Case Study 13-1: A Woman With Depressed Mood
Alula Tarif's daughter, Leila, had called the community mental health clinic to request an evaluation for her mother. She said that she and her older brother live with her mother and that - though her brother does not think that there is anything wrong with their mother - she has become very worried about her mother's increasing complaints of fatigue, lack of energy, and loss of interest in life. She had bought her mother some multi-purpose vitamins, but when she did not seem to improve, she had taken her mother to the primary care physician, who recommended that she be evaluated at the community mental health clinic. When Leila called for an appointment, she said that it was very important that her mother be seen by a woman doctor. An appointment was arranged with a female psychiatric nurse practitioner. Alula Tarif enters the examining room hesitantly, holding the arm of her daughter, Leila. She is dressed in a black long skirt and long-sleeved loosely fitting tunic top and is wearing a headscarf that covers her hair and forehead. She appears much older than her stated age of 43 years. Her face is lined and there are dark circles under her eyes. She does not make eye contact and appears very anxious. She responds to the nurse's greeting with a nod. Leila explains that her mother speaks Kurdish, and although she understands a little English, she does not speak much English. The nurse asks Mrs. Tarif if she would like to have her arrange for an outside interpreter. When Leila translates the question, Mrs. Tarif becomes very agitated and prepares to leave unless Leila can stay and interpret for her.
Promoting Student Interest in Mental Health Nursing
Factors related to undergraduate nursing education are among the issues inhibiting interest in mental health nursing as a field of practice. To gain more understanding about views about mental health nursing, a survey was conducted with undergraduate nursing students at a major university in Australia after implementation of a mental health nursing course. The data provide information about student beliefs, concerns, and how mental health nursing might be promoted.
Computer-Assisted CBT for Depression and Anxiety: Increasing Accessibility to Evidence-Based Mental Health Treatment
Cognitive-behavioral therapy (CBT) is the most effective nonpharmacological treatment for almost all mental disorders, especially anxiety and depression. The treatment is time limited, encourages self-help skills, is problem focused, is inductive, and requires that individuals develop and practice skills in their own environment through homework. However, most of those with mental health issues are unable to seek help because of factors related to treatment availability, accessibility, and cost. CBT is well suited to computerization and is easy to teach to nurses. In this article we describe outcome studies of computer-assisted CBT (cCBT), outline the current technologies available, discuss concerns and resistance associated with computerized therapy, and consider the role of nurses in using cCBT.
Rethinking mental health nursing education in Australia: A case for direct entry
Desperate times call for creative solutions. The mental health workforce shortage has created an opportunity to rethink current and future education and training needs in order to prepare competent and compassionate practitioners to meet the changing demands of consumers and their carers requiring mental heath treatment and support. This article urges consideration of an undergraduate direct entry mental health programme similar to that of midwifery or the nursing foundation/mental health branch programmes of the UK.
Increasing confidence of emergency department staff in responding to mental health issues: An educational initiative
Introduction: This paper reports on one major finding of an educational initiative aimed at improving the care of persons presenting to emergency departments (EDs) with mental health issues. This goal, to improve care, was based on the premise that enhanced knowledge and skills of ED staff in mental health, including drug and alcohol issues, would result in increased confidence and competence of staff. The outcome of this would be that they could provide more effective and efficient service and thus better facilitate triage of persons with these problems. Objective: To increase the confidence of staff in working with increasing numbers of mental health presentations in EDs. Methods: Pre and post Emergency Mental Health Alcohol and Other Drugs (EMHAD) course questionnaires assessed self-ratings of clinical confidence in working with people with mental health issues. Follow-up interviews assessed if new found confidence in mental health had been integrated into daily ED practice. Results: Self ratings of clinical confidence, including knowledge and skills, showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest that participants in the course had retained and integrated information into practice. This was especially evident in their ability to talk to people about mental health problems and to triage more appropriately. Conclusion: Since attending the course staff feel more confident and competent to deal with mental health, including alcohol and other drug presentations, in the emergency department.
Case Study 18-1: Comprehensive Assessment of a Patient With Antisocial Personality Disorder
James is a 27-year-old Caucasian male who presented at interview with expansive mood. Affect was friendly, engaging, and initially appropriate to words. He appeared well groomed, tall, and very muscular, wearing clean, expensive name-brand athletic wear, jeans, and sneakers. He was tanned, with large dark eyes and long eyelashes, highlighted by a single, blackish-blue, teardrop-shaped tattoo under one eye. (Interviewer aware that literature shows that some gang members have one tattooed teardrop under their eye as a symbol for each person's life they have taken.) James reported that last month he had been court ordered to go to counseling but skipped a few appointments, as he believed he knew more about life than the counselor. In a matter-of-fact way, he stated that because he missed counseling and had a fight with the mother of his 4-year-old son, he was arrested. He then presented as very remorseful, with intrusive eye contact, and stated, "The judge told me I had to resume counseling, so I'm ready to work on improving myself." He then leaned forward in his chair and stated, "I was in a gang for awhile but I gave up that life for the sake of my son."