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Biomedical subjects

W K Mohr

Publications and source records attributed to W K Mohr.

At least 19 recordsLinked to original sources

A prolegomenon on restraint of children: implicating constitutional rights.

News media and advocacy groups have brought to public attention a disturbing number of recent deaths proximal to the use of physical restraints. This paper examines the evidence indicating that use of these procedures can be dangerous to patients; explores the theoretical basis and practical application of restraints; and argues not only that their use may be unethical as a therapeutic intervention, but that it may have constitutional implications.

Centers for Medicare and Medicaid Services, U.S.↗

Living in the fallout: parents' experiences when their child becomes mentally ill.

Parental loss of a child to mental illness and the resulting grief is a relatively unacknowledged phenomenon. This study aimed to capture the process through which parents journey in the face of their child's mental illness. Conducting a series of focus groups, the authors sought to further the understanding and the needs of these families. They identify seven themes from initial awareness to the formation of a new stability. Identification of this grief process is an important step that can heighten practitioners' awareness so that future interventions and support systems can be developed to help these families deal with their pain and burden.

Adolescent↗

Bipolar disorder in children.

This article presents an overview of bipolar disorder (BPD) in children, a condition that only recently has been recognized as a legitimate diagnosis. Bipolar disorder in children is underrecognized for many reasons including lack of awareness, diagnostic confusion, and the different clinical picture in children. Available data strongly suggest that prepubertal childhood BPD is a non-episodic, chronic, rapid cycling, mixed manic state. It may be comorbid with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) or it may demonstrate features of ADHD and CD, further complicating recognition and subsequent treatment. Treatment issues are discussed, and some reasons for the urgency of early recognition and treatment are explained.

Age of Onset↗

Mechanisms of injury and death proximal to restraint use.

Restraints have been subsumed under the rubric of "interventions" in the nursing literature. However, alarming reports of lethal consequences proximal to their use raise the issue to a life and death matter that requires immediate attention from professionals. Little is known about the mechanisms of death and other adverse consequences of restraint use. This article describes these mechanisms and also considers some hypothesized factors and adverse effects associated with their use.

Adult↗

Opening caregiver minds: National Alliance for the Mentally Ill's (NAMI) provider education program.

The belief that poor parenting and dysfunctional families give rise to mental illness has been perpetuated by psychodynamic and family systems theories that lack supporting scientific evidence, and interventions based on these theories have failed to produce clinical improvements. Nevertheless the National Alliance for the Mentally III (NAMI) found that many clinical training programs continue to teach these outdated theories and interventions and that the mental health system is often destructive to family systems. This article describes a new 10-week program that is designed to educate service providers that will include families in the care of their chronically ill loved one. The program is based on a competence and adaptation rather than a pathology foundation and it shifts the discourse from causes to effects of illness.

Adaptation, Psychological↗

Children exposed to violence: measurement considerations within an ecological framework.

The authors argue that children who are exposed to violence constitute a vulnerable and understudied population. Assessment of these children, whether for purposes of research or practice, should meet certain criteria that may not be satisfied with technology presently available to practitioners and researchers. This article presents a number of principles that can improve the precision and utility of practitioner and researcher evaluations and assessments, as well as the instruments that they develop for these purposes.

Bias↗

Rethinking professional attitudes in mental health settings.

Given that the psychiatric nursing standards developed by the American Nurses Association strongly advocate the inclusion of families in treatment settings, the study discussed in this article sought to determine how families were actually experiencing care in mental health settings for children and adolescents. The aim was to elicit the perspectives of parents whose children were hospitalized in psychiatric hospitals and to examine those experiences against the ideal rhetoric set forth by the standards of care. Results of in-depth interviews with a purposeful sample of parents demonstrate that there is a significant gap between standards and practice.

Adolescent↗

Discontinuing treatment in children with chronic, critical illnesses.

Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

Child, Preschool↗

Deconstructing the language of psychiatric hospitalization.

The purpose of this study was to deconstruct the language of psychiatric nurses' documentation and charting. Employing concepts developed by post-modern theorists, everyday professional activities can be examined in unique ways that uncover how they conceal or skew rather than reveal and illumine patient conditions. The study design and sample was exploratory; content analysis with first and second level analyses. Nine major categories of charting entry were found. Deconstruction of the language and discourse of nursing through a Foucaultian lens goes beyond what is manifest to what is not said. Professional assumptions about patients and the social construction of patients and patient problems are exposed.

Hospitalization↗

Breaking through the hegemony of homogeneity: revitalizing curriculum and students.

Undergraduate programs provide fertile ground from which future practitioners, researchers, and teachers of psychiatric mental health nursing will emerge. Health care has changed dramatically, offering opportunities for new and innovative roles and prompting faculty to develop novel ways of thinking about the future role of psychiatric nurses. Nursing faculty are challenged to devise new and creative approaches to teaching psychiatric nursing at the undergraduate level in ways that will instill enthusiasm for the field. In this article, the efforts of the University of Pennsylvania to approach psychiatric mental health courses in new ways will be described. These innovations are designed to stimulate passion for what the authors see as a complex and exciting field that requires revitalization.

Career Choice↗

The DSM and child psychiatric nursing: a cautionary reflection.

The DSM is the key reference guide for clinicians and it continues to be the way in which practitioners apply discrete categories to behaviors that are sufficiently disruptive to social institutions to have come to the attention of tertiary care systems. As a way to classify and diagnose mental disorders, the DSM has been a source of controversy in the psychiatric community since its development. This article reviews some of the limitations of the DSM approach to psychiatric nosology with respect to practice with children. Alternative conceptualizations and approaches to childhood psychopathology are proposed and implications for child psychiatric nurses are discussed.

Child↗

Prevalence and effects of child exposure to domestic violence.

In recent years, researchers have focused attention on children who are exposed to domestic violence. Although presently there are no scientifically credible estimates of the national prevalence of children exposed to domestic violence, existing data suggest that large numbers of American children are affected. This article discusses the limitations of current databases and describes a promising model for the collection of reliable and valid prevalence data, the Spousal Assault Replication Program, which uses data collected through collaboration between police and university researchers. Research examining the effects of childhood exposure to domestic violence is also limited by a range of methodological problems. Despite this, however, sufficient evidence from the body of studies exists to conclude that such exposure has adverse effects. The specific effects may differ depending on a host of variables, such as the children's ages, the nature and severity of the violence, the existence of other risk factors in the children's lives (for example, poverty, parental substance abuse), and whether the children are also directly physically abused. In general, childhood exposure to domestic violence can be associated with increased display of aggressive behavior, increased emotional problems such as depression and/or anxiety, lower levels of social competence, and poorer academic functioning. A scientifically credible body of research on the prevalence and effects of childhood exposure to domestic violence is necessary to promote the development of effective interventions and to permit the proper channeling of public and private funds. This article identifies some of the steps that can be taken to build the research capacity necessary to obtain the needed data.

Child↗

The challenge of creating thoughtful research agendas.

This article is an affirmative rejoinder to a recent editorial calling for revitalizing psychiatric research and education. It reviews the shortcomings of our present knowledge- and research-base using the state of child psychiatry as an exemplar. It concludes that we, as a specialty, must be cautious in setting a course for a research agenda in the new millenium and posits that the most informative research and intervention will occur by using multiple measures and sources of information. As understanding of patients and their problems in development and in context grows, intervention research that will be useful, timely, and cost-effective must include cross-discipline teams of researchers and practitioners who will speak to these complexities.

Adolescent↗

A tale of two centuries: voices of the past and present.

This article compares the reported experiences of children and adolescents receiving inpatient treatment in contemporary psychiatric hospital settings with those of women institutionalized in mental hospitals from 1840 to 1945. Qualitative data include case study material from former psychiatrically hospitalized patients and archival narratives. Analysis includes matching themes from in-depth interviews with archival narratives. Nine representative experiences emerged and are presented in a typology under broader themes of structure, process, and outcome. Similarity of patient experiences over two centuries leads to questions about the meaning of advances in understanding mental illnesses in the context of attitudes, biases, and staff behavior toward patients that remains disturbingly unchanged.

Adolescent↗

A restraint on restraints: the need to reconsider the use of restrictive interventions.

Children with behavior problems are put in units with milieu therapy for the support and guidance of a specialized health care team, supposedly experts in the care of children with these unique and urgent needs. The reality of such units, however, is that those with the most contact with the children are often inadequately prepared, both in terms of knowledge and skills, to manage disruptive behaviors. As a result, the milieu that is supposed to provide support and structure can actually exacerbate the trauma for the vulnerable child. Preliminary data are presented from an ongoing study that is investigating the experiences and memories of formerly hospitalized children. Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force. There was a marked lack of understanding by the children of why given interventions were used. Although coercive interventions are sometimes necessary, ethical, legal, and other professional considerations make it clear that more work is needed. Research to identify the patterns of lack of knowledge and skills, as well as to develop appropriate interventions are recommended.

Adolescent↗

Cross-ethnic variations in the care of psychiatric patients: a review of contributing factors and practice considerations.

The number of ethnic minority persons in the United States is increasing faster than that of the Caucasian population. This means that nurses will be caring for an increasingly diverse patient pool. Ethnic differences have been discovered to play a role in the efficacy of psychoactive medication. These differences result from a number of biological as well as non biological factors. Nurses have a professional obligation to be aware and sensitive to differential response to treatment.

Communication Barriers↗