Nursing interventions in adult psychiatric outpatient care. Making nursing visible using the Nursing Interventions Classification.

AIM: To describe and to clarify the work of nurses in psychiatric outpatient care using a standardized nursing terminology and to describe the potential benefits and challenges in the use of the terminology. DESIGN: A qualitative study of ethnographically grounded fieldwork in four adult outpatient units located in three major cities in Finland. METHODS: A two-phase ethnographically oriented study, consisting of observations and focus group interviews in four psychiatric outpatient care units (in January-March 2018). During this process, the identified nursing interventions were mapped into the Nursing Interventions Classification. RESULTS: We identified 93 different nursing interventions, covering all seven domains. Categories describing potential benefits and challenges were as follows: giving words to nurses' work and the challenge of overlapping interventions. CONCLUSION: Our findings indicate that the Nursing Interventions Classification is a suitable means to describe nursing in the psychiatric outpatient care setting. Our findings support the theory that describing nurses' work using a nursing terminology can make nursing visible and further empower nurses and help them to structure their work. The lack of other professionals, especially physicians, has led to nurses taking over new tasks officially and unofficially and we suggest that the issue needs to be studied further. IMPACT: Nurses' role in the psychiatric outpatient care has been described as invisible and difficult to describe. Our findings suggest that a nursing terminology can make nursing visible, not only from the perspective of patient health records but is also a way to conceptualize nurses' work.

"Providing structure" as a psychiatric nursing intervention: a review of the literature.

PURPOSE: The focus is on a nursing intervention called "providing structure" (PS). This label does not exist in the Nursing Interventions Classification. The following three questions were asked: (a) How is PS defined? (b) What are the goals of PS? and (c) What is the evidence regarding the effectiveness of PS? DESIGN AND METHOD: A systematic literature review. Forty articles, predominantly qualitative studies of PS, were selected for review. FINDINGS: Regarding PS, three elements were mentioned: to impose and maintain rules and limits; to assess the condition of the patient; and to interact with the patient. The goals for PS related to patient security, making expectations explicit, and recovering from illness. Major findings were reviewed, but little was found about the effectiveness of PS.

Sistemas de classificação de pacientes psiquiátricos: análise da produção científica / Psychiatric patients classification systems: analysis of the scientific production

Objetivo: analisar a produção científica acerca dos sistemas de classificação de pacientes psiquiátricos (SCPs), conformeo nível de dependência da equipe de enfermagem psiquiátrica. Metodologia: trata-se de um estudo de revisão integrativade literatura que utilizou os descritores "enfermagem psiquiátrica", "dimensionamento de pessoal" e "classificação" pararealizar buscas nas bases de dados PUBMED, MEDLINE, CINAHL e LILACS. Selecionou-se nove publicações, que atenderam oscritérios de inclusão e proporcionaram uma resposta à questão norteadora: "Qual é o conhecimento científico produzidonacional e internacionalmente sobre os sistemas de classificação de pacientes psiquiátricos, sua distribuição ao longo dosanos em estudo, o delineamento metodológico mais utilizado e as temáticas abordadas?" Resultados: a análise permitiu aidentificação de 55,5% da produção no período de 1980 a 1994 e 44,4% de 2001 a 2008; 77,7% dos artigos encontravam-senas bases PUBMED e CINAHL; o delineamento metodológico mais empregado foi a teoria fundamentada (55,5%); e atemática mais abordada foi a criação/validação de um instrumento para SCP (77,7%). Conclusão: acredita-se que odesenvolvimento de estudos que apliquem instrumentos para SCP possa qualificar sua implementação nas instituições deinternação psiquiátrica.

Section 5(4) of the Mental Health Act 1983: the art of applying the Act.

Section 5(4) of the Mental Health Act 1983 allows patients to be detained by nurses of the 'prescribed class' for a maximum of 6 hours. There is a paucity of research on the subject of Section 5(4); however, the little research that has been conducted has shown that there are gaps in the knowledge of registered nurses and nursing students due to be registered with regard to the following areas of Section 5(4): duration of the holding power; whether the client can be treated against their will; eligibility for detention; and criteria for implementation. This article will seek to clarify these gaps and provide nurses with a comprehensive systematic guide to follow should they have to invoke the section.

Nursing care delivery in Japanese psychiatric units.

Japan has the largest number of psychiatric beds per population in the world. At the same time, little research had been done to describe nursing care delivered in psychiatric units. To describe contents of nursing care, the framework for care classification and measuring methods must be examined. The purpose of this study was to develop a nursing intervention classification and examine the correlation between amount of care and patients' mental states. Data were collected from 39 patient care records from 4 randomly selected psychiatric hospitals. Patients' function and condition were evaluated by their doctors using the Global Assessment of Functioning (GAF) and the Brief Psychiatric Rating Scale (BPRS). Six care categories were extracted: basic activities of daily living, psychological support/interpersonal skills, medical support, monitoring, family support and miscellaneous. By examining three cases with this classification, there were significant correlations between the GAF and BPRS scores and amount of care for two acutely ill psychotic patients.

Nursing care makes a difference. Application of the Omaha System.

Nursing classification systems enable practitioners to describe their contributions to client care. The results of this study indicated an improvement in the outcome ratings, using the Omaha System, as a result of nursing interventions for 47 clients with chronic mental illness receiving services in three academic nurse-managed centers. The Omaha System was found to be a valid and reliable nursing documentation tool for outcome and quality of care measurement for clients with mental illness. This study describes how the Omaha System was used by undergraduate nursing students who were caring for adults with mental illness in nurse-managed centers.

Building an intercultural nursing terminology bank for the phenomenon, Violence, of the International Classification of Nursing Practice: a methodological perspective.

The aim of this article was to present the methodology and results of an investigation into the intercultural evolution of the nursing phenomenon--Violence--from the identification phase to the summative evaluation phase, in order to contribute to the evolution of the International Classification of Nursing Practice (ICNP). The organizing construct was concept analysis of a nursing phenomenon. The identification of a universal problem in psychiatric-mental health nursing by a team of 10 international leaders in the speciality led from the phase of concept analysis to development of a postgraduate educational module. The results of the original analysis of the concept and findings from clinical and evaluation data resulted in further analysis and consequent synthesis of the concept. Results will be disseminated to the International Council of Nursing (ICN) for the International Classification of Nursing Practice (ICNP) to further the evolution of the phenomenon from a focus on the individual to that of the aggregate (social violence). The methodology pointed to a lack of transfer in the phenomenon from a focus on the individual to that of aggregates in the ICNP. There was also a paucity of intercultural components. The phenomena of Abuse and Aggression appear to have been used synonymously with Violence, without an explanation. The data, and the methods used for its collection and submission, will enhance the ICNP.

Care after chaos: use of critical incident stress debriefing after traumatic workplace events.

CISD is a specific model of group debriefing, which can be used to accelerate recovery from traumatic work-place events. The impact of critical incidents may be debilitating-from recurrent intrusive images, persistent fear, displaced anger, guilt, and isolation. CISD can accomplish psychological closure, prevention, and mitigation of traumatic stress, and promote return to normalcy, benefiting the individual, organization, and the community at large. The field of critical incident stress management is open to advanced practice nurses who seek to apply their crisis-intervention expertise within a nontraditional role and workplace setting. With specialized training, the advanced practice nurse may pursue a career as a crisis-response provider, working independently or with an established CISM team. Practice requirements include CISM certification, along with the acquisition of a referral source. The prevention and mitigation of traumatic stress can yield a rewarding career in CISM.

Nursing interventions in crisis-oriented and long-term psychiatric home care.

Psychiatric nurses in The Netherlands are moving out of residential mental health institutions and are pioneering home care for the acutely and chronically mentally ill. The purpose of this study was to identify the interventions nurses currently use and to describe the differences between crisis-oriented and long-term psychiatric home care. Data was collected of 159 nursing care plans from four participating crisis-oriented and two long-term psychiatric home care teams. All stated nursing activities were identified and subsequently labelled and classified using the Nursing Intervention Classification (NIC). Results revealed that in both crisis-oriented and long-term psychiatric home care, nurses used a wide range of nursing interventions. Medication Management, Coping Assistance and Activity Therapy were the most frequently undertaken nursing interventions in both types of care. Within crisis-oriented care, Emotional Support and Self-esteem Enhancement dominated, whereas long-term care focused on Socialization Enhancement and Home Maintenance Assistance. The results will be used for further research and for standardization of nursing care plans within these categories of nursing practice.

Causes of institutionalism: patient and staff perspectives.

Institutionalism is a pattern of passive, dependent behavior observed among psychiatric inpatients, characterized by hospital attachment and resistance to discharge. Survey research was conducted with 211 staff and 47 "institutionalized" patients in a public psychiatric hospital to determine their beliefs on the causes of institutionalism. Four explanatory models of institutionalism were investigated: the predisposition model, the total institution model, the asylum model, and the symptoms model. Patients and staff differed on all models. Responses indicated acceptance of multiple causes for the phenomenon, with patients and staff showing highest agreement on the need for hospitalization as asylum from the world. Patients and staff differed most on the role of the institution in promoting institutionalism. Job classification of staff also resulted in significant differences in beliefs on all models except the asylum model.

Patient's capable of managing--basic process of psychiatric nursing in a hospital environment.

The aim is to describe the basic process of psychiatric nursing in a hospital environment and to produce a practical theory of psychiatric nursing by the grounded theory method. The data were collected by means of observation and interviews and analysed simultaneously, so that the preliminary results and experience gained in the field shaped the data collection process. The data were subjected to continuous comparison analysis and classified into categories by open coding. The basic process was identified by means of axial coding and theoretical memos. The selective coding consisted of related categories grouped around a core category. The basic process of psychiatric nursing involves the patient's needs for care, the helping methods available and the objectives of care. The patient needs help because of his/her inability to manage in daily life, and the role of nursing is to help the patient to manage. The basis of psychiatric nursing lies in caring for the needs of the patient by employing various helping methods. Patient management consisted of three categories, each subsuming three subcategories. Examination of the content of these led to the identification of different types of psychiatric nursing, labelled as confirming, educating and catalytic. The results suggest that collaborative methods in psychiatric nursing enable and support the patient's participation in his/her care and show that both nurses and patients consider collaboration a good helping method, although requiring a change in attitudes and activities for both the nurse and the patient. In spite of changes in psychiatric nursing, there has been no essential development, as most of the care provided is still normative and traditional and the patient is a passive recipient.

Interventions related to compliance.

Compliance by clients with prescribed health care regimens has become an area of intense interest for health care providers. With statistics pointing to the fact that patient compliance can range anywhere from 10% to 94%, there is a definite need for strategies that are available to health care providers, in particular nurses, to assist clients in adhering to their health care regimens. Although much research has been done to measure compliance and identify determinants, little has been done in the area of developing specific strategies and interventions to assist clients with their lifestyle changes. Nurses, using empirically validated nursing interventions to treat identified problems or nursing diagnoses, are in the unique position of being able to impact and enhance the clients' ability to adhere to their prescribed regimens. In this study a total of 225 nursing activities were identified to operationalize the five selected nursing interventions and were rated by 32 master's-prepared nurses certified in the area of diabetes education and psychiatric/mental health. Four activities received weighted ratios of less than 0.50 and were thus discarded. One hundred nine (48%) received ratios of less than 0.80 and are considered minor supporting activities, and 112 (50%) were weighted as greater than or equal to 0.80 and are thus considered major supporting activities. The ICV scores for the five nursing interventions ranged from 0.76 to 0.81.