Evaluation of outcomes in Psychiatric Consultation-Liaison Nursing practice

The stigma of a psychiatric diagnosis: prevalence, implications and nursing interventions in clinical care settings

The stigma associated with psychiatric and substance abuse disorders is a formidable barrier to the achievement of health and well-being for persons who carry such a diagnosis or who exhibit symptoms. Attitudes of nurses and treatment providers toward patients with comorbid psychiatric and substance abuse disorders can be influenced by stigma, which can have a negative impact on the therapeutic process and development of trust necessary to support good patient outcomes. Understanding the interrelated components of stigma, including labeling, stereotypes, and discrimination, can help nurses to reduce its impact in clinical care settings to improve the care experience for patients and nurses. Implementing interventions based on the core values of the nurse-patient relationship to enhance understanding, mutual trust, and acceptance of differences can contribute to improved communication and patient assessments in an effort to improve patient outcomes.

Mental health liaison nursing, taking a capacity building approach

PURPOSE

This paper explores the use of capacity building practice as an approach for the mental health liaison nurse (MHLN).

CONCLUSIONS

The role of the MHLN has established itself within nursing, with various approaches to the role documented in the nursing literature. Most descriptions of the role are limited by simply explaining what the MHLN does, rather than explaining the underlying approach and evaluation of the model suggested. Capacity building practice is explored in the context of the liaison role, and its use is demonstrated in a clinical example of suicide risk in a general hospital setting.

PRACTICAL IMPLICATIONS

The future scope of MHLN and their use of capacity building approaches may lead to the improvement of consumer health outcomes and also develop the skill of the non-mental health nurse in generalist settings.

Quality of mental health care for nursing home residents: a literature review

Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors.

Evaluation of a new mental health liaison role in a rural health centre in Rocky Mountain House, Alberta: a Canadian story

This paper describes the evaluation of a mental health liaison (MHL) role in a rural community in Alberta, Canada. The role provides advocacy, education, indirect and direct client intervention, and follow up. It was developed to eliminate gaps in mental health care and build collaborative cultures between the local hospital, physicians' offices, mental health clinics, and community agencies. Obtaining stakeholder feedback was an important step in assessing initial service impact while providing directions for role refinement and future programme development. A total of 116 questionnaires were distributed to physicians, hospital staff, and community mental health assessing stakeholder perception relating to various functions of the MHL. A 50% (n = 58) response rate was achieved with broad representation from different partners, including 75% of local physicians. The majority of respondents positively perceived the roles, functions, and impact of the MHL, including relationship development across the hospital community, improved access to services, and perceived improved client outcomes. The results reinforced that the MHL service meets a previously unmet need in this rural setting. Findings are being used to refine roles, provide local learning and resource development, understand issues relating to programme development in other areas, and develop client level outcomes relating to the services delivered.

Patient health outcomes in psychiatric mental health nursing

This integrative literature review examined evidence concerning the relationship between psychiatric mental health nursing interventions and patient-focused outcomes. Empirical studies, published between 1997 and 2007, were identified and gathered by searching relevant databases and specific data sources. Although 156 articles were critically appraised, only 25 of them met the inclusion criteria. Findings from this review showed that the most frequently used outcome instruments assessed psychiatric symptom severity. Most of the instruments targeted two symptom categories: altered thoughts/perceptions and altered mood. Other outcome instruments were categorized in the following domains: self-care, functioning, quality of life and satisfaction. The most important finding of this review is the lack of consistently strong evidence to support decisions concerning which outcome instrument or combination of instruments to recommend for routine use in practice. Based on this review, additional research to conceptualize, measure and examine the feasibility of outcome instruments sensitive to psychiatric mental health nursing interventions is recommended.

Clinical outcomes of depressed clients: a review of current literature

The purpose of this paper is to review current literature reporting clinical outcomes of depressed clients who are treated by advanced practice psychiatric nurses (APPN), primary care providers, and other mental health care providers. The APPN has always been prepared to provide both individual and group psychotherapy. Now the role has expanded to include prescriptive authority and an increased focus on the psycho-neurobiological aspects of treatment. To date, there are limited outcomes studies of APPN care. A computer search of research publications was conducted, which yielded 50 articles. After careful review of each, four quantitative studies were retained. The search was expanded to include other disciplines; ten additional studies were included.

An examination of the services provided by Psychiatric Consultation Liaison Nurses in a general hospital

The political, professional and economic context in which mental health care is delivered has witnessed significant changes in recent times. The movement of psychiatric patients from institutions to community settings has seen the emphasis of the loci of care delivery shifting with increasing numbers presenting to general hospitals. The speciality of the Psychiatric Consultation Liaison Nurse (PCLN) has emerged as a bridge between mental health and general hospital services. A descriptive, non-experimental research approach was employed to establish patient profiles and to provide an overview of the depth of service provision. This design was selected as the most appropriate because of the limited information on the PCLN in an Irish setting and secondly, as the study was limited to one rural geographical location. A questionnaire was utilized to collate the details of patients who had received a mental health assessment. The findings presented here are the profiles of patients assessed by the PCLN during the 3-month study period. The results add further credence to the existing evaluative studies in presenting the characteristics of patients within the Irish context and further contribute to the unique body of evidence that defines the mental health nurse in an advancing role.