinical outcomes of depressed clients who are treated by advanced practice psychiatric nurses (APPN), primary care providers, and other mental health care providers. The APPN has always been prepared to provide both individual and group psychotherapy. Now the role has expanded to include prescriptive authority and an increased focus on the psycho-neurobiological aspects of treatment. To date, there are limited outcomes studies of APPN care. A computer search of research publications was conducted, which yielded 50 articles. After careful review of each, four quantitative studies were retained. The search was expanded to include other disciplines; ten additional studies were included.

Strategies Used by Advanced Practice Psychiatric Nurses in Treating Adults With Depression

PURPOSE Strategies used by psychiatric advanced practice registered nurses (APRNs) in treating clients with depression are described to explore their effectiveness. DESIGN AND METHODS Ten APRNs participated in semistructured individual interviews for this qualitative descriptive study. The use of either a symptom severity scale or symptom reduction checklist was used to measure the effectiveness of the strategies used. FINDINGS APRNs identified a biopsychosocial approach as the primary component of their treatment of clients with depression. Other strategies identified include psychopharmacology, cognitive-behavioral therapy, and partnering with the client. PRACTICE IMPLICATIONS Treatment of depression can be enhanced with the incorporation of the biopsychosocial strategies along with standard treatment modalities.

Advanced Practice Psychiatric Nurses' Outcomes of Care: A Pilot Study

This pilot study evaluated the effectiveness of the Advanced Practice Psychiatric Nurse (APPN) in improving clinical outcomes of depressed clients and measured their clients’ level of satisfaction with APPN care. A longitudinal study design using repeated measures was conducted to evaluate clinical outcomes and satisfaction with care of depressed clients treated by APPNs. The findings suggest that APPNs are highly effective in treating clients with depression and that clients are very satisfied with the care they receive from APPNs.

Civility and Self‐Care in Nursing Go Hand in Hand

I have noticed an increase in the number of references to incivility or bullying in nursing on several social media sites. They have included examples of nursing students, clients, and nurses all being treated in a manner that shows a lack of respect and that they had felt bullied in some way and vice versa. The American Nurses Association’s (ANA, 2015) Code of Ethics forNurseswith Interpretative Statements conveys that all nurses have an obligation to promote an ethical, safe, and civil environment for their clients as well as themselves. In the rapidly changing climate of health care, education, and the demands placed on providers and educators, especially nurses, the level of stress is extremely high. The incidences of bullying or behaviors of incivility are on the increase. Clark (2015) discussed characteristics of a healthy workplace. These included “civil conversations at all organizational levels, shared organizational vision and values, leadership, both formal and informal, and civility conversations at all levels of the organization” (Clark, 2015, p. 19). While reading the posts on social media, it became clear the common factor in all instances was related to increased stress and lack of self-care. During times of increased stress, it is easy to become reactive to a situation and lose objectivity. When these occur there is a direct impact on the day-today interactions with clients, colleagues, and students. This often leads to incidences of bullying. Incivility can have a significant impact on our physical, mental, and spiritual wellbeing. If incivility behaviors continue they could result in symptoms of depression, anxiety, gastrointestinal symptoms, headaches, loss of self-esteem, and decreased interest in the organization and nursing. By being more proactive in dealing with stress, we can decrease the possibility of being disrespectful to others. So you might be asking yourself, how do I deal with the behaviors of incivility and the stress associated with those behaviors? Therapeutic communication techniques are an essential component of any relationship. Both verbal and nonverbal communication skills are essential in the exchange of ideas

Trauma, Violence, and Stigma: What Can We Do?

Gun violence, mass shootings, and bombings are a public health crisis. To date there have been 341 identified cases of mass shootings in the United States: 445 dead and 1,281 injured. In many of these cases it has been stated that the perpetrator suffered from a mental illness. The insinuation is that the violence occurred because of the mental illness, which in reality was not always the case– many of the perpetrators made bad choices regarding how to handle the conflict they were experiencing. Some were in fact most likely due to either an untreated or undertreated psychiatric disorder. This has had a severe impact on increasing the stigma of mental illness (McGinty, Webster, & Barry, 2013). Regardless of the “cause” of the increase in violence with guns, psychiatric mental health nurse practitioners (PMHNPs) need to be actively involved in helping to decrease the stigma by performing a thorough assessment, including a trauma assessment, on each client. Clients who have suffered some type of traumatic event in their lives particularly at a young age, may often use extreme measures to deal with conflict or stressors in the their lives. Another area that is worth exploring in trying to understand the reason people choose violence to deal with issues may be explained by reviewing Erickson’s Stages of Psychosocial Developmental. Take, for example, the first stage, which is trust vs. mistrust, and the inability to master this stage can lead to feelings of fear, anxiety, and mistrust. These feelings manifest as fear or mistrust of the world. The inability to master the second stage, autonomy vs. shame and doubt, can lead to someone suffering from low self-esteem and feelings of shame. The inability to achieve the third stage, initiative vs. guilt, manifests in a lack of ambition and feelings of guilt. So if we just consider the lack of mastering the first three stages or any one stage, could have an impact on how the person views the world and how they see themselves in the world. As the person matures, he or she could overcome these issues with support and therapy. The reporting of some of the cases on social media depicts the perpetrator as someone who has had a troubled past, which aligns with the inability to master the stages.

Remembering a Pioneer of Psychiatric Mental Health Nursing

Grayce Sills (1926–2016) was in many ways the Gentle Giant of Psychiatric Mental Health Nursing. She was a champion of the underserved as well as her students who would eventually come to care for those most in need. I was very fortunate to have met Grayce and still remember her words of wisdom regarding furthering my education. Psychiatric Mental Health Nursing has lost one of our pioneers and greatest supporters. Similar tributes are also printed in the Archives of Psychiatric Nursing and the Journal of the American Psychiatric Nurses Association. Please join me in remembering and celebrating the life of Grayce McVeigh Sills, born April 18, 1926, in Bremen, Ohio, died April 3, 2016 at Kobacker House Hospice. Proceeded in death by her parents, Joseph and Edythe (nee Smith); beloved partner Sharon Huesman; her sister Mabel McVeigh Arnold; her brother Emil Clifton McVeigh; her brother James Lester McVeigh and her nephew Michael Arnold. Joyfully remembered by her daughter Kathleen Sills of Concord, MA; and her grandchildren Talia and Sage Hahn of Concord, MA; as well as her nephews and nieces, Walter Arnold Jr. (Sue) of St. Petersburg, Florida; Judy Arnold of Indianapolis; Mark Arnold Sr. (Carol) of Pickerington, Ohio; TimothyArnold of Baltimore, OH; RuthAnnMcVeigh Corder (Robert) of Cary, NC; Jim McVeigh (Imozelle) of Chula Vista, CA,: special cousins, William Hilyard and Gina Vernaci of Lakewood, OH; Evelyn Fueger (Max) of Fairborn, OH; Charlene Norris of Victoria TX; dear friend Beth Basil of Columbus, Ohio; and numerous other grandnieces, grandnephews, cousins, friends and colleagues. Grayce grew up in Bremen, Ohio and graduated from high school in 1944. She attended Ohio University for two years but a summer program at Rockland State Mental Hospital School of Nursing in New York resulted in her deciding to become a nurse. She graduated fromRockland State Hospital School of Nursing (1950) and attended Teachers College, Columbia University (1950–51). Sills accepted a position atDayton StateHospital (1955). In 1956 she obtained her Bachelor’s degree from the University of Dayton. In 1964, Sills received a Master’s in Sociology from The Ohio State University. In this same year she also began her teaching career in the School, later College, of Nursing. She received her Ph.D. in Sociology from Ohio State in 1968.