Mary Durand Thomas

Utilizing Insider-Outsider Research Teams in Qualitative Research

Teams including members from both inside and outside the organization being studied make valuable contributions. A team configuration including both insiders and outsiders is highly effective because variations in the experience history of researchers on the team broaden the available perspectives and maximize the potential interpretations of observed behaviors. An insider-outsider research team consisting of university faculty and nurses at two psychiatric hospitals conducted a study, Meanings of State Hospital Nursing. This article summarizes the study, discusses issues to be resolved when using an insider-outsider research team, and presents the ways in which this approach enhanced the trustworthiness of our findings.

Incorporating standardized patients into a psychosocial nurse practitioner program.

Interactions with standardized patients (SPs) provide customized, immediate clinical learning for graduate nursing students. SPs are lay persons trained to portray a role in a faculty-designed health care scenario for a series of students. Student learning results from the experience of the encounter, performance feedback from the SP, subsequent classroom discussion with peers, faculty critique, and review of the videotaped interaction. Design and implementation of an SP experience involves clarification of goals for the encounter, development of the clinical scenario, recruitment and training of SPs, preparation of students, and management of the logistics of the exercise. Although the process is labor-intensive, we have found SP experiences versatile, valuable, and popular with students.

Intrahospital relocation of psychiatric patients and effects on aggression

Aggression is a recurring problem with psychiatric patients and can pose special problems on inpatient units. The purpose of this study were to identify changes in patients aggression as a consequence of routine individual relocation and to identify the relationship of certain variables with patterns of aggression. Using an adaptation of the Overt Aggression Scale (Yudofsky, Silver, Jackson, Endicott, & Williams, 1986), data were collected from the patient records of 201 individuals who had been admitted to a state hospital and subsequently transferred to another ward in the same hospital. There was a phase by day interaction with the day-to-day pattern of aggression in the pretransfer phase differing significantly from that in the posttransfer phase. The highest mean aggression for a single day was the day following transfer; the second highest was the day before transfer. There were main effects for age and number of hospital admissions.

One system, many perspectives: Stakeholders and mental health system evaluation

Abstract The use of an action research model to integrate the perspective of multiple stakeholders in the evaluation of a states mental health reform is described. The process of forming the evaluation team (a mix of university and state legislative staff) is addressed in the context of the political and scientific nature of public systems evaluation. A brief description of action research and its role in program evaluation provides the basis for discussing how the principles of action research were incorporated into the study, from the definition of research questions, to sampling, measurement, analysis and dissemination.

Preparing psychosocial nurse practitioners for health care delivery

A central task for faculty in programs preparing health care practitioners is to remain timely in educating for the prevailing and future social and health services context. Current considerations in preparing advanced practice psychiatric nurses include the need for greater recognition of comorbidity, concerns about health care access and utilization for vulnerable populations, and changing patterns of practice. In addition, there is a great need to expand the cultural competence and diversity of the population of advanced practice nurses who deliver care to recipients in an increasingly multicultural society. This article describes the educational program developed at the University of Washington to prepare expanded role Psychosocial Nurse Practitioners and sets forth the rationale for major decisions and current directions.

On public sector psychosocial nursing: a conceptual framework.

1. Nursing practice is driven more by its environment than by knowledge provided by faculty or even strong relationships between faculty and staff. Because that environment is publicly supported, programs reflect changes in the ideological environment. 2. The psychosocial nursing specialty incorporates psychiatric/mental health nursing and social sciences to reduce the negative environmental influences while increasing the positive ones. 3. Public sector psychosocial nurses must be familiar with changing laws and regulations as well as the history of hospital and community programs for the mentally ill; understand the complexity of society and that the state hospital is only one component of a large system; and contribute to the development of their subspecialty.

Recommendations for state-wide evaluations: Lessons relearned

Abstract This paper draws some conclusions from our experience with the state-wide evaluation of the Washington State Mental Health Reform Act. Some of these lessons will be familiar, but we note that as the scope of the evaluation widens, so too does the complexity and difficulty of the process, and other evaluators can expect similar complications. We also comment on a number of the decisions we made in our project, and on the characteristics of this type of evaluation and evaluation context, in the hope that these reflections might be useful in other situations.

The rise of public sector psychosocial nursing

For a number of years, the Department of Psychosocial Nursing, University of Washington, engaged in a region-wide State-University collaboration with the Division of Mental Health authorities in states of the Pacific Northwest. This collaboration provided the basis for another 12 years of a Washington State Division of Mental Health-Department of Psychosocial Nursing contract to improve nursing in the states two mental hospitals. This article describes the history, contractual relationships, and components of these projects. It concludes with a discussion of the consequences of these years of State-University cooperation, including conceptual issues, and the generation of the psychosocial nursing subspecialty, public sector psychosocial nursing.

An intensive cultural experience in a rural area

More well-trained mental health professionals serving rural and minority populations are needed. This article describes an intensive clinical experience for psychiatric mental health nursing graduates in the rural, culturally diverse Tri-Cities (Pasco, Richland, and Kennewick) of Washington. Before discussing the short-term learning experience and outcomes, the social history of the area is explained because of its impact on current health needs and the kinds of learning opportunities available. In addition, personal reflections of student participants are included.

A public-academic approach to designing a state mental health program evaluation

This article describes a collaboration between a state legislature and a state university to evaluate the impact of a legislatively-mandated reorganization of the states mental health service delivery system for adults. The authors address political, logistical, and methodological issues associated with the collaborative evaluations design and implementation.