Applying Bowen Theory to Psychiatric Assessment and Disposition in the ED

BACKGROUND

A number of variables have been shown to influence whether an individual who experiences an emergency psychiatric assessment is admitted to a psychiatric hospital. This study focused on the theoretical orientation of the assessing clinician as a possibly influential variable. The theoretical orientation being studied was Bowen family systems theory or Bowen theory (Bt). Overall the Bt perspective looks at the family as the primary crucible that generates symptoms but at the same time as the natural unit and the best built-in resource to deal with those symptoms.

AIMS

This study examined whether the theoretical orientation of the nurse psychiatric assessor would affect her inpatient admission rate of patients seen for psychiatric evaluation in an emergency department (ED).

METHOD

A clinician/researcher with extensive experience applying Bt in clinical practice worked in a Crisis Management Service providing psychiatric evaluation and disposition in a busy community hospital ED. Given Bt's emphasis on the system rather than individual pathology, the clinician researcher hypothesized that her psychiatric hospitalization rate would be lower than the other clinical nurse specialists. A retrospective chart review analyzed 1 year of cases from all referrals that might have resulted in psychiatric hospitalizations (n = 1,801).

RESULTS

The clinician/researcher's psychiatric hospitalization rate was significantly lower (p = .004) than the other clinicians.

CONCLUSION

An approach to psychiatric assessment in the ED applied a Bt perspective in a way that significantly reduced psychiatric hospitalizations.

What Are Nursing Attitudes to Youth Who Engage in Self-Harm? An Integrative Review

This integrative review explored nursing assessment of youth who self-harm. Eleven papers published between 2000 to 2020 met inclusion criteria. Three themes emerged: "Doctors and nurses' perceptions of assessment of self-harm", "Attitudes and experiences of assessment of self-harm" and "Assessments and outcomes". The ways youth communicate is an important consideration when assessing and planning for care. The metaphor of Narcissus is used to understand youth beliefs, self-image and how they communicate these thoughts. This paper suggests an alternative reading of what young people, who presents with self-harm, are trying to communicate to others and how this is integrated into assessment.

Care Pathways in a Suicide Crisis Assessment Nurse (SCAN) service

AIM

The Suicide Crisis Assessment Nurse service has been developed as a Primary Care suicide intervention over the last decade. The current study aimed to describe the demographic details of users of this nurse led service, and to evaluate subsequent care pathways following this intervention.

METHODS

This study was conducted using a retrospective file review with a cross-sectional observational design investigating demographic details of service users and care pathways in a Suicide Crisis Assessment Nurse service within a defined catchment area of Ireland between June 2015 and May 2017.

RESULTS

The majority of referrals were managed in Primary Care following Suicide Crisis Assessment Nurse intervention. There was an increase in Primary Care management pathway in the second year of the service which was independent of age and gender.

CONCLUSION

There was an increase in referrals to the service over time, and the majority of presentations were managed in primary care following Suicide Crisis Assessment Nurse intervention. The study suggests that primary care interventions for suicidal crises merit further research.