Fulfilling the need for a coordinated approach. Case management and community nursing.

Case management represents an alternative to the multidisciplinary team in coordinating community care. The case manager role is open to community nurses, among other disciplines, and offers an opportunity to combine management skills with clinical care.     

Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.     

Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement

There is a lack of guidelines for preoperative management of psychiatric medications leading to variation in care and the potential for perioperative complications and surgical procedure cancellations on the day of surgery. The Society for Perioperative Assessment and Quality Improvement identified preoperative psychiatric medication management as an area in which consensus could improve patient care. The aim of this consensus statement is to provide recommendations to clinicians regarding preoperative psychiatric medication management. Several categories of drugs were identified including antidepressants, mood stabilizers, anxiolytics, antipsychotics, and attention deficit hyperactivity disorder medications. Literature searches and review of primary and secondary data sources were performed for each medication/medication class. We used a modified Delphi process to develop consensus recommendations for preoperative management of individual medications in each of these drug categories. While most medications should be continued perioperatively to avoid risk of relapse of the psychiatric condition, adjustments may need to be made on a case-by-case basis for certain drugs.     

The application of reusable learning objects (RLOs) in preparation for a simulation laboratory in medication management: An evaluative study

To enhance the preparedness of undergraduate nursing and midwifery students to participate in the safe provision of medication administration on their clinical placements, an innovative blended learning strategy was designed and developed by the authors. The blended learning strategy included a suite of online reusable learning objects specific to medication management theoretical knowledge and psychomotor skills to prepare students for a 90-minute practical face to face simulation laboratory session. Students identified that the reusable learning objects had prepared them for the simulation laboratory session and was rated as a productive learning experience. The blended learning strategy implemented to teaching and learning medication management to undergraduate nursing and midwifery students can positively influence students’ acquisition of knowledge and psychomotor skills to safely administer medications prior to their practice placements in a clinical setting.     

Risk management--the forensic nursing response 'ability'

The clinical risk manager is a new forensic nursing role opportunity and affords unique and individual communication to all health care staff as a confidential sounding board for case review, discussion, and avenue for change.     

The management of pain in long-term care

OBJECTIVE: The purpose of this paper is to present salient principles of pain management in nursing homes and other long-term care settings. METHODS: Review and author opinion. RESULTS: Pain is a common problem in nursing homes and other long-term care facilities. Often unrecognized and under-treated, pain is a major source of suffering and functional impairment. These patients present substantial barriers to pain assessment and management. Multiple concurrent disease processes, cognitive impairment and communication difficulties, and limited access to diagnostic technologies make assessment more difficult. Multiple medications, altered physiology and pharmacology and limited access to a variety of drug and non-drug interventions make treatment strategies more difficult to implement. DISCUSSION: Clinicians who care for patients receiving long-term care services must help establish a treatment plan that is reasonable given the limited resources and skills available in nursing homes and other long-term care facilities. Medication regimens should be simplified as much as possible. Contingency plans for pain management must be anticipated and made available so that delays do not occur during medication changes or dosage adjustments. Long-term care facilities need substantial support from physicians and other pain experts for education to continuously update their skills and knowledge. As the need for health systems for frail elderly persons continues to grow, it is important to provide comfort and effective pain control appropriate for these new settings.     

PSYCHIATRIC NURSING CASE MANAGEMENT: PAST,PRESENT, AND FUTURE

This literature review examines the evolution of psychiatric nursing case management in the United States. Various models, both inpatient and outpatient, are described, along with the roles of the case manager in each setting. The development of clinical pathways to monitor and document outcomes in acute settings is examined, along with the difficulties in adapting them specifically to psychiatric nursing case management. The types of data collected and the use of outcomes to support programs for the mentally ill are reviewed. Finally, recommendations for psychiatric nursing case management are made to provide guidelines for the future.     

Psychiatric nursing case management: past, present, and future

This literature review examines the evolution of psychiatric nursing case management in the United States. Various models, both inpatient and outpatient, are described, along with the roles of the case manager in each setting. The development of clinical pathways to monitor and document outcomes in acute settings is examined, along with the difficulties in adapting them specifically to psychiatric nursing case management. The types of data collected and the use of outcomes to support programs for the mentally ill are reviewed. Finally, recommendations for psychiatric nursing case management are made to provide guidelines for the future.     

Nurse delivered medication safety screening program for home care visits

Home care clients have safety barriers related to medication storage, disposal, and safe use of opioids. Limited research is available regarding medication safety initiatives in the home care setting. This study evaluates a medication safety initiative, linked with opioid misuse and overdose prevention screening, for home care clients with different levels of service. Training and screening tools designed for community pharmacies by the Opioid & Naloxone Education (ONE) Program were modified for use by home health nurses. All new admits to the home health services were screened for medication storage, medication disposal, and use of pain medications. Patients taking opioids were screened for opioid-specific risks. Interventions based on screening results included education, provision of medication lock boxes, drug disposal packets, and/or naloxone. Most home care clients (85%) are properly storing their medication and 38% were not properly disposing unused medications. Higher levels of care had greater pain medication needs, including the provision of naloxone. This study demonstrates the opportunity to incorporate medication safety screening into nursing home health visits.     

Teaching medication administration through innovative simulation

Nurse educators are constantly seeking innovative ways to better prepare nursing students for clinical practice in the health care environment. One approach implemented by an associate degree program of nursing in southern Ohio is an automated medication dispensing system in the skills laboratory setting to evaluate first-year students' competency in administering medications. This self-report convenience survey evaluated the perceptions of 51 first semester nursing students following the implementation of a medication dispensing system in the skills laboratory prior to competency evaluation for medication administration. The authors' findings supported the use of the Demo Dose medDISPENSE automated medication dispensing system as a valuable teaching strategy because it reinforces the students' knowledge base of the six rights of medication administration and their confidence level. In addition, the potential for preventing medication errors by nursing students was discovered.     

The self-management of psychiatric medications: a pilot study

The self-management of psychiatric medications: a pilot study This paper reports on a pilot study where a scheme for the self-management of medication has been devised as an intervention strategy, where the mental health nurse and the mentally ill client work together to improve the client's knowledge of prescribed medication and medication-related issues. Aspects of non-compliance and the various factors involved in the non-compliance of psychiatric medications by the person who is severely mentally ill are discussed. When noncompliance to psychiatric medication is briefly examined, the complexity of the phenomena becomes increasingly apparent, confounding single intervention strategies, therefore as the phenomena is multidimensional, so must be any response. A review of the literature, and from the past clinical experience of the authors, suggests that when there is an involved therapeutic alliance, and the active participation of both the client and the mental health nurse in a rehabilitation orientated self-medication management scheme, a difference can occur for the client where their understanding of, and compliance with, psychiatric medication can improve. This could possibly improve the overall quality of life for the mentally ill person. Within a psychosocial rehabilitation setting, a self-medication management scheme has been developed that gradually facilitates the client's responsibility for managing their own prescribed medication, and in conjunction with this increased awareness of their medication and related issues, the focus eventually leads to the client having complete responsibility for managing their own medication. This self-medication management scheme consists of several graded stages that are contractual in nature, in which the clients and nurses are active participants. A rating and self-reporting scale has been developed within the scheme and is used by both the nurse and the client to assist in gauging the client's understanding and knowledge of issues related to their medication use. This self-medication management scheme has demonstrated that when severely mentally ill persons are given the opportunity to practice and manage their own medication as a component of the rehabilitative process, a self-medication management scheme does make a difference.     

Why I want to be a psychiatric nurse: constructing an identity through contrasts with general nursing

The justification of psychiatric specialization among undergraduate nursing students is examined The data highlight how students are able to produce a positive view of their initial entry into nursing and then later create a positive and distinctive specialist occupational identity through negative comparisons with general nursing Their experience in both psychiatric and general settings is drawn upon to add credibility to their claims Contrasts based on the work schedules, patient focus, professional autonomy, opportunity for professional development, and required skills are considered     

Case management "within the walls": a glimpse into the future

Case management integrates patient and provider satisfaction, takes into consideration cost factors, and provides a means of managing the individual's health concerns. It offers nurses an opportunity to demonstrate their roles in multidisciplinary healthcare teams. Using the case management approach, nurse case managers can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance patients' quality of life, decrease length of hospitalization, increase patient and staff satisfaction, and promote the cost-effective use of scarce resources. This article will review case management, acute care case management, the essential characteristics and job responsibilities of the nurse case manager, and the stages of nursing case management. This article presents the nurse case manager's involvement with a patient in the critical care unit who sustained an aneurysmal subarachnoid hemorrhage. A glimpse into the future will be viewed.     

Teaching successful medication administration today: More than just knowing your ‘rights’

Medication administration is an important skill taught in undergraduate nursing programs. Student learning for this activity includes not only how to prepare and administer medications, but also includes interventions such as patient and family teaching. Students also are taught a series of ‘rights’ in order to prevent medication errors. There are many factors, both personal and system related, which contribute to medication errors in the health care environment. The purpose of this article is to provide strategies for teaching students medication administration that encompass the multiple factors involved to ensure safe practice. This opinion paper is based on the authors' considerable years of teaching experience (35 years clinical setting and classroom teaching with senior students in final year of baccalaureate program for 1st author and 16 years total for co-author).Recommendations put forth by the authors are: a) leveling students’ clinical experiences in administering medications to include understanding of system factors, b) structured scenarios and purposeful linking of theory to clinical courses to advance students' knowledge and skills related to medication administration as they progress through the program, 3) revisiting math skills.     

The Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention for enhancing adherence to HIV/AIDS medications: a pilot study.

This article describes the Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention designed to enhance adherence to HIV/AIDS medications and reports the results of a pilot study aimed at assessing the feasibility of CAP-IT. Initially, CAP-IT was designed to be implemented by nurse case managers during regularly scheduled home visits; it is currently under revision for use in an outpatient, ambulatory care setting. CAP-IT is an innovative, structured nursing assessment and care-planning activity that allows a standardized assessment of client needs and tailored highly active antiretroviral therapy adherence intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. Pilot study results in a sample of 10 home care patients suggests that clients have knowledge and skill deficits related to adherence and in the management of the side effects of medications. In addition, the pilot study supported the acceptability of the protocol to clients and the feasibility of integrating CAP-IT into nurse case manager practice. The pilot study results also provided evidence for the efficacy of CAP-IT. The next steps include testing CAP-IT in a randomized clinical trial to determine its effectiveness.     

Improving knowledge and skills for use of medication by patients after stroke: evaluation of a nursing intervention

OBJECTIVE: The objective of this study was to determine if a tailored nursing intervention, as opposed to usual rehabilitation care, can improve knowledge and behavioral skills for correct use of medication use in aged stroke patients. DESIGN: Stratified random sampling created two homogenous groups: 73 intervention patients, who were provided with the nursing intervention program along with usual rehabilitation care, and 82 controls, who underwent usual rehabilitation care alone. Participants were assessed within the first week of admission to the rehabilitation ward, 3 mos after stroke (at the end of the intervention), and 6 mos after stroke. An assessment instrument measuring correct knowledge and skills concerning medications was used. RESULTS: After 3 and 6 mos, intervention subjects were significantly better than controls in knowledge of shape and dosage of their medications, in knowledge of side effects and correct response to side effects, and in adherence to their dietary regimen. However, for knowledge of color and daily schedule of medications, there were differences at 3 mos, but differences were diminished after 6 mos. CONCLUSIONS: This nursing intervention, tailored to the specific needs of the aged stroke patient, increased the patients' knowledge and skills concerning medication therapy, but to a limited extent and for a limited time.     

Psychosocial rehabilitation

One example of a psychosocial rehabilitation model uses an intensive case management approach. This approach offers an interdisciplinary model that integrates pharmacotherapy, social skills training, and family involvement. This evidence-based plan of care is cost-effective and offers psychiatric nurses opportunities to facilitate symptom management, facilitate self-efficacy, and improve communication and social skills. Ultimately, nursing interventions promote a higher level of functioning and quality of life. Nurses in diverse practice settings must be willing to plan and implement innovative treatment models that provide seamless mental health care across the treatment continuum.     

Nurse educators respond to the needs of the chronically mentally disabled

A recurrent theme in the psychiatric literature is the paucity of educational programs and orientation programs for the nurse generalist that offer individualized content specific to the needs of the chronically mentally disabled (CMD) client. Concerned with the lack of educational content and the complexity of the needs of the CMD two nurse educators developed, implemented, and evaluated an educational module for preparing the novice psychiatric nurse to care for CMD clients in inpatient treatment settings. The module builds upon nurses' physical assessment skills, nursing diagnosis skills, and management of chronic and episodic illnesses, and bridges these skills with traditional psychiatric-mental health content. With an increased interest in nursing case management, the educational module presents educational support germane to the concepts inherent in supportive and rehabilitative case management. Moreover, the current political, social, and economic climates are mandating that nurses become actively involved in discharge planning. The educational module addresses such issues and identifies strategies for assuring nurse involvement.     

Redesigned nursing practice: a case management model for critical care.

Changes within the health care system necessitate changes in nursing practice. Given the financial environment and the need to balance the cost/quality equation, case management will become increasingly important and has the potential to become the predominant care delivery system of the 1990s. This transition represents a tremendous opportunity for nursing. The CCM role offers many potential advantages and benefits for individual nurses and the profession as a whole. Nurses practicing as case managers have the opportunity to function in a highly professional, independent manner with a great deal of interdisciplinary collaboration. In addition to the challenges and satisfactions of the work itself, the nurse case manager may also enjoy a higher salary and more scheduling control and flexibility. The broader advantages of case management include its benefits to patients and institutions and its fit with current trends in the health care environment. Nurse case managers manage hospital systems to produce optimal clinical outcomes for patients in the shortest time using as few resources as possible. This approach to care delivery places nurses in a position to demonstrate the tremendous contribution they can make to achieving the institution's goal of delivering high-quality, cost-effective care. Thus, case management fits extremely well with current trends in health care financing and outcome measurement. The model described in this article illustrates one approach to implementing these important concepts in a critical care setting.