Immediate post intervention effects of two brief youth suicide prevention interventions

This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview--Counselors CARE (C-CARE)--and C-CARE plus a 12-session Coping and Support Training (CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from seven high schools (N = 341). Students were assigned randomly to C-CARE plus CAST, C-CARE only, or "intervention as usual." The predicted patterns of change were assessed using trend analyses on data available from three repeated measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.

Evaluation of indicated suicide risk prevention approaches for potential high school dropouts

OBJECTIVES

This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up.

METHODS

Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up.

RESULTS

Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females.

CONCLUSIONS

School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.

Seclusion and restraint: what we need to know

Seclusion and restraint are controversial, restrictive interventions employed by psychiatric nurses in response to patient violence. While these interventions are used widely, relatively little is known about them. There is little support in the literature for the efficacy of seclusion and restraint. Although it seems impractical to suggest that seclusion and restraint be eliminated, many questions about these processes are unanswered. Nurses are in an ideal position to conduct studies related to patients' behavior and the use of seclusion and restraint. This article presents a review of the literature related to seclusion and restraint and suggests areas for future research.

Growth versus stability: older primiparous women as a paradigmatic case for persistence

The early pregnancy experience of women over 30 offers paradigmatic evidence which supports the significance of persistence for the study of nursing phenomenon. Pregnancy and first-time motherhood have come to be associated with change, growth and development. This research, which was undertaken to describe the changes experienced by older primiparous women during early pregnancy, illustrates how research grounded in a particular paradigm, in this case the growth or developmental paradigm, can limit the interpretation of data. When viewed from a developmental perspective, women in this sample were seen as resistant to change and could be said to be having trouble 'adapting' to their impending motherhood. However, when these women were viewed from the perspective of stability they were seen to engage in activities that allowed them to persist in their current self-view. In the biological sciences, persistence refers to a compensatory process which allows a system to maintain goal-directedness in spite of both internal and external disturbances. Women in this sample used balancing and buffering to continue their self-patterns. Balancing represented the verbal and behavioural processes women engaged in to integrate their experience of themselves as pregnant into their sense of themselves as not pregnant. Buffering included those activities that women used to maintain a sense of themselves in the face of the threat posed by their impending motherhood. Balancing and buffering represent mechanisms used in the service of persistence and reflect pattern maintenance activities.

Nursing theory: the 21st century

On September 21, 1990, at the University of California, Los Angeles, Neuropsychiatric Institute and Hospital, six nurse theorists participated in a panel discussion on theory development for the 21st century. The theorists included Dorothy Johnson, Betty Neuman, Dorothea E. Orem, Rosemarie Rizzo Parse, Martha E. Rogers and Callista Roy. The panel provided the participants the opportunity to speculate on the course for future development of nursing knowledge. Three questions were posed to the panel relating to the development of their models, the direction nursing theory will take in the 21st century, and current research emerging from the extant theories. The panel also addressed questions from the audience.

Methodological concerns in evaluating psychiatric nursing care modalities and a proposed standard group protocol format for nurse-led groups

The importance of detailing therapeutic effort and its outcome cannot be underestimated. The need to document outcomes has been re-emphasized in recent psychiatric mental health literature; however, the methodology for addressing threats to validity is well established. This article identifies the problems and issues related to a systematic evaluation of a therapeutic group intervention in an inpatient setting, specifically threats to validity, and describes the processes used in planning and implementing a standard group protocol format. The findings of this project depicting problems in the clarity and precision of documenting nursing practice are believed to be typical and generalizable. However, problems related to clarity and precision have not been addressed in the nursing literature. For a number of reasons, nursing staff members have not been sensitized to the importance of describing their practices in sufficient detail to allow others to replicate these practices. And yet, adequate evaluations of nursing efforts, particularly programmatic initiatives, require systematic testing with repeated trials. Although no description can describe in absolute terms what occurred, clear and precise descriptions of an intervention provide the foundation for valid conclusions about the effort. A detailed standard group protocol format provides a basis for establishing internal validity in subsequent quasi-experimental research designs as well as program evaluation studies.