Journal of Psychosocial Nursing and Mental Health Services
Vol. 46 No. 6 June 2008
Replacing the Revolving Door: A Collaborative Approach to Treating Individuals in Crisis
Michelle Lauer, RN, BSN, BC; and Rose Brownstein, RN II, BC
ABSTRACT
The Crisis Assessment and Psychiatric Emergency Services (CAPES) unit was designed to improve the quality of psychiatric treatment,
contain costs, and provide relief to overburdened psychiatric inpatient and emergency services in Delaware. This innovative program is
the result of collaboration between public and private agencies to treat individuals in crisis. The myriad factors that contributed to a
broken system and instigated Delaware’s search for a solution are discussed in this article. The CAPES unit has resulted in improved
communication among providers, decreased committal rates, better linkage to appropriate levels of care, increased safety, and improved
coordination of services. Clinical implications for nursing practice include providing more holistic care in a safer environment.
ABOUT THE AUTHORS
Ms. Lauer is Patient Care Coordinator, Psychiatry, and Ms. Brownstein is an RN II, BC, on the psychiatric crisis team, Christiana Care
Health System, Wilmington, Delaware.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or
indirectly in this activity, including research support.
Address correspondence to Michelle Lauer, RN, BSN, BC, Patient Care Coordinator, Psychiatry, Christiana Care Health System, 710
Woodsdale Road, Wilmington, DE 19809; e-mail: mlauer@christianacare.org; or Rose Brownstein, RN II, BC, 16 Riverview Avenue, Chesapeake
City, MD 21915; e-mail: rosealma2@yahoo.com.
Siblings of Individuals with First-Episode Psychosis: Understanding Their Experiences and Needs
Jacqueline Sin, MSc, BSc(Hons.)-Thorn, BN, BGS, PgCertCPN, RMN; Nicki Moone, BSc(Hons.)-Thorn, Dip. Nursing, RMN; and Paul Harris,
BSc(Hons.)-Thorn, Dip. SW
ABSTRACT
The growth of early intervention in psychosis services (EIPS) has prompted needed research to provide a robust evidence base to underpin
practice. The typical service model embraces key psychosocial interventions, including family interventions. A literature review
revealed a number of relevant studies that recognized the role of siblings in families affected by severe mental illness or mental
impairment, but little was found about the impact of first-episode psychosis on siblings. To address this apparent oversight, we
conducted a study to gain an understanding of sibling experiences. Ten siblings (ages 16 to 30) with a brother or sister diagnosed with
first-episode psychosis took part in individual semi-structured interviews. The key findings were grouped in regard to emotional impact,
relationships in the family, and siblings’ roles and coping patterns. The study also revealed that families are able to identify
positive gains out of a fundamentally negative experience.
ABOUT THE AUTHORS
Ms. Sin is Education and Practice Lead in Psychosocial Interventions, Berkshire Healthcare NHS Foundation Trust and Thames Valley
University, Ms. Moone is Clinical Nurse Specialist, Family Work for Psychosis Service, Reading Community Mental Health Team, Berkshire
Healthcare NHS Foundation Trust, and Mr. Harris is Team Leader, Early Intervention Team, Wokingham District Council Community
Services/Community Mental Health Team, England, United Kingdom. The authors’ “Thorn” qualification represents accreditation by the
Psychosocial Interventions for Psychosis Programme in the United Kingdom.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or
indirectly in this activity, including research support.
The authors thank all of the siblings who participated in this study and shared their experiences.
Address correspondence to Jacqueline Sin, MSc, BSc(Hons.)-Thorn, BN, BGS, PgCertCPN, RMN, Prospect House, Prospect Park Hospital, Honey
End Lane, Reading RG30 4EJ, England, United Kingdom; e-mail: jacqueline@urbanfuture.org.
Health Disparities in Military Veterans with PTSD: Influential Sociocultural Factors
Ann Marie Nayback, MSN, FNP-C
ABSTRACT
Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to
health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research
indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher
morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural
factors that affect the development of PTSD and to publicize health disparities in military combat veterans.
ABOUT THE AUTHOR
Ms. Nayback is an active duty Army Family Nurse Practitioner, a Major in the U.S. Army, and a doctoral student at the University of
Texas School of Nursing, Austin, Texas. The views expressed in this article are those of the author and do not reflect the official
policy or position of the Department of the Army, Department of Defense, or the U.S. Government.
The author discloses that she has no significant financial interests in any product or class of products discussed directly or
indirectly in this activity, including research support.
The author thanks Dr. Alexandra Garcia for her encouragement and judicious review of this manuscript and Dr. Linda Yoder for her ongoing
support.
Address correspondence to Ann Marie Nayback, MSN, FNP-C, 20910 Foothill Pine, San Antonio, TX 78259; e-mail: ann_nayback@yahoo.com.
