Critical care areas are fast moving, often chaotic, and therefore confusing, even frightening, to patients attempting to understand what has happened to them. The nurse acts to mitigate these reactions by understanding the range of possibilities that can occur with patients, including potential psychiatric issues, and serving as patient advocate to ensure that appropriate treatment is initiated. Certainly there may be other psychiatric problems not described in the preceding text. The main possibilities are covered in this article. Assessing and acting early are tools the critical care nurse uses to meet patient needs and prevent behavioral problems that can interfere with life-preserving care.

Aims and objectives. The proposed model of event-generated dependence characterizes dependence in older adults as an emergent phenomenon that may arise from interaction between the older adult with compromised health and the social environment, resulting in altered reciprocity.Background. Pejorative characterizations of dependence in older adults influence nursing care negatively. Concept analyses recommend the recognition that dependence is interactive in nature, not an inherent trait of the individual, and that dependence involves changes in interpersonal reciprocity.Conclusions. The model provides a testable causal path between dependence and psychological outcomes.Relevance to clinical practice. The event generated dependence model can sensitize nurses to an alternative view of dependence. It is important for nurses to recognize their role in determining the social environment of care, attend to the promotion of reciprocity with older adults as care is provided, and incorporate changes in their attitudes toward inequitable reciprocity.

PURPOSE:To review assumptions inherent in the nurse-patient relationship as historically described and practiced, and to propose an alternate framework for nurse-patient interaction that is congruent with current health care environments.ORGANIZING CONSTRUCTS:The theory of human relatedness and the nurse-patient relationship.METHODS:Analysis of assumptions inherent in the current theoretical and empirical literature on nurse-patient relationships and evidence from observation of nurses engaged in practice. Proposal and discussion of the theory of human relatedness as an alternative model for conceptualizing nurse-patient relationships.CONCLUSIONS:The theory of human relatedness framework provides new insights and opportunities for assessment, intervention, and research within the context of nurse-patient relationships.

Fatigue is a phenomenon that advanced practice psychiatric nurses may see in both psychiatric and nonpsychiatric clients. Qualitative study findings support the need for health care professionals to intervene with the relational effects of fatigue. This article details the use of relatedness theory as a framework for nursing interventions. Relatedness states of disconnectedness and parallelism, and changes in relatedness elements of synchrony, sense of belonging, reciprocity, and mutuality are addressed. Therapeutic approaches to the negative relatedness influences of fatigue include evaluating the lack of presence, decreasing expectations, addressing effects on the family, and influencing the states and elements of relatedness.

Important considerations for the growth of psychiatric home health care as a treatment modality include program design, incorporation of medical and psychiatric nursing care, definition of the service population relative to age, and rigorous research into all components of psychiatric home care. Using a case study approach, three client examples are presented that incorporate these considerations and highlight lessons relevant to understanding psychiatric home care parameters. Practitioners are encouraged to use research as a tool in scrutinizing intermediary guidelines critically, demonstrating alternatives that offer better outcomes, and forming proactive plans for ensuring that optimal and effective care is the yardstick of treatment.

The purpose of this study was to develop and test psychometrically a self-report instrument designed to measure sense of belonging in adults. The Sense of Belonging Instrument (SOBI) is a 27-item, self-report instrument consisting of two separately scored scales, SOBI-P (psychological state) and SOBI-A (antecedents). Content validity was assessed by a panel of experts. Construct validity, internal consistency, and retest reliability were examined through a series of studies with three subject groups: community college students, patients in treatment for major depression, and Roman Catholic nuns. Results suggest that SOBI-P is a valid and reliable measure of sense of belonging. SOBI-A appears to reflect an individual's motivation for sense of belonging but requires additional study regarding its construct validity and internal consistency.

Theory of human relatedness addresses a pervasive human concern, establishing and maintaining relatedness to others, objects, environments, society and self. This theory, derived from a series of inductive and deductive strategies, views relatedness as a functional, behavioral system rooted in early attachment behaviors. Individuals move through different states of relatedness including connectedness, disconnectedness, parallelism and enmeshment. Social processes that contribute to this movement are sense of belonging, reciprocity, mutuality and synchrony. Disruptions in clients' relatedness contribute to biological, psychological, and social disturbances.

Sense of belonging is a concept that has not been researched in psychiatric nursing practice. Using a concept-analysis strategy proposed by Walker and Avant, the authors present a detalled description of the concept that evolved from a series of inductive and deductive strategies. Sense of belonging is defined as the experience of personal involvement in a system or environment so that persons feel themselves to be an integral part of that system or environment. Sense of belonging has important applicabillity for clinical use as well as continued theory development in psychiatric nursing.