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

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.

'Partnership': a co-operative inquiry between community mental health nurses and their clients. 1. Research methodology, process and reflections

The aim of this study was to explore the utility of co-operative enquiry between community mental health nurses and their clients. The research design was a form of co-operative enquiry. Two nurses and two clients volunteered to participate as co-researchers and co-subjects with two facilitators in a co-operative inquiry group. The subject of the inquiry, agreed by the group, was the relationship between the nurse and client. The method for the inquiry was developed by the participants and consisted of dialogue groups. This paper provides a description of the research design and methodology with a first-person account of the research experience and reflections by the two facilitators. The process is considered with particular reference to the influence of the study facilitators. Their position changes from wanting to influence an 'external' relationship to one of being influenced within the research relationship over time through reflection and growing self-awareness. This results in the inquiry ultimately being driven by the agenda of the group rather than the process. The outcomes of the study were both informative and transformative and the content of the inquiry relating to the nurse-client relationship will be presented in a second paper.

The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model's usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its 'fit' with the needs of the client group and the ward team philosophy.

The role of reflection in the development of practice theory: a case study

Many authors view practice theory as the strongest form of theory for an applied discipline like nursing. It is based upon the idea that theory emanates from practice, is strengthened and is returned to inform practice. The first part of this paper is concerned with identifying the contribution that practice theory can make to patient care. While there are many positivistic ways of generating practice theory, one method which is getting increasing attention is reflection. In this paper, Boud et al.'s framework for reflection is used to identify phenomena related to the empowerment of patients and staff in psychiatric hospitals (Boud et al. 1985). A real life case study is described and concepts and beginning propositions are uncovered. Conclusions are drawn which from the basis for theory development and testing.

Developing user involvement in mental health services

This paper describes the user consultation component of a corporate approach to the mental health needs assessment of a local population. The context of the paper is established by presenting the views of users and user representatives on current mental health services. This is followed by the development of participants' views of an 'ideal' mental health service within the boundaries of technical feasibility. Three focus groups were held with current service users, and one group with user representatives. The users have extensive experience of a range of mental health services. The findings suggest that user representatives tend to represent their own needs rather than those of users. It would also seem that service users are not a homogeneous group, different groups having different priorities. Overall, users' views of current services generally reflect previous studies, but the 'ideal' approach seems to broaden the discussion and identify an agenda for change. This agenda is framed within categories of service delivery, service providers, labelling, advocacy, future research, leaving services, involvement, co-ordination, information, choice and accessibility. There is no clear role specifically identified for mental health nurses by users, but many opportunities are highlighted. Exploration of the utility of co-operative inquiry between mental health nurses and service users is recommended.

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 2--Presentation and discussion of findings

A nursing model selected by a population of ward managers was implemented on a long-stay psychiatric ward in Northern Ireland using an adapted action research approach within a quasi-experimental design. A range of dependent variables were appraised at one pre-test and two post-test evaluation points on an experimental (Ward X) and a control ward (Ward Y). A thorough review of the literature and methods used can be found in Part 1 (McKenna et al., 1995, Int. J. Nurs. Stud., 32, 79-94). The findings and their interpretations are presented here. Results indicate that on the experimental ward there were statistically significant improvements in "Psychiatric Monitor", patients' and staff's perception of ward atmosphere, patient satisfaction, staff's views about nursing models, and patient dependency levels. No significant changes were noted in nurse satisfaction levels nor nurses' perception of patients' behaviour. Particular emphasis is placed on the possible threats to the internal and external reliability of these findings and on the attempts made to control these threats.