Journal of Psychosocial Nursing and Mental Health Services
Vol. 47 No. 9 September 2009
Mental Health Needs in a Post-Disaster Environment
Gary Milligan, MSN, MSHA; and Teena M. McGuinness, PhD, PMH-NP, BC
ABSTRACT
Maintenance of a daily routine, which includes scheduled medications, access
to a health care provider, and a stable environment, forms an anchor point in
the lives of people diagnosed with mental illness. When a disaster, either man
made or natural, interferes with these, patients often experience an acute
exacerbation of their illness. Efforts to mitigate the ensuing disruption
require a contingency plan in the event of a disaster; a plan ensuring access
to medications, health information, and caregiver stability, allows those with
mental illness to continue to function at an acceptable level. Recent world
events, such as the Asian Tsunami in 2004 and Hurricane Katrina in 2005,
indicate that minimal research exists regarding the magnitude of the effects of
disasters on those with mental illness. A review of the literature indicates
that the impact on survivors’ mental well-being is directly related to the
level of exposure to a disaster. Mental health professionals must include
crisis management, planning, and communication in pre- and post-disaster
interventions with people who have mental illness.
AUTHORS
Mr. Milligan is Instructor, Community and Mental Health Nursing, and Dr.
McGuinness is Professor of Nursing, University of Alabama at Birmingham School
of Nursing, Birmingham, Alabama.
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 Gary Milligan, MSN, MSHA, Instructor, Community
and Mental Health Nursing, University of Alabama at Birmingham School of
Nursing, NB 352, 1530 3rd Avenue South, Birmingham, AL 35294-1210; e-mail:
gmillig@uab.edu.
doi:10.3928/02793695-20090731-01
Behavioral Management of Auditory Hallucinations: Implementation and
Evaluation of a 10-Week Course
Martha D. Buffum, DNSc, RN, PMHCNS-BC; Robin Buccheri, DNSc, RN, PMHNP;
Louise Trygstad, DNSc, RN, CNS; April A. Gerlock, PhD, ARNP, PMHNP-BC,
PMHCNS-BC; Patricia Birmingham, MS, RN; Glenna A. Dowling, PhD, RN, FAAN; and
Gloria J. Kuhlman, DNSc, RN, CNS
ABSTRACT
A 10-session behavioral course for self-management of auditory
hallucinations in patients with schizophrenia has demonstrated positive
outcomes. This article evaluates both the course’s implementation and
benefits to patients attending the course. Teleconferencing, electronic media,
and 26 monthly conference calls were used to educate six advanced practice
nurses (APNs) at six sites about the course implementation. Thirty-two patients
within the U.S. Department of Veterans Affairs participated in the course. All
of the APNs reported course helpfulness, improved communication with patients
about voices, and improved harm assessment. Of the patients, 96% found the
course helpful: 67% no longer heard voices to harm self or others, and 60% had
improved auditory hallucination intensity scores. The project demonstrated
successful implementation and practice integration with APNs’ activities
corresponding to Rogers’ stages of innovation adoption. Facilitators and
barriers to implementation are also described.
AUTHORS
Dr. Buffum is Associate Chief Nurse for Research, and Ms. Birmingham is Fee
Clinical Reviewer, VA Medical Center, Dr. Buccheri is Professor, and Dr.
Trygstad is Professor Emerita, University of San Francisco, School of Nursing,
Dr. Dowling is Professor and Chair, Department of Physiological Nursing,
University of California, San Francisco, San Francisco, California; Dr. Gerlock
is Psychiatric Nurse Practitioner, VA Puget Sound Health Care System, and
Clinical Associate Professor, University of Washington, School of Nursing,
Seattle, Washington; and Dr. Kuhlman was formerly Clinical Nurse Specialist, VA
Palo Alto Health Care System, Menlo Park Division, Menlo Park, California. In
addition, Dr. Buffum is Associate Clinical Professor, and Ms. Birmingham is a
doctoral student, University of California, San Francisco, San Francisco,
California.
The authors disclose that they have no significant financial interests in
any product or class of products discussed directly or indirectly in this
activity. This material is the result of work supported with resources and the
use of facilities at VA Medical Center, San Francisco, California; VA Puget
Sound, Seattle, Washington; and VA Palo Alto Health Care System, Palo Alto,
California. This project was funded by a grant from University of San Francisco
Faculty Development Funds.
This article is dedicated to the nurses who work to decrease the suffering
of their patients with auditory hallucinations.
Address correspondence to Martha D. Buffum, DNSc, RN, PMHCNS-BC, Associate
Chief Nurse for Research, VA Medical Center (118), 4150 Clement Street, San
Francisco, CA 94121; e-mail: Martha.Buffum@va.gov.
doi:10.3928/02793695-20090730-01
Psychiatric Nurses’ Decision to Restrain: The Association Between
Empowerment and Individual Factors
Pamela L. Lindsey, DNSc, RN
ABSTRACT
The use of restraints in all health care settings has come under increased
scrutiny in recent years. Although the organizational context has been
suggested as a possible influence on restraint use, few researchers have
examined whether organizational factors affect use of restraints and
nurses’ decisions to restrain patients hospitalized in psychiatric
facilities. The purpose of this study was to examine the association of
nurses’ work empowerment (an indicator of organizational culture) with
nurses’ decision to restrain. This study also examined the association
between individual characteristics of the patient and of the nurses with
nurses’ decision to restrain. Lastly, this study examined the decision
patterns used by psychiatric nurses in response to patient situations in which
restraint might be considered.
AUTHOR
Dr. Lindsey is Assistant Professor, Illinois State University, Normal,
Illinois.
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 acknowledges her dissertation committee: Dr. Kathleen Delaney
(chair), Rush University College of Nursing; Dr. Mary Johnson, Rush University
College of Nursing; Dr. Ann Minnick, Vanderbilt University School of Nursing;
and Dr. Mary Ann Boyd, Southern Illinois University Edwardsville School of
Nursing.
Address correspondence to Pamela L. Lindsey, DNSc, RN, Assistant Professor,
Illinois State University, Campus Box 5810, Normal, IL 61790; e-mail:
pllinds@ilstu.edu.
doi:10.3928/02793695-20090730-02
