Taking personal responsibility: Nurses' and assistant nurses' experiences of good nursing practice in psychiatric inpatient care

Nursing documentation in inpatient psychiatry: The relevance of nurse-patient interactions in progress notes-A focus group study with mental health staff

AIMS AND OBJECTIVES

To gain insight into mental health staff's perception of writing progress notes in an acute and subacute psychiatric ward context.

BACKGROUND

The nursing process structures nursing documentation. Progress notes are intended to be an evaluation of a patient's nursing diagnoses, interventions and outcomes. Within this template, a patient's status and the care provided are to be recorded. The therapeutic nurse-patient relationship is recognised as a key component of psychiatric care today. At the same time, the biomedical model remains strong. Research literature exploring nursing staff's experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse.

DESIGN

Qualitative design.

METHODS

Focus group interviews with mental health staff working in one acute and one subacute psychiatric ward were conducted. Systematic text condensation, a method for transverse thematic analysis, was used.

RESULTS

Two main categories emerged from the analysis: the position of the professional as an expert and distant observer in the progress notes, and the weak position of professional-patient interactions in progress notes.

CONCLUSIONS

The participants did not perceive that the current recording model, which is based on the nursing process, supported a focus on patients' resources or reporting professional-patient interactions. This model appeared to put ward staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process. Essential aspects of nursing care related to recovery and person-centred care were not prioritised for documentation.

RELEVANCE TO CLINICAL PRACTICE

This study contributes to the critical examination of the documentation praxis, as well as to the critical examination of the documentation tool as to what is considered important to document.

Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement

Staff members' engagement with patients is a critical element of inpatient psychiatric care, essential to safety, the hospitalization experience and the development of a culture of care. Currently broad concerns exist around the amount of time inpatient psychiatric nurses expend in patient engagement and the quality of these interactions. In this paper we present a model of engagement that clarifies necessary skills to support the engagement process. The model is based on Peplau's theory of interpersonal relations, patients' ideas on healing elements of psychiatric hospitalization and research on inpatient therapeutic relationships. We are currently using this model for a web-based teaching/learning course to cultivate interpersonal engagement, and to explicate how through operationalizing their inpatient role, nurses support patients in the development of their mental health and well-being.

Nursing Staff Stress and Individual Characteristics in Relation to the Ward Atmosphere in Psychiatric In-Patient Wards

This study investigated the interplay between nursing staff stress, Mastery, Moral Sensitivity, individual characteristics and the ward atmosphere in psychiatric in-patient care. Data were collected through five questionnaires from 93 nursing staff. Multivariate analysis showed that Moral Strength, Moral Burden, Internal Demands, Perceived Stress and age were related to several factors of the ward atmosphere. We conclude that efforts to reduce stress levels and create a supporting ethical climate on psychiatric wards would be beneficial for both psychiatric nursing staff and their nursing practice.

Does 'Time Together' increase quality of interaction and decrease stress? A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach

INTRODUCTION

Despite the long-known significance of the nurse-patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process.

METHODS AND ANALYSIS

This is a multisite study with a single-system experimental design using frequent measures. The primary outcomes are quality interactions for patients and perceived stress for staff. Secondary outcomes are levels of symptoms of anxiety and depression for patients and stress of conscience for staff. A process evaluation is performed to describe contextual factors and experiences. Data are collected using questionnaires, participant observations and semistructured interviews. For analysis of quantitative data, both visual and statistical methods will be used. Qualitative data will be analysed using qualitative content analysis.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethical Review Board in the region (Dnr 2016/339-31). The findings will contribute to the development of nursing interventions in general, but more specifically to the development of the intervention. This is relevant both nationally and internationally as similar interventions are needed but sparse. The findings will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT02981563.

From ideals to resignation - interprofessional teams perspectives on everyday life processes in psychiatric inpatient care

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric inpatient care has been described by both ward staff and patients as being demanding and disorganized, lacking opportunities for quality interactions in everyday life through joint activities. Qualitative research on interprofessional teams' perspectives on everyday life processes in psychiatric inpatient care is lacking. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Staff have ideals about care and collaboration, but the obstacles they face in everyday life, such as a poor environment, power asymmetry, lacking structure and the demands of managing chaos, mean that they appear to resign and shift focus from the patients' best interests to self-survival. Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge, these findings have not been reported in the international evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given these findings we suggest interventions such as Protected Engagement Time as well as reflective dialogues within interprofessional teams. This would help staff to resume their caring role in everyday life in psychiatric inpatient care and put their ideals into practice.

ABSTRACT

Introduction Patients and ward staff describe psychiatric inpatient care as demanding, characterized by unpredictable events, yet research on interprofessional teams perspectives of everyday life processes in psychiatric inpatient care lacks. Aim This study aims to explore everyday life processes in psychiatric inpatient care, as reported by staff in interprofessional teams. Method A grounded theory design was used and 36 participants were interviewed. Results The analysis resulted in a process-oriented core category From ideals to resignation. Related to this core category were three further categories: Knowing where to go, Walking a path of obstacles and Shifting focus from the patient's best interests to self-survival. The staff had ideals about care and collaboration, but a poor environment, power asymmetry, lacking structure and demands of managing chaos meant that they appeared to resign from putting their ideals into practice. Discussion Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge similar findings have not been reported in the international evidence. Implications In order to support interprofessional teams to work according to their ideals, interventions such as Protected Engagement Time and reflective dialogues within the teams are suggested.