Mary Ann Boyd

Mental health issues of women deployed to Iraq and Afghanistan.

The number of women serving in the military and deployed to active-duty is unprecedented in the history of the United States. When women became a permanent sector of the U.S. Armed Services in 1948, their involvement was restricted to comprise only 2% of the military population; today women constitute approximately 14.5% of the 1.4 million active component and 18% of the 850,000 reserve component. Yet, little attention has been paid to the mental health needs of women military members. This review article highlights the history of women in the military and then focuses on the impact of combat exposure and injuries, military sexual trauma, alcohol use, and family separations which are associated with PTSD, depression, suicide, difficulty with reintegration, and homelessness.

Quality Indicators for Primary Mental Health Within Managed Care: A Public Health Focus

Primary mental health is an orientation to care that addresses mental health needs of consumers on point of first contact with caregivers. Core values, and principles drawn from a public health perspective serve as the foundation for indicators of quality within managed primary mental health. A model, illustrating the key components for quality indicators, includes stakeholder groups (consumers, families, providers, and payers), quality concerns (access, appropriateness, outcomes, and prevention), and the spectrum of clinical processes (assessment, treatment, rehabilitation, and support). Responsibility for monitoring quality is vested in these stakeholder groups. To enable them to fulfill their responsibilities, indicators are proposed in the form of checklists. The checklists assist stakeholders in evaluating the plans and services offered by managed care entities.

Polydipsia in the chronically mentally ill: A review

Polydipsia, or excessive intake of water, is reviewed in the chronically mentally ill from a nursing perspective. The purpose of this article is to review research related to excessive water ingestion, the magnitude and types of problems that these patients experience, and the treatment interventions reported. Future research and practice should focus on understanding the patients experience of polydipsia and how it relates to the patients level of functioning, testing assessment tools, and determining appropriate interventions.

The Individual who is Severely and Persistently Mentally Ill: Dkections for Research and Practice

Psychiatric mental health nursing has not invested time and resources in the care of those with severe and persistent mental illness. In this article, current nursing research is reviewed and practice/research directions are delineated in the following areas: acute and chronic manifestations of symptoms, behavioral manifestations related to institutionalization, responses to psychiatric disorders over time, the long-term effects of psychotropic medication on behavior, and the impact of physical illnesses on psychiatric disorders. Knowledge is sorely needed in all of these areas to improve the nursing care of those persons with severe and persistent mental illness.

Atypical Antipsychotics: Impact on Overall Health and Quality of Life

The use of antipsychotic medications for the treatment of schizophrenia requires a detailed assessment of patient history, including comorbidities and concomitant medications. Because all antipsychotics may produce a complex array of adverse effects, the patient’s drug therapy may lead to exacerbation of pre-existent health problems and impaired quality of life. The occurrence of drug-related side effects such as cardiac disturbances, diabetes, and obesity is important to document for these patients, especially if they are already at increased risk because of underlying disease, substance abuse, or smoking. Antipsychotics may also cause anticholinergic effects, gait disturbances, and excessive sedation, which are particularly important reactions to monitor in elderly patients. Psychiatric nurses need to be aware of the risk for these side effects in relation to patients’ new or ongoing medication so that potentially serious events can be recognized and corrected. Appropriate patient education about medication is also an important component in helping patients to recognize and manage side effects and to gain the most from their drug therapy.

Integration of Psychosocial Rehabilitation Into Psychiatric Nursing Practice

Psychosocial rehabilitation (PSR) is one of the leading approaches in care of persons with mental illness and is redefining treatment in mental health delivery systems. This approach was initiated by families and consumers who were frustrated with the inadequacies of most mental health systems to provide support and meaningful social and interpersonal experiences for those with severe and persistent mental illness. Now, an interdisciplinary body of knowledge is being developed. Nursing has an opportunity to participate in the development of PSR models. This article describes the principles and concepts of PSR and proposes that nursing begin integrating nursing care into PSR through the use of the Reed process model.

Behavioral disturbances associated with dementia: Nursing implications

As “baby boomers” come of age, the number of older adults will dramatically increase. The demand for nursing care of the elderly population will be at an all-time high, especially for those with dementia of the Alzheimer’s type, one of the most devastating illnesses that threatens this group. The care of the patient with Alzheimer’s disease is particularly challenging because researchers and clinicians are only beginning to understand this very complicated disorder. This article presents an overview of the care and treatment of patients with Alzheimer’s disease. Specific nonpharmacological and pharmacological interventions are discussed within the context of cognitive impairment and the behavioral/psychological (consistency) symptoms of dementia.

The Clinical Antipsychotic Trials of Intervention Effectiveness: What Did We Learn?

THE CLINICAL ANTIPSYCHOTIC Trials of Intervention Effectiveness (CATIE), conducted between January 2001 and December 2004 and sponsored by the National Institute of Mental Health, included two major clinical trials, one focusing on schizophrenia and the other on Alzheimers disease. The goal of both trials was to study the effectiveness of antipsychotics compared with a conventional antipsychotic without any bias from the pharmaceutical industry. Results from the first phase of the schizophrenia trials were available in 2005, with results from the second phase released in 2006 (Lieberman et al., 2005; McVoy et al., 2006). There were numerous responses to the CATIE trials in the literature from psychiatrists, the larger medical community, and the pharmaceutical industry. Yet, there was a noticeable lack of critique or discussion from the psychiatric nursing community. A recent search of the CINAHL database using the terms CATIE, schizophrenia, and Alzheimers disease elicited no nursing articles. The following discussion of Phase I of the CATIE schizophrenia trial launches the first, of hopefully, many critiques of these well-publicized, influential trials.

Considerations for antipsychotic therapy: Implications for the safe and appropriate management of patients

We are pleased to present highlights of the 2001 American Psychiatric Nurses Association symposium entitled “Considerations for Antipsychotic Therapy: Implications for the Safe and Appropriate Management of Patients.” This symposium presented several timely discussions on antipsychotic therapy from the clinical standpoint: decreasing stress and trauma to the psychiatric patient and staff, improving patient long-term health and treatment success, and fostering effective therapeutic relationships.

A target weight procedure for disordered water balance in long-term care facilities

1. Water intoxication is a severe complication of disordered water balance. Hyponatremia precedes water intoxication and can be identified through abnormal diurnal weight variation. 2. The St. Louis Target Weight Procedure (STWP) is a nonintrusive method that includes a clients baseline weight, frequent weights throughout the day, a target weight of 5% above the baseline weight, and restricted fluids if the target weight is exceeded. 3. The STWP was positively related to an increase in urine concentration; thus it is successful in restoring normal fluid balance.