Marsha Snyder

Critical Thinking: A Foundation for Consumer-Focused Care

Both providers and recipients of health care services are now focusing attention on not only what is provided but also how services are provided. The goal is consumer satisfaction, with pressure on the provider of services to meet customer demands. This shift in focus challenges the knowledge and skills of nurses, and their ability to solve problems in collaboration with their customers. To provide consumer-focused care, nurses will need to develop critical thinking skills that utilize logical/analytical and intuitive/creative approaches to solving problems. Critical thinking skills that integrate these two approaches will provide practitioners expertise in flexible, individualized, and situation-specific problem solving. Nursing staff who are able to focus on the consumer will be better prepared to meet the demands of todays competitive health care market. The challenge facing educators is to prepare nurses with a foundation from which to provide this care.

Smoking Cessation and Serious Mental Illness

A focus group methodology was employed to identify personal, social, and environmental factors that affect smoking cessation in persons with serious mental illness. Four focus groups were held: two for those who had attempted to quit smoking and two for those who had never attempted to quit. Smoking is central to daily survival in patients with serious mental illness. Social and environmental reinforcement can both assist and hinder efforts to stop smoking. Smoke-free environments influence decisions to quit smoking if positive social comparisons with nonsmokers occur. Peer modeling and interpersonal connections with nonsmokers can offer links to forming supportive nonsmoking relationships.

Preparing Nursing Students for Contemporary Practice: Restructuring the Psychomotor Skills Laboratory

The restructured laboratory experience offered a safe environment that supported student experimentation with psychomotor skills and self-initiated approaches to problem solving. Restructuring psychomotor laboratory experiences with emphasis on communication and conceptualization of principles supported students to begin addressing clinical problems with flexibility, creativity, and the premise for lifelong skill acquisition. Students who have skills that extend beyond technique will inevitably be better prepared to meet the demands of health care systems and patients now and in the future.

Center for Integrated Health Care: primary and mental health care for people with severe and persistent mental illnesses.

The Center for Integrated Health Care capitalizes on the abilities, drive, and autonomy of advanced practice nurses, resulting in an exciting, timely academic nursing center exemplar. People with severe and persistent mental illnesses receive care that is targeted specifically to a population with chronic mental illnesses and tailored to the unique individual by integrating primary and mental health care. This Center is a partnership between Thresholds, a psychosocial rehabilitation center, staff and University of Illinois at Chicago, College of Nursing faculty. The Centers goals are to provide quality care, support teaching and learning for nursing and other health professional learners, and generate new knowledge related to the integration of mental and physical health care. To achieve long-term sustainability, the Center must partner with a federally qualified health center.

Integrated primary and mental health care services: an evolving partnership model.

TOPIC Persons with serious psychiatric disabilities experience high rates of medical co-morbidities that, if properly treated, could improve overall well-being and the course of recovery. PURPOSE This brief reports describes how two organizations-Thresholds Psychiatric Rehabilitation Centers and University of Illinois College of Nursing-partnered to offer integrated behavioral and physical health care responsive to the needs of the population and committed to consumer-centered, holistic and preventative care. Most recently, the partnership offers primary care in different community settings through different service models-tele-monitoring, home visits, group visits. SOURCES USED A combination of published literature, staff report, and quality assurance data informs this report. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The authors conclude that primary care outreach is a promising strategy in mental health settings and that the Chronic Care Model (CCM) provides a set of guidelines for designing and monitoring quality integrated care for a partnership model of integrated care.

SERIOUS MENTAL ILLNESS AND SMOKING CESSATION

Persons with serious mental illness (SMI) are faced with substantial challenges to their health. This population is two to three times more likely to smoke cigarettes than persons who do not suffer from mental illness. In particular, young adults are at high risk for vulnerability to both SMI and cigarette smoking. Although there are proven methods for smoking cessation, both pharmacologic and non-pharmacologic interventions show limited usefulness for SMI who smoke. Alternative health care options as well as support groups and physical exercise are discussed as methods that may be useful in smoking cessation. Finally, integration of smoking cessation programming into existing mental health treatment services may offer the greatest opportunity for client success.

Clinical ladders: do they reflect levels of competence?

Staff nurses positioned within two discrete clinical ladder levels were surveyed for their responses to two components of clinical competence: job performance and problem-solving tactics. Although findings suggest that clinical ladders do not seem to provide clear delineation of competence levels, several interventions with staff nurses may increase clinical ladder viability: 1) opportunity to practice and utilize mixed and integrative problem-solving styles, 2) challenging work experiences, and 3) opportunity to mentor and be mentored.

Substance Use and Brain Reward Mechanisms in Older Adults

Substance use among older adults is on the rise, with statistics indicating this to be a growing health problem. Brain changes in the reward center of the brain that naturally occur with aging are offered as one source of these statistics. Aging is generally associated with increased prevalence of chronic disease, disability, and death, and therefore a public health goal for older adults is to maintain health, independence, and function. Psychiatric-mental health nurses are uniquely positioned to assist older adults in achievement of these goals through health assessment and promotion. The use of client-centered counseling approaches that recognize the older adults developmental need for autonomy and choice in decision making have been shown to be effective in increasing motivation in this adult population.

Late-onset posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a complex psychological response to a perceived life-threatening trauma that includes re-experiencing the trauma, avoidance, intrusive thoughts, hyperarousal, and dissociation. Exposure to trauma in early adulthood increases the potential for further psychological threats throughout life. In older adult populations, PTSD is an underrecognized and undertreated disorder that can result in psychosocial disability, substance use, and other negative health outcomes. This article examines the range of symptoms related to PTSD in older adults and expands on health care provider sensitivity to the interrelationship of mental and physical health when addressing the needs of older adults with this disorder.

WOW specialty home care service for individuals with serious mental illness.

Integrated Health Care (IHC) is a nurse-managed center of the College of Nursing, University of Illinois at Chicago through which faculty nurse practitioners and clinical nurse specialists provide primary and mental healthcare services for people with serious mental illness in partnership with Thresholds, the leading freestanding psychiatric rehabilitation agency in Illinois with locations throughout metropolitan Chicago. This article describes a new project to increase access to IHC services and improve health outcomes for the most vulnerable, hard-to-reach Thresholds clients (called members) through an innovative combination of strategies to outreach beyond IHCs three clinic locations, including: house calls, group visits, and telemonitoring, IHC Without Walls (IHC WOW). As an academic nursing practice, we view IHC WOW as an opportunity to integrate teaching and evidence-based practice; accordingly our objectives include expansion of novice and advanced practice experiential learning within this innovative practice domain.