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Biomedical subjects

N Nehls

Publications and source records attributed to N Nehls.

15 recordsLinked to original sources
PubMed2000

Being a case manager for persons with borderline personality disorder: perspectives of community mental health center clinicians.

The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case manager's focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.

Attitude of Health Personnel↗
PubMed2000

Recovering: a process of empowerment.

Persons with borderline personality disorder constitute a vulnerable population not only because of the natural history of the disorder, but also because they are frequently stigmatized by persons entrusted with altering the course of the disorder. In this article, the predominant forms of treatment that have been available to persons with borderline personality disorder are reviewed, and it is concluded that they are, albeit unintentionally, oppressive. It is demonstrated how a critical examination of the concept of recovery opens the possibility for delivering care in a fundamentally different way. Grounded in the underlying assumptions of recovery and interpretive phenomenological research, a proposal that moves beyond recovery toward developing and disseminating a practical theory of recovering is presented.

Borderline Personality Disorder↗
PubMed1999

Borderline personality disorder: the voice of patients.

The purpose of this interpretive phenomenological study was to generate knowledge about the experience of living with the diagnosis of borderline personality disorder. Persons identified as meeting DSM-III-R (American Psychiatric Association, 1987) or DSM-IV (American Psychiatric Association, 1994) criteria for borderline personality disorder were invited to participate in a private interview focusing on what it means to live with the diagnosis. The data were analyzed using the procedures of interpretive phenomenological data analysis (Benner, 1994; Diekelmann, Allen, & Tanner, 1989). Three themes were identified: (a) living with a label, (b) living with self-destructive behavior perceived as manipulation, and (c) living with limited access to care. The findings suggest that mental health care for persons with borderline personality disorder could be improved by confronting prejudice, understanding self-harm, and safeguarding opportunities for dialogue.

Attitude of Health Personnel↗
PubMed1997

The preceptor model of clinical instruction: the lived experiences of students, preceptors, and faculty-of-record.

The preceptor model of clinical instruction will become increasingly popular due to the cost of undergraduate education, the scholarly demands of research and teaching, and an interest in developing new partnerships among students, clinicians, and teachers. It is quite timely, therefore, that nurse researchers reveal the nature and utility of this instructional model prior to its widespread use. To that end, hermeneutic interviews (N = 31) were conducted with senior-level undergraduate nursing students (n = 10), staff nurse preceptors (n = 11), and master's and PhD-prepared faculty-of-record (n = 10). Employing interpretive phenomenology, the authors identified common meanings, relational themes, and a constitutive pattern designated learning nursing thinking. An examination of this pattern and its associated themes may help identify those teaching practices that should be extended and those that should be altered.

Attitude of Health Personnel↗
PubMed1995

Narrative pedagogy: rethinking nursing education.

Narrative pedagogy is an interpretive approach to teaching and learning that is being used to foster educational reform. As it pertains to nursing education, narrative pedagogy is an approach to thinking about teaching and learning that evolves from the lived experiences of teachers, clinicians, and students. In this article, the author reviews the philosophical underpinnings of narrative pedagogy, provides examples of how narrative pedagogy can be used to rethink the teaching of nursing knowledge and practice, and discusses the strengths and limitations of narrative pedagogy as an alternative approach to teaching and learning.

Aged↗
PubMed1994

Brief hospital treatment plans for persons with borderline personality disorder: perspectives of inpatient psychiatric nurses and community mental health center clinicians.

Despite growing recognition of the challenges inherent in helping persons with borderline personality disorder, systematic investigation of caring for this population in specific treatment situations is lacking. In this study, an innovative hospital treatment program for persons with borderline personality disorder was evaluated. Using an interpretive phenomenological approach, a team of researchers analyzed data from in-depth, individual interviews with inpatient psychiatric nurses and community mental health center clinicians (n = 13) and thereby identified a constitutive pattern, the paradoxes of helping. At a time when innovation in caring for persons with this disorder is sought, an examination of these paradoxes will help identify those practices to be abandoned, those to be extended, and those to be preserved.

Adult↗
PubMed1993

Developing a systems approach to caring for persons with borderline personality disorder.

Most community mental health centers have not established a treatment approach for seriously ill persons with borderline personality disorder that is multi-focused, coordinated, comprehensive, and continuous. The authors propose that the systems approach to caring for persons with schizophrenia (Stein, Diamond, & Factor, 1990) be modified and tested for its efficacy in helping seriously ill persons with borderline personality disorder. The rationale for proposing this model of care and its underlying principles and clinical components is described in this paper.

Borderline Personality Disorder↗
PubMed1991

Borderline personality disorder and group therapy.

This study examined the process and outcome of group therapy for community health center clients with borderline personality disorder. The results indicated that group members rated Yalom's curative factors to be increasingly helpful over time, and that universality and existential factors were consistently ranked as very helpful group process variables. The group sessions also were associated with positive outcomes, as evidenced by significant improvement in Goal Attainment Scale scores and the depression and hostility scales of the Brief Symptom Inventory. The results of this study suggest that group therapy is a valued and effective treatment option for people with borderline personality disorder.

Adult↗
PubMed1980

Joint custody: an exploration of the issues.

Joint custody, an increasingly popular custody decision, allows both divorced parents to share equally the rights and responsibilities of child-rearing following their divorce. The authors discuss the potential positive and negative effects of this new and highly controversial custody decision by reviewing relevant research and theoretical concepts. Suggestions for further research are offered.

Child↗
PubMedDate not supplied

Borderline personality disorder: gender stereotypes, stigma, and limited system of care.

In North America, there may be no other psychiatric diagnosis more laden with stereotypes and stigma than borderline personality disorder. People who live with this label--the majority being female--are often marginalized or denied access to mental health services. In this article, the author reviews the theoretical underpinnings of the diagnosis, as well as the stigmatizing practices and limited services for seriously ill persons with borderline personality disorder diagnoses. In light of this review, new directions for mental health practice, education, and research are proposed.

Attitude to Health↗
PubMedDate not supplied

Group therapy for people with borderline personality disorder: interventions associated with positive outcomes.

Group psychotherapy is becoming a more prevalent treatment option for people with borderline personality disorder. Various types of group approaches have been discussed; however, data about specific interventions and their relationship to outcomes for subgroups of people with borderline personality disorder are lacking. The purpose of this study was to explicate the interventions used in a successful group therapy program developed for community mental health center clients with borderline personality disorder. Two independent raters used the Hill Counselor Verbal Response Category System-Revised to describe and categorize the therapists' verbal responses. Coding of eight videotaped sessions indicated that the therapists' level and type of verbal activity did not change over time. The most frequently utilized interventions across sessions were providing information and seeking information. These responses are indicative of a moderate and high degree of structure. The results suggest that clinicians must consider the unique needs of serious and persistently ill people with borderline personality disorder and plan group interventions accordingly.

Adult↗
PubMedDate not supplied

Brief hospital treatment plans: innovations in practice and research.

Hospital care for persons with mental health problems has changed dramatically in the past two decades. The emphasis on community-based models of care, cost containment, and the concern that psychiatric hospitalization may be ineffective or even harmful for some clients has led to the development of innovative hospital treatment programs. In this paper, the author examines a brief hospital treatment program developed for persons who have been identified, either previously or currently, with borderline personality disorder. The typical features of brief hospital plans, the lived experiences of five participants, and the changes in hospital utilization before and after the involvement in the program are discussed. The findings reveal the benefits as well as the limitations of this innovative program in improving the day-to-day lives of people with mental health problems. The methodology and results of this study provide direction for innovation and diversification in psychiatric nursing practice and research.

Borderline Personality Disorder↗
PubMedDate not supplied

Caring for individuals with severe and persistent mental illness: the contributions and challenges of residential case aides.

The challenge of helping individuals with mental illness live more independently and purposefully within the community warrants a collaborative system of caregiving between professional and paraprofessional caregivers. Residential community support aides are a crucial component of this system of care. However, current investigation of their daily work experiences is lacking. In this study, a team of researchers, employing an interpretive phenomenological approach, analyzed data from in-depth, individual interviews with 5 residential community support aides and identified a constitutive pattern: the teacher as learner. Examination of this pattern and its associated themes will identify those clinical practices that should be preserved and those that are in need of change.

Attitude of Health Personnel↗
PubMedDate not supplied

Lessons learned from developing, implementing, and evaluating a model of community-driven nursing.

The Helene Fuld Health Trust, HSBC Bank USA,Trustee has made generous contributions to the development of community-based nursing education. As a recipient of funds, faculty at the University ofWisconsin-Madison School of Nursing developed, implemented, and evaluated a pilot curriculum for undergraduate nursing students. The first phase of the project changed the landscape of community-based nursing education through faculty development. Unlike traditional approaches to faculty development, a resident expert model of faculty development based on dialogue was used. The second phase changed the landscape of teaching and learning community-based care through curricular and instructional revisions. Noteworthy changes were the creation of a curriculum responsive to both individual student and community needs, and recruitment of a cadre of teachers to enhance the cost-effectiveness of clinical education. The third phase changed the landscape of community-based nursing education through evaluation research. Several strategies were used to assess the project's usefulness, including interpretive phenomenological study of interview data and review of conventional outcome measures. Each phase of the project contributed to a new vision of community-based nursing education, a vision in which nursing as service is taught and learned.

Community Health Nursing↗