While the media frenzy focuses on the physical risks of concussion, there is also growing concern about the academic repercussions for students who sustain the injury. We do not currently have a uniform evidence-based approach for optimally returning a student back to learning activities after a concussion. We also do not understand how the diverse consequences of a concussion may affect academic self-efficacy and performance. The purpose of this study is to explore the effects a concussion may have on college students who are navigating the return to learn (RTL) process. This research aims to inform whether there are measureable deficits in academic self-efficacy using the previously validated and abridged survey measure, the Self-Efficacy of Learning Form (SELF-A). Time of injury during the academic semester is also considered, as we hypothesize greater healing should negate the concussion's effects on the measure of self-efficacy. In addition, the research explores students' experiences with RTL using a semi-structured interview approach. The results suggest that college students who suffer a concussion during an academic semester have lower measures of academic self-efficacy compared to a control group of their peers. In addition, results show that students are returning to learn while still suffering from the effects of their concussion. This study found no significant correlation between the healing time of a concussion and the scores on the SELF-A. The interviews served to underscore the diverse myriad physical and psychological challenges a student faces, as well as the precarious variance in RTL strategies. This study highlights the challenges that students face while they RTL following a concussion, and begs the investigation of whether better RTL practices can help mitigate the negative effects. It underscores the necessity for further research, evidence-based medical care, instructor accommodations, and institutional policies to support students' safe RTL and ability to perform at their maximal academic potential.

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Bakgrund: Psykiatrisjuksköterskan har historiskt sett pendlat mellan att vara omvårdnadsansvarig till att vara förlängd arm till andra yrkeskategorier som till exempel läkare. Studier visar att specialistsjuksköterskan har en komplex kompetens som hen upplever inte alltid lyfts av organisationen och att hen ofta upplever sig klämd emellan patienters, medarbetares och organisationens krav. Specialistsjuksköterskor i psykiatrisk vård börjar nu bli en bristvara och då deras roll, status och betydelse framstår som diffus   kan det bli svårt att rekrytera nya sjuksköterskor att utbilda sig och stanna kvar inom psykiatrisk vård. Då mycket få studier är genomförda i psykiatrisk öppenvård och med ledningsperspektiv var det av intresse att tillfråga just enhetschefer med ansvar att anställa personal. Syfte: Att beskriva enhetschefers uppfattningar om och förväntningar på specialistsjuksköterskans betydelse och roll i psykiatrisk öppenvården. Metod: Studien genomfördes som en empirisk intervjustudie med semistrukturerade frågor som ställdes individuellt till sju enhetschefer verksamma inom psykiatrisk öppenvård. Materialet bearbetades med en kvalitativ innehållsanalys med induktiv ansats. Resultat: I resultatet framkom huvudkategorin ”Arbetsuppgifter och förväntningar” med underkategorierna Bedömningar, Samordnande och samverkande roll, Läkemedelsadministrering, Utvecklingsarbete, Flexibla ansvarsområden, Bemötande och kommunikation samt Kompetens. Diskussion: Specialistsjuksköterskan har många olika roller att träda in i inom psykiatrisk öppenvård och förväntas använda sin kompetens där den behövs. / Background: Psychiatric nurses has historically oscillated between being responsible of nursing care to be an extended arm to other professionals such as physicians. Studies show that the specialist nurse has a complex competence that according to the nurses is not always highlighted by the organization and often find themselves trapped between patients, other employees and the organization's demands. Specialist nurses in psychiatric care are now becoming scarce and when their role, status and importance appears diffuse, it may be difficult to recruit new nurses to train and remain in psychiatric services. Since very few studies have been carried out in outpatient psychiatric services and management perspective, it was of interest to the matter to ask the views of unit managers with responsibility to hire staff. Aim: To describe unit managers' perceptions and expectations of the specialist nurse's importance and role in psychiatric outpatient services. Method: The study was conducted as an empirical interview study with semi-structured questions that were asked individually to seven unit managers occupied in psychiatric outpatient care. The material was processed with a qualitative content analysis with inductive approach. Results: The result showed the main category "Duties and expectations" with the subcategories Assessments, Coordinating and cooperative role, Drug administration, Development, Flexible responsibilities, Treatment and communication as well as Competence. Discussions: The specialistnurse has many variable roles to enter in psychiatric outpatient care and are expected to use their expertise where it is needed.

Decisions concerning psychiatric medication are complex and often involve a protracted process of trial and error. The serious and enduring nature of side effects associated with psychiatric medication demands that medical and experiential expertise is shared in a way that is supportive of the longer term recovery journey. Historically poor concordance rates point to a lack of trust and difficulties in sharing decisions constructively. This Ph.D. explores views and experiences of shared decision making for psychiatric medication management amongst mental health service users and practitioners. The study was conducted in a community mental health service, in the UK. A participatory methodology was employed, within a social constructionist paradigm. Service users and a carer were involved in all phases of the research process. Thirty qualitative interviews were undertaken with different stakeholders: psychiatrists, community psychiatric nurses, and service users. A thematic analysis was employed. In addition, an applied conversation analysis was undertaken on four recorded outpatient medication related meetings. Enablers of and barriers to shared decision making were found at three levels of analysis: the interaction, the relationship, and the system. Many divergent discourses were apparent across these levels, both within and between the different stakeholder groups. A typology of involvement is proposed and discussed, from fractured passivity through to active self- management. The barriers to collaborative practice identified in these findings, and the structural factors at work in the mental health system in particular, were seen to explain the gap between policy ideals and current practice. Strong therapeutic relationships were found to be a vital enabler, comprising of: a formation of trust, practitioners knowing and believing in service users’ potential, and ‘walking the journey together’. Shared decision making in this study is found to be a dynamic process over time, involving two (or more) participants in a complex interplay. The thesis emphasizes the interaction between structure and agency in shared decision making in psychiatric medication management and highlights how power is enacted in the context of shared decisions in a community setting. Original theoretical, methodological and practical contributions to knowledge are presented and discussed.

Objective: According to the Joint Commission (2012), about 80% of serious medical errors are related to miscommunication between healthcare providers. The Joint Commission (2012) recommended the utilization of standardized communication tools to reduce the number of medical errors related to the miscommunication. The Situation-Background-Assessment-Recommendation (SBAR) communication tool is a standardized tool that has been used to improve the effectiveness of communication between healthcare providers. The purpose of this project was to evaluate the effectiveness of using SBAR communication tool for warm handoff between primary care providers and behavioral health providers in order to provide a continuous and complete transition of care for patients with psychiatric disorders or psychosocial issues. Method: A mixed method design was implemented in an integrated primary care clinic at two locations in Phoenix, Arizona. A brief presentation about the SBAR tool and copies of the SBAR tool was provided for the clinic staff. Data were gathered from four participants (two nurse practitioners and two behavioral health workers) using structured observation, pre-and post-test surveys, and structured interviews. Length of study was one month. Results: During the data collection, there were 40 observed warm handoffs, 12 unobserved warm handoffs between primary care nurse practitioners and behavioral health workers. Seventy-five percent of the participants felt that the SBAR helped them in organizing their thoughts and providing/obtaining adequate information during warm handoff. They reported satisfaction when using the SBAR tool. There was no statistically significant difference in the scores of collaboration and satisfaction about care decisions between pre and post-SBAR intervention. Conclusion: The SBAR communication tool has the potential to improve communication between primary care providers and behavioral health workers to improve the quality and safety of care for patients with psychosocial concerns. Utilizing SBAR may increase teamwork and ensures adequate hand-off information on the warm handoff. Multiple PDSA cycles should be conducted to refine the change and make it applicable and sustainable in the integrated care setting.

The purpose of the present study was to assess patient improvement in a specific freestanding partial hospital. Improvement was assessed in two specific areas: 1) symptom reduction as measured by the Symptom Check List-90-Revised (SCL-90-R) and 2) social adjustment as measured by the Social Adjustment Scale Self-Report (SAS-SR) at admission, discharge and three month follow-up. In addition, improvement was assessed from two perspectives: 1) patient evaluation and 2) therapist evaluation. Results indicated that there was statistically significant improvement from admission to discharge on the SCL-90-R and the SAS-SR. This improvement was maintained from discharge to three month follow-up. Findings also revealed statistically significant improvement when analyzed from both the patient perspective and the therapist perspective.

Psychiatric patients, particularly schizophrenics, tend to be less accurate decoders of facial expressions than normals. The involvement of three basic information processing stages in this deficit was investigated: attention; encoding; and processing. Psychiatric inpatients, classified by diagnosis and severity of pathology, and nonpatient controls were administered seven facial cue decoding tasks. Orientation of attention was assessed through rate of diversion of gaze from the stimuli. Encoding was assessed using simple tasks, requiring one contrast of two facial stimuli and selection from two response alternatives. Processing was assessed using a more complex task, requiring several contrasts between stimulus faces and selection from numerous response alternatives. Residualized error scores were used to statistically control for effects of attention on task performance. Processing task performance was evaluated using ANCOVA to control for effects of encoding. Schizophrenics were characterized by generalized information processing deficit while affective disorder subjects evidenced impairment only in attending. Attention impairments in both groups were related to severity of psychopathology. Problems in encoding and processing were related only to a schizophrenic diagnosis. Their decoding deficits appeared attributable to general visuospatial discrimination impairment rather than repression-sensitization defenses or the affective connotation of cues. Adequacy of interpersonal functioning was associated with measures of attending and processing but not encoding. The measures of encoding, however, may have lacked adequate discriminating power due to low difficulty.

The factor structure of the Luria Nebraska Neuropsychological Battery (LNNB) Form II was examined. A principle components factor analysis was performed on a sample of 102 psychiatric and neurologic subjects. It was necessary to remove 45 items from the analysis due to perfect performance by most subjects. The results were orthogonally rotated to simple structure using a Varimax method of rotation, and then compared to previous LNNB Form I and Form II results. Thirty-three factors were generated in the Exploratory Factor Analysis (EFA) . There was a very high agreement with the factors from Form I. Only one new factor was identified that didn't have a comparable Form I factor, and this factor appears to have neurological support. The similarity of the factor solutions between the two forms supports the continued use of factors derived from Form I for the interpretation of Form II, and supports the underlying structure presupposed by Lurian constructs. The present study also tested the significance of the hypothesized factor structures through confirmatory factor analysis (CFA). No hypothesis about the underlying factor structure based on previous exploratory studies was supported. The CFA did suggest that the best factor solution to the LNNB Form II is one that (a) has correlated factors and (b) has items loading on more than one factor. The confirmatory results were interpreted as not supporting the current exploratory results, or the previous factor analytic results. Problems notwithstanding, researchers may be better directed to propose factor models for the LNNB that have correlated factors, and to work samples approaching the 10 to 1 recommended sample size for multivariate analysis. One conclusion that was drawn from the concurrence between the two Form II studies pertains to psychiatric populations used in both studies. It was necessary to exclude a large number of items in each study due to perfect performance by most of the subjects on those items. Most of the items removed were identical in both studies supporting the notion that a shortened version of the LNNB could be administered to psychiatric populations.

Recent research on the contribution of cognitive and social factors to psychopathology has been narrowly focused on isolated cognitive-social aspects of adjustment. This study takes a broader perspective by examining a) cognitive structure in addition to cognitive content and b) general aspects of interpersonal style rather than isolated social behaviors. Maladjustment was. examined with respect to premorbid history as well as current adjustment. The hypotheses were that cognitive integration interacts with cognitive complexity to influence psychological disturbance; that a positive relationship exists between interpersonal flexibility and psychopathology; and that a positive relationship exists between the proportion of ambiguous constructs which they employ and a person's level of psychopathology.

Background: Dementia is a degenerative neurological disorder that afflicts a growing proportion of the global population. Complementary alternative medicine (CAM) modalities are under investigation for their therapeutic value in the management of dementia. Purpose: Nursing care of dementia sufferers can include managing agitation and negative behaviors; this study investigates staff appraisal of the Multi-Sensory Stimulation Environment (MSSE) as an intervention for these nursing challenges. Methods: A purposive sample of nursing staff employed in residential care for dementia patients were recruited 10 weeks after the initiation of an open-access MSSE at the facility to complete a confidential self-administered questionnaire. Results: 79% of potential participants returned completed surveys for a total sample of n = 23. 70% of survey respondents felt that residents were utilizing the MSSE "Somewhat Frequently" or "Very Frequently." 77% of the staff felt the MSSE should continue in use at the facility or continue with some alterations. The sample suggested that the MSSE is helpful for mood, specifically anger, sadness, anxiety, and restlessness, but not for boredom. Higher-scoring items in favor of the MSSE intervention included confusion, perseverating, wandering, and interpersonal conflict. Conclusion: Several components of agitation and negative behavior in the dementia population appear to be improved with the use of an MSSE according to this sample. Further research is needed to support the results of this sample and to explore more detailed recommendations regarding the use of MSSE in dementia care.