The role of nurses in psychiatric services

Specific features of the nursing process in practical activities of nurses of psychiatric service of the Russian Federation should receive special attention in the system of vocational training. Increase of the volume and improvement of quality of training, reorganization of nurses' work in an inpatient and outpatient setting are the main approaches to improving the quality of medical care and, among other things, mental health of the population.     

Psychiatric nurse reports on the quality of psychiatric care in general hospitals

Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11,071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively.     

Governance in operating room nursing: nurses' knowledge of individual surgeons

This paper explores governance and control in operating room nurses' clinical practice. Traditionally, operating room nurses have been portrayed as "handmaidens" to the surgeons, a position which implies that nurses' bodies and the knowledge they use in practice are sites of discursive control by others. This paper unsettles this understanding by showing how operating room nurses studied ethnographically in an Australian setting are both disciplined by and actively shape practice through knowing surgeons' technical requirements for surgery, through inscribing them in discourses of time, and through having deep knowledge of the surgeons' "soul". We argue that as a form of governance, nurses' knowledge of surgeons is a subjugated form of knowledge, located low down on a hierarchy of knowledges. Furthermore, as a form of governance that has previously been unarticulated in the literature, it transcends the traditional lines of authority and control in the nurse-doctor relationship. The data in this paper are drawn from an ethnographic study that explored a range of nurse-nurse and nurse-doctor communication practices in operating room nursing.     

Older patients in the acute care setting: rural and metropolitan nurses' knowledge, attitudes and practices

ABSTRACT: Many studies reporting nurses' knowledge of and attitudes toward older patients in long-term care settings have used instruments designed for older people. However, nurses' attitudes toward older patients are not as positive as their attitudes toward older people. Few studies investigate acute care nurses' knowledge of and attitudes toward older patients. In order to address these shortcomings, a self-report questionnaire was developed to determine nurses' knowledge of, and attitudes and practices toward, older patients in both rural and metropolitan acute care settings. Rural nurses were more knowledgeable about older patients' activities during hospitalisation, the likelihood of them developing postoperative complications and the improbability of their reporting incontinence. Rural nurses also reported more positive practices regarding pain management and restraint usage. However, metropolitan nurses reported more positive attitudes toward sleeping medications, decision making, discharge planning and the benefits of acute gerontological units, and were more knowledgeable about older patients' bowel changes in the acute care setting.     

Psychosocial care Center for Alcohol and Drugs (CAPS ad): nursing insertion and practices in São Paulo City, Brazil

This exploratory study with a qualitative approach aimed to identify nurses' insertion and practices at Psychosocial Care Centers for alcohol and drugs in S?o Paulo City, Brazil. Sixteen nurses participated in the study. Data were recorded and were analyzed by dialectic hermeneutics and guided by Brazilian psychiatric reform premises. The results evidenced nurses' difficulties to take part in the care recommended at these services, as their practices are more linked up with the traditional mental health care model. Causes of this phenomenon include nurses' lack of preparation to act in psychoactive substance-related issues and lack of knowledge on specific contents that would favor their insertion into care practice in these scenarios. It is concluded that more attention should be paid to these contents in nursing education, as the legal requirement of nursing presence at these services is insufficient as a strategy to guarantee their actual insertion.     

About the culture of in-home nursing

As nurses assume a multitude of roles in health care, public and professional perspectives of nursing vary and, consequently, both clients and providers, including nurses themselves, do not fully appreciate the nature of in-home nursing. In this study ethnographic methods were used to capture participants' perspectives of the actions, practices, values, and beliefs that collectively comprise the culture of nursing in the context of home nursing services in rural Australia. Findings reveal how nurses' and clients' experiences of in-home nursing differ from the textbook picture, and how interactions between nurses' practice approaches and care recipients' enactment of the client role create a cultural context affecting clients' health and well-being. Given similar findings in other countries, the insights gained merit consideration by all professionals concerned about refining home care service approaches in keeping with currently espoused valuing of client-centered, empowering care partnerships.     

A comparison of GPs and nurses in their approach to psychological disturbance in primary care consultations

It has frequently been reported that GPs fail to diagnose many of the psychological problems that present to them. It also appears that practice nurses working in primary care also show similar diagnostic 'failings'. This study extends these observations by reporting the psychiatric diagnostic practices of GPs and nurses working in the same settings of six general practices. After each consultation the health professional involved assessed the degree of psychological morbidity and the amount of time they had spent attending to this problem. The health professionals' assessment was compared with the score from a General Health Questionnaire completed by the patient. Analysis of 1646 consultations revealed that GPs saw patients with more psychological problems than nurses. Nurses, however, spent significantly more time dealing with their psychological workload than their GP colleagues, after allowing for the fact that they saw fewer patients in this category. This observation raises the question of whether this use of scarce time resource in the consultation is appropriate.     

Effect of Evidence-Based Acute Pain Management Practices on Inpatient Costs

Objectives. To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based acute pain management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based acute pain management practices have on inpatient cost.
Data Sources/Study Setting. Data from a randomized "translating research into practice" (TRIP) behavioral intervention designed to increase the use of evidence-based acute pain management practices for patients hospitalized with hip fractures.
Study Design. Experimental design and observational "as-treated" and instrumental variable (IV) methods.
Data Collection/Extraction Methods. Abstraction from medical records and Uniform Billing 1992 (UB92) discharge abstracts.
Principal Findings. The TRIP intervention cost on average $17,714 to implement within a hospital but led to cost savings per inpatient stay of more than $1,500. The intervention increased the cost of nursing services, special operating rooms, and therapy services per inpatient stay, but these costs were more than offset by cost reductions within other cost categories. "As-treated" estimates of the effect of changes in evidence-based acute pain management practices on inpatient cost appear significantly underestimated, whereas IV estimates are statistically significant and are distinct from, but consistent with, estimates associated with the intervention.
Conclusions. A hospital treating more that 12 patients with acute hip fractures can expect to lower overall cost by implementing the TRIP intervention. We also demonstrated the advantages of using IV methods over "as-treated" methods to assess the direct effect of practice changes on cost.     

新入职护士对精神科护理知识认知情况调查

目的了解精神病医院新入职护士对精神病护理知识的认知状况,为精神科临床新入职护士的带教提供理论依据,进一步提高精神病医院的护理质量。方法自行设计问卷,对惠州地区三所精神病医院2013年新入职的71名护理人员进行调查。结果新入职护士对精神病护理知识认知存在偏差,其中,如何与精神病人接触与交谈及对精神病人意外事件的处理项目认知度较低。学历、社会环境因素与影响精神科护理识知的认知相关(p<0.01)。教学经历、实践经历是影响新入职护士对精神科护理知识认知的主要因素。结论学校有必要对护理专业学生加强对精神科知识的理论教学与实践培训;临床对新入职护士的带教中,应制订比较系统的专科培训计划,以全面提高精神病医院的临床护理质量。     

Inside ‘bed management’: ethnographic insights from the vantage point of UK hospital nurses

In the face of unprecedented financial and demographic challenges, optimising acute bed utilisation by the proactive management of patient flows is a pressing policy concern in high‐income countries. Despite the growing literature on this topic, bed management has received scant sociological attention. Drawing on practice‐based approaches, this article deploys ethnographic data to examine bed management from the perspective of UK hospital nurses. While the nursing contribution to bed management is recognised formally in their widespread employment in patient access and discharge liaison roles, nurses at all levels in the study site were enrolled in this organisational priority. Rather than the rational, centrally controlled processes promulgated by policymakers, bed management emerges as a predominantly distributed activity, described here as match‐making. An example of micro‐level rationing, for the most part, match‐making was not informed by explicit criteria nor did it hinge on clearly identifiable decisions to grant or deny access. Rather it was embedded in the everyday practices and situated rationalities through which nurses accomplished the accommodations necessary to balance demand with resources.     

Chancers, pests and poor wee souls: problems of legitimation in psychiatric nursing

This paper explores the relationship between psychiatric nurses and 'problem' patients as a means of commenting on the occupation of psychiatric nursing. Proceeding from a detailed examination of the case of one particularly problematic female patient, and drawing on a body of observational and interview data relating mainly, though not exclusively, to nursing activity on two very different psychiatric wards, we argue that what is critical in determining nurses' categorization of some patients as 'problems' is not so much the level or nature of patients' demands, as much previous work has suggested, but rather the patient's willingness to legitimate the nurses' therapeutic aspirations. Possessing neither readily identifiable technical skills nor unambiguous authority, the psychiatric nurse must look to her dealings with patients to sustain a viable professional identity. 'Problem' patients are those who call attention to the fragility of nursing authority by rejecting, implicitly or explicitly, the special services that the psychiatric nurse stands ready to provide.     

From discipline to control in nursing practice: A poststructuralist reflection

The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, the external forces—diffuse yet pervasive—impacting upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities.     

Caring and researching: complementary or exclusionary practices?

The conception of empirical nursing has been disseminated, based on "doing", updated according to professional practice, impairing the interdisciplinarity between care, research and the building of a specific knowledge able to provide scientificity to its actions. Thus, authors aimed at understanding nurses' conceptions on care and research, analyzing their practices and verifying if they are complementary or exclusionary. They used participant observation and semi-structured interviews with nurses working at a University Hospital located in the state of Rio de Janeiro, Brazil. Results showed different discourses on care and research as well as the difficulties to associate these activities that, for nurses, are theoretically complementary but practically exclusionary.     

Study of nosocomial respiratory infections and nurses' performance related to infection control measures in artificially ventilated patients

The aim of this study was to assess nurses' performance related to control and prevention of nosocomial respiratory infection in artificially ventilated patients and to estimate incidence and the causative microorganisms of such infection. The study was conducted on 30 ventilated patients and 30 nurses who were responsible for their care. An observation checklist was used to assess nurses' practices regarding daily care activities, ventilator decontamination, use of universal infection control measures and maintenance of the patients' care environment. A second sheet was developed to estimate incidence of nosocomial respiratory infection and identification of the causative microorganisms. A third sheet was designed to help in daily assessment of the patient's health condition. The study revealed a high incidence of nosocomial respiratory infections (83.3%) and pseudomonas was the causative agents in more than one-fourth of the cases. Moreover, nurses' infection control practices were inadequate.     

Nurses' professionalism in Canada: a labor process analysis.

This article draws on a body of research conducted by the author over the past ten years on the social organization of nursing work. It explores questions surrounding nurses' contemporary labor process control and its meaning for nurses' professionalization and proletarianization. Both are dynamic processes, changing as public administration of the Canadian health care system changes and as nurses are successful in winning more complete self-regulation. Nurses are currently being articulated more and more securely to dominant ideas of public sector management through textually mediated technologies. Nurses find new upwardly mobile careers and challenging, responsible, and more respected work. However, as the generation of objective information for professional accountability, cost-accounting, and managerial decision-making becomes unified in computerized patient information systems, producing and using such information becomes a central and determining core of everyday nursing work. It organizes nurses into a "managed" practice of patient care, contradictory for them in many ways. Outstanding among these contradictions is a new professionalized standpoint of cost-efficiency that subordinates nurses' traditional interests and grounding of their work in the standpoint of care.     

Early warnings: health care preparedness

As nurses, we represent the backbone of the health care system. It is essential that we have a core understanding of infectious disease emergencies and begin to use the strengths that characterize nursing. These strengths include the ability to evaluate situations and use evidence on which to base our actions. Early identification of an infectious disease emergency is one example of using nursing skills to strengthen emergency preparedness. During an infectious disease emergency, nurses certainly will bear the burden of patient management. Because of this, the need for infectious disease emergency preparedness has become a national priority and a moral imperative for all nurses. One topic necessary for ED and OH nurses' preparedness has been discussed in this article, but nurses must take the initiative to learn more about disaster preparedness and incorporate these skills into everyday practice.     

Collaborative and supervisory relationships between attending physicians and advanced practice nurses in long-term care facilities

Recent years have seen an increased interest and use of advanced practice nurses in long-term care. Models of best practices of supervision and collaboration have been promulgated by many organizations, but none have specifically addressed how these interactions should occur in the nursing home setting. To better define the role of the attending physician and advanced practice nurses to provide optimal resident care, the American Medical Directors Association formed a work group to address collaborative and supervisory relationships in long-term care facilities.     

Trends in acute mental health care: Comparing psychiatric and substance abuse treatment programs

This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (eg, by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).