The evaluation of a nursing model for long-stay psychiatric patient care. Part 2--Presentation and discussion of findings

The First Nurse-Patient Encounter in a Psychiatric Setting: discovering a moral commitment in nursing

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty.

Framework of behavioral indicators evaluating TB health promotion outcomes: a modified Delphi study of TB policymakers and health workers

Background

Although TB health promotion directed at policy makers and healthcare workers (HCWs) is considered important to tuberculosis (TB) control, no indicators currently assess the impact of such promotional activities. This article is the second in a series of papers that seek to establish a framework of behavioral indicators for outcome evaluation of TB health promotion, using the Delphi method. In the first article, we sought to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients. The objective of this second article is to present an indicator framework that can be used to assess behavioral outcomes of TB health promotion directed at policy makers and HCWs.

Methods

A two-round, modified Delphi method was used to establish the indicators. Sixteen experts who were knowledgeable and experienced in the field of TB control were consulted in Delphi surveys. A questionnaire was developed following 4 steps, and involved ranking indicators on a five-point Likert scale. The consensus level was 70 %. Median, mode, and Coefficient of variation (CV) were used to describe expert responses. An authority coefficient (Cr) was used to assess the degree of each expert’s authority.

Results

Consensus was achieved following the two survey rounds and several iterations among the experts. For TB health-promotion activities directed at policymakers, the experts reached consensus on 2 domains (“Resource inputs” and “Policymaking and monitoring behaviors”), 4 subdomains (“Human resources” among others), and 13 indicators (“Human resources per 100,000 person” among others). For TB health-promotion activities directed at HCWs, the experts reached consensus on 5 domains (“Self-protective behaviors” among others), 6 sub-domains (“Preventing infection” among others), and 15 indicators (“Average hours of daily workplace disinfection by ultraviolet radiation” among others).

Conclusions

This study identified a conceptual framework of core behavioral indicators to evaluate TB health-promotion activities directed at policymakers and HCWs involved in TB control. Validation in other parts of the world could lead to global consensus on behavioral indicators to evaluate TB health promotion targeted at policymakers and HCWs.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-015-0087-4) contains supplementary material, which is available to authorized users.

Consulting the oracle: ten lessons from using the Delphi technique in nursing research

AIM

The aim of this paper was to provide insight into the Delphi technique by outlining our personal experiences during its use over a 10-year period in a variety of applications.

BACKGROUND

As a means of achieving consensus on an issue, the Delphi research method has become widely used in healthcare research generally and nursing research in particular. The literature on this technique is expanding, mainly addressing what it is and how it should be used. However, there is still much confusion and uncertainty surrounding it, particularly about issues such as modifications, consensus, anonymity, definition of experts, how 'experts' are selected and how non-respondents are pursued.

DISCUSSION

This issues that arise when planning and carrying out a Delphi study include the definition of consensus; the issue of anonymity vs. quasi-anonymity for participants; how to estimate the time needed to collect the data, analyse each 'round', feed back results to participants, and gain their responses to this feedback; how to define and select the 'experts' who will be asked to participate; how to enhance response rates; and how many 'rounds' to conduct.

CONCLUSION

Many challenges and questions are raised when using the Delphi technique, but there is no doubt that it is an important method for achieving consensus on issues where none previously existed. Researchers need to adapt the method to suit their particular study.

Perceptions of the real and the ideal ward atmosphere among trainees and staff before and after the introduction of a new work rehabilitation model

Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees' and staff's perspective concerning the real ward atmosphere and that the staff's perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff's estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee's perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time.

Perceptions of care and services by the clients and families: a personal experience

This study was initiated in response to a provincial mental health policy emphasizing the primacy of the person and the hospital's decision to adopt total quality management. The objective of the project was to learn more about how clients and families viewed the care and services received during a psychiatric admission. Their perceptions were elicited through seven focus groups including multiple admission (3) clients and families of single and multiple admission clients (2 each). Group sessions were tape-recorded, transcribed and analysed for themes. Three major themes were identified: quantity and quality of care, individuality and partnership. Both positive and negative comments were made within each of these themes, but two major areas for improvement were continuity of care and the environment. The findings are being used to change practices within the Department of Psychiatry.

Theory and research: a linkage to benefit practice

This paper begins with a critical overview of what the extant literature sees as the relationship between research, theory and practice. Most scholars maintain that there are two main viewpoints: research exists to build theory from practice and/or research exists to test existing theory in practice. It will be argued that is too simplistic a view and four specific linkages will be proffered: Theory Testing Research, Theory Generating Research, Theory Evaluating Research and Theory Framed Research. All four will be discussed and their contribution to the knowledge base of nursing practice explored. In concluding, an argument will be put forward proposing the view that undertaking research without considering theory is an empty and non-productive exercise.

The evaluation of a nursing model for long-stay psychiatric patient care. Part 1--Literature review and methodology

A modified action research approach was used to implement a selected nursing model on a long-stay psychiatric ward. Within a broader quasi-experimental design, specific quality of care indicators were appraised before and after the implementation of the model. These dependent variables were also monitored on a control ward and data were collected on both wards at one pre-test and two post-test points. This paper presents a comprehensive overview of the literature and the methodology for the study. Planned change theory was used as a guiding framework for the implementation of the model and this process is described in detail.