Biopsychosocial nursing assessment: a way to enhance care plans

1. A psychiatric nursing assessment tool reinforces the primary nursing care model; re-establishes nursing's input at comprehensive treatment plan meeting; reorients the staff to the total nursing needs of the client; and provides a tool for establishing nursing diagnoses. 2. Implementation of the nursing assessment form has educated other staff about professional nursing practice, as well as promoted a greater understanding of the nursing process and reinforced accountability for the nurses. 3. The form enables clients to be viewed from a holistic biopsychosocial nursing context, and nursing care plan recommendations are more individualized and inclusive of the total aspects of patient needs.     

A proposal for change to achieve competence in long-term psychosocial nursing care

Psychiatric nursing in a large institutional setting presents challenges to the nursing staff, who must remain competent in the specialized areas of psychiatric and medical nursing. Chronically mentally ill individuals present complex and continuing nursing care needs that must be addressed using a holistic approach to nursing assessment and care. The complex needs of nursing staff and patients in an institutional setting have been described. Methods of assisting the nurse to achieve competence using education and experience have been implemented and described with the goal of improving holistic nursing care to chronically institutionalized individuals.     

Psychiatric nursing recruitment. Roles for educators and nursing staff

Recruiting new nurses to a relatively unpopular specialty in the midst of a nursing shortage is challenging. However, the literature offers educators and clinical nursing staff important insight regarding the promotion of student interest in psychiatric nursing. Clearly, a collaborative effort is needed. Educators and clinicians should work together to provide students with a satisfying psychiatric nursing experience. Through a combination of effective, intellectually stimulating classroom instruction and positive, welcoming clinical experiences, educators and clinical nursing staff may increase the number of nursing graduates who pursue this rewarding specialty.     

A process-oriented approach. Selecting a nursing model for psychiatric nursing.

The nursing literature is replete with articles and books that describe nursing conceptual frameworks and models and encourage their use in clinical, education, and research activities. Although much information exists on the content of nursing models, less has been written about how a model is to be chosen and the process that may facilitate the choice of a model. This article reviews potential benefits and limitations of nursing models and conceptual frameworks and describes a three-phase process for selecting a model for psychiatric nursing practice.     

Caring in forensic nursing. Expanding the holistic model

Nurses have practiced forensic nursing for many years without formal recognition of the domain as a discipline for specialized study. Forensic nursing expands the traditional concept of holism to include the medical-legal aspects of potential or actual client problems. The American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) recently have designated forensic nursing as a unique specialty. Recognition of forensic nursing as a specialty area of practice within nursing mandates that the specialty define and explicate its major conceptual base. A concept germane to the practice of forensic nursing is that of caring. Caring as a central concept to the role of this specialty is discussed, and the implications for its inclusion in a curriculum preparing forensic nurses are explored.     

The Woodwork Effect: Estimating It and Controlling the Damage

Many patients in home- and community-based services (HCBS) are not people who, without HCBS, would be in nursing homes. Those attracted to HCBS tend to be people who are younger, better supported, less dependent, and more mentally intact than their nursing home counterparts. Studies show that only about a quarter of the clients selected as likely to enter nursing homes within the coming year are likely to do so, even though they receive no HCBS. Of the 43 studies reported, more than two-thirds had rates of control group nursing home admission of less than 20%. Most patients would also be likely to have experienced only a short nursing home stay even if they were admitted. The result: Receiving HCBS reduced nursing home use rates on average by only a small percentage, not enough to offset the costs of HCBS. Moreover, both older and more recent studies show only small to insignificant effects on most adverse patient outcomes.     

Predictors of Nursing Home Admission: A Social Work Perspective

Abstract

Institutionalisation of geriatric patients is a growing trend in ageing societies, such as Singapore. Earlier studies focused on the sociodemographic profile and attributes of nursing home residents and applications, but neglected to address the predictors of nursing home admission from a social work perspective. The present retrospective study identifies independent risk factors that predispose a patient to a nursing home discharge from a general rehabilitation ward in a community hospital in Singapore, with a multidisciplinary emphasis on clinical intervention. Factor analysis results reinforced findings that functional impairment and dementia are consistent predictors of nursing home admission. Multivariate logistic regression analysis showed that positive predictors of nursing home admission include older age, length of hospital stay, low socioeconomic status, dementia, and functional disability. Social work interventions include early referrals to the medical social worker, so that options for social and family support can be explored prior to deciding to place patients in a nursing home. Other interventions include suitable family therapy and counselling for patients and their families.     

Family Support in Nursing Homes Serving Residents with a Mental Health History

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact with their relatives and supportive of their care. In nursing homes, daily contact, an ongoing relationship, involvement in assessment, and being responsible for the resident constitute the model family support. This study advances the understanding of family support in nursing homes and conveys information to guide practice through proposing ways to enhance family support and involvement in nursing homes.     

Forensic psychiatric nursing. Discursive practices and the emergence of a specialty

1. While some authors argue that specialization is a threat to holistic nursing practice, others suggest that specialization is not only desirable and inevitable but should follow a rigorous process, including specific educational curriculum and examination procedures. 2. Two opposing views regarding forensic nursing are found in contemporary nursing literature. Some authors resist the discourse of specialization in nursing, while the discursive practices of others (e.g., leaders in forensic psychiatric nursing) could reflect a desire for power. 3. Using a poststructuralist approach, the controversy that has accompanied the development of forensic nursing through discursive practices is analyzed.     

Physical Abuse of Older Adults in Nursing Homes: A Random Sample Survey of Adults With an Elderly Family Member in a Nursing Home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Mental Disorders Among Non-Elderly Nursing Home Residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

Mental disorders among non-elderly nursing home residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

Barriers preventing high-quality nursing care of people with disabilities within acute care settings: a thematic literature review

This literature review was conducted to identify obstacles in the provision of quality nursing care to people with disabilities within acute care settings. Research in 2006 by the Disability Rights Commission found that people with disabilities have healthcare needs that are not being adequately met with the quality of care expected or anticipated. Obstacles to the provision of high-quality nursing care are a matter of concern to nursing clinicians, educators and researchers involved with establishing and maintaining professional standards of care for nursing practice. Therefore, this review has identified three major themes illustrating barriers to provision of high-quality nursing care in the acute care setting to people with disabilities. Themes identified were: professional competence, professional attitudes and organisational management. Nurses have an obligation to take into account the concerns and needs of individual clients with a disability.     

Does Home- and Community-Based Care Affect Nursing Home Use?

A study was conducted to assess change in numbers, expenditures, and case mix of nursing home residents as Medicaid investment in home- and community-based services (HCBS) 1915(c) waivers increased in seven states. The seven states provided Medicaid expenditure and utilization data from 2001 to 2005, including waiver and state plan utilization. The Minimum Data Set was used for nursing home residents. For three states, community assessment data were also used. In six states, the number of nursing home clients decreased as the numbers of HCBS clients grew. However, in most states, the number of additional waiver clients often greatly exceeded reductions in nursing home residents. Nursing home payments decreased moderately, but this decrease was offset by increases in HCBS waiver and state plan expenditures, leading to a net increase in long-term support services (LTSS) expenditures from 2001 to 2005. Increases in waiver expenditures outpaced increases in waiver clients, indicating expansion of services on top of expansion in clients. States that showed substantial increases in HCBS showed only modest increases in nursing home case mix. The case mix for nursing home residents was more acute than that for HCBS users. The expectation that greater HCBS use would siphon off less severe LTSS users and hence lead to a higher case mix in nursing homes was partially met. The more acute case mix in nursing homes suggests that HCBS serves some individuals who were previously cared for in nursing homes but many who were not. Efforts to promote substitution of HCBS for institutional care will require more proactive strategies such as diversion.     

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Staff perceptions of staff-family interactions in nursing homes

Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6-month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff–family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff–family interaction positively. Findings suggest explanatory processes in staff–family interactions, while pointing toward promising interventions.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.     

A troubling triangle. An exploration of loneliness, helplessness, and boredom of residents of a veterans home

1. Lack of companionship, no opportunity to care for others, and little variety result in the problems of loneliness, helplessness, and boredom for many nursing home residents. 2. Loneliness, helplessness, and boredom may be even greater challenges than physical and functional problems for individuals in nursing homes. 3. Through clinical research and practice innovations, nursing has an opportunity to take a leading role in increasing information about emotional and functional issues that affect the quality of life for nursing home residents.     

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.