People living with a mental health issue is elevated both nationally and internationally, and the likelihood of a person interacting with someone who has a mental health issue is high. It is even higher for those who work in the health care profession, so understanding their attitudes on this matter is important. As a review of current literature reveals, there is not only stigma in the health care system, but there is also stigma among health care professionals and students. One of the groups of students that has not been researched to a great extent is nursing students and the degree of stigma they have for caring for those with mental health issues. A cross-sectional survey was conducted to assess the degree of stigma among these individuals. A voluntary online survey was done was administered to undergraduate nursing students at a university in the southeastern part of the United States using the twenty item Opening Minds Scale for Health Care Providers (OMS-HC). The results indicated that mental illness stigma did exist within the student nurse community with no association between gender, classification, and mental health nursing course completion and total score on the OMS-HC scale.

Community treatment orders (CTOs), which allow for involuntary psychiatric treatment of individuals who meet particular legal criteria while they are living in the community, have been in effect in Ontario since 2001. Some similar form of mandated community-based psychiatric treatment exists in every Canadian province and in many other jurisdictions around the world. In the wake of deinstitutionalization, CTOs filled a gap in mental health care, allowing for the treatment of people with serious and persistent mental illness (SPMI) who were otherwise unable or unwilling to access care; however, CTOs brought their own host of legal, ethical and practice dilemmas, as well as mixed results in research about their effectiveness. This doctoral research examines the way CTO policy is situated within a larger historical, social, legal and discursive system; the way it is deployed, operationalized and negotiated in day-to-day practice; and the layered effects that this has on the multiple actors involved. This study gives voice to a small and vulnerable subset of the population who, in addition to experiencing mental illness, have layered experiences of stigmatization and low socio-economic status. The purpose of this study was to explore the cultural context, beliefs and values underlying the CTO and perpetuated by the CTO, as it was used in community mental health care in Ontario, through an examination of its impact on identity of people living with SPMI. The study was guided by a theoretical framework that brought together the work of Michel Foucault on governmentality and Elizabeth Grosz on body image in order to critically examine the issue of identity from both the outside in (how identity is constructed) and the inside out (how that constructed identity is experienced). It used a critical ethnographic methodology. Data collection included in-depth interviews with persons with SPMI (N=7), family members (N=5) and clinicians (N=10), observations of health care practices for people with CTOs, and analysis of documents used during the CTO process. Data was analyzed using critical discourse analysis. This study revealed insights in the into social context of CTOs, that is, the complex social landscape in which CTOs operate; the social practice of CTOs, that is, the many steps and many actors involved in the CTO process; and the social impact of CTOs, that is the effect of CTO processes on both the constructed and the experienced identity of the patient, family member and clinician. The constructed identity of the patient included perceptions of the patient as risky, defective, and in need of surveillance; the experience of this identity was characterized by feelings of being criminalized, disconnected, muted, traumatized and gaslit. The constructed identity of the family members included an idealization of families as responsible and available, and instrumentalization of the family role. This identity experience was characterized as a dissonance between roles, a witnessing of the absurd, and as putting a strain on other elements of life/identity. The constructed identity of the clinician in relation to CTOs included the role of enforcer, fall-guy, paternalistic provider, and the patient’s adversary. The experience of this identity was characterized by frustration, powerlessness, distress, and an acceptance of dissonance. CTOs, while facilitating access to some treatments and services, also act to construct identities for patients that further limit their full integration into communities as valued members. An examination of the constituent parts of the CTO highlights areas in which CTO processes could be changed; research participants conveyed areas in which they thought the CTO could be improved, including changes to methods of police intervention, better collection and use of administrative data, systemic change, the use of specific approaches to care, changes to the timings of renewals, and changes to the Consent and Capacity Board hearings. The discussion highlights ways in which a re-examination of the context in which CTOs are used can lead to the consideration of political and therapeutic means to reduce both the circumstances that lead to mental and emotional distress and to improve our responses to mental and emotional distress when these are experienced by members of our communities.

Abstract Introduction and Background Many people in the pediatric population are be brushed off and misdiagnosed when it comes to depression. I decided to research into pediatric depression and how the effects of their peers, parents, and exposure to violence correspond with depression and how it effects their daily life. Purpose Statement The purpose of this literature review is to systematically and critically appraise current literature to examine the associations between pediatric depression and sleep issues, exposure to violence, peer relationships, and parental criticism. Literature Review For this literature review I gathered a total of 5 articles which are included in this review. All the 5 articles are academic journals. These articles all come from CINAHL complete from the ETSU library database. Findings When the pediatric population is exposed to emotional abuse, emotional neglect, physical abuse, physical neglect, peer victimization and peer fighting, they were reported to have significantly greater depressive symptoms and hopelessness than the pediatric population who did not experience as much violence and neglect (Benton et al. 2020). Children who had preschool-onset major depressive disorder, after receiving parent-child interactive therapy with a focus on emotional development were found to experience a significant reduction in insomnia, daytime fatigue, and total sleeping problems (Hoyniak et al., 2020). There was also a strong correlation that the more parental criticism an adolescence receives, the higher the risk for major depression there is (Nelemans et al., 2020). The CLPM model indicated that depressive symptoms increased the risk for subsequent peer rejection consistently and peer acceptance mainly before eighth grade (Yang et al., 2020). And in the patients who came to the ER with non-psychiatric complaints, after screening for depression many of their results indicated a moderately-severe depression score which presents a need for additional help from a mental health care provider (Arrojo and Hooshmand, 2021). Conclusions Overall, there is a strong correlation between pediatric depression and sleep issues, exposure to violence, peer relationships, and parental criticism. The studies proved that the more parental criticism a child received, the more depressive symptoms they faced, as well as the more sleeping issues they experienced. The data also proved that in adolescence the influence of peers is strong and peer relationships have heavy influence on the depressive symptoms shown by adolescence. When children are exposed to a ‘web of violence’ they are also more inclined to experience depression and many children try to internalize their mental health issues to please their parents. There needs to be more general education about pediatric depression and more implementations of mandatory screenings added to the EHR. For many of these studies, if they were to be performed again, they would benefit from more diversity as well as larger sample sizes. This would provide a more generalizable set of data that could be applied in more places.

Clinical practice guidelines (CPGs) for Attention Deficit Hyperactivity Disorder (ADHD) recommend documentation of symptom scales and comorbidity screenings at the time of diagnosis and routinely throughout care. Rates of documentation for these tools in pediatric primary care are consistently low, creating a gap in care that impairs diagnosis, management, and patient outcomes. The purpose of this quality improvement project was to implement an online ADHD portal that emails, collects and scores these tools. The aims of the project are to improve utilization of CPGs by increasing documentation rates of symptom scales and comorbidity screenings for pediatric patients with ADHD. One primary care pediatrician located in Middle Tennessee piloted the project, with the goal to expand this practice change to additional partners in the future. Following submission to the IRB, the committee determined this type of quality improvement project to not require their oversight. A six-month retrospective chart review was conducted to determine baseline rates of documentation for the two outcomes. During the ten-week project, the portal was activated and evaluation tools were sent. A second chart review will be conducted at the conclusion of the project to determine if utilization of CPGs for the two outcomes has improved. Limitations included small sample size and accessibility barriers. The expected outcomes of this project include successful implementation of the online portal with improved rates of documentation for symptom scales and comorbidity assessments. This project could potentially improve CPG utilization and ultimately impact the quality of care for pediatric patients with ADHD.

The purpose of this thesis is to critique the literature focusing on the role of pineal gland volume and function and the development of schizophrenia by asking the question, "What is the relationship between pineal gland physiologic function and development and symptom severity of schizophrenia? It is crucial that health care providers continue advocate for better understanding of schizophrenia in order to develop a more appropriate treatment and relive the suffering of those with schizophrenia. A review of published literature focusing on the pineal glands association with schizophrenia was performed using several databases including: ScienceDirect, PubMED, Google Scholar, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Elton B. Stephens Co. (EBESCO). Key search terms included: Pineal gland, melatonin and schizophrenia, pineal gland and schizophrenia, sleep and schizophrenia, melatonin and treatment for schizophrenia, alternative treatments for schizophrenia, and pineal volume and schizophrenia. Based on current researching findings, it is my prediction that the chief consensus among the literature will be that physiologic abnormalities often coincided with schizophrenia, but do not indicate the severity of the disease or seem to have a strong correlation to the cause of the disease. It is also my prediction that alternative therapies will be beneficial in reducing symptoms severity, and adverse effects cause by psychiatric medications.

Background: High-fidelity simulation recreates real-life situations in a safe learning environment and encourages critical thinking in students. Published research in simulation in psychiatric/mental health nursing is sparse. Methods: Four scenarios exemplifying drug or alcohol abuse utilizing the computerized, mannequin SimMan® were implemented. Students evaluated their learning experience following completion of the simulation via a 20-item, Likert-scale survey which included open-ended questions. Results: Results were positive. Students rated all items on the survey as “agree” or “strongly agree” (Mean 4.77, SD=0.55). Conclusions: High fidelity clinical education simulations are an effective means of facilitating student learning of psychiatric and mental health clinical experiences. Students found simulation to be a useful and engaging means by which to learn to care for clients with drug or alcohol abuse disorders.

Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two different mandates: criminal justice (public protection) and health care (public good). Nurses’ involvement at one of the systems’ points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and health care professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCRMD) represent significant threats to the safety of the public, and orders conditions aimed at keeping the community safe. The aim of this research project was to explore how psychiatric and public safety discourses construct the identity of persons UST or NCRMD during RB hearings, and nurses’ contribution to such identity construction. Critical ethnography methodology was employed, mobilizing three data sources: interviews with forensic psychiatric nurses, observations of RB hearings, and RB documentary artifacts. A poststructuralist lens was used to discern how RB culture produces truths about persons UST or NCRMD that sustain the hegemony of public safety and psychiatric discourses. The main finding was that the forensic psychiatric structure leverages therapeutic nursing interventions and documentation as evidence of deviancy, so that persons UST or NCRMD can be objectified and produced as dangerous, prior to socially rehabilitating them. Discursive structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering it coercive and punitive. Thus, a care-and-custody dichotomy is insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for research, practice, and education in forensic psychiatric nursing, nursing ethics, and other nursing specialties on the medico-legal borderland.

Suicide has existed throughout recorded history. It is a phenomenon that has been both culturally and morally defined across time and civilizations. It is estimated that over 34,000 Americans deliberately take their own lives annually. Moreover, according to some experts, between 6 and 28 individuals are directly affected by each completed suicide. These individuals are referred to as suicide survivors. The consequences for suicide survivors are multidimensional in part because relationships to the deceased play a vital role in bereavement. Previous research studies in the areas of suicidology and bereavement have failed to explore the experience of mothers bereaved by the suicide death of a child. The purpose of this qualitative study was to explore phenomenologically the lived experience of mothers following the suicide death of a child. One-on-one, semistructured interviews were conducted with 9 mothers. The time since the suicide ranged from 1 year and 3 months to 21 years and 6 months. Data analysis was driven by Max van Manen's descriptive-investigative process. This process involved guided reflections using van Manen's 4 existentials: spatiality, corporeality, temporality, and relationality. The interviews began with a general statement; 'Tell me about your child." General questions related to the existentials were asked during the interviews to clarify the participants' stories. Data were managed using NVivo 9.0 qualitative data management software. Three essential themes were inductively derived from the data: 1) Know My Child: Not the Act, 2) Frozen Past: Altered Future, 3) Ocean of Grief. The 3 essential themes provide a deeper understanding of the role of stigmatization in the grief process of mothers following the loss of a child to suicide. In addition, these themes contribute to an appreciation of the role of past memories and future orientation as mothers are enmeshed in the grief process and its unpredictable path. Data from this study clarify the unique circumstances and needs of mothers as they attempt to navigate life after losing a child to suicide. The findings from this study suggest areas for future research and will assist healthcare professionals including nurses, school counselors, and mental health professionals as they approach mothers who are suicide survivors.

Excerpt: The above study has many of strengths, including an important topic, excellent sample size, well-articulated design and questionnaire, thorough factor analysis with goodness-of-fit tests, a clear explanation of the rationale for the findings, as well as their current applications in the medical field. Despite these strengths, the fit of the findings to the five-factor model of Elhai and Palmieri (2011) would appear to be lower than the fit to a two-factor model, a model that explains the data well. Therefore, we recommend that practitioners refrain from adopting and implementing the five-factor model for PTSD treatment in traumatic spinal injury victims due to insufficient support at this time.

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