Integration of a peer practitioner in a hospital unit for patients with psychotic disorders: an exploratory qualitative study.

Introduction: Studies on the integration of peer mental health practitioners (PMHP) in hospitals are sparse, despite significant benefits being reported for patients and professionals. The integration of PMHP requires the consideration of several parameters and a change in the culture of care. This study aims to understand the impact of the integration of a PMHP in a hospital unit caring for patients with psychiatric disorders. Methods: A qualitative content analysis of three focus groups with the interdisciplinarity team were conducted. A consulting PMHP was integrated into the entire research process. Results: Data analysis revealed five main themes: the importance of integration, benefits for patients linked to the identification process, benefits for the team and institution, potentials risks, and perspectives. Discussion: The study was conducted in a hospital setting with patients suffering from severe psychiatric disorders associated with behavioral disturbances. The benefits reported in the results outline the feasibility of PMHP integration in an acute psychiatric care setting. Nevertheless, further formalization of the PMHP role is required to minimize possible areas of tension between respective fields of activity of each professional.

The scope of nursing practice in a psychiatric unit: A time and motion study.

WHAT IS KNOWN ABOUT THE SUBJECT?: The evaluation of nurse care practices poses many challenges, including the identification of all the aspects of the care given. Few studies have looked at the scope of nursing practice in psychiatry. However, the evaluation of care practices in the mental health field poses many challenges, including the identification of all aspects of care. WHAT THE DOCUMENT ADDS TO EXISTING KNOWLEDGE?: Findings demonstrated that mental health nurses do not invest in all domains of their scope of practice in the same way and the time spent with patients is low. Several factors contributed to this, including the increasing complexity of care, stagnant staffing levels, and a culture of care that continues to be influenced by the medical model. Current models of care still retain the stigma of this past, prioritizing medically delegated tasks rather than promoting a holistic approach to care. Although the professional identity of nurses is evolving and asserting itself, the paradigm shift in practice is still incomplete. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to describe concretely what is actually expected of nurses, to help them allocate their time effectively and to identify opportunities for improvement. The field of practice of nurses is put under stress by a demanding work environment subject to many pressures and constraints. Changing practices so that nurses can use the full scope of nursing practice requires strong nursing leadership and action on education and the organization of care, particularly on clinical assessment. ABSTRACT: Introduction The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry. Aim The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017, Perspect Infirm Rev Off Ordre Infirm Qué, 14, 51) Scope of Nursing Practice Model. Method This 56-day descriptive observational study used the time and motion method to follow eight nurses. Results 500 h of observations were carried out. The greatest lengths of time were allocated to communication and coordination of care activities and to "non-healthcare" domains. Less time was devoted to activities related to clinical evaluation and therapeutic education. Discussion Findings demonstrated that MHNs do not perform all the possible functions in the domains of their scope of practice in the same way, and time spent with patients was short. Several factors contributed to this, including the fact that nurses are working in increasingly demanding care settings that keep them under constant pressure.

The Joint Crisis Plan: A Powerful Tool to Promote Mental Health.

Purpose: The Joint Crisis Plan (JCP) has received growing interest in clinical and research settings. JCP is a type of psychiatric advance statement that describes how to recognize early signs of crisis and how to manage crises. The purpose of the present study, to our knowledge the first to be conducted on this topic in the French-speaking context and to include inpatients, was to describe the content of JCPs and how they are perceived by patients and the providers. Methods: The study used an exploratory, mixed, sequential method. Existing JCPs were retrospectively collected in several clinical contexts (hospital, community settings, and sheltered accommodation). Based on their analyses, we conducted semi-structured interviews including some rating scales on the perception of the JCPs among patients and providers in these settings. For the qualitative analyses, content analyses were conducted with a hybrid approach using NVivo 12 software. Data were double-coded and discussed with a third researcher until agreement was reached. Results: One hundred eighty-four JCPs were collected retrospectively and 24 semi-structured interviews were conducted with 12 patients and 12 providers. No relatives could be included in the research process. The content of the studied JCPs was relevant and indicated that patients had good knowledge of themselves and their illness. Improvements in the quality of the therapeutic relationship, respect for patients' choices and wishes, and a greater sense of control of their illness were reported. The JCP was perceived as a very useful tool by patients and providers. Concerning JCP limitations, lack of staff training, difficulties with the shared decision-making process, and the poor availability of the JCPs when needed were reported. Conclusion: The study highlights that JCPs may be used with patients suffering from a large variety of psychiatric disorders in different care settings. The JCP is perceived as very useful by both patients and providers. The promising results of this study support the promotion of the wide use of JCPs with patients who have experienced crises. It is important to continue to research JCPs through impact studies that include family members.

Recovering the Capacity to Live outside of a Psychiatric Hospital: Impact of a Specialized Inpatient Program.

Deinstitutionalization in psychiatry led to a decrease in hospital beds, short hospital admissions focussed on symptoms reduction, and the development of ambulatory care. However, the needs of patients who despite symptoms reduction do not display the minimal competencies to live alone or in a sheltered accommodation, are not met in such a context. They usually go through long admissions and fail to improve. In 2016, we implemented a new inpatient program focused on fostering the development of the competencies needed to adapt to living outside the hospital; the aim of this study was to evaluate if it lead to the resolution of these situations or in contrary if it turned into a long stay unit. 116 patients admitted to the program between 2016 and 2018 were included in the study. They were psychiatric inpatients who had no home, did not find a place in a sheltered accommodation and couldn't be discharged. In the majority of cases, the situation was resolved within 180 days and the majority of patients was referred to a sheltered accommodation. Functional and symptom levels improved significantly over time. A specific focus on restoring competencies to live outside of hospital allows complex patients to improve their functional level and to find a place to live in the community within a relatively short time. While deinstitutionalization has been beneficial to the vast majority of patients, denying the specific needs of a minority of patients leads to unnecessary long and inefficient hospital admissions.

Methodological reporting in feasibility studies: a descriptive review of the nursing intervention research literature.

BACKGROUND: In reaction to weaknesses in feasibility studies reporting, the Consolidated Standards of Reporting Trials (CONSORT) statement published an extension for feasibility studies in 2016. AIM: The aim of this study was to systematically review and appraise the reporting of feasibility studies in the nursing intervention research literature based on the CONSORT statement extension for feasibility studies. METHOD: Papers published prior to January 2018 that described feasibility studies of nursing interventions were retrieved. Components of feasibility studies were coded, and code frequencies were analysed. RESULTS: The review included 186 papers. Although most papers (n = 142, 76.3%) included the label 'pilot' or 'feasibility' in their title, reporting for other components generally did not adhere to one or several CONSORT recommendations. Most papers reported objectives (n = 116, 62.4%), designs (n = 95, 51%), or rationales for sample size (n = 165, 88.7%) that were incongruent with the purpose of feasibility studies. DISCUSSION: This review results in two main implications for nursing research. First, we noted that the reporting of feasibility studies is weak. While all papers described feasibility studies, almost half focused exclusively on testing the effectiveness of an intervention. Second, we identified rationales for sample size along with key references that could offer guidance in reporting feasibility studies while being coherent with the CONSORT recommendations.

[Psychiatry]. / Psychiatrie.

Children of patients with psychiatric disorders are at higher risk to develop a psychiatric illness. In addition, phases of crisis and hospitalization of the parent are often traumatizing to the children, especially during childhood. Although a specific offer to face these issues is compulsory in some countries, such is not the case in Switzerland. In this paper we describe the implementation of a special offer for children of parents with mental illness (Famille +) in the service of general psychiatry at the Department of psychiatry of the Lausanne University hospital in Switzerland. We will also discuss the development and implementation of the Joint Crisis Plan, a collaborative tool where psychiatric patients and clinicians define the strategies that should be applied in case of crisis, which strengthens the empowerment of patients and their participation to decisions about their treatment.

Les enfants de patients souffrant d'un trouble psychiatrique ont un risque accru de développer eux-mêmes des troubles psychiatriques au cours de leur vie. De plus, les phases de crise et les hospitalisations de parents sont souvent vécues de manière traumatisante par leurs enfants. Bien qu'une offre spécialisée pour les enfants de patients psychiatriques soit obligatoire dans certains pays nordiques, tel n'est pas le cas en Suisse. Le développement d'un tel programme est décrit dans cet article. Il y sera aussi question du développement et de l'implantation du plan de crise conjoint, un outil partenarial entre patients et soignants qui définit les interventions et les modalités de prise en charge en cas de crise et permet ainsi de renforcer l'autodétermination des patients et leur participation aux décisions qui les concernent.

[Recovering the capacity to live outside of hospital : results from a specialized inpatient program]. / Restaurer la compétence à vivre hors de l'hôpital psychiatrique : résultats d'un programme spécialisé.

An important number of psychiatric patients have difficulties to live outside of hospital and to stabilize their living situation. This results in long hospitalizations which are in conflict with the current strategies of brief hospital admissions for acute treatment. In order to tackle this issue, the service of general psychiatry of the Department of psychiatry of the CHUV, in Lausanne, Switzerland, has opened in June 2016 a rehabilitation inpatient unit of 18 beds focusing specifically on the development of the minimal abilities required to adapt to living in a flat or in a sheltered accommodation. This paper describes the first 12 months of activity of this unit.

Un nombre non négligeable de patients psychiatriques traversent une phase de vie au cours de laquelle ils sont incapables de vivre hors de l'hôpital, que ce soit en appartement ou en milieu protégé. Ceci conduit à des séjours de longue durée dépassant la mission de soins aigus de l'hôpital psychiatrique contemporain. Pour traiter ce problème, le service de psychiatrie générale du CHUV a ouvert en juin 2016 l'unité de réadaptation Les Roseaux, qui accueille des patients présentant, en raison de leurs troubles psychiatriques, des difficultés majeures d'insertion dans la communauté. Une équipe multidisciplinaire faiblement médicalisée, basée sur le concept de case management et composée d'infirmiers, d'assistants sociaux, d'éducateurs et d'assistants en soin et santé communautaire offre des soins de réadaptation adaptés à leurs difficultés. Cet article fait le point après 12 mois de fonctionnement du programme.