Examining the efficacy of no-suicide contracts in inpatient psychiatric settings: implications for psychiatric nursing

Verbal and written no-suicide contracts are commonly practiced by psychiatric nurses in inpatient psychiatric facilities. However, evidence is sparse regarding whether no-suicide contracts are effective tools for maintaining patient safety. The purpose of this paper is to examine the use of the verbal and written no-suicide contracts, discuss the resulting implications for psychiatric nurses on inpatient units, and suggest alternative clinical practices for inpatient psychiatric nurses to utilize to increase patient safety.     

Relationship between nursing interventions and outcome achievement in acute care settings

The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS). Research assistants audited charts for documentation of nursing interventions. The results indicated that nursing interventions aimed at exercise promotion, positioning, and self-care assistance predicted functional status outcome. Higher functional status outcome predicted therapeutic self-care ability at hospital discharge. The results demonstrate that nurses can use MDS and TSCS data on patient outcomes to gain insight into the effectiveness of their interventions.     

Detection and diagnosis of psychiatric disorders in primary medical care settings

Research efforts accelerated in the 1990s to define the presentation of common psychiatric disorders in primary care settings. Two diagnostic instruments, the DSM-IV-PC and the PRIME-MD, were introduced in 1994, and a self-report form of the PRIME-MD, the PHQ, was published in 1999. These tools have streamlined the larger, often cumbersome psychiatric nomenclature of the DSM-III and DSM-IV and appear to be more useful in general medical settings. It still is not practical to use either instrument in its entirety for all patients in a busy primary care practice. Studies have suggested an efficient and effective, two-step method of screening primary care patients for psychiatric disorders, however. In this approach, a limited number of probing questions extracted from the PRIME-MD or PHQ (or DSM-IV-PC) are posed to patients, either in person or by a written self-report (i.e., a general health update or review of systems). Then a follow-up evaluation is done to confirm or refute positive screening results. Short, simple questionnaires that address specific topics (e.g., CAGE for alcohol screening or the GDS for mood disorders in older adults) complete and complement this approach. This method has the advantage of being easy to incorporate into routine office practice using minimal physician or office staff time, while showing acceptable sensitivity and specificity in studies to date. More research, particularly prospective studies, is needed to confirm the effectiveness of this approach and expand it beyond the few available studies that have focused mostly on depressive disorders.     

The relationship among medical diagnosis, nursing diagnosis, and nursing intervention and the implications for home health care.

The purpose of this study was to identify the most commonly used medical diagnoses, nursing diagnoses, and nursing interventions for home health care based on 244 patient records. Nursing interventions were categorized into three groups: assessment, instruction, and other. The results showed that for the three most commonly used medical diagnosis groups--"infectious and parasitic disease," "disease of the circulatory system," and "neoplasms"--the most related nursing diagnoses were "alteration in mobility," "alteration in cardiac status," and "alteration in comfort: pain." The most used nursing interventions were "instructions." The results indicated that nurses identified patients' physiological problems mostly in relation to medical diagnoses, and teaching was the most frequently used nursing intervention in home health care.     

Challenges of measuring and linking patient outcomes to nursing interventions in acute care settings

Abstract Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practise, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcome measures, nursing's lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes. The present article aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care.     

Effect of a psychiatric diagnosis on nursing care for nonpsychiatric problems

This study was designed to test how patients' psychiatric diagnoses would affect nursing care for medical problems. Sixty nurses were randomly assigned to three groups in this posttest-only experiment. Control group nurses read a vignette describing a man admitted with a possible myocardial infarction (MI). Nonpsychotic group nurses also read that the person was on alprazolam. Psychotic group nurses read that the person was on haloperidol, benztropine, lorazepam, trazadone, fluoxetine, and lithium. Psychotic group nurses estimated a decreased probability that the patient was having an MI and were less likely to respond to additional possible MI symptoms. An increased awareness of the potential to stereotype medical patients with a history of psychosis might assist nurses when providing care.     

The prevalence of psychiatric morbidity on a coronary care ward

Numerous studies have documented the high prevalence of psychological and emotional disorders in patients seen in general medical settings. However, despite the emphasis placed on holistic approaches to nursing care in all professional models of nursing practice, much of this distress is still missed by nursing staff. The Hospital Anxiety and Depression (HAD) scale is an easy-to-use self-administered screening instrument purportedly designed to detect psychological distress amongst hospitalized patients with physical illnesses. On using the HAD scale on patients admitted to a coronary care ward of a district general hospital, 44% were found to be suffering high levels of anxiety or depression. This figure is consistent with the results of similar studies in other cardiac wards and out-patient clinics. In most cases, the levels of distress found were not sufficiently severe to warrant seeking specialist psychiatric support. Instead, there is much that the general nurse can do to alleviate the understandable fears and worries of patients being treated for cardiac disease. However, to respond appropriately, nursing staff must be able to identify psychological distress in patients. The HAD scale, if it can be validated in cardiac in-patient settings, provides an instrument which could easily become part of the routine assessment of patients' nursing needs.     

The nursing shortage in acute and critical care settings

The nursing shortage is seriously challenging hospitals to provide safe, quality care to acute and critically ill patients. Most frequently reported are the registered nurse (RN) shortages in intensive care units (ICUs) and step-down units. Issues surrounding the nursing shortage are multifaceted and require comprehensive solutions. Although work place conditions are typically cited as the leading cause of the shortages, other factors, including a rapidly aging RN workforce, have been implicated. Furthermore, fewer young people are choosing nursing as a career and graduating classes of RNs are decreasing in size. Remedies for the acute and critical care nursing shortage will require highly innovative initiatives and multiple long-term strategies focused on forces driving the growing nursing shortage. One solution to workplace issues may lie in the philosophy of the Magnet Hospital program. The advanced practice nurse can play a significant role in providing leadership in addressing factors and designing comprehensive and innovative strategies directed at recruitment and retention of RNs in acute and critical care settings.     

The nature of clinical supervision in psychiatric nursing: a survey of clinical specialists

There is a growing body of theory and research on clinical supervision within other mental health disciplines; however, there has been little study of clinical supervision within psychiatric mental health nursing. This article reports the results of a survey of 61 psychiatric mental health specialists to determine their attitudes toward selected supervisory issues. Two-thirds of the respondents had received further supervision beyond the master's degree, one-half reported a personal psychotherapy experience, and one-half were certified in psychiatric mental health nursing. There were significant differences of opinion between clinical nurse specialists who were certified and those who were not and between those who reported a personal therapy experience and those who did not. The authors suggest that more attention be paid to the development of curriculum content regarding clinical supervision in graduate nursing programs. In addition, they recommend further research on the topic of clinical supervision in psychiatric mental health nursing.     

Psychiatric diagnosis: some implications for mental health nursing care

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.     

Psychiatric diagnosis: some implications for mental health nursing care

This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.