This chapter examines beliefs about death and dying and its influence on care provision to members of culturally diverse groups. It discusses variations in attitudes regarding advanced directives, life support, disclosure of diagnosis, and the designation of decision makers during terminal illness. The chapter identifies variations in beliefs, practices, and traditions during death and dying experiences between culturally diverse groups. The chapter assesses the psychological, cultural, spiritual, and/or religious factors influencing the death and dying experience of members of culturally diverse groups. It examines selected cultural practices related to the care of the body and burial after death. The chapter describes the impact of attitudinal barriers impacting the death and dying experience of patients with HIV/AIDS. Finally the chapter addresses American Association for Colleges of Nursing (AACN) end-of-program competencies for baccalaureate nursing education.
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This chapter describes a brief history of person-centered care (
PCC) and identifies the characteristics of PCC. It discusses the importance of organizational structure to support PCCand effective communication. It then articulates the way in which psychosocial factors affect patient decision-making and clinical outcomes. The chapter lists the strategies to support patients’ and caregivers’ engagement in their care. It discusses the importance of constructing a PCCplan for patients with physical illness and injury that incorporates psychosocial factors and the Social Determinants of Health ( SDoH). It also discusses discharge planning as a means of ensuring continuity of care, and describes the use of shared decision-making techniques and patient decision aids to encourage PCC. The chapter focuses on strategies and practices that support a broad definition of PCCwith the goal of improving patient safety and the quality of patient care, while providing strategies to help reduce barriers to PCCimplementation.
This chapter explains posttraumatic stress disorder (PTSD) and its epidemiology. It explores some of the theories behind PTSD and describes how to assess, screen, diagnose, and treat PTSD. Many of the theories presented to describe and help understand PTSD are primarily based on psychology. Some such theories include the dual representation theory of PTSD, emotional processing theory, and Ehlers and Clark’s (2000) cognitive theory. Assessment of PTSD should value early detection and recognition and be completed in a manner that is integrated, prudent, thorough, and well informed. The goal of assessment should be to develop an individualized treatment and support plan that includes goals based on the strengths and need areas of the individual. In practice, PTSD screening is only likely to be done when someone is felt to be at higher than usual risk of suffering from the disorder.
This chapter helps the reader to learn what syllabus tells about the instructor. Instructors have their own style of delivering information and their own standards in terms of expectations of their students. Nursing is a profession in which classroom attendance is usually mandatory. If the nursing student misses class and does not learn the standard precautions to prevent spread of infection, a patient could die as a result. If the psychosocial assessment is worth 20 of 100 points, instructor strongly believes that nursing students need to understand the psychosocial components of patients and disease. At one end of the continuum are those instructors who have acquired much in the way of direct patient care experience before they start to teach. At the other end are those who have gone into teaching and perhaps research rather early in their nursing careers. Both can offer perspectives that nurses can profit from.
This chapter reveals the experiences of 35 nurses who were deployed for the wars in Iraq and Afghanistan. The nurses describe how “doing nursing” in a war zone changed them personally and expanded their nursing skills, and how reintegration was more difficult than they had anticipated. Some nurses reported a fairly smooth transition with strong support from their families and communities. They wanted people to be patient with them, listen to their stories, and be nonjudgmental. They wanted to be thanked for their service and feel appreciated. On the other hand, nurses who felt a lack of support and connection were devastated. Some nurses struggled in their relationships with family and friends who did not seem to understand that they needed to heal themselves emotionally, psychologically, and spiritually after being deployed. Some nurses reported turmoil in their extended families with the sharing of responsibilities for elderly parents.
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Toward Community-Based Practice: The Changing Role of the Registered Nurse in Psychiatry and Mental Health
The World Health Organization (WHO) was founded in 1946 and when members wrote its constitution they defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In this immediate postwar period, mental health was considered just as important for social stability as physical health. Sweeping changes moved through psychiatry and psychology in the decades on either side of World War II, which came to profoundly affect nursing. For many practitioners emerging from the experience of World War II in particular, psychoanalysis was seen as a useful tool because their wartime experience had led them to focus on mental illness that could be categorized as neurosis, which they believed was caused by environmental factors and could be treated. Despite continued advances in neuroscience and brain biology, mental health nursing is still essentially an interpersonal process.
Both full-time military service members (
MSMs) and part-time Reserve and National Guard component ( RC) personnel face multiple transitions related to training, education, deployments, and reintegration to accomplish the Armed Force’s missions. This chapter’s purpose is to provide a better understanding of the complex transitional phases of deployments and/or the reintegration from the military to civilian life. It provides information about the physical, behavioral, and social impacts during the various stages of deployment for the MSM/ RC, along with their families/loved ones. The Ecological Model of Veteran Reintegration and its four levels of system factors—individual, interpersonal, community organizations, and societal effects—are used to illustrate the interchanging psychosocial and environmental aspects. The chapter presents specific reintegration challenges of employment, education, and caregiving. Nurses have a pivotal role in screening psychosocial and physical needs, while promoting healthy coping and parenting, to expand the delivery of family-centered care during these transitions.