From psychiatric ward to the streets and shelters.

The issue of discharge from hospital ward to the streets is seldom explored in the literature, but all too commonly experienced by individuals experiencing psychiatric disorders. The Community University Research Alliance on Housing and Mental Health sought to determine how frequently people were discharged from psychiatric wards to shelters or the street in London, Ontario, Canada. A number of data sources were accessed to determine instances of discharges to shelters or the street. Data were analysed to determine the number of moves occurring between hospital and shelter or no fixed address. All datasets revealed the problem of discharge to shelters or the street occurred regularly. All data sources used have the difficulty of likely underestimating the extent of the problem. This type of discharge occurred at least 194 times in 2002 in London, Ontario, Canada. Policies that contribute to this problem include income-support policies, the reduction in psychiatric hospital beds and the lack of community supports. Without recognition, this problem is at risk of remaining invisible with no further improvements to the situation.

Homelessness and housing crises among individuals accessing services within a Canadian emergency department.

ACCESSIBLE SUMMARY: Studies have indicated that individuals who are homeless access hospital emergency departments more frequently and may have different needs than individuals who are housed. Successful interventions have been developed and tested to reduce discharge to homelessness for psychiatric inpatients but have not been similarly tested for discharge from emergency departments. This study was developed to provide baseline data on this issue to inform future emergency department interventions. Findings from the current study suggest that discharge from emergency departments to homelessness happens frequently in London, Canada. Participants are unlikely to spontaneously disclose their housing/homelessness issue when first entering the emergency department, which may result in services that do not adequately meet their complex needs. Screening for housing issues is necessary within emergency departments and psychiatric crisis teams as housing issues may be a reason for accessing care or contribute to the presenting condition. Nurses are in an ideal position to evaluate housing needs among emergency department patients. Services outside of the emergency department are also needed to address housing issues, particularly outside of regular office hours. ABSTRACT: Individuals who have mental health issues and are homeless or in housing crisis have been found to access emergency departments more frequently than individuals with stable housing. While emergency departments primarily focus on medical issues, homeless individuals may require psychosocial support as well. This study examined issues around housing crises and emergency department use for individuals with mental illness in Canada. Collecting baseline data about these issues is important to inform subsequent interventions. Administrative data from a hospital emergency department and psychiatric crisis service were collected, and five individuals accessing the emergency department for psychiatric reasons were interviewed. Results indicated that individuals with an identified housing crisis accessed the emergency department 930 times in 6 months. None of the interview participants identified housing as the primary reason for accessing the emergency department, but all noted that housing was a contributing stressor. Future research is needed to examine ways in which discharge to homelessness from emergency departments can be avoided and identify alternative services to address housing concerns, particularly for individuals with mental illness. Crisis service and emergency department staff, especially nurses, can play an important role in screening for housing issues and connecting individuals to outside services.

Clients' reflections on relationships with nurses: comparisons from Canada and Scotland.

It has been suggested that the crucial elements in nursing situations are the nurse, the client, and what goes on between them. This paper examines what goes on between clients and nurses during interpersonal relationships, from the perspective of the clients. Data are presented from studies conducted in Canada and Scotland. It is shown that what clients want, or do not want, during relationships with their nurses, is similar on both sides of the Atlantic. The findings reported in this paper are relevant to transcultural nursing, ethical care, the growth in consumerism, and client advocacy. The findings suggest also that there is a need for nursing research to focus on clinical outcomes in order to establish whether clients' perceptions of helping relationships have any relevance to favourable health outcomes, and the evidence base for clinical nursing.

Role changes experienced by clinical staff in relation to clients' recovery from psychosis.

This study investigates the subjective experiences of staff from many interdisciplinary teams working with clients in the recovery process from psychosis. The clinical staff interviewed in this study included: staff nurses, clinical nurse specialists, occupational therapists, psychologists, social workers, rehabilitation workers, recreation therapists, music therapists, psychiatrists, and lodging home operators. The purpose of this study was to examine the clinical staff's changing roles and relationships with clients recovering from psychosis. The investigation used a naturalistic qualitative design with an ethnographic method of data analysis. The participants were clinical staff working with clients about to commence treatment with clozapine or risperidone. The settings used were a tertiary-care psychiatric hospital and a general hospital. The clinical staff members who participated in the study were interviewed every 3 months. In the initial interview, members of the clinical staff were asked about their knowledge regarding the new medication and their role in the decision to try the new medication. In all the interviews, clinical staff members were asked about how the recovery process was progressing with the client. Data regarding clinical staff fears related to the client's situation, changes in their relationships with the client and the client's family, and what they perceived to be current rehabilitation implications, were collected. Some of the clinical staff roles that evolved during the recovery process were: health teacher; advocate; counsellor; and support person.

Celebrating our past. The history of Hamilton Psychiatric Hospital.

1. There is a risk of losing important parts of our psychiatric nursing history as a result of the rapid rate of mental health reform and the closing or changing of governance of major psychiatric facilities. 2. Hamilton Psychiatric Hospital provided leadership in psychiatric nursing in Canada for more than a century and is now changing governance from being a provincial psychiatric hospital to part of a community general hospital. 3. The hospital's tradition includes nonrestrictive care policies that have been in place for more than a century, a humanistic approach to care, being the first facility in Canada to require theory-based nursing care from all nursing staff, innovative practice models, and achieving authorship or co-authorship from more than 17% of the RN staff.

Evaluation of bridging institution and housing--a joint consumer-care provider initiative.

1. The most common alternative housing choice in the community for individuals with serious mental illness was a boarding home. 2. Community consumers noted that being with other people was the most important benefit of the teaching apartment, followed by eating, learning new skills, and entertainment. 3. Although they reported negative aspects about the homes, most consumers did not want to change anything about their boarding home.

Ethical problems encountered by mental health nurses.

This descriptive study examines ethical conflicts reported by psychiatric-mental health nurses in community and inpatient settings. Generalist community nurses were included for comparison. The analysis of cases included reviewing general descriptions of the cases and identifying decision maker, principles involved, and type of moral conflicts. Fifty-seven case situations were collected: 20 cases from a psychiatric hospital, 18 cases from community mental health programs, and 19 cases from a general public health program. Fifty-one of the 57 cases reflected ethical problems. Using Jameton's (1984) categories, 30 of the 57 cases were rated as a dilemma, 18 were rated as moral uncertainty, and 3 were rated as examples of distress. The mental health nurses indicated that they believed they were the decision maker in the majority of cases. The general community nurses were more likely to believe the client was the decision maker. The identified principles, based on Veatch and Fry (1987), were doing good, or beneficence (26); confidentiality (10); autonomy (9); avoiding deception (4); and preventing killing (2). In the remaining 6 cases no principles were identified. Staff conflict was present in 13 of 20 inpatient cases, as compared with only 3 cases in each of the community settings (p less than .005).

Uniqueness within the nurse-client relationship.

The uniqueness of individual nurse-client relationships was explored by comparing therapeutic relationships of two different clients with the same nurse, and two different nurses with the same client. This secondary analysis included 38 nurses who had two different clients in the original study, and 13 clients who had two different nurses. Instruments included the Working Alliance Inventory, semantic differential scales related to the nurse's view of the client and the client's view of the nurse, and the Relationship Form. The same nurse working with two different clients had different preconceptions, and a different relationship with respect to bond, task, and goals with each client. There was a relationship between the time required to establish a therapeutic relationship with the two different clients. Clients working with two different nurses had no significant relationship on any of the relationship measures. Findings suggest that the same individual, whether a nurse or a client, experiences very different therapeutic relationships with different people.

Assertiveness training: does it make a difference?

The impact of assertiveness training on job-related functioning has not been evaluated. This study, conducted in a tertiary care psychiatric facility, assessed whether assertiveness training changed nurses' perceptions of assertiveness, attitudes toward power, functioning within the nursing team, and functioning within the multidisciplinary team. This article describes a four-part assertiveness training course that was found to significantly affect feelings of assertiveness.

Hildegard Peplau meets family systems nursing: innovation in theory-based practice.

Nursing theories which have evolved from mental health--psychiatric nursing have focused on the individual nurse-client relationship. Other nursing theories generally focus on the individual as client. Therefore, nurses working with families may have difficulty in applying these frameworks to their practice. Nursing theories need to be expanded to include families, groups and communities more explicitly. The well established theory of Hildegard Peplau, which previous studies have found to be the theory most frequently used by psychiatric nurses, and the family systems nursing theory of Wright and Leahey share a complementary focus. Both theories form part of the interpersonal paradigm of nursing; both view nursing from an interactional perspective, rather than focusing on individuals. Use of a combined theoretical approach offers several advantages. The approach explicitly considers both the individual and the family. The combination provides grounding for family work in an articulated nursing theory.

Primary what?

What is meant by 'primary care' Is it peculiar to nursing? Is it concerned with Primary Health Care? The authors delivered this paper at one of the Special Interest sessions in Tel Aviv at the Quadrennial Congress and stimulated the audience to much thought. Are we sure we are always talking about the same thing?