Delineating Quality Indicators of Inpatient Psychiatric Hospitalization.

BACKGROUND: Assuring quality care is critical to the well-being and recovery of individuals receiving inpatient psychiatric treatment, yet a comprehensive map of quality inpatient care does not exist. AIMS: To isolate and describe quality elements of inpatient psychiatric treatment. METHODS: A survey queried psychiatric inpatient nursing leaders on what they considered to be critical elements of quality. The survey was emailed to 40 American Psychiatric Nurses Association members, and 39 individuals responded. In the survey, participants were asked to comment on the importance of six dimensions of quality as well as quality indicators used on their units. RESULTS: Data from this survey indicate how thought leaders conceptualized quality of inpatient care. A unifying philosophy of care was endorsed as a quality element as was structure that affords staff available time on the unit-engaging with patients. While staffing levels were viewed as important, the respondents commented on the nuances between staffing and quality. Participants endorsed the importance of involving individuals in their treatment planning as well as tapping into patients' perspectives on the treatment experience. CONCLUSIONS: The participants' responses compliment the quality literature and reinforce the need to develop a comprehensive map of quality elements. These elements interact in complex way, for instance, staffing, engagement, and teamwork is tied to the organizational structure and philosophy of care, which in turn facilitates consumer involvement in care. Thus, gauging the impact of quality on outcomes will demand consideration of the interaction of factors not just the linear relationship of one element to an outcome.

Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes.

This study examines the relationships of depression, anxiety, and stress with adherence to self-management behaviors and diabetes measures in 42 African American adults with type 2 diabetes (T2D). Participants were recruited from an outpatient clinic located in an urban area of a midsized city in the southeastern USA. The mean age of the sample was 54.9 years (SD = 9.9) and the majority of the participants were female (73.2%), high school graduates (55.3%), unemployed (70.7%), and publicly insured (77.8%). Each participant completed a demographic survey and the Depression, Anxiety and Stress Scale 21. Adherence to self-management behaviors (physical activity, diet, and medication use) was assessed using surveys and self-reports. Glycated hemoglobin (A1c) and body mass index (BMI) were obtained from participants' medical records at the time of the participants' clinic visits. Depression, anxiety, and stress were not significantly correlated with self-management behaviors. Depression (r = 0.38, p = 0.03), anxiety (r = 0.56, p = 0.001), and stress (r = 0.36, p = 0.04) were positively correlated with A1c. The greater the dietary risk assessment score, the higher the A1c (r = 0.34, p = 0.05). Anxiety was the strongest correlate of A1c followed by depression, stress, and dietary risk assessment. Future studies to confirm this study's findings in a larger sample are warranted. Interventions to mitigate the effects of these correlates should be designed and tested to improve health outcomes in African American adults with T2D.

Lifestyle and Behavioral Interventions to Reduce the Risk of Metabolic Syndrome in Community-Dwelling Adults With Serious Mental Illness: Implications for Nursing Practice.

Adults with mental illness are at increased risk of being diagnosed with metabolic syndrome and consequently cardiovascular disease, diabetes, and stroke. The current article explores community-based interventions to decrease the risk of metabolic syndrome by changing health behaviors among adults with serious mental illness (SMI). Ovid Medline, PsycINFO, and CINAHL were searched for nonpharmacological studies of behavioral or lifestyle interventions addressing risk of metabolic syndrome among adults with SMI. Thirteen studies, seven with statistically significant results, were included in the review. Despite the well-known risks of metabolic syndrome, the majority of available studies had small samples with insufficient power. There was little consistency in methods or outcome measures. Studies that were client-directed and involved peer and staff support appeared most useful in changing health behaviors and improving quality of life. Further research is needed to guide nursing practice in implementing effective methods to reduce the risk of metabolic syndrome in community-dwelling adults with SMI.

Don't get bugged: practical strategies for managing bedbug infestation in psychiatric rehabilitation programs.

Bedbug infestation has become a major problem in the United States. Infestations can be frightening and expensive and appear to be more prevalent in urban settings and low-income housing such as homeless shelters, public housing, and single-room occupancy apartments. This exposes consumers and staff of psychiatric rehabilitation agencies to higher risk of infestation. This brief report outlines practical suggestions for managing bedbug infestation in such agencies. Drawing on resources readily available on the Internet and the experience of Thresholds, a large provider of psychiatric rehabilitation services based in Chicago, this report describes strategies for responding to infestation. Providers need to assume that bedbug infestation is a significant risk and prepare accordingly. Assertive, persistent, and calm response is recommended.

The effect of an inpatient transition intervention on attendance at the first appointment postdischarge from a psychiatric hospitalization.

BACKGROUND: Only 42% of initial appointments following psychiatric hospitalization are kept nationally. Missed appointments increase the likelihood of rehospitalization and increase costs of outpatient care. OBJECTIVE: This study explored the feasibility, outcomes, and cost of a transition intervention on attendance at the first postdischarge appointment. DESIGN: A pilot study using a one-group prospective design interviewed 15 patients hospitalized with psychosis to address potential barriers to attendance at the first postdischarge appointment. Patients also identified an agenda for this appointment and received a reminder letter. RESULTS: Twelve (92%) of 13 patients attended the postdischarge appointment compared with the previous rate of 44%. Two additional patients were unable to attend because they had been rehospitalized before the scheduled time of the first appointment. DISCUSSION: Contact with a clinician who can bridge the gap between discharge and the first postdischarge appointment is feasible and may be helpful in increasing attendance rates.

Treatment settings and metabolic monitoring for people experiencing first-episode psychosis.

Monitoring for metabolic sequelae of antipsychotic medications is inconsistent in clinical settings. In this study, frequency of such monitoring in 40 individuals experiencing a first episode of psychosis was analyzed according to the setting in which they received treatment (i.e., inpatient unit, outpatient clinic, or metabolic screening clinic). The traditional outpatient clinic was the least likely of the three settings to monitor blood glucose, blood pressure, weight, and waist circumference. In any setting, blood lipids were measured in only 2 of the 40 patients. Reasons for these findings and recommendations for reducing barriers to screening are presented.

Assessment of a point-of-care metabolic risk screening program in outpatients receiving antipsychotic agents.

STUDY OBJECTIVE: To assess the usefulness of a metabolic risk screening program, including point-of-care glucose testing, to quantify baseline metabolic risk in outpatients receiving antipsychotics. DESIGN: Retrospective, cross-sectional, cohort study. SETTING: University-affiliated department of psychiatry clinic. PATIENTS: A total of 92 adult outpatients (49 women, 43 men; mean +/- SD age 38.96 +/- 12 yrs) who were receiving antipsychotics and had undergone screening for metabolic syndrome at the clinic during 2004-2007. MEASUREMENTS AND MAIN RESULTS: Patient data were recorded on a metabolic screening checklist by a pharmacist or nurse. The checklist captured demographics, vital signs (height, weight, body mass index [BMI], blood pressure, waist and hip circumference, point-of-care random glucose level), personal and family knowledge of current illnesses (diabetes mellitus, hypertension, hyperlipidemia), modifiable risk factors (smoking, alcohol, level of activity), current drug therapy, and recommendations to the psychiatrist. The patient population who underwent screening included 49 African-Americans (53%), 21 Caucasians (23%), 16 Hispanics (17%), and 6 Asians (7%). Diagnoses were documented for 88 patients: schizophrenia or schizoaffective disorder in 53 patients (60%), and bipolar disorder and major depressive disorder was equally divided in the remaining 35 patients (40%). Of 89 patients (three patients had missing data on waist circumference), 63 (71%) met criteria for level 1 metabolic risk (abdominal obesity); of these 63 patients, 38 (60%) met criteria for level 2 risk (abdominal obesity plus hypertension). Patients with a random glucose level greater than 140 mg/dl had a higher likelihood for being at level 2 risk than level 1 risk (chi(2)=5.99, df=1, p=0.014). Women had a significantly higher likelihood for level 1 metabolic risk compared with men (chi(2)=5.99, df=1, p=0.019). African-Americans had a significantly higher likelihood of level 1 risk (p=0.026) and BMI greater than 30 kg/m(2) (p=0.003) compared with Caucasians. Patients with a BMI greater than 30 kg/m(2) had a significantly higher likelihood of diabetes (p=0.006), hypertension (p=0.03), and hyperlipidemia (p=0.05). Overall, 5 (5%) of the 92 patients met criteria for prediabetes risk. CONCLUSION: Point-of-care metabolic risk screening, done with a systematic interprofessional team approach, can provide clinicians with a practical method for identifying metabolic risk in patients prescribed antipsychotics.

The pharmacology game.

This article gives instructions for designing a visually attractive, entertaining, faculty-led computer game for pharmacology review in a nursing education program. The game uses Microsoft PowerPoint, a presentation program that is inexpensive, easy to master, and widely available. Instructions for using Visual Basic for Applications to customize the game are included to allow tracking questions asked and the score of groups playing the game. The game can be easily adapted to material by specific nursing programs with access to PowerPoint.