How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners.

BACKGROUND: Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP). PURPOSE: To explore what meaning people with SMI associate with the care provided by a PMHNP. METHODOLOGY: A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP). RESULTS: Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia. CONCLUSIONS: The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance. IMPLICATIONS: For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

What does the nurse practitioner mean to you? A patient-oriented qualitative study in oncological/palliative care.

AIMS AND OBJECTIVES: To explore what meaning patients associate with their experiences with a nurse practitioner (NP) in oncological or palliative care. BACKGROUND: Care provided by NPs results in high patient satisfaction, mostly related to the assurance of continuity of care, and to receiving information and advice on coping with the disease. Research shows that health care provided by NPs equals the quality of care provided by physicians. Patients may be even more satisfied with care provided by NPs. Because patients' views have only been examined quantitatively, underlying experiences and meanings remain unclear. DESIGN: A qualitative study from a phenomenological perspective. METHODS: In 2017, seventeen outpatients aged 45-79 years, receiving oncological or palliative care, were interviewed in depth. Data were analysed by Colaizzi's seven-step method and by the Metaphor Identification Procedure. RESULTS: Six fundamental themes emerged: the NP as a human (1) and as a professional (2), the NP providing care (3) and cure (4), NPs organising patient care (5) and the impact on patient's well-being (6). MIP analysis revealed six metaphors: NP means trust; is a travel aid; is a combat unit; is a chain; is a signpost; and is a technician. CONCLUSIONS: NPs mean a lot to patients. NPs are valued as reliable, helpful and empathic. Patients feel empowered, at peace and in control as a result of the support, guidance and attention to them as a person as well as to aspects of the disease. Providing expert, integrated care makes patients feel safe and embraced in the NP's expertise. RELEVANCE TO CLINICAL PRACTICE: This qualitative insight into patients' experiences will contribute to the body of knowledge on patients' perceptions of the treatment and support provided by NPs. It adds to the further development of the NPs' profession and education.

Feasibility and Added Value of Executive WalkRounds in Long Term Care Organizations in the Netherlands.

BACKGROUND: Currently available tools for the management of safety in health care are largely based on quantitative management information. Executive WalkRounds (WalkRounds [WR]) seems useful as a leadership tool to detect "soft signals"-alerts of unsafe situations or practices-and to enhance the mutual trust between frontline staff and the board of directors. The majority of the research on WR has been performed in hospitals. Therefore, a study was conducted to assess how the boards of directors of long term care organizations value WR as a leadership tool to perceive soft signals, and whether soft signals are of added value to enhance patient safety. METHODS: WRs were introduced in a convenience sample of six organizations-two mental health care institutions, two nursing homes and home care organizations, and two institutions for the physically and intellectually disabled-between July 2012 and December 2013. Data were gathered from observation and reporting forms. Feasibility was evaluated by open-group interviews. A mixed-method analysis was performed using descriptive statistics and content analysis. RESULTS: WRs were considered feasible, and the added value for the boards of directors consisted of an increased sense of urgency and safety awareness. The dialogue between the board of directors and frontline staff in each organization was essential for a collective patient safety culture. In total, WRs were used 68 times, and 298 soft signals were identified; most addressed care delivery and communication. Overall, 245 improvement activities were reported, of which 109 related to work environment. CONCLUSION: WRs were considered useful and feasible for detecting soft signals in long term care organizations. These signals are valuable for enhancing patient safety and can be used by the board of directors in addition to the current quality management systems.

Patient Safety Policy in Long-Term Care: A Research Protocol to Assess Executive WalkRounds to Improve Management of Early Warning Signs for Patient Safety.

BACKGROUND: At many hospitals and long-term care organizations (such as nursing homes), executive board members have a responsibility to manage patient safety. Executive WalkRounds offer an opportunity for boards to build a trusting relationship with professionals and seem useful as a leadership tool to pick up on soft signals, which are indirect signals or early warnings that something is wrong. Because the majority of the research on WalkRounds has been performed in hospitals, it is unknown how board members of long-term care organizations develop their patient safety policy. Also, it is not clear if these board members use soft signals as a leadership tool and, if so, how this influences their patient safety policies. OBJECTIVE: The objective of this study is to explore the added value and the feasibility of WalkRounds for patient safety management in long-term care. This study also aims to identify how executive board members of long-term care organizations manage patient safety and to describe the characteristics of boards. METHODS: An explorative before-and-after study was conducted between April 2012 and February 2014 in 13 long-term care organizations in the Netherlands. After implementing the intervention in 6 organizations, data from 72 WalkRounds were gathered by observation and a reporting form. Before and after the intervention period, data collection included interviews, questionnaires, and studying reports of the executive boards. A mixed-method analysis is performed using descriptive statistics, t tests, and content analysis. RESULTS: Results are expected to be ready in mid 2014. CONCLUSIONS: It is a challenge to keep track of ongoing development and implementation of patient safety management tools in long-term care. By performing this study in cooperation with the participating long-term care organizations, insight into the potential added value and the feasibility of this method will increase.

Mental health nursing and first episode psychosis.

The purpose of this literature review is to identify mental health nursing's contribution to the care and treatment of patients with a first episode of psychosis; A systematic literature review was undertaken, with 27 articles selected for study. Five domains were identified: development of therapeutic relation, relapse prevention, enhancement of social functioning, stimulation of medication adherence, and support of family members. The level of evidence of mental health nursing's contribution to the care and treatment of those undergoing their first episode of psychosis was low. Our review suggests that mental health nurses should reflect upon their own daily practices within the five domains.

Emotional intelligence of mental health nurses.

AIMS: The aim of this study is to gain insight into the level of emotional intelligence of mental health nurses in the Netherlands. BACKGROUND: The focus in research on emotional intelligence to date has been on a variety of professionals. However, little is known about emotional intelligence in mental health nurses. METHOD: The emotional intelligence of 98 Dutch nurses caring for psychiatric patients is reported. Data were collected with the Bar-On Emotional Quotient Inventory within a cross-sectional research design. RESULTS: The mean level of emotional intelligence of this sample of professionals is statistically significant higher than the emotional intelligence of the general population. Female nurses score significantly higher than men on the subscales Empathy, Social Responsibility, Interpersonal Relationship, Emotional Self-awareness, Self-Actualisation and Assertiveness. No correlations are found between years of experience and age on the one hand and emotional intelligence on the other hand. CONCLUSIONS: The results of this study show that nurses in psychiatric care indeed score above average in the emotional intelligence required to cope with the amount of emotional labour involved in daily mental health practice. RELEVANCE TO CLINICAL PRACTICE: The ascertained large range in emotional intelligence scores among the mental health nurses challenges us to investigate possible implications which higher or lower emotional intelligence levels may have on the quality of care. For instance, a possible relation between the level of emotional intelligence and the quality of the therapeutic nurse-patient relationship or the relation between the level of emotional intelligence and the manner of coping with situations characterised by a great amount of emotional labour (such as caring for patients who self-harm or are suicidal).