Psychopharmacological and electroconvulsive treatment of anxiety and depression in the elderly

Tasks and activities of Advanced Practice Nurses in the psychiatric and mental health care context: A systematic review and thematic analysis

BACKGROUND

To adequately describe the advanced psychiatric nursing roles and to distinguish them from the other roles of psychiatric and general nursing care, it is necessary to explore the concrete tasks and activities and the scope of practice of Psychiatric Mental Health Advanced Practice Nurses (APN).

OBJECTIVE

to extract, summarize and systematize the tasks and activities of the Psychiatric Mental Health APN from the international scientific literature.

DESIGN

systematic literature review reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement and checklist.

METHODS

The database search was performed using CINAHL, PubMed/Medline, Cochrane Library and Google/Google Scholar databases. Literature sources in English and German, which reported tasks and activities of the Psychiatric Mental Health APNs were included in the analysis. No time restrictions were defined. Roles such as Community Mental Health Nurses and Public Mental Health Nurses were excluded from the analysis. Data were extracted by independent reviewers for qualitative thematic analysis.

RESULTS

An extensive body of international literature on Psychiatric Mental Health APN sub-roles could be identified through a systematic literature search. Through our synthesis the main tasks and activities of Psychiatric Mental Health APNs could be identified and described. Altogether 46 items (practice dimensions) could be identified from the 20 sources and finally systematically summarized into six themes or "practice domains": (1) direct (clinical) nursing and care practice, (2) care coordination and case management, (3) psychosocial health promotion and prevention, (4) consulting, education and coaching, (5) leadership and public relations, and (6) research and practice development.

CONCLUSIONS

The results of this review provide a thorough outline of the tasks and activities of the Psychiatric Mental Health APN. Thus, the results reported here form the basis for a further differentiation of the tasks and activities of the Psychiatric Mental Health APNs from the basic nursing activities as well as tasks and activities of the generalist APNs. In this context, however, an attempt should be made to increase the specificity of the settings by including the tasks and activities of the community and public mental health nurses.

Improving geriatric mental health nursing care: making a case for going beyond psychotropic medications

Providing high-quality mental health nursing care should be an important and continuous preoccupation in the gerontological nursing field. As the proportion of elderly people in our society is growing, the emphasis on high-quality care will receive increasing attention from administrators, politicians, organized groups, researchers and clinical nurses. Recent findings illustrate unequivocally the important contribution of nurses to achieving the goal of high-quality geriatric care. However, the quality of care for the elderly with psychological difficulties has not been addressed. The objective of this article is to illustrate that while nurses can accomplish much to improve the well-being and mental health of the elderly, their skills are often underutilized. Psychotropic drugs are often the first-line interventions used by health-care professionals to treat mental health concerns of elderly persons. Alternative therapies that could be implemented and evaluated, such as psychological counselling, supportive counselling, education and life review, are infrequently used. Nevertheless, current scientific data suggest that it would be very advantageous if nurses were to play a dominant role in the care of elderly people who are depressed or experiencing sleep pattern disturbances. The same can be said about elderly chronic users of benzodiazepines, as well as those with cognitive impairment. Evidence for the use of psychotropic medications as a viable treatment option for the elderly both in the community and in the long-term care setting who are experiencing mental health challenges is examined. Alternative non-pharmacological approaches that nurses can use to augment care are also briefly discussed.

Drug and ECT treatment of depression in the elderly, 1996-2001: a literature review

A computer-based literature search of all antidepressant and electroconvulsive therapy (ECT) treatment studies published between 1995 and September 2001 was conducted. In addition, a review of published chapters, review articles, and metaanalyses was also conducted. Articles were categorized into those reporting comparative studies, those in which the therapeutic agent was not compared with another, articles about ECT, and review articles. These recent publications support the conclusions from prior reviews that antidepressants and ECT are effective and safe treatments for depressed elderly patients. Differences in efficacy and side effects appear to be slight among the various types of antidepressants. Research studies of depressed elderly increased markedly since 1995 compared with all previous years although more studies are still necessary.