Intellectual well-being is the ability to constantly expand upon one’s own knowledge through creative and stimulating activities and experiences and to share what is already known with others. It is the exercising of the mind.
In this paper we aimed to explore: (1) challenges that people with mental illnesses (MIs) describe in engaging in smoking cessation, (2) challenges that mental health providers (MHPs) perceive that people living with MIs face, and (3) how the perceived challenges are similar and/or different from both perspectives. Semi-structured interviews were used to obtain narrative data from 16 MHPs and 13 psychiatric inpatients with MIs. We identified themes purport societal, group, and individual factors may influence smoking cessation treatment engagement. The scope of the perceived challenges appeared varied in the narratives of MHPs as compared to those with MI.
"All have their worth and each contributes to the worth of the others." The Silmarillion, by J.R.R. Tolkien In my view, this quote captures the drive to achieve equity in mental health care. All people have worth, and every person's worth adds to the worth of every other per- son. Our psychiatric-mental health nursing care is driven by this absolute belief that all people are of equal worth, of equal value.
In the world of Social Work, there are many frameworks and theories that professionals use with clients in their treatment plan. The change process, developed by Prochaska and DiClemente in the late 1970s, is a model that allows healthcare professionals to meet the client where they are in their readiness to change. This is essential for supporting behavioral health clients as they work toward change. Identifying where a client is in their readiness to change allows the social worker and client to work together to select an intervention that is most appropriate for the client’s readiness to change. Social workers use this model understanding that change is not necessarily a linear process, as clients move along the continuum. This model can be applied in any social work setting to support clients and promote their autonomy so that they are able to move forward at their own pace.
Pre-Contemplation
In this stage, the client does not have the intention to change. They are not aware that their behavior is creating a challenge for themselves. They may choose to defend their current behaviors when others ask if they are interested in change. For example, a client who smokes one pack of cigarettes a day may express frustration with friends and family who are concerned about their tobacco use and its health effects.
Pre-Contemplation Example
Social worker: “Thank you for sharing that you are using tobacco. Are you interested in stopping tobacco use?”
Client: “I enjoy using tobacco, especially with my friends. I don’t want to talk about it today.”
Contemplation
During contemplation, clients know they are experiencing a challenge and are considering a change in their behavior. However, they are not fully committed to change. This stage may include weighing the pros and cons of change, identifying barriers to change, and experiencing conflicting emotions. Clients may remain in the contemplation stage for prolonged periods of time. For example, a client who smokes one pack of cigarettes a day may begin to consider stopping tobacco use, make a list of pros and cons, but not be quite ready to start the process of stopping.
Contemplation Example
Client: “Maybe I do need to change. But, I don’t know that I’m ready.”
Social worker: “So, you understand that change is important but maybe you are not quite ready to change.”
Preparation
This stage is when a client is ready to take steps toward change, usually within the next month. The client will begin to experiment with small changes and may make a list of goals, prepare an action plan, or collect information about the change they wish to make. For example, if a client’s goal is to stop tobacco use, they may take steps such as smoking less each day or learning about the health benefits they will experience after quitting.
Preparation Example
Client: “I am ready to change and I’m going to take steps toward change.”
Social worker: “Okay! What kind of steps are you thinking about?”
Client: “I am thinking about cutting back on my tobacco use by two cigarettes a day each week.”
Social worker: “Since you are smoking 20 cigarettes per day, does that mean you are thinking about smoking 18 per day for a week, then 16 for a week, and so on?”
Client: “Yes!"
Action
The action stage is characterized by behavior modification and action toward a goal. The client is changing the behavior or aspect of their life that has created a challenge. In this stage, support from family and friends is important as a client works toward change.
Action Example
Client: “I am committed to stopping using tobacco. My health provider made sure I have nicotine replacement therapy.”
Social worker: “What a great choice. I understand that stopping tobacco use impacts health in many positive ways.”
Maintenance
In the maintenance stage, the client will avoid former adverse behaviors, maintain healthy coping mechanisms, and stay focused on their goals and recovery. They may continue counseling, support groups, and interacting with an accountability partner. People committed to maintaining change can do so for their entire lives.
Maintenance Example
Client: “I’m so proud of myself. I stopped using tobacco 3 months ago. My accountability partner, counseling, and support group have been a huge help.”
Social worker: “I’m so proud of you.”
Clients can be in different stages of the change process in different areas of their life. For example, a client may be in the pre-contemplation stage in relation to their readiness to stop using alcohol. This same client may be in the action phase in relation to stopping tobacco use.
BH WELL exists to promote behavioral health and wellness among individuals facing behavioral health challenges. Learn more about BH WELL at https://bhwell.uky.edu. Follow us on social media.
I’m a jack-in-the-box, safe and secure in the confines of my box. Sadly, this safety and security are short-lived. Outside the box, the crank is constantly turning, turning, and without warning, I’m thrust into an intense rollercoaster of fear, guilt, and anger.
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I’m a jack-in-the-box, safe and secure in the confines of my box. Sadly, this safety and security are short-lived. Outside the box, the crank is constantly turning, turning, and without warning, I’m thrust into an intense rollercoaster of fear, guilt, and anger. I’m triggered by a sight, a smell, a taste, or a noise I’m thrust into my past trauma, reliving each physical sensation and emotional experience either through flashbacks while awake or through nightmares while asleep. I’m engulfed by my flashbacks and nightmares, struggling to snap out.
As I realize there is no immediate threat, I begin to calm down. My body loses all energy and collapses, mentally exhausted. At the first opportunity, I flee back into my box, willing myself to brave the moments ahead. Despite feeling composed back in the box, I’m left feeling on edge and on guard. When will I be propelled out of my box again? What will the trigger be that time? Where will I be and who will be around me? Not knowing when I will burst out of the box not only alarms me, but also alarms those who exist outside of the box: my loved ones, my coworkers, or even strangers on the street or in the store.
The triggers, flashbacks, and nightmares happen again and again over months and months. Over time, I try to take myself away from anything and everything that reminds me of distressing memories. Sometimes I am numb to my feelings. No matter what I do to avoid my triggers, I’m reminded of my experiences again and again.
That’s why I decided to get help! My mental healthcare provider helped me through a plan that involved some medications and therapy to help with my problem. I learned to recognize my triggers and gained some skills to take care of the challenges with my feelings, thoughts and behaviors. Then one day, I popped out of my box and realized ‘it is just a box’. I realized my bad memories can exist alongside new and happier memories that I am making now. Then I decided that while the box remains, and while the bad memories are still there, I can choose to face my trauma while being supported by my mental healthcare provider. The more I learn about facing my trauma, the more I’m reminded that I don’t have to pop out of anything. I can just be.
If you or someone you know is experiencing post-traumatic stress disorder (PTSD), there is hope. Contact your health provider or call the National Helpline at 1-800-662-HELP (4357) supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).
References
Administration for Community Living. (n.d.). MHDD: Post-Traumatic Stress Disorder. The Mental Health and Developmental Disabilities National Training Center. Retrieved June 7, 2022, from https://rise.articulate.com/share/_krWkjSaEunOmpN8wSRR6k2Zl9WK Hwzz#/
Cleveland Clinic. (2021, June 15). Living With PTSD? How to Manage Anxiety and Flashbacks. Cleveland Clinic. Retrieved June 7, 2022, from https://health.clevelandclinic.org/living-with-ptsd-how-to-manage-anxiety-and-flashbacks/
Torres, F. (2020, August). What is Posttraumatic Stress Disorder (PTSD)? American Psychiatric Association. Retrieved June 7, 2022, from https://psychiatry.org/patients-families/ptsd/what-is-ptsd
U.S. Department of Health and Human Services. (2019, May). Post-Traumatic Stress Disorder. National Institute of Mental Health. Retrieved June 7, 2022, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
For hundreds of years, there has been a dynamic duo in the hospital setting: the social worker and nurse. A healthy partnership between social workers and nurses is vital as they both provide effective, holistic care. Here are 7 key elements of the partnership between social workers and nurses that contribute to positive patient outcomes:
1. Partnering in Patient-Centered Ethical Duties
In the National Association of Social Workers (NASW) Code of Ethics (1996), social workers are ethically bound to support the dignity and worth of a patient. In the same way, the American Nursing Association (ANA) Code of Ethics (2015) calls for nurses to protect human dignity and patient rights. Each profession’s training requires a patient-centered focus.
2. Assessing a Patient’s Physical and Psychological Needs
Identifying needs and desires of a patient is one of the first steps of the social work and nursing team. As part of a multidisciplinary team, social workers and nurses contribute to the development of each patient’s treatment plan. The nurse will assess a patient’s medical and psychological needs and provide care to ensure that these needs are met according to their professional scope and standards, clinical guidelines, and best practices. Social workers also complete an evidence-based biopsychosocial assessment early in treatment to inform a patient’s individual treatment plan. This assessment serves as a guideline in discharge planning, where the social worker determines the various environmental, social, medical, and family supports that a patient will need upon discharge.
3. Advocating for Patient’s Autonomy and Rights
Social workers and nurses each play key roles to ensure that every part of a patient’s treatment is ethical, appropriate, and respectful. Both social workers and nurses remain aware of any barriers throughout a patient’s treatment, initiating investigations for abuse and neglect (as needed), informing a patient of their treatment options during care, maintaining confidentiality, and including them in all decisions regarding their treatment.
4. Answering Questions for a Patient or their Family
With a multitude of factors which require consideration in a patient’s treatment, it is natural for a patient and family to have questions concerning timeline, the treatment plan, medications, and long-term care. In this dynamic duo, nurses take the lead on conversations concerning a patient’s diagnosis, treatments, and medication management. In turn, the social worker takes the lead on conversations about long-term care plans, providing counseling in challenging situations, and connecting the family to needed resources. As such a dynamic duo, both the social worker and nurse ease a patient and their family’s minds, which can lead to better health outcomes. In fact, when patients are educated about their diagnosis and treatment plan better health outcomes can be expected (Fernsler, J. I. et al, 1991).
5. Individual and Group Counseling
Diagnosis and treatment plans can be challenging for patients and families. Making lifestyle changes to improve wellness can often seem overwhelming. A nurse's rapport with a family can create opportunities to offer emotional support and referral to a social worker if needed. A social worker may counsel patients and families individually to process these feelings and challenges in behaviors and skills to achieve recovery. In addition, patients and families may participate in group counseling sessions. Group counseling is an evidence-based practice that allows individuals to receive treatment together in a group with others who may be experiencing similar life stressors.
6. Providing Financial Planning and Assistance
In addition to concern for their loved ones, families frequently endure financial stress related to healthcare and hospital stays. While the nursing team works to ensure proper medical treatment and recovery, the social work team is tasked behind the scenes to address the financial situation with the family. As recovery is underway, social workers may refer patients to legal aid, federal financial assistance programs, community-based resources, and payment plans provided by the healthcare institution.
7. Developing Discharge Plans
Nurses and social workers alike are proponents of a patient living their best life after hospitalization. However, the social worker and nurse assist a patient and family leading up to discharge in different ways. The nurse will provide timely communication with a patient and family regarding medical assessments and ongoing care needs. This includes explaining to a patient and family regarding all necessary health information, medications, and other health needs. In a complimentary manner, the social worker’s role for discharge planning focuses on securing housing (or other accommodation) placement, financial resources, and social support. The social worker may coordinate ongoing patient and family assessment and counseling, follow-up, and community resources needed to ensure continuity of care after discharge.
Conclusion
The collaboration between social workers and nurses in hospital settings creates a dynamic duo. Together, they have the common goal of providing care to patients in ways that enhance patient outcomes. Partnering in ethical duties, assessing patients’ physical and psychological needs, advocating for patients’ rights, providing individual and group counseling, financial planning and assistance, and developing discharge plans are all ways that social workers and nurses work together toward providing excellent care.
References
Code of Ethics for Nurses. American Nurses Association. (2017, October 26). Retrieved November 17, 2022, from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
Fernsler, J. I., & Cannon, C. A. (1991). The whys of patient education. Seminars in oncology nursing, 7(2), 79–86.
National Association of Social Workers. (1996). Code of ethics of the National Association of
Social Workers. NASW Press.
Social Workers in healthcare: How they make A difference. Adelphi University Online. (2021, June 10). Retrieved May 18, 2022, from https://online.adelphi.edu/articles/social-workers-in-healthcare-how-they-make-a-difference/
Williams, C. C., Bracht, N. F., Williams, R. A., & Evans, R. L. (1978). Social work and nursing in hospital settings: a study of interprofessional experiences. Social work in health care, 3(3), 311–322.
My life constantly glitches. I often get caught up in one moment and have to repeat things to assure myself that it’s okay to move on with my day. My brain tells me I can’t contaminate anything.
My life constantly glitches. I often get caught up in one moment and have to repeat things to assure myself that it’s okay to move on with my day. My brain tells me I can’t contaminate anything.
If I touch something dirty, I have to wash my hands. Wait... my hand touched the sink, so I wash again. Wait... I touched the sink handle that I touched with my dirty hand. I wash again. The towel that I wiped my hands on also touched my face and snot could have gotten on it. I wash again.
I sanitize the door handle with a disinfecting wipe. Wait... there are chemicals in that disinfectant. I try to move on, but my attention is snagged on that one detail. I wipe off the disinfectant with a paper towel so that no one else gets chemicals on their hands.
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I sit at my computer, reading something. At first, I try to read it in my head. Wait... did I really get anything out of it? I read it again. This time aloud. Wait... I messed up one word. I have to start over and read it perfectly to get the intended message of the sentence.
I get ready to hop into bed and look over at my desk. A couple of things are cluttered around. I tell myself “It’s okay. Those things can wait until the morning.”. My brain sends a different message: “No, I have to clean it now or else it will bother me, and I won’t be able to sleep”.
Moments like these control my whole day. When I try to move past whatever is bothering me, my mind continues to fixate on it. There’s always a “wait...”. I’m nervous... tense... and distressed. I don’t want to give in to the thoughts because I know that they’re irrational. However, the thoughts persist, and at some point, I can’t take it anymore.
If you can relate to my experiences, there is hope and there is help. Health professionals can provide treatments such as therapy and medications. I used to feel helpless, constantly replaying every moment. Receiving treatment has helped prevent my obsessions and compulsions from controlling my life. Are you experiencing obsessive-compulsive disorder? It’s never too late to ask for help.
References
International OCD Foundation. (n.d.). How is OCD Treated? International OCD Foundation. Retrieved May 10, 2022, from https://iocdf.org/about-ocd/ocd-treatment/
International OCD Foundation. (n.d.). What Causes OCD? International OCD Foundation. Retrieved May 10, 2022, from https://iocdf.org/about-ocd/what-causes-ocd/
International OCD Foundation. (n.d.). What is OCD? International OCD Foundation. Retrieved May 10, 2022, from https://iocdf.org/about-ocd/
International OCD Foundation. (n.d.). Who Gets OCD? International OCD Foundation. Retrieved May 10, 2022, from https://iocdf.org/about-ocd/who-gets/
Mayo Foundation for Medical Education and Research. (2020, March 11). Obsessive-compulsive disorder (OCD). Mayo Clinic. Retrieved May 10, 2022, from https://www.m ayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
If you or someone you know is experiencing obsessive-compulsive disorder (OCD), there is hope. Contact your health provider or call the National Helpline at 1-800-662-HELP (4357) supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).
People with mental illnesses (MI) smoke at higher rates than the general population. However, few mental health providers (MHPs) deliver tobacco treatment to patients with MI especially within inpatient psychiatric settings. According to evidence, fewer than half of MHPs in the US mental and behavioral health settings provide the recommended evidence-based tobacco treatment interventions to their clients with MI. This paper uses the theory of planned behavior to examine factors associated with provider intentions to deliver and their experiences in providing evidence-based tobacco treatment to clients with MI. Data were obtained from a cross-sectional survey of 219 providers in a state psychiatric hospital in Kentucky. Attitudes, subjective norms, and perceived behavioral control were associated with providers’ intentions to deliver tobacco treatment when controlling for demographic and work-related variables. However, only profession, subjective norms, and attitudes were associated with reported provision of evidence-based tobacco treatment. Given the underuse of routine tobacco treatment for this vulnerable population, understanding factors influencing provider delivery of tobacco treatment is needed to guide strategies for reducing the disproportionate rates of tobacco use and related burden among people with MI.
This is the story of John. John is 45 years old and has recently experienced numerous substantial life changes. Watch the video below to hear John’s story and identify some risk factors and warning signs that increase the risk of suicide for John.
Patient Background
Meet John
John is 45 -years old.
After 10 years of marriage, he recently went through a divorce and is now living alone. He has visitation with his 10-year-old daughter every other weekend.
John was recently fired from his factory job of over 15 years and is unemployed because of his increased drinking.
John acknowledges feeling increasingly depressed and hopeless since his divorce and the loss of his job.
Over the last two weeks, he has had insomnia and loss of appetite, leading to weight loss and loss of interest in hobbies including hunting and going to the shooting range with friends. His use of alcohol has also increased considerably in the past 2 weeks.
John has a few close friends but has little contact with his family. He has expressed his hopelessness and while drinking with his friends he’s said things like, “My family might be better off without me.”
His increased drinking led to being pulled over by the police and charged with DUI, one week ago.
Can you identify some risk factors and warning signs that increase the risk of suicide for John?
According to the National Institute of Mental Health (2021) and the American Psychological Association (2019), warning signs for suicide include the following.
Talking
Talking about wanting to die, experiencing guilt or shame and/or being a burden to others.
Feelings
Feelings of emptiness, sadness, hopelessness, feeling trapped and/or feeling unbearable emotional or physical pain.
Changes in behaviors
Changes in behaviors such as making a plan or researching ways to die, preoccupation with death and dying, has recently experienced serious losses, withdrawing from family and friends or social activities, loss of interest in school, work or hobbies, saying goodbye, giving away important items, or making a will, taking unnecessary or dangerous risk, displaying extreme mood swings, eating or sleeping more or less and/or increases in drug or alcohol use.
Lee Anne Walmsley, Ph.D., EdS, MSN, RN, is an Assistant Professor in the UK College of Nursing. She is also a part of the BH WELL faculty team. Her life's work is about mental health and well-being. In this brief video, she shares her thoughts on feeling stuck.
