A systematic program to enhance clinician group skills in an inpatient psychiatric hospital

This article describes the collaborative effort of a team of discipline directors, administrators, and academicians to create a systematic program to enhance the group competencies of a large clinical staff working at a state hospital. The effects of the program were tested by a quasi-experimental field study. Quantitative measures of group process provided limited support for program effectiveness. Stronger support came from qualitative inquiry. The development and effectiveness of the program is examined within a larger context of group programs housed in large health care organizations.     

Faith-to-faith at the bedside: theological and ethical issues in ecumenical clinical chaplaincy.

Chaplains who serve in a clinical context often minister to patients representing a wide variety of faiths. In order to offer the best pastoral care possible, the chaplain should first possess a set of personal theological convictions as a foundation for ministry. Second, he or she needs to be sensitive to the beliefs and practices of the patients. Third, it is vital to develop a relationship of acceptance and trust not only with patients under their care, but also with family members and caregivers as well. At times, situations will arise that are purely religious or theological. In a clinical setting, however, the questions and problems that arise more often are both theological and ethical. It is beneficial for the chaplain to be involved in an ethics committee, where the specifics of each case can be discussed, and staff can offer counsel to patients and their families. This study examines issues that chaplains face at the bedside, such as terminal care, life-prolonging treatments, dementia, persistent vegetative state, and euthanasia-assisted suicide. We will discover that those who are involved in clinical pastoral ministry will be called upon to be a comforter, mediator, educator, ethicist, and counselor.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Group climate and group development in a community meeting on a short-term inpatient psychiatric unit

Group climate and group development of the community meeting on a short-term inpatient psychiatric unit are examined. The Group Climate Questionnaire (GCQ) was administered to all staff and patients present at the weekly community meeting on an acute treatment unit in a teaching hospital over a 12-week period. Results show that staff and patients perceive the community meetings in relatively similar ways, that the group climate of a community meeting can attain a positive working state, and that, at times, the meeting can progress through developmental stages of group process. Behavioral observations support the GCQ as a measure of group interaction.The authors gratefully acknowledge the assistance of Mary Pat Donnelly with the statistical analyses and the cooperation of all staff and patients who participated in this study.     

Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Despite demonstrations of the utility and cost effectiveness of behavioral programming, such techniques are not commonly employed in psychiatric inpatient settings. Several explanations for this have been proposed, including inadequate levels of training and competence in behavioral programming among prevalent treatment staff. This study employed a multiple choice inventory to assess behavioral knowledge among subjects representing several direct care disciplines commonly found in inpatient psychiatric settings. The results support assertions of relatively low levels of behavioral knowledge among disciplines that are most prevalent in such settings. The implications of these results for initiatives to enhance behavioral knowledge and skills are discussed.     

The use of publicly-posted performance feedback in an inpatient psychiatric treatment setting

This study examined the effects of publicly-posted performance feedback on the in-hospital behavior of patients residing on a self-management unit at a large, state operated, psychiatric treatment facility. When contrasted to a baseline phase in which staff received weekly information regarding patients' performance, scores in six of the eight assessment areas improved when this information was provided directly to patients. The authors' conclude that performance feedback may be a useful adjunct to inpatient treatment programs because it clarifies programmatic expectations, helps focus attention on developing strategies or interventions to meet those expectations, and encourages active treatment participation from patients and staff.     

A comparison of two mental status examinations in an inpatient psychiatric sample

This study compares the psychometric properties and clinical use of the Mini-Mental Status Exam (MMSE) and the Modified MMSE (3MS) in patients admitted to an acute medical-psychiatric inpatient unit. Internal consistencies were .56 for the estimated MMSE and .72 for the 3MS. Regression analyses revealed that the 3MS was a significant predictor of both length of hospital stay (LOS) and the need for additional services postdischarge. Regressions were also used to evaluate the contribution of the four new items contained in the 3MS: Word Generation, Similarities, Second Recall, and Date and Place of Birth. The 3MS was a significant predictor of LOS and the need for discharge services, whereas the MMSE did not contribute to any regression model. Word Generation was found to be a significant predictor of patients' needing posthospital services. Results support prior findings of the 3MS's superiority over the (estimated) MMSE and help to demonstrate the continued importance of cognitive screening in psychiatric samples.     

Treatment outcome of an inpatient group therapy for couples

In this article, we present the outcomes of an inpatient group treatment programme for couples with complicated problems that need intensive therapy. Each group includes five couples who are admitted for seven weeks. They receive a range of verbal and non‐verbal therapies in a fixed weekly protocol. Outcome was measured by means of two self‐report questionnaires (SCL‐90 and IPSI) completed before and after the treatment programme and at six and eighteen months of follow‐up. The results show that clinical group therapy for these couples is effective.     

MMPI-A structural summary variables: prevalence and correlates in an adolescent inpatient psychiatric sample

This study examined the prevalence and correlates of Archer and Krishnamurthy's MMPI-A Structural Summary (SS) dimensions in a sample of 632 adolescent psychiatric inpatients through a series of correlational analyses. These analyses examined the relationship between factor dimensions and categorically defined dimension elevations and external criterion measures that included chart review data, therapist ratings, chart diagnoses, and cognitive test performance. The SS dimensions provided additional interpretive yield for some within-normal-limits profiles. An examination of the pattern of correlations revealed small to moderate relationships between all SS variables and external criterion measures.     

Comparison of group climate in an eating disorders partial hospital group and a psychiatric partial hospital group

Women in an eating disorders partial hospital program and a psychiatric partial hospital program were compared on a self-report measure of group climate following a psychodynamic-interpersonal therapy group. Those with eating disorders experienced their groups as more engaged and as more avoiding than those in the psychiatric partial hospital group. Therapists may be able to use initial heightened engagement in eating disorder groups to counteract the tendency to avoid content.     

Alcoholics in inpatient,short-term interactional group psychotherapy: an outcome study

The differential outcome of 100 psychiatric inpatients distinguished by the presence/absence of secondary alcoholism was examined in shortterm closed group psychotherapy. Alcoholics did not differ from the general sample in outcome, but displayed distinct active/aggressive personality features. Group outcome was not affected by the presence/absence of alcoholic members.     

Microcomputerized clinical and research laboratories in psychiatric inpatient,settings

Microcomputers have become increasingly useful in clinical settings, performing functions ranging from test administration to composition of narrative reports. They may in the near future be involved in therapeutic procedures. Clinicians and researchers have begun to wonder whether a microcomputer can take over a wide range of functions in clinical psychiatric settings, becoming a versatile and cost-effective tool. This paper describes the development of a comprehensive system for research and clinical data management on a psychiatric inpatient unit. The core of the system is an Apple II-Plus microcomputer equipped with PASCAL, standard peripherals, and an inexpensive custom interface. The system has met the current data management needs of the unit, and its expandability allows planning of assessment-and treatment-related research.