Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.     

Creative solutions: Innovative use of the arts in mental health settings

A recent study of occupational stress on the unit (Clare, 2004) highlighted that staff valued the importance of the socialization process in reducing their stress levels. This process incorporates the need for peer support and acceptance, and an understanding of what is expected of them (e.g., roles and responsibilities), supported by a culture of learning, problem solving, and working together. This process is similar to the approach taken by the arts project in nurturing ideas and initiatives in a safe, respectful way. It is apparent that the arts project has been more than just a creative activity; it has had wider implications for both staff and service users in reducing stress. It has: * Enabled staff retention. In fact, there is a waiting list of nurses wishing to work on the unit. * Reduced incidents of damage to property. * Reduced use of p.r.n. medication. * Enhanced the good reputation of the service, which is often commented on by visitors to the unit. The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity.     

Personal empowerment program: addressing health concerns in people with schizophrenia

Three staff nurses in the Outpatient Schizophrenia Service of the Foothills Medical Centre in Calgary, Alberta, Canada, became concerned about the weight gain of their patients. Patients and their family members were also concerned and asking for help. Before integrating a program to address these concerns, staff first had to demonstrate that a program of this nature would be beneficial for clinic patients. Of the 75 clients screened, many presented with problems in the areas of weight, blood pressure, and fasting blood sugar and lipid levels. Although not a research study, an 8-month pilot project was implemented to address these concerns. It was hypothesized that integrating all dimensions of wellness in patient programming would have a positive effect on various defined indicators (e.g., weight, body mass index, blood pressure, and fasting blood sugar and lipid levels). Screening tests before, during, and after the 8-month project provided the physical outcome measurements. Social and psychological outcomes were described through observation and group member feedback. The positive results are significant in terms of empowering patients in the long-term management of their health.     

Children's Intent Participation in a Pediatric Community of Practice

This study analyzes informal learning, drawing on video recordings of staff-child interaction in a pediatric unit. It is shown that even very young patients engage in intent community participation, carefully noting fine variations in examination and treatment practices. They orient to everyday routines in successively more complex ways, gradually acquiring novel repertoires of practices; advancing from nonverbal uptake to an active use of medical terminology, and to actively assisting staff members. Ultimately, the children themselves assume almost full responsibility for routine procedures. The unit had adopted partnership-oriented routines, and the doctors and nurses spent much time in securing the children's consent and participation in their own treatment. In contrast to much earlier work in pediatric settings which has shown children to be marginal participants; even the youngest patients were engaged, and they successively acquired a set of novel practices related to treatment procedures. Together with doctors and nurses, the children could be seen to form a community of practice. But community is not something fixed; instead it is seen as an emergent phenomenon, dependent on staff members' and children's mutual alignments and collaborative action. Learning is thus analyzed as a social and relational phenomenon.     

How to work with elderly patients on a general psychiatric unit

Currently, there are specialized geropsychiatric units being used for elderly psychiatric inpatients. However, these units are not always available to the growing elderly population. The general inpatient psychiatric unit seems to be well suited for treating the medical and mental illness of elderly psychiatric patients (Billig, 1989; Conwell, 1989; Liptzin, 1987). As identified earlier, nurses may not be enthusiastic about adding this population to their unit. Our society is youth-oriented and the elderly tend to be viewed as slow, needy, and sick. It is essential for nurses to explore their own feelings regarding aging and what it means to be old. If the nurse has not dealt with issues such as her own mortality and that of her parents and close friends, it may be difficult for her to understand and work with the elderly. The ability to understand the feelings of another and to communicate this understanding has been identified as a crucial variable related to positive therapeutic outcome (Kirk, 1982). Inservice programs and groups that give the staff opportunities to explore their attitudes and feelings toward the elderly may result in more effective therapeutic interventions (Farley, 1983). To many elderly patients, nurses are seen as supportive figures, interpreters of the unknown, and potential allies who have an empathic regard for them (Davis, 1968). The nurse can use these impressions to initiate interventions. This, along with coming to terms with one's own feelings about aging, can result in a greater understanding of these patients. This article has given a very brief overview of the many issues related to the care of the elderly psychiatric inpatient.(ABSTRACT TRUNCATED AT 250 WORDS)     

PRN medication use in inpatient psychiatry

1. Administration of p.r.n. medications occurs frequently for staff nurses in inpatient psychiatry. 2. The appropriate use of p.r.n. medications is not well addressed in nursing textbooks or hospital policies and procedures. 3. Thorough assessment of patients is an essential step in the safe administration of p.r.n. medications. 4. Concise, accurate clinical evaluations may be the most successful way to determine the best dose of medication for each patient.     

When disaster strikes. The concerns of staff nurses

1. This study determined how involvement with an earthquake affected patient care delivery and ascertained what nurses need to continue providing safe and efficient care in future disasters. 2. Although 60% of the staff had experienced a previous disaster, the literature described that learned coping does not automatically "transfer" to present loss experiences. 3. Providing staff with debriefing sessions and other support groups is helpful in the post-trauma period. At all levels, there is a need to communicate concerns and to be involved in disaster drills and other disaster preparedness sessions.     

Safe Spaces: Gay‐Straight Alliances in High Schools

In activists’ circles as in sociology, the concept “safe space” has been applied to all sorts of programs, organizations, and practices. Few studies have specified clearly what safe spaces are and how they support the people who occupy them. We examine one social location typically understood to be a safe space: gay‐straight alliance groups in high schools. Using qualitative interviews with young adults in the United States and Canada who have participated in gay‐straight alliances, we unpack this complex concept to consider some of the dimensions along which safe spaces might vary. Based on interviews with participants, we derive three interrelated dimensions of safe space: social context, membership, and activity.     

A smoke-free environment: psychiatric nurses respond

1. After only 1 month of establishing a smoke-free environment, 75% of the staff on Ward "A" and 70% of the staff on Ward "B" reported that the nonsmoking policy was a success. 2. Levine's Four Conservation Principles of Nursing provide a conceptual framework for developing nursing interventions that address the patient with an urge to smoke. 3. Administrative implications for nurses who manage a smoke-free unit have been presented as guidelines that can foster a successful transition to a smoke-free environment.     

Mental health acuity system. The measure of nursing practice

As the mental health unit continues working with the acuity system, areas within the system can be improved, such as simplifying the number of behavioral emergencies and decreasing any overlap of behavioral categories. As the supervisor anticipates "fine-tuning" the system, the process of obtaining feedback from the majority of nursing staff on the unit and involving the senior staff nurses as a group in any revisions will be repeated. The sense of the mental health acuity system at St. Francis Hospital is that it reflects all the intricacies of the work that the mental health staff perform. This validity needs to be maintained throughout any revisions because it is integral to continuing the excellence of the system. The mental health staff knows best the work that they perform daily and this acuity system validates the quality and quantity of the care.     

Implementing a smoking ban in an acute psychiatric admissions unit

In contrast to general medical hospitals, psychiatric hospitals often allow patients to smoke cigarettes. In addition to obvious health concerns, smoking can also interfere with clinical assessments and therapeutic activities, Implementation of a smoking ban on an acute male admissions unit did not result in any increase in aggressive behaviors. In addition, staff attitudes following the ban improved, and most staff members believed the ban was both ethical and beneficial to patients. Our research indicates that banning smoking on an acute admissions unit is feasible and well tolerated by patients and staff, although it may require extra vigilance for smoking-related contraband.     

How to evacuate a psychiatric hospital: a Hurricane Katrina success story

This article describes the successful evacuation of an entire psychiatric hospital from New Orleans, Louisiana, to Memphis, Tennessee, on a weekend night. The destination site was 400 miles away and buses were used for transport. The evacuation occurred shortly before Hurricane Katrina struck New Orleans and included 73 adult, adolescent, and child acute psychiatric patients. Thirty-five staff members also participated in the evacuation with their families and pets. This report is significant because little is known about how to implement a disaster plan that involves the transport of an entire psychiatric hospital-patients, nurses, physicians, staff, and family members--to another city. The knowledge gained can also benefit psychiatric nurses and their organizations when establishing or modifying their disaster plans.     

Highlights from a Study of Abuse of Patients in Nursing Homes

This article reports some major findings from a random sample survey of nurses and nurses aides in 32 long-term care facilities. After defining key terms, we review the literature in an attempt to establish what is currently known about patient maltreatment in nursing homes. Next, data from the survey are presented to profile the staff and to describe difficulties in nursing home work. Findings on the extent and correlates of physical and psychological abuse of patients are then reported. The article concludes with recommendations to reduce abuse of patients.     

The Influence of Agency Staffing on Quality of Care in Nursing Homes

ABSTRACT

Data from a large sample of nursing homes were used to examine the cross-sectional association between use of agency staff, regular staff, and quality. Agency use data came from a survey conducted in 2003 (N?=?1071 nursing homes). The agency and regular staff measures were for nurse aides, licensed practical nurses, and registered nurses. We used a single quality factor constructed from the 14 quality measures in Nursing Home Compare. More agency nurse aides resulted in a smaller increase in quality, compared to the use of an equivalent number of regular nurse aides. Agency registered nurse staff were associated with better quality factor scores, especially in the presence of high levels of regular licensed practical nurses. Our results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.     

Changing attitudes about self-injury prevention management: lessons learned

In the behavioral health environment, nurses often use continuous staff monitoring and, at times, physical restraints, to manage the severity of patients' self-injury. Both options put staff in control, are the most restrictive in nature, and can be financially draining on the hospital's budget. This can result in negative reactions by both patients and staff. It is important to develop a program that will empower patients to control their behavior and allow staff to be aware of their perceptions and attitudes toward patients who self-injure. This article describes the leadership initiative that drove the development, training, and implementation of a self-injury prevention project and the lessons learned by staff.     

Three dimensions mental health professionals emphasize when judging levels of functioning of the severely mentally disabled in the community

Ratings of the level of functioning of severely disabled clients collected from staff of mental health agencies, while attractive as outcome measures, lack specificity and, at times, consistency. Three multidimensional scaling (MDS) studies were conducted to identify the dimensions staff emphasize when they compare clients as to their level of functioning. Analogues of clients were created to serve as stimuli, dissimilarity judgments of pairs of stimuli were collected, and an individual differences MDS model was applied in each study to distinguish client variance from the judges' perspectives. Ratings along specified dimensions also were collected and compared to the MDS solutions. One dimension emerged as pre-eminent, but it corresponded to many of the pre-selected dimensions, such as competence with daily living tasks, clarity of thinking, appearance and manner, and overall functioning. The other two dimensions were belligerence and openness to psychological intervention or distress with one's problems. Differences among judges were sizable; nevertheless, considerable support for emphasizing these three dimensions was found upon reviewing the contents of other assessments of functioning. Concentrating on these three dimensions of functioning may promote greater agreement among raters, highlight where functional improvements occur, and expand the coverage of functional differences without markedly increasing the costs of assessment.     

The latex allergic psychiatric patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.     

A balancing act. Continuing education for staff nurses

Basic nursing education programs prepare nurses as generalists. Continuing education programs for psychiatric nurses are needed to provide additional knowledge and expertise in this specialty area. 2. This educational program was developed for psychiatric staff nurses who have completed their orientation but are new to their institution or to the psychiatric clinical area. 3. Content of the program includes an overview of theories, therapeutic relationships, psychiatric terminology, the nursing process as it relates to patients with psychiatric problems, psychotropic medications, electroconvulsive therapy, and DSM-III R. 4. A pretest based on the content of this program can help assess the learning needs of each new nurse. The nurse may then attend the entire program or only specific parts based on individualized needs.     

Missile attacks and nursing staff: impact of the Gulf War.

Missile attacks on Israel during the Gulf War created an expected atmosphere of fear and anxiety among hospital nursing staff. There seems to be little doubt that staff group sessions were helpful in alleviating these feelings. The group members openly expressed this sentiment, and it was also the clear impression of the group leaders. The groups were also helpful in dealing with the prevalent theme of conflicting loyalties of the nurses, ie, their profession versus their families. The desire for and benefit from group sessions decreased secondary to a shift in the perceived threat. As the external threat receded, stress became largely due to prolonged hours in close quarters with other staff. It is too early to be aware of any long-term consequences on nursing staff from the recent war situation. Assessments in this regard are intended in the future, most likely in the form of written evaluation and personal interviews.     

The psychiatric technician: trespasser or welcomed ally?

1. The increasing shortage of nurses, higher patient acuity levels, and greater demands placed on nursing to meet standards of care have contributed to the use of psychiatric technicians to alleviate the burden on nursing and ensure the delivery of quality patient care. 2. Psychiatric technicians provide care for a select group of patients under the supervision of the primary nurse. The patients assigned to psychiatric technicians require minimal direct nursing intervention. 3. Psychiatric technicians reported increased self-confidence and self-esteem; the nurses were able to perform more professional nursing activities, increasing their job satisfaction and promoting staff retention; and the patients received high-quality care.