Journal of the American Psychiatric Nurses Association

The purpose of this study was to describe the experiences of individuals who survived the loss of one or both parents through parental homicide or homicide/suicide as adolescents. Participants (N = 34) were aged between 12 and 19 years at the time of the death and were aged between 29 and 64 years at the time of the interview. Participants were interviewed twice and asked to tell the story of their lives. Data were analyzed in the hermeneutic phenomenological tradition using a stepwise process of developing categories and then a single complex theme. Common categories of participants’ childhoods included abuse both before and after the uxoricide and vivid memories of the homicide. As adults, most participants reported difficulties with intimate relationships, legal problems, and substance use. Integrity was an overarching theme for these participants. Among those who had integrated the story of the homicide into their adult lives, some believed that they were doing well whereas others did not. Some participants had isolated the event and considered that they were doing well as a result. These findings are limited by the convenience sample but offer a rich portrait of the lives of individuals who experienced uxoricide as adolescents. Clinicians might be advised to tread carefully if individuals report that they have isolated rather than integrated the uxoricide into their adult lives. No evidence exists in support that either stance is preferable.

BACKGROUND: Healthy living programs (HLPs) within the context of mental health units are an applied response to the concerns of metabolic syndrome and the associated physical illnesses to which people with serious mental illness are susceptible. OBJECTIVE: To illustrate how nurses, with other health professionals and service users, have established and maintained HLPs in two locked forensic mental health units in New Zealand. DESIGN: This illustrative case study adopts a multimodal approach to data collection and analysis. Across two programs, interviews were undertaken with service users (n = 15) and staff (n = 17), minutes of meetings were analyzed for major decision points, and clinical notes were reviewed to identify which service-user health status measures (body mass index, glucose tolerance test results, blood pressure, and medication use) were recorded. RESULTS: Similarities were identified in the way the HLPs were implemented and maintained by champions who advocated for change, challenged staff attitudes, secured funding, and established new systems and protocols. Successful implementation depended on involvement of the multidisciplinary team. Each program operated within a different physical environment and adopted its own philosophical approach that shaped the style of the program. The HLPs had an impact on nurses, other staff, and on the culture of the institutions. The programs raised dilemmas about restrictions and risk versus autonomy and self-management. CONCLUSION: Understanding the effects of the clinical and philosophical contexts in which HLPs are established and the way challenges and benefits are affected by context has practical significance for the future development of health programs in forensic settings, prisons, and general mental health units.

Sexual assault research has focused almost exclusively on urban areas, and research examining the experiences of expert service providers is nearly nonexistent. The purpose of this study was to add to the understanding of providers’ experiences in working with sexually assaulted women in rural communities. Secondary victimization theory suggests that the nature of postassault expert interventions may have an adverse impact on victims. The focus of this hermeneutic phenomenological study was to explore the lived experiences of providers regarding their interactions with sexual assault survivors living in rural communities. Data were gathered from prosecutors, law enforcement, crisis center advocates, social workers, and victim-witness associates. Data analysis led to the identification of five significant themes: (a) rural-specific confidentiality issues, (b) resource needs in a rural setting, (c) the connection between victim blaming and low levels of reporting, (d) negative provider views of the community, and (e) smaller communities provided better victim care. Psychiatric nurses and mental health care systems have many opportunities to intervene with abused women in inpatient, outpatient, and other community settings. In primary and acute care setting, nurses should assess patients for a history of violence using multiple screening questions and should also educate victims and their families about available resources.

AIM: To conduct a formative evaluation of a treatment program designed for inmates with impulsive and aggressive behavior disorders in high-security facilities in Connecticut correctional facilities. METHOD: Pencil-and-paper surveys and in-person inmate interviews were used to answer four evaluation questions. Descriptive statistics and content analyses were used to assess context, input, process, and products. FINDINGS: A convenience sample of 26 adult male (18) and female (8) inmates participated in the study. Inmates were satisfied with the program (4-point scale, M = 3.38, SD = 0.75). Inmate hospital stays were reduced by 13.6%, and psychotropic medication use increased slightly (0.40%). Improved outcomes were noted for those inmates who attended more sessions. CONCLUSIONS: The findings of the formative evaluation were useful for moving the START NOW Skills Training treatment to the implementation phase. Recommendations for implementation modifications included development of an implementation team, reinforcement of training, and attention applied to uniform collection of outcome data to demonstrate its evidence base.

Nearly 20% of American men with HIV/AIDS pass through a correctional facility each year. As these men pass through the criminal justice system, discontinuation of health care access and nonadherence to prescribed treatments often occur. Men who are not engaged in health care during and after incarceration are at risk for treatment interruption and disease progression. Correctional facilities are therefore important sites for secondary prevention of HIV/AIDS. Unprecedented scientific attention and resources are currently directed at detecting and treating HIV in the criminal justice system. To support these efforts to increase health care access, we must have a better understanding of the cultural and situational factors that structure opportunities for secondary prevention during incarceration and during the transition from correctional facilities back into the community. This article presents a timely review of the literature on the health needs of incarcerated men living with HIV/AIDS. The author uses the primary health care framework to describe the movement of HIV-positive men through the criminal justice system as a series of strategic opportunities to initiate and establish a process of care. The author concludes that although we understand many of the challenges of providing care to men who become incarcerated, and have evidence of effective health-promoting services, we are only beginning to understand how to make health care services accessible and acceptable to HIV-positive male inmates, and we have not yet used some proven HIV prevention tools.

This article provides an update regarding individual state legislation for advanced practice psychiatric nursing, building on previous briefings. Specific attention is given to independent versus collaborative practice regulations, titling, and prescriptive authority. There is review of contemporary issues and focus on scope and standards of practice, workforce data, certification, and advanced practice regulatory models.