Brief admission program. An alliance of inpatient care and outpatient case management

1. Brief planned and crisis admissions to an inpatient psychiatric unit are presented as a component supportive of outpatient care and case management for chronically mentally ill patients. 2. Typical patients admitted to this inpatient short-term program are those experiencing a life stress or temporary crisis; chronically mentally ill patients who cycle and experience exacerbations of their illness; and those who need to make the transition from an acute inpatient unit to community living. 3. The Brief Admission Program treats the individual's response to and the consequences of a lifelong illness and enables the patient to return to his previous level of functioning and continue necessary outpatient treatment.     

ESSENTIAL ELEMENTS OF A FAMILY PSYCHOEDUCATION PROGRAM IN THE AFTERCARE OF SCHIZOPHRENIA*

This paper describes a psychoeducation program designed for families and caregivers of patients who suffer from schizophrenia on an inpatient ward of an acute care hospital in a major metropolitan city. It is based on 10 years of experience working with over 600 relatives and caregivers. It discusses the research pertinent to developing such a program, the five elements the authors consider necessary to its success, and the stages of the actualprogram. The five elements include universal service, crisis intervention, social functioning of patient and famly, 2 years continuity of care postdischarge, and the role of the family clinician. It addresses issues raised by working as a muultidisciplinary team and problems in service delivery. A case history illustrates the process.     

Out-of-Pocket Health Care Expenditures by Russian Consumers with Different Health Status

The paper uses the Russia Longitudinal Monitoring Survey 2003 database to study the types of official and shadow out-of-pocket health care expenditures by consumers with high and low health status. The analysis shows that the inability of less healthy people to pay unofficially for more effective outpatient care results in their higher demand for official inpatient and outpatient treatment. This pattern creates the need to sustain excessive inpatient facilities and slows down health care restructuring. Yet, since the state is incapable of fulfilling its obligations for providing free health care and meet the current demand, in inpatient institutions all consumers, and less healthy ones in particular, spend considerable sums on drugs, even though the latter are guaranteed to be free. Consequently, the current Russian health system itself leads to replacing outpatient with inpatient care, which is more costly both for the patients and for the state.      

Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

Working with children with obsessive compulsive disorder

1. Children with OCD are a special challenge for nursing staff. 2. Children with OCD often are unable to comply with preexisting behavior management programs at child psychiatric units. 3. Each child who enters an inpatient unit must be viewed as an individual, separate from his or her diagnosis, and what works for one patient with a particular diagnosis may not work for another patient with the same diagnosis. 4. A special plan devised with input from the entire nursing team is the best way to ensure that continuity of care is carried out among all staff on the unit.     

Benefits of psychosocial rehabilitation programming in a treatment mall

Psychiatric patients need educational interventions that help them recover and increase their ability to live and work independently following discharge from the hospital. The psychosocial rehabilitation treatment mall model is designed to meet this educational need. Treatment malls are a new approach to psychosocial rehabilitaion for patients in state psychiatric hospitals. Treatment malls provide psychoeducation and skill-building activities in a centralized, school-like setting for participants from all patient care units. It differs from traditional strategies that use decentralized one-on-one or unit-based models. Treatment malls provide a self-directed learning experience that meets the person-centered needs of participants. Evidence is increasing that this psychosocial educational model can provide lasting benefits for psychiatric patients, including symptom management, reduced psychiatric hospital readmission rates, and improved quality of life.     

Caring for Persons with Serious Mental Illness

Abstract

This article places evidenced-based knowledge of practice within the social context of care and proposes five policy objectives and specific policy and program changes to address care needs of people with serious mental illness. In spite of demonstration programs that provide the basis for proposed policy initiatives throughout the United States, treatment provision for this population remains inadequate and their safety and well-being continues to be at risk. The authors suggest that treatment initiatives need to be tied to stable policies protecting the mentally ill from adverse social context changes. The authors conclude that policies are needed that will enhance housing assistance, independent social functioning, personal empowerment, and treatment engagement. In addition, efforts are needed to make better use of inpatient hospital care, to better understand the role of assisted treatment, and to better develop consistent long-term fiscal support for the seriously mentally ill. They offer specific policy recommendations for changes in HUD programs, Medicaid and Medicare funding, and treatment programming that address these needs.     

Psychiatric Information Systems: An Analysis of Inpatient and Outpatient Unit Capabilities

This paper describes how a sample of inpatient and out-patient psychiatric treatment units use technology to aid in patient care through scheduling, tracking, billing, and documenting clinical services. We conducted semi-structured interviews (n = 68) at four inpatient and four outpatient psychiatric facilities in Oregon. Results indicate psychiatric facilities are assembling systems for managing information that include a combination of electronic linked clinical records, paper records, and unit-specific, unlinked databases. Barriers remain in (1) improving the sophistication of psychiatric information systems, (2) improving linkages of behavioral health with other medical information systems, and (3) increasing information technology support.     

Addressing Psychosocial Barriers to Hospital Discharge: A Social Work Led Model of Care

Australian hospitals regularly care for patients who cannot be discharged routinely due to complex psychosocial needs that manifest as barriers to discharge. These long-stay or “stranded” patients are at risk of detrimental health outcomes resulting from their extended stay while also potentially delaying admission for those who need acute care. This article discusses a new social work led model of care developed at an Australian metropolitan hospital that targets long-stay patients with psychosocial barriers to discharge. The model of care, overseen by a specialist social worker and assistant, demonstrates how the social work profession can take leadership within the psychosocial realm to improve both organisational and patient outcomes.     

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

Effects of suicidal behavior on a psychiatric unit nursing team

1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

The Infirmary as a Short-Term Psychiatric Facility

Abstract

The purpose of this study was to describe the role of the Oregon State University Infirmary (inpatient unit) in the provision of crisis intervention services for students with emotional problems. The focus was on the working assumptions of the infirmary program, the patient population which utilized the infirmary, the dimensions of treatment, and treatment outcomes.

Data were collected for a three year span on all patients who had contact with the infirmary for problems of an emotional nature. Records were reviewed for demographic variables, presenting symptomatology, diagnosis, treatment, disposition, and outcomes. Comparisons were made between these patients and those who received outpatient services through the Oregon State University Mental Health Clinic.

Demographic data indicated that patients who were treated in the infirmary differed only slightly from either the general student population of the university or from students receiving outpatient services. Presenting symptoms reflected a wide range of emotional problems. The severity of psychopathology was demonstrated by the finding that one-quarter of the patients manifested symptoms of acute psychosis, suicidal preoccupation, acute drug reaction, or toxic alcohol reaction. Consistent with the working assumptions of the program, the focus of treatment was short-term, intensive, and symptom directed. Treatment outcomes as determined by followup data were generally positive.

It was concluded that the infirmary provided an important treatment option which extended rather than duplicated outpatient services. The need for such an option was clearly demonstrated. The study was supportive of the concept that a university infirmary has the potential for utilization as a multipurpose facility.     

Staff & client perceptions of unit quality: a pilot study

This pilot study compared psychiatric health care team members' perceptions of unit quality with discharged clients' perceptions of quality of care received on the unit. The staff members were from four different service units in one acute care psychiatric facility. The study used the Perceptions of Unit Quality (PUQ) scale, a valid and reliable outcome measurement instrument, developed by Cronenwett. Most quality assurance instruments that exist have focused on individual caregivers' or service-specific views of quality, but the PUQ scale allows quality assurance data that represent team performance to be described through team perceptions of quality. Results of this pilot study suggest that use of the PUQ scale, in conjunction with clients' perceptions of unit quality, may be a legitimate approach in continuous quality improvement efforts in psychiatric-mental health care centers.     

Do Family Meetings Improve Measurable Outcomes for Patients,Carers, or Health Systems? A Systematic Review

Abstract

Family meetings are a common intervention in acute and subacute inpatient care settings. The aim of this systematic review was to investigate the quantitative research exploring the impact of inpatient family meetings on patient, carer, or service outcomes. A search of electronic databases (Medline, Cinahl, Embase, PubMed, and Psychinfo) was conducted from the earliest available time until July 2012. Inclusion and exclusion criteria were applied, and quality assessment of included articles was conducted. Eight studies were included in the final selection. Results indicate that there is some low-to-moderate quality evidence that inpatient family meetings reduce psychological distress of family carers and assist in meeting their information and support needs. There is weak evidence that inpatient family meetings may help to reduce readmission rates and facilitate entry to continuing care programs.     

Tourette's syndrome

1. Tourette's syndrome is a disorder with a multitude of complex behavioral problems with major implications for social impairment and emotional pain. 2. The generic care plan anticipates the predictable management problems in adolescent patients. It offers nursing interventions, particularly structure, which is important in managing symptoms. 3. The treatment process is slow. The successful implementation requires consistent efforts from the nursing staff, treatment team, and family.     

BPD and the Need for Community

SUMMARY

This chapter emphasizes the importance of a community/systems approach in managing the treatment of individuals with borderline personality disorder. The natural systems existing around patient, clinician and family are recognized, and we examine how working teams are built from these systems. The Borderline Center at McLean Hospital is used as an illustration of an organizational model that utilizes the concept of the “holding environment” (Winnicott, 1965) to provide comprehensive services to borderline patients and their families. As patients move through various levels of care and exhibit typical borderline symptomatology, the importance of communication and coordination on the part of the treatment team is highlighted. This chapter also will illustrate the essential ways in which patients, clinicians and families are able to join together in the treatment of this disorder, with special emphasis on the necessity of family involvement. We also will examine how the treatment teams provide the foundation for larger communities, which are critical to sustaining the ongoing work of its members.     

A gender-based incidence study of workplace violence in psychiatric and forensic settings

Limited data exist analyzing the role of gender in workplace violence in health care settings. This study examined whether different types of threatening incidents with patients (physical, verbal, sexual, or posturing) were salient to male versus female staff across psychiatric settings (inpatient forensic, inpatient acute/chronic psychiatric, and outpatient psychiatric). Results indicated that although women disproportionately experienced sexualized threats, they were not more likely to report such incidents as salient and threatening. The study also assessed the extent to which situational variables contributed to staff's feelings of threat. Results showed that rapport with the patient, quality of relationships with coworkers, and presence of coworkers in the area were not significantly related to how threatened staff felt in a recent threatening incident. Findings are discussed within the context of staff training and organizational benefits.