Search

Mexican immigrant mothers face many challenges that put them at increased risk for poor mental health. To understand the factors that lead to the development of depressive symptoms among Mexican immigrant mothers, we analyzed data from 20 qualitative, semistructured interviews. Participants included low-income, Mexican-born mothers of young children living in North Carolina. Most of the mothers in our study reported experiencing depressive symptoms after becoming parents. They expressed their symptoms as feelings of sadness, depression, loneliness, shame, and anxiety. Economic stressors contributing to their emotional health included financial obligations, work, and child care. Social stressors included family separation, social isolation, and discrimination. To cope with these stressors, mothers relied heavily on social networks and community resources. Our results suggest that a combination of both risk and resiliency factors shape the emotional health of Mexican immigrant mothers. [ABSTRACT FROM AUTHOR]

The development of problem behaviors among adolescents is affected by complex interactions between risk and protective factors. This study was designed to determine whether selected risk and protective factors described among participants in the National Longitudinal Study of Adolescent Health predicted problem behavior cluster membership. Approximately, 13,000 adolescents from the Add Health study were examined. Three clusters of adolescents (exhibiting normal, problem, and deviant behaviors) and changes in cluster membership over 1 year were examined for relationships to specific risk and protective factors. Findings revealed that factors for current behavior problems differ from those for changes in cluster membership. These results suggest that approaches to preventing problems may differ from those required to help adolescents who are already manifesting problems. [ABSTRACT FROM AUTHOR]

The article discusses L. S. Beeber and colleagues' study on the use of interpersonal psychotherapy in improving depression symptoms of low-income mothers. After their randomised controlled trial that involved 226 mothers with clinically significant depressive symptoms, they concluded that no reduction was made after home-delivered interpersonal therapy with parenting enhancement. The author praised the methodology used in the study that made used of appropriate measures and their analyses.

Emotional regulation involves managing attention, affect, and behavior, and is essential for long-term health and well-being, including positive school adjustment. The purpose of this secondary data analysis from the Durham Child Health and Development Study was to explore how parent and teacher reported emotional regulation behaviors related to school adjustment outcomes (social skills, academic performance, and academic achievement) during early childhood. Parent and teacher reports on emotional regulation behaviors showed mixed concordance, however they correlated with critical aspects of school adjustment. Clinical and practical implications are discussed, including the role of psychiatric nurses in promoting positive emotional regulation and school adjustment outcomes across settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood., Design & Methods: A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis., Results: Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability., Conclusion & Practical Implications: Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this article is to describe the process used to create the Mental Health Innovation (MHI), a multicomponent implementation strategy that integrates evidence-based mental health interventions into the Nurse-Family Partnership (NFP), a national home visiting program delivered by nurses to low-income mothers., Organizing Construct: The Exploration, Preparation, Implementation, Sustainment (EPIS) framework outlines the multistep, stakeholder-engaged process used to develop the MHI., Conclusion: Engaging stakeholders provided an in-depth understanding of NFP infrastructure and the needs of NFP nurses and their clients. This understanding was key to designing a multicomponent implementation strategy to integrate mental health interventions within national and local NFP infrastructure and existing care processes., Clinical Relevance: Application of implementation frameworks such as EPIS provides a guide to integrating evidence-based interventions in a systematic, intentional, and rigorous manner, which in turn may promote their wide scale use and long-term sustainability., (© 2021 Sigma Theta Tau International.)

Background: Up to half of low-income mothers experience symptoms of depression and anxiety that affect their well-being and increase their children's risk for behavioral and emotional problems. To address this problem, an engaged research/practice planning team designed the Mental Health Innovation (MHI), a multicomponent implementation strategy that integrates evidence-based mental health interventions within the national Nurse-Family Partnership (NFP). The MHI includes four implementation strategies: online training modules, clinical resources, team meeting modules, and virtual consultation., Methods: A convergent, mixed methods observational design was applied to evaluate implementation outcomes, guided by the RE-AIM framework. We operationalized Reach as the number and demographics of women enrolled in NFP agencies exposed to MHI strategies. Adoption was operationalized as the number and proportion of nurses and supervisors who used MHI implementation strategies. For implementation, we assessed multilevel stakeholders' perceptions of strategy acceptability and feasibility. Data were pulled from NFP's national data management systems and collected through focus groups and surveys. Quantitative data were analyzed using counts and summary statistics. Qualitative themes were generated through content analysis., Results: The MHI reached agencies serving 51,534 low-income mothers (31.2% African American and 30.0% Latina). Adoption rates varied across implementation strategies. Between 60% and 76% of NFP nurses ( N = 2,100) completed each online module. Between 27% and 51% of nurse supervisors ( n = 125) reported using each team meeting module. Of 110 teams invited to participate in virtual consultation, 40.9% ( n = 45) participated. Mothers served by agencies participating in virtual consultation differed significantly from those who did not, with lower percentages of African American and Latina. Qualitative themes suggest that MHI strategies were generally viewed as acceptable; perceptions of feasibility varied across strategies., Conclusions: This study identified both strengths and opportunities for improvement. Further evaluation is needed to assess the MHI's effectiveness in improving mothers' mental health., Competing Interests: Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration's Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement's Breakthrough Series (BTS) Model in home visiting programs., Methods and Findings: Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN's proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs., Conclusions: Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes., Competing Interests: The authors have no competing interests.

Background: Effective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members' perception of communication quality with clinicians may be associated with their psychological symptoms., Objectives: To examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs)., Design: A cross-sectional study., Settings and Participants: The participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea., Methods: Participants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis., Results: The mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants' HADS-depression scores (β = -.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates., Conclusions: The findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Developmental delay in very young children is trending upward. Maternal depressive symptoms are known to negatively impact child development and may also impact family management of the child's condition. Research on family management guided this second phase of a sequential mixed methods study. The purpose of this study was to explore mothers' perceptions of family management of their children's developmental delays. Mothers of very young children who received early intervention services were interviewed. A team-based content analysis approach revealed key findings: (a) views of the child that were not holistic, (b) condition management ability was informed by what the mother thought her child needed, (c) views of condition impact were related to adapting to possible child outcomes and experiences of isolation, and (d) parental/caregiver mutuality was impaired by conflict. Understanding perceptions of family management and influence of depressive symptoms in this context is essential to extend assessment and intervention.

Maternal depression was recently conceptualized as a network of interacting symptoms. Prior studies have shown that low self-efficacy, as an index of maternal functioning, is one important source of stress that worsens depression. We have limited information, however, on the specific relationships between depression symptoms and self-efficacy. In this study, we used regularized partial correlation networks to explore the multivariate relationships between maternal depression symptoms and self-efficacy over time. Depressed mothers (n = 306) completed the Center for Epidemiological Studies Depression (CES-D) scale at four time points, between four and eight weeks apart. We estimated (a) the network structure of the 20 CES-D depression symptoms and self-efficacy for each time point, (b) determined the centrality or structural importance of all variables, and (c) tested whether the network structure changed over time. In the resulting networks, self-efficacy was mostly negatively connected with depression symptoms. The strongest relationships among depression symptoms were 'lonely-sleep difficulties' and 'inability to get going-crying'. 'Feeling disliked' and 'concentration difficulty' were the two most central symptoms. In comparing the network structures, we found that the network structures were moderately stable over time. This is the first study to investigate the network structure and their temporal stability of maternal depression symptoms and self-efficacy in low-income depressed mothers. We discuss how these findings might help future research to identify clinically relevant symptom-to-symptom relationships that could drive maternal depression processes, and potentially inform tailored interventions. We share data and analytical code, making our results fully reproducible.

Only a small proportion of research-tested interventions translate into broad-scale implementation in real world practice, and when they do, it often takes many years. Partnering with national and regional organizations is one strategies that researchers may apply to speed the translation of interventions into real-world practice. Through these partnerships, researchers can promote and distribute interventions to the audiences they want their interventions to reach. In this paper, we describe five nurse scientists' programs of research and their partnerships with networks of national, regional, and local organizations, including their initial formative work, activities to engage multi-level network partners, and lessons learned about partnership approaches to speeding broad-scale implementation., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: There are no Korean instruments to assess the concepts associated with end-of-life communication quality., Objectives: To translate and culturally adapt the Quality of Communication (QOC) questionnaire into Korean and evaluate its acceptability and internal consistency., Methods: We first translated the QOC from English into Korean, then back-translated from Korean to English, and evaluated the cultural appropriateness of the items. We pretested and refined the Korean version of the QOC with 11 ICU family members. Subsequently, the Korean version of the QOC was administered to 62 family members of chronically critically ill patients recruited from 10 ICUs to evaluate its internal consistency., Results: Participants completed the Korean QOC without difficulty during the pretest, and it showed acceptable internal consistency (Cronbach's alpha ≥0.85)., Conclusion: This study provided preliminary evidence of the acceptability and reliability of the Korean QOC in ICU family members. Nonetheless, further evaluation, including item relevance and other psychometric properties, is warranted., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Adequate assessment of depressive symptomatology is a necessary step toward decreasing income-related mental health treatment inequity. No studies have focused on comparing instruments used to detect depression in women from low-income backgrounds who are mothers of young children-a period of increased risk for depressive symptoms., Methods: To address this gap, two commonly used instruments (Center for Epidemiologic Studies Depression Scale [CES-D] and Hamilton Rating Scale for Depression [Hamilton]) were compared with a depression diagnosis (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-V]) in a sample (n = 251) of mothers from low-income backgrounds with children ranging from 1 to 54 months old. Diagnostic utility was examined in light of contextual factors associated with maternal depressive symptoms., Results: In this sample, CES-D had better screening sensitivity and specificity than Hamilton. Our results suggest that Hamilton may underdiagnose cases of major depressive episodes (MDE) as defined by DSM-V among black and low-income mothers compared with CES-D. In addition, we identify items in CES-D, which do not contribute to alignment with DSM-V and are appropriate targets for future improvements. Our analysis identifies interpersonal relationships and mother's age as the primary risk factors, which differentiate between CES-D and Hamilton determinations versus MDE diagnosis. In addition, we find regional differences in CES-D and Hamilton., Conclusions: It is important to tailor the measure to the context, and a calibration sample should be considered for studies of sufficient size.

Purpose: The purpose of this study was to validate five concepts central to secondary traumatization (ST) using narratives of psychiatric mental health advanced practice nurses., Design and Methods: The study was designed as a directed content analysis of narrative notes (N-30)., Findings: Consistency was found between narrative notes and the concepts. This study revealed that exposure and vulnerability precede empathic engagement, reaction, and alteration/transformation. The bidirectional outcome of alteration/transformation suggested that conditions leading to ST could have a positive outcome., Practice Implications: Failure to recognize symptoms of ST and provide reflective supervision may compromise the nurse's ability to maintain a work-life balance and provide quality patient care., (© 2015 Wiley Periodicals, Inc.)

Background: In 2015, the Co-Chairs and Steering Committee of the Research Council members recognized the need to reevaluate the council's priorities., Objective: To determine the top priorities for the Research Council., Design: Use of liberating structures: Impromptu Speed Networking, 1-2-4-all, and Crowd Sourcing., Results: Identified Research Council priorities included the following: efforts to increase psychiatric mental health (PMH) research funding; serve as a connector to bring researchers together; foster research through state chapters; increase collaboration between PhDs and DNPs; and develop models for organizational support for PMH staff nurse involvement in research., Conclusions: The liberating structures used are valuable strategies for engaging groups of people to identify what matters most to the group. Through the use of these novel techniques, the American Psychiatric Nurses Association Research Council has identified priorities for the work of the council. This has led to actions planned for the coming future with the intent to move PMH nursing research forward., (© The Author(s) 2016.)

Background and Purpose: Intervention fidelity (IF) is a relatively recent methodological consideration in nursing research that refers to the adherent and competent behaviors by the interventionist. The purpose of this study was to explore an alternative method of determining IF using chronological field notes (CFNs)., Method: A secondary analysis using data from an intervention study. A randomly selected sample of CFNs (N = 181) written by interventionist nurses (N = 20) were coded using the Collaborative Study Psychotherapy Rating Scale, a validated fidelity instrument used in similar studies., Results: The study provides no evidence that the field notes could be used for determining intervention fidelity., Conclusion: Further research is needed on IF that would provide less intrusive an alternate method.

Disadvantaged women with migraine headaches have a particularly high risk of developing comorbid depression and often isolate themselves from others-or socially withdraw-to manage these disorders. Despite this, little is known about whether or how social withdrawal as a self-management strategy for episodic migraine might contribute to the more severe symptom burden in this group. In this article, we explore the potentially cumulative, deleterious effect that this strategy may have in modulating migraine-depression symptom severity in this population and argue that further theoretical and empirical work from nursing and complexity science perspectives is needed to better understand this phenomenon.

Depression is a serious disorder with severe and far-reaching consequences. Two decades of observational research have shown robust associations between maternal depression and adverse consequences on offspring (Campbell et al., 2004; Campbell, Matestic, von Stauffenberg, Mohan, & Kirchner, 2007; Campbell, Morgan-Lopez, Cox, & McLoyd, 2009; National Research Council & Institute of Medicine, 2009). Depressive symptoms may pose particular risk to infants and toddlers with neurodevelopmental disabilities, whose long-term outcomes depend heavily on the provision of Early Intervention (EI). EI is most effective with active parental engagement. Maternal depressive symptoms may reduce parental engagement, thereby limiting EI benefits to the child (Gaynes, Gavin & Meltzer -Brody, 2005; O'Hara & Swain, 1996). At present, maternal mental health is not directly addressed in EI. The purpose of this paper is to discuss the literature and significance of maternal depression and apply that evidence to mothers of children with developmental delays and disabilities. We conclude that maternal mental health and well-being is currently insufficiently addressed in the EI population. An increased integration of mental health and EI services is needed to serve the unique needs of families who face an increased risk of stress and depression while coping with their child's special needs.

Researchers, educators and clinicians have long recognized the profound influence of the mid-twentieth century focus on interpersonal relations and relationships on nursing. Today, in nursing, as well as in medicine and other social sciences, neuroanatomy, neurobiology and neurophysiology have replaced interpersonal dynamics as keys to understanding human behavior. Yet concerns are being raised that the teaching, research and practice of the critical importance of healing relationships have been overridden by a biological focus on the experiences of health and illness. As a way to move forward, we return to Hildegard Peplau's seminal ideas about the transformative power of relationships in nursing. We propose that Peplau's formulations and, in particular, her seminal Interpersonal Relations in Nursing can provide direction. We do not propose that her formulations or her book be simply transposed from the 1950s to today's classroom and clinic. But we do believe that her ideas and writings are dynamic documents containing concepts and derived operations that can be brought to life in clinical practice. Finally, we explore Peplau's transformative idea that nursing is, at its core, an interpersonal process both to acknowledge an idea that has shaped our past and can guide us into our future., (© 2014 John Wiley & Sons Ltd.)

Background: Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials., Objective: Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to improve their impacts, given that interventions require continuous improvement. This article provides a framework and illustrations of work our team members have developed to address this tension., Methods: Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them., Results: We describe a framework used to address these issues and illustrate its use in improving nurses' skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers' care of their children, addressing parents' mental health problems, classifying families' risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in practice settings and translating findings from these studies into ongoing program implementation., Conclusions: The conduct of research focused on quality improvement, model improvement, and implementation in NFP practice settings is challenging, but feasible, and holds promise for improving the impact of the NFP.

Linear mixed models (LMMs) can be used to analyze continuous longitudinal response variables of research studies. Specific aims are then addressed through tests of fixed effects comparing means. However, generated fixed effects results can vary according to the choice of the covariance structure, and so strategies for selecting a model should be utilized first to identify an appropriate covariance structure. We describe alternative LMMs for analyzing continuous longitudinal data and discuss a strategy for using model selection criteria to choose among those models. This is accomplished through the analysis of an exemplar data set considering a wide variety of alternative models for the means, variances, and correlations., (Copyright © 2012 Wiley Periodicals, Inc.)

Objectives: We evaluated the effectiveness of a community-based participatory research-grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status., Methods: We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months., Results: Medicaid knowledge and skills improved (P < .001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR] = 1.92; P = .007), and this likelihood increased in higher-risk subgroups (OR = 2.03 and 2.83; P = .04 and .006, respectively). Depression and functional status improved in the intervention group over time (P = .016 for both). No differences were found in routine or preventive care, or general health., Conclusions: Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population.

In the wake of a devastating flood that destroyed the ecology of a small town, undergraduates taking their first clinical course in psychiatric mental health nursing formed AGAST (Awesome Guerillas Against Situational Trauma) and, with their instructor, performed individual and group crisis intervention over an intensive 90-hour clinical rotation. Three theories were used to help guide the students assessments and interventions with survivors. The clinical experience required innovation, close connection with the host community, and multi-level support from the educational institution. Students rose to the occasion and blossomed in the rich clinical matrix of the experience. The example can be applied to the use of other naturally-occurring events as theaters for innovative clinical teaching.

Factors to explain the rising incidence of depressive symptoms among young women making the transition from home to university life were investigated. A path analysis of data from 213 18- and 19-year-old women entering a large university indicated that negative life events, interpersonally derived social support, self-esteem, and depressive symptoms were significantly related. Negative life events that affected the women's self-esteem (drawn from the women's performance in interpersonal relationships) were most strongly associated with depressive symptoms, and self-esteem derived through efficacy (i.e., taking control and acting assertively) was not associated with negative events. The women in the sample appeared to derive efficacy self-esteem from relationships. An analysis of the data supported developing interventions to improve interpersonal relationships rather than focusing on competence in gaining access to resources.

Cognizant that only 20% of depressed individuals seek treatment, Healthy People 2000 has recommended a goal of increasing this figure to 45%. This flows from a recognition of depression as a serious and costly problem, with women carrying twice the risk of men. Primary care settings are the first contact a depressed woman may make with the health care system. This study piloted a collaborative model in which a Psychiatric Mental Health Advanced Practice Nurse (PMH-APN) was available on site to assist providers to recognize women with depressive symptoms and to provide intervention. Thirty three women were identified by primary care providers and referred for screening to the PMH-APN. Assessment and intervention based on the interpersonal theory of Peplau were accomplished in an average of eight sessions with the PMH-APN. Pre and postintervention descriptive data on the primary outcome (depressive symptoms) and three theoretically congruent mediating variables (performance and social self-esteem and satisfaction with interpersonal relations) were consistent with the expected outcomes of the intervention.

Interpersonal pattern, defined as the category in which separate interpersonal acts are linked by similar, defining characteristics, is a critical, data-rich concept that is used in the therapeutic nurse-client relationship. If this concept is studied within the framework of aesthetic knowing in nursing, the processes of deliberate involvement that form the crux of the nurse-client relationship become illuminated. An illustrative case study brings this concept to life by demonstrating the use of interpersonal pattern as the focus of intervention with a frail, elderly woman. In this case study, the nurse practices aesthetic knowing to assess and respond to the woman, and ultimately assist in her forward movement towards optimum function and health. Linkages of this type of intervention to all of nursing practice are made by integrating the use of interpersonal pattern with aesthetic knowing in nursing.

This article provides a blueprint to guide the nurse's work with the client whose depression interferes with his or her health. It is based on an expanded version of Peplau's interpersonal theory and illustrates systematic assessment and intervention through the therapeutic nurse-client relationship. Differentiation of depression from related health problems and criteria for referral to a mental health professional such as a psychiatric-mental health advanced practice nurse are outlined. Practical interventions through the therapeutic relationship are illustrated to guide the nurse in working directly with the depressed client.

Using Hildegard Peplau's theoretical model and focusing on the concept of pattern integrations, clinical data from a pilot intervention program for depressed women were analyzed. The program consisted of a collaborative relationship between primary-care providers and two Psychiatric-Mental Health Clinical Nurse Specialists in which women experiencing symptoms of depression were identified and referred to the research program. Data derived from clinical intervention done over a 4-month period with 6 women (42 hours of clinical tapes) was used for analysis. Clusters of behaviors constituting pattern integrations were analyzed for the reciprocal interactions of the nurses and the clients. Four pattern integrations common to the women in the sample were identified. Clinical examples and a framework for intervention using the patterns integrations is presented.

The mass deployment of nurses during World War I removed them from their structured professional culture and thrust them into the unfamiliar world of men at war. Analysis of personal accounts indicates that for some nurses, this event increased awareness of conflicts between autonomous professional practice and the "good woman" image. It led them to examine the disparity between healing and participation in war and to experience sex-based inequality in the face of equal danger. The emerging dialectic provoked personal and professional change. The value of confrontation with differentness as an impetus to growth is examined.

In an attempt to protect the self from anxiety associated with the need for tenderness, the depressed patient enacts particular interpersonal phenomena designed to create distance and control intimacy. A theoretical framework using Sullivan and Peplau explains these phenomena in the context of the therapeutic nurse-patient relationship and guides specific responses by the nurse to create a corrective interpersonal experience. Case material illustrates these processes.