The nursing process in crisis-oriented psychiatric home care

Crisis-oriented psychiatric home care is a recent development in the Dutch mental health care system. Because of the difference between psychiatric care in the home and in the hospital, an action research project was initiated. This project was directed at the nursing process and the nurses' role and skills in psychiatric home care. The main goal of the project was to describe and to standardize nursing diagnoses and interventions used in crisis-oriented and long-term psychiatric home care. The development of supporting methods of assessment and intervention were also important aspects of this project. In this article a crisis-oriented psychiatric home care programme and the first developmental research activities within this programme are described. To support the nursing process, the development of a nursing record and an assessment-format, based on Gordon's Functional Health Patterns (FHP), took place. By means of content analysis of 61 nursing records, the most frequently stated nursing diagnoses, based upon the North American Nursing Diagnosis Association (NANDA) taxonomy, were identified. The psychiatric diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were also collected. The most common categories found were those of mood disorders and schizophrenia or psychotic disorders. Seventy-five per cent of the nursing diagnoses showed up within four FHP: role-relationship, coping-stress tolerance, self-perception/self-concept and activity-exercise. The nursing diagnosis of 'ineffective individual coping' was stated most frequently. This is not surprising because of the similarities in the definitions of this nursing diagnosis and the concept of 'crisis' to which the psychiatric home care programme is oriented. Further research activities will be focused on standardization of nursing diagnosis and the interventions that nurses undertake in this type of care.     

Person-Centered Psychiatric Nursing Interventions in Acute Care Settings

The knowledge base and understanding regarding psychiatric nursing interventions in acute care settings has been limited. The purpose of this hermeneutic phenomenological study was to explore psychiatric nurses’ experiences in providing nursing interventions to adult clients in acute care settings. Six expert psychiatric nurses were recruited through purposive, snowball sampling and participated in key informant interviews. Analysis of the data revealed the central theme of person-centered care (PCC), which involved developing and delivering PCC plans; determining goals; fostering empathy, support, and hope; listening in one-to-one interactions; providing person-centered teaching; and enhancing coping strategies.     

Creating a new whole: helping families of people with schizophrenia

Collaboration between psychiatric nurses and family members is considered an important part of caring for people with schizophrenia either in hospital or at home after discharge. Studies have demonstrated family involvement in terms of caring for patients who have been discharged early from hospital. An extensive review of the literature and related studies regarding nursing interventions have been done, but there have been limited studies on what psychiatric nurses actually do when working with the families of people with schizophrenia in Thailand. The purpose of the present study was to explore relationships between Thai psychiatric nurses and families in terms of administering nursing care to patients. Grounded theory methodology was used to examine the processes through which psychiatric nurses work with families. Data were collected by 16 psychiatric nurses through in-depth interviews, observations, and field notes. Data were analyzed using constant and comparative methods of other studies, which revealed the process by which nurses can create a new whole between families, patients, and Thai psychiatric nurses. The process consists of four major stages: establishing trust, strengthening connections, promoting readiness to care, and supporting family.     

Use and effectiveness of psychiatric nursing care plans

Nursing administrators require that bedside nurses should use nursing care plans, which also serve the purposes of auditors, educators and others. They are time consuming, they are not uniformly liked by bedside nurses, and they are not used with equal rigour everywhere. Their efficacy as enhancers of quality of care given has seldom been investigated and never demonstrated. In an attempt to repair this deficiency, the author documented 158 transactions between psychiatric nurses and their patients over a 5-month period. In each instance, the quality of the care given was judged and scored. Subsequently, the author determined whether nursing care plans existed and, by comparing them with the transactions, determined whether or not they had been followed. These nurses did not generally follow the care plans, though usually they thought they had. Transactions done where a nursing care plan existed were not better than those done in the absence of nursing care plans. In transactions following an existing nursing care plan, the quality of care given was judged to be lower than in those where an existing nursing care plan was not followed, a result which was statistically highly significant. These findings are discussed, and the author notes the clear implication of this study that nursing care plans are less than helpful to bedside nursing.     

Strategies in caring for women with postpartum psychosis--an interview study with psychiatric nurses

Aim and objective. The aim of this study was to explore strategies in caring for women with postpartum psychosis used by nurses. Background. The most serious type of psychiatric illness in connection with childbirth is postpartum psychosis. Nearly two in 1000 newly delivered women are stricken by postpartum psychosis. Most of these patients need psychiatric care to recover. While earlier studies point to the need for psychiatric care, knowledge of specific nursing strategies in caring for postpartum psychosis patients remains limited. Methods. Interviews with 10 experienced psychiatric nurses were carried out, transcribed verbatim and an inductive content analysis was made. Result. The main strategies for care found in this study were: (i) To create a patient–nurse relationship and (ii) To apply nursing therapeutic interventions. Presence, continuity and nurse‐patient partnership contributed to create a relationship and incorporate the rest of the care team. To satisfy the patients’ basic needs and feeling of security was the foundation of the nursing therapeutic interventions. Confirmation and giving hope were also used as nursing therapeutics as well as information to the patient and her relatives about her illness. Conclusion. The conclusion of the study is that strategies used by nurses are a combination of general and psychiatric nursing approaches but the specificity in caring knowledge for caring patients with postpartum psychosis requires further development. Relevance to clinical practice. The result of the study indicates that it is important to organize patient care for postpartum psychosis with continuity and consistency and to support the nurse to create a relationship and therapeutic intervention with the patient. The present study shows the importance of further developing specific nursing theories that can be applied when caring for patients with postpartum psychosis. It also shows the need for further pedagogical education for mental health nurses.     

Psychiatric nursing management of medication-free psychotic patients

This article discusses how a team of psychiatric nurses manages acutely psychotic patients on a clinical research unit without the use of psychotropic medications. The article describes a schizophrenia research unit, identifies the behaviors of acutely psychotic patients, and provides examples of effective nursing interventions used on the unit. These interventions are grounded in principles of interpersonal psychiatric nursing practice and milieu therapy. The discussion is directed to psychiatric nurses and other health care professionals who are employed on research units.     

Nurses' views on situations related to privacy in providing home care for persons with long-term mental illness: an exploratory study

The main aim of this exploratory study was to explore the views of nurses and mental health care workers on situations related to patient privacy in the home care of persons with long-term mental illness in Sweden. A specifically designed questionnaire was developed from theoretical constructs obtained in a qualitative study and distributed to 1,139 respondents. Data from 660 district nurses, psychiatric nurses, and mental health care workers revealed significant differences in perceptions by age, gender, and professional groups. For example, psychiatric nurses and mental health care workers indicated to a greater extent than district nurses feelings that relate to intrusion on patient privacy. Respondents who were 41 years or younger also indicated to a greater extent than those who were older that they felt home care was an intrusion on patient privacy. Moreover, men indicated to a greater extent than women feelings of insecurity in their professional role. Further investigation is needed, especially into how nurses deal with situations that intrude on patient privacy and how nursing intervention impacts on the patients' own sense of privacy.     

NURSES' VIEWS ON SITUATIONS RELATED TO PRIVACY IN PROVIDING HOME CARE FOR PERSONS WITH LONG-TERM MENTAL ILLNESS: AN EXPLORATORY STUDY

The main aim of this exploratory study was to explore the views of nurses and mental health care workers on situations related to patient privacy in the home care of persons with long-term mental illness in Sweden. A specifically designed questionnaire was developed from theoretical constructs obtained in a qualitative study and distributed to 1,139 respondents. Data from 660 district nurses, psychiatric nurses, and mental health care workers revealed significant differences in perceptions by age, gender, and professional groups. For example, psychiatric nurses and mental health care workers indicated to a greater extent than district nurses feelings that relate to intrusion on patient privacy. Respondents who were 41 years or younger also indicated to a greater extent than those who were older that they felt home care was an intrusion on patient privacy. Moreover, men indicated to a greater extent than women feelings of insecurity in their professional role. Further investigation is needed, especially into how nurses deal with situations that intrude on patient privacy and how nursing intervention impacts on the patients' own sense of privacy.     

The Johnson Behavioral Systems Model as a framework for patient outcome evaluation

Background: Although there is a great deal of interest in the outcome of the nursing care of psychiatric patients, there is little empirical research about the effectiveness of nursing care.Methods: This study evaluated the medical record documentation by nurses as an important database (N = 380 patients). The predicted patient outcome instrument developed by the authors was used to collect the data related to patient demographics, acuity, nursing diagnosis, short-and long-term goals, and nursing interventions. The Johnson Behavioral System Model was the nursing conceptual framework used.Findings: Overall, 80% of the predicted patient outcomes were achieved by the time of discharge, with increased length of stay being a factor in increasing the likelihood of achievement of goals. A positive link was found between achievement of outcomes at time of discharge and nursing interventions. A nursing theoretical framework made it possible to prescribe nursing care as a distinction from medical care.Conclusion: This study showed the importance of the nursing database in the medical records and the effectiveness of nursing interventions on predicted patient outcomes achieved by the time of discharge.     

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.     

Contribution of professional nurses of ambulatory nursing services to home nursing care

The meaning and understanding of home care is a leading factor in health care both nationally and internationally. The implementation of the law on care insurance in Germany demonstrates the understanding of home care and shows changes in health care policy. This new context of health care delivery influences the nursing profession. New challenges arise and changes in nursing perspectives are necessary. The presented study focuses on the contribution of nurses in home care situations. Its aim is to illuminate and to understand the perspective of home care nurses. Grounded Theory approach is used. Altogether, nine participants are interviewed. The results show that nurses aim at keeping care recipients in a home care situation as long as possible. In order to achieve this, the contribution of nurses are not just limited to rediscountable benefits. Voluntary interventions such as managing housework and emotional support for care recipients are also being rendered. However, these actions depend on several factors, such as the relationship between the nurse and the care recipient, the home care situation or the professional attitude of the nurse. In this context, nurses have to develop strategies to deal with these various tasks. The discussion emphasizes the legislative framework of home care in Germany as well as factors that influenced the study.     

Emergency department nursing management of patients with orthopedic fractures resulting from motor vehicle accidents

Nursing management of patients with orthopedic fractures resulting from motor vehicle accidents is a frequent challenge for nurses in an emergency department setting. The nurse must have knowledge of the mechanics of injury, the classification of the resulting fracture types, and the usual medical interventions. In addition, emergency department nurses should follow plans of care that are based on nursing diagnoses so that appropriate nursing interventions can be determined and consistently provided. Initiation of these care plans must not be delayed until the patient is admitted to an inpatient nursing unit, but should be begun in the emergency unit setting. This article presents information that the emergency room nurse needs in order to make plans for nursing care, and discusses seven nursing diagnoses that are almost always appropriate for patients seen in the emergency department who are experiencing orthopedic fractures resulting from motor vehicle accidents.     

Mental Health Nursing in Greece: Nursing Diagnoses and Interventions in Major Depression

The aim of the study was to assess nursing diagnoses and nursing interventions that were accordingly implemented during the care of inpatients with major depression in Greece. Twelve nurses working in three major psychiatric hospitals were recruited. Semi-structured interviews were used and audio-recorded data indicated that risk for suicide, social isolation, low self-esteem, sleep problems, and imbalanced nutrition are the nursing diagnoses most commonly reported. Establishing trust and rapport is the primary intervention, followed by specific interventions according to each diagnosis and the individualized care plan. The findings of the study also highlight the need for nursing training in order to teach nurses initial assessment procedures and appropriate evidence-based intervention techniques.     

A Psychiatric Nursing Admission Assessment Tool for Children and Adolescents

To ensure that children and adolescents receive quality care, psychiatric nurses must gather assessment data on admission that is accurate and comprehensive. This step of the nursing process is becoming more crucial as hospital stays decrease, requiring nurses to prioritize patient needs quickly and implement plans of care. The authors describe the development of a nursing admission assessment tool designed to collect data systematically on children and adolescents admitted to acute inpatient psychiatric units. Lewin's change theory (1961) is used as a framework for describing the challenges of instituting a new documentation system.     

Interventions used by nursing staff members with psychogeriatric patients resisting care

Although resistance to care can have a major impact on the provision of care, relatively limited research has been reported on the topic. This research examined differences in the use of interventions by nurses in different care settings to manage resistance to care with eating and dressing. A convenience sample of 50 nurses (34 working in psychiatric hospitals and 16 in nursing homes) participated in the study. Nurses in both settings reported using similar interventions for both problems. Non-nursing interventions were consistently mentioned to be more common when resistance was accompanied by physical aggression than by verbal aggression.     

Learning in clinical nursing practice

In this study, a qualitative interpretivist perspective was used to analyze the following research question: How does clinical nursing practice facilitate learning? Forty nurses working in acute care, long-term care, and home care were interviewed about their clinical practice experiences and the learning that resulted. Data were analyzed using a constant comparative method. Study results indicate that clinical nursing practice facilitates both personal and professional development of nurses by fostering an examination of the concepts of self-respect, hope, control, vulnerability, acceptance, loss, and persistence. Implications for continuing educators and staff development instructors are drawn.