<p> <b>Purpose:</b> The purpose of this DNP quality improvement project was to increase primary care provider knowledge about indications for adolescent depression screening. </p><p> <b>Background:</b> Approximately 13.3% of adolescents experienced depression in the past year. In Oklahoma alone, rates are increasing, with depression totaling 60% of all mental health illness among adolescents. Primary care providers see approximately 75% of adolescents; however, mental health conditions are missed 84% of the time. Current clinical guidelines recommend screening for adolescent depression during wellness visits or when risk factors are present. </p><p> <b>Methods:</b> The providers of interest were nurse practitioners, physicians, and physician assistants providing primary care to children between the ages of 12 and 17 in a private pediatric practice group consisting of three clinics. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention through use of a pre-test/post-test quantitative design. An email invited participants to complete an anonymous pre-test survey to evaluate knowledge and beliefs surrounding adolescent depression, then view an educational presentation on adolescent depression and screening guidelines, then complete a post-survey to evaluate any changes in knowledge and intention to screen. Results were shared with clinic representatives to help refine the education for future testing cycles and other clinic sites. </p><p> <b>Results:</b> Data collection took place over one week. Five providers completed both the pre-test and post-test surveys. Provider knowledge scores significantly increased 29% after participating in the education and self-reported knowledge on screening increased. </p><p> <b>Conclusions:</b> DNP quality improvement projects like this help develop strategies to increase best practices, leading to improved patient outcomes. Nurse-led improvement programs like this contribute to healthcare literature and the advancement of the nursing profession by developing patient-centered interventions applicable to a wide variety of providers. Results may be used to develop strategies to increase and align provider practices with best standards to help promote early identification and treatment of adolescents with depression. </p><p>

This study explores how some mental health nurses are therapeutic, in terms of the art of healing, and how they have learned to be this way. The study originated in my experience of feeling abject while working as a mental health nurse. The research question addressed this situation through exploring whether or not therapeutic education was needed in mental health nursing. Ten mental health nurses participated in the study. Giorgi’s (2009) empirical phenomenological method was chosen because of its established status, and its grounding in Husserlian phenomenology which places a primacy on experience. A review of the literature included commentaries, qualitative empirical studies, case studies, and theoretical models, and indicated that mental health nurses may be therapeutic in idiosyncratic ways. A crucial aspect to these ways unfolded in this study as openness, through which the other may come to be in her own truthfulness. Significant methodological considerations were how we ‘constitute’ meaning, how meaning can ‘force itself’ like a gestalt, empathy may be self-alienating, and words ‘sedimented’ in tradition. These linked to how we can question being captivated in ‘experiences of truth’. Findings from Giorgi’s (2009) method were that mental health nurses are therapeutic through ‘being with’ others, through innate characteristics, that learning is through openness, and is facilitated through a therapeutic environment. Giorgi’s (2009) method is critiqued, and compared to a phenomenology of the therapeutic in relation to the research interviews (after Husserl and Merleau-Ponty). It was shown that the phenomenological ‘opens up’ language while method narrows meaning. The phenomenology showed that allowing an uncertain relation between two people was crucial, and how recognising the sensual aspect of meaning opened a healing space for another to be, through which a person’s own truthfulness may emerge. Openness appears to be innate, indicating one question for further study.

<p>The study aims to assess the readiness of professional nurses in Khayelitsha health sub district to render mental health care services as stipulated in the Healthcare 2010 Plans for the western Cape. The Main objectives are to assess the readiness of professional nurses in the Khayelitsha health sub district to render mental health care services after de institutionalisation of mentally ill persons in terms of skills and resources, as well as to explore feelings and perceptions of professional nurses regarding the Healthcare 2010 plans for the Western Cape with refernce to mental health.</p>

<p>The study aims to assess the readiness of professional nurses in Khayelitsha health sub district to render mental health care services as stipulated in the Healthcare 2010 Plans for the western Cape. The Main objectives are to assess the readiness of professional nurses in the Khayelitsha health sub district to render mental health care services after de institutionalisation of mentally ill persons in terms of skills and resources, as well as to explore feelings and perceptions of professional nurses regarding the Healthcare 2010 plans for the Western Cape with refernce to mental health.</p>

<p> <b>Background:</b> Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically. </p><p> <b>Purpose:</b> The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified. </p><p> <b>Methods:</b> In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level. </p><p> <b>Results:</b> The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.</p>

Magister Curationis - MCur / The study aims to assess the readiness of professional nurses in Khayelitsha health sub district to render mental health care services as stipulated in the Healthcare 2010 Plans for the western Cape. The Main objectives are to assess the readiness of professional nurses in the Khayelitsha health sub district to render mental health care services after de institutionalisation of mentally ill persons in terms of skills and resources, as well as to explore feelings and perceptions of professional nurses regarding the Healthcare 2010 plans for the Western Cape with refernce to mental health. / South Africa

Post-Traumatic Stress Disorder (PTSD) is a mental illness resulting from exposure to a traumatic event. Symptoms of PTSD vary, but those affected commonly experience nightmares, flashbacks, hypervigilance, and trouble sleeping; they may also avoid people or situations that trigger traumatic memories. It is estimated that PTSD affects about 10-30% of all United States veterans. Additionally, traditional treatment methods have an average dropout rate of 25% among military personnel. Inadequate PTSD symptom management may lead to depression, anxiety, suicidality, isolation, unstable relationships, and substance misuse. The purpose of this review is to examine the current research concerning the use of service dogs as a treatment option for the management of PTSD and its associated symptoms among veterans with PTSD. A database search was done using CINAHL, APA PsycInfo, and MEDLINE. Limited research has been done on the effects service dogs have on American veterans' management of PTSD. A total of eight studies met all inclusion criteria and were analyzed as part of this literature review. The results of this review of the current literature suggest that psychiatric service dogs have a positive influence on the management of PTSD among veterans. The studies analyzed suggest that the acquisition of a service dog contributes to lower PTSD scores and sequelae among veterans.

A mentor is a qualified mental health practitioner, namely in this instance a nurse who facilitates guides and supervises the learning experience and assesses the student’s competences in practice. This longitudinal study examines the perceptions of mentorship in clinical practice from nurses, as they move from students to recognised professionals with authority to advise and assess students’ competence in practice. This ethically approved study mainly uses qualitative methods. Initially it involved interviewing eight completing mental health nursing students, and 270 mainly qualitative questionnaires were sent to qualified mental health nurse mentors in clinical practice. The final data collection of the study involved interviewing six qualified nurses/mentors who were originally the students in this study. Existential phenomenology was a valuable means of interpreting the perceptions of both the students, qualified nurses and the mentors. This ontological perspective explores the consciousness of the self, operating within a collective consciousness of their world. The data analysis initially followed Van Manen’s holistic approach; then extracting essences, identifying themes and then synthesizing essences. This was then followed by an existential processing of the data from the first and second interviews. The results reveal that the students believe that mentoring is an absolute necessity for their practical training; but the mentoring experience is precarious due to the numerous barriers. The results also highlighted incidences where students who experience ineffective mentoring are inspired to become much more effective at mentoring, because they do not want their students to experience the poor mentoring they had received. The participants in this study said students who are not competent are still passing practice, and the craft of mental health caring is not taught to an appropriate standard. However, learning from the experience of the transitional process was also revealed, and how the development of the self affected the perception of mentoring.

This thesis examines how women with a diagnosis of borderline personality disorder (BPD) negotiate their identity in relation to risk, also referred to as their ‘risk identity’. This is defined as, ‘…the view people have of themselves and project to others in their talk and actions in relation to risk and risk taking’. The theoretical perspective which underpins the study is informed by ontological realism, epistemological discursive/linguistic social constructionism, and an ideological critical liberatory position primarily derived from the work of Foucault (1978; 1991a; 1991b; 1998; 2002; 2008a; 2008b; 2009). This perspective informed the decision to adopt email interviews as a method for generating appropriate texts for analysis. Eight women diagnosed with BPD were interviewed over a period of ten months. Adopting a critical emancipatory methodology which incorporated feminist principles of research, Lather’s (1991) adaptation of Van Maanen’s (1988 cited in Lather 1991) ‘four tales’ was employed to view and analyse the texts from four theoretical perspectives; a ‘Realist Tale’, a ‘Critical Tale’, a ‘Deconstructivist Tale’, and a ‘Reflexive Tale’. By ‘layering’ these tales, the findings revealed sets of tensions discernable within the context of interactions with staff, the nature of services, and the wider material and discursive resources at play which inform how risk identities are negotiated. Converging Western discourses of the subject, binary gender discourse, neoliberal discourse, ‘psy’ discourses, and discourses around motherhood were found to be key discursive resources through which risk identity is produced, resisted and projected. In addition these to broad discursive findings, the study also contributes to the existing empirical literature that focuses on the lived experience of those with a BPD diagnosis. A conclusion is drawn that women with a BPD diagnosis not only receive a label which discursively excludes them from being able to be viewed as a ‘good subject of psychiatry’ (and hence leads to them being viewed as dangerous and risky), but that their difficulties and need for relational approaches to manage risk and promote recovery run counter to the way that mental health services are structured in the current neoliberal era.

This thesis explores whether participatory action research (PAR) can be a vehicle for knowledge democracy in mental health by telling the compelling tale of a team of mental health service users formed to conduct a PAR project in adult NHS mental health services. PAR is a methodology that seeks change through action and the collaborative efforts of participants, often people from marginalised groups. The team, self-named PAR Excellence, actively participated in every step of the research process, from the initial identification of the research topic (shared decision making in mental health), literature review, research design, data collection and analysis, to dissemination. The original contribution to knowledge is in two parts: findings on shared decision making and the use of recorded service user experiences in mental health, and findings on the PAR process itself. Through these intertwining efforts, an original analysis of knowledge democracy in the context of adult NHS mental health services in the UK has been reached. Having chosen shared decision making in mental health, PAR Excellence developed a multi-media library of service user experiences to be used as a shared decision making resource. They explored with NHS mental health staff whether this approach supported shared decision making through qualitative focus groups and interviews. It was concluded that whilst the use of recorded service user experiences as a shared decision making resource was generally welcomed in principle by staff, in practice there was limited utilisation of the resource. However, it was highly valued as an opportunity for staff reflective practice, and when used judiciously, showed the potential for having a profound effect for service users. It was also found that shared decision making is a complex concept that has many different meanings amongst staff, and they work in a system where true shared decision making cannot consistently occur. However, it was discovered that staff found the involvement of service users in the research process gave the project authenticity and credibility over research generated purely by traditional researchers, and were therefore more likely to engage with it. The shared decision making resource also provoked a particularly positive response in staff members who have used mental health services themselves. Throughout the project, qualitative focus groups were also held with PAR Excellence to explore the participatory process and its outcomes overall. These findings established that the motivations of the team (who were highly critical of mental health services) were rooted in a profound understanding of the power mental health services had over them, dissatisfaction with services, and a deep sense of injustice. This led the team to express a concept of subversive "meddling" in mental health services to address these issues. They found that whilst personal transformation through PAR was achievable, the potential for more general, external transformation was limited due to the enmeshment of the political and economic climate in which mental health services operate.