Ninety-seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow-up study. At follow-up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self-supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow-up period than other groups. The overall suicide rate was low compared with most similar studies.

Personality disorders 2–5 years after treatment: a prospective follow‐up study

Aim To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation. Design A scoping review was performed. Data sources A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar. Review methods Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes. Results Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention. Conclusion The COVID-19 pandemic has taken an emotional toll on older adults' psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions. Impact With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jan.15063

Psychological impacts and online interventions of social isolation amongst older adults during COVID-19 pandemic: A scoping review.

The Australian National University (ANU) and the University of South Australia (UniSA) have embarked on Federally-funded project to collaborate in the design, development and delivery of a range of undergraduate and postgraduate courses in engineering. The collaboration investigates new ways to bring together the strengths and discipline expertise of each institution to the students of both universities, utilising blended teaching and learning approaches. The collaboration brings much change - at the organisational level in the blending of programs, at the staff level in their approaches to teaching and at the students' level in their approaches and engagement with cross-institutional blended learning. This paper focuses on how change management principles were used to guide a systematic approach to engaging students into the learning culture associated with the Engineering Hubs and Spokes Project's theme - 'Advanced Collaboration for Excellence'.

Leading change: Applying change management approaches to engage students in blended learning

Nurse practitioner prescribing in Australia: A comprehensive literature review.

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

https://journals.sagepub.com/doi/pdf/10.1177/1527154420957259

The Pursuit of Nurse Practitioner Practice Legislation: A Case Study.

Patients with borderline personality disorder (BPD) can be dramatic and highly passionate, and their life situations often appear chaotic and distressing. Caring for patients with BPD often causes healthcare providers (HCPs) to consider a patient to be “hard to work with” or “diffi cult to treat.” Each patient visit may present as a crisis or emergency, regardless of the reason for seeking care. Interactions can leave even the most experienced HCPs feeling mentally exhausted or overwhelmed. This brief overview addresses assessment, comorbidities, pharmacologic and nonpharmacologic management, and evidence-based recommendations to effectively care for patients with BPD.

Borderline personality disorder: Implications and best practice recommendations.

The purpose of this article is to describe this use of relative value units (RVUs) among nurse practitioners (NP), including the challenges NPs may experience. Relative value units were developed as a means to determine reimbursement for health care based on time spent with the patient and skills required to complete the interaction, while addressing any disparities of reimbursement based on geography or insurance. Increasingly, providers such as NPs are being evaluated based in large part on how many RVUs they generate, which seems to prioritize productivity and may overlook many nonbillable aspects of the NP role such as emotional support or patient education. Nurse practitioners working in settings that require more invasive procedures may seem to be more productive on paper, regardless of the number of patients seen. Relative value units may not adequately reflect the skill and time taken to care for patients with chronic illness. Gender differences have been noted, both in terms of the number of RVUs generated for care of male or female patients, and those generated by male or female providers. If NPs are evaluated primarily based on productivity as measured by RVUs, we must consider how this might minimize or even invalidate the therapeutic relationship and holistic approach to patient care. Relative value units may negatively affect the willingness of NPs to serve as preceptors. Finally, as NPs experience less face-to-face time with patients and more demands for productivity, there may be a loss of quality care and professional integrity, which raises the risk of burnout among NPs.

Relative value units in health care: Friend, foe, or necessary evil?

https://www.npjournal.org/article/S1555-4155(15)00091-4/pdf

The Full Practice Authority Initiative: Lessons Learned from Nevada

Sleep disorders, such as insomnia, are a common complication of many physical and mental health problems. This article reviews insomnia disorder, including assessment, comorbidities, and management. It is imperative that primary care providers understand how to provide the safest pharmacologic and nonpharmacologic treatments to patients with insomnia.

Implications and recommendations for addressing insomnia disorder

A qualitative, multiple-participant case study design was employed to identify legislative barriers to full practice authority legislation and how they were overcome during Nevada’s 2013 legislative session. Eight barriers were identified: lack of a clear vision; lack of physician support; inability to address all stakeholders; lack of a strong coalition; lack of vital resources; nurse practitioner role recognition; community and regulatory organizations; and social media. Efforts to overcome these issues are described. The findings may be useful in states vying for full practice authority legislation, and may act as a stepping stone toward addressing the provider shortage in the United States.

Full Practice Authority Initiative: Lessons Learned from Nevada

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