Patient assessment in psychiatric nursing

Nurses' perceptions of mental health assessment in an acute inpatient setting in New Zealand: a qualitative study

This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semistructured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.

A comparison of patient needs as ranked by patients and nurses

A group of patients (n=69) were asked to arrange the three most important of 10 groups of needs, identified by patients in a previous study, in order of priority from one to three. A group of nurses (n=89) were asked to arrange same groups of needs in order of priority from one to three according to how they believed patients would rank them. No significant differences were found between patients cared for at medical and at surgical wards or between nurses working at different departments. However, differences were found between the rankings of patients and nurses.

A New Model for the Mental Health Nursing Change of Shift Report

Nursing shift reports are intended to enhance the continuity and quality of nursing care delivered by providing results of nursing assessments, summarizing medical information, and drawing attention to specific nursing interventions and goals anticipated during the upcoming shift. In this article, contemporary literature on shift reports is reviewed with specific attention to the unique characteristics and problems that commonly occur in change of shift reports in a mental health setting. The framework proposed is Gordon's functional health patterns because it provides a holistic structure for organizing patient data in a clear, objective manner. Additional methods for enhancing shift reports are recommended, including the use of specific behavioral descriptions, the inclusion of data from targeted nursing assessments, and the discussion of alternative care approaches that support the development of consistent, collaborative nursing interventions across shifts. A case example is used for demonstration.

Detecting nurse-perceived patient treatment difficulty of psychiatric patients in hospital: an evaluation of a patient assessment sheet

Many changes have occurred in hospital psychiatric care, including decreased length of hospital stay and increased patient acuity. These changes highlight the need for nurses to adequately assess and formally document patient treatment difficulties. The purposes of this study were to determine the ability of the Patient Assessment Sheet (PAS) to predict patient 'problems' that psychiatric nurses perceived as associated with patient treatment difficulty, and to identify the patient problems missing from the PAS. These purposes were accomplished by comparing the PAS to the Hospital Treatment Rating Scale (HTRS). A correlational design and multiple linear regression technique were used. Eight psychiatric registered nurses assessed a total of 110 patients, admitted consecutively to one inpatient psychiatric unit. The HTRS and the PAS were used independently for each patient. Four PAS items (active affect, passive affect, aggression toward self, and patient confusion) significantly predicted 38% of the variance from the HTRS; and three HTRS items (isolation and withdrawal from relationships, noninvolvement in treatment, and wide variability in mood) significantly predicted 22% of the residual variance from the HTRS. The identified PAS and HTRS items help to make visible patient problems associated with nurse-perceived patient treatment difficulty. This identification is potentially important for both clinical and political purposes.

Hospital-based psychiatric experience before community-based practice for nurses: imperative or dispensable?

This article describes an Australian research project that explored the relevance of hospital-based experience in preparing psychiatric nurses for community-based practice. A qualitative design was selected to obtain in-depth information in an area in which no formal research has been undertaken. In-depth interviews were conducted with 6 psychiatric nurses currently engaged in community-based practice. The interviews were audiotaped, and the transcribed data were analyzed for major themes. The results indicated that the participants did not believe their hospital experience had prepared them to function effectively in the community. In some respects hospital experience was perceived as having hindered their transition into the community environment. This exploratory study indicates the need for further research and the exploration of alternative methods to prepare psychiatric nurses for community-based practice.

A summative evaluation of clinical competence: students' and nurses' perceptions of inpatients' individual physical and emotional needs

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence for Swedish student nurses. Each of the randomly sampled 48 student nurses and their corresponding supervisors (48 nurses) assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients (n = 48) were interviewed about their perceived needs. Student nurses' and nurses' assessments were compared with the individual patient's opinion. Both the students' and the nurses' assessments showed close similarities with the patients' own estimations, although certain under- and overestimations for both physical and emotional needs were found, with a predominance of overestimation of emotional needs. Student nurses and nurses also showed uncertainty in some of their assessments, mainly concerning emotional needs. Their assessments were closer than student nurses/patients or nurses/patients, and also closer for physical than for emotional needs. The conformity in student nurses' and their supervisors' assessments might be understood as the supervisors' influence as role models. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care.

An investigation into the description of patients' problems by nurses using two different needs-based nursing models

This paper describes an investigation into how nurses describe patients' problems and the possible effects of an espoused nursing model on these descriptions. A descriptive study was conducted on two medical wards in a Welsh District General Hospital. Data collected were subjected to content analysis using Gordon's Functional Health Patterns to order the data. The two wards investigated, whilst being very similar in many ways, utilized different nursing models. Findings showed that the nurses studied, when describing patients' problems, most commonly used medical diagnoses or the medical reasons for admission. Patients' problems identified predominately addressed bio-physical needs with scant attention given to psycho-social needs. Despite the use of two different nursing models the language and emphasis of problem description were very similar and there was no evidence of the application of the conceptual underpinnings of the two models. It is suggested that although the use of a ready-made nursing language may have drawbacks, the British nurse should understand and assess the value of the North American Nursing Diagnosis Association's (NANDA) nursing diagnoses. Without such involvement this system may be implemented in the United Kingdom (UK) without the input and influence of practising nurses.

Sexuality, sexual abuse. Omissions in admissions?

The main focus of this paper is to highlight the evidence relating long-term effects of childhood sexual abuse to presenting complaints on acute admission wards and to explore how sexuality, as an aspect of nursing concern, is broached by mental health nurses. There are few nursing articles on sexual abuse issues which are research-based, this literature has to be drawn from a wider field. Several authors recognize this paucity highlighting the need for future research in this area. The evidence from the literature review (1985-1995) makes it clear that the environment, the perceived interpersonal skills of the nurse and a general lack of definition of the nurse's role has a large influence on whether or not these issues are addressed. Following discussion about these findings, recommendations are made for inclusion of teaching on sexuality and sexual abuse, interpersonal skills training and illumination of assessment practice, with space for personal growth and development, in pre- and post-registration nurse education. This theme is developed further by considering how these recommendations could be introduced on acute admission wards.

Patients' needs in hospital: nurses' and patients' views

This study set out to identify the most important needs of hospital patients on surgical and medical wards and to assess the ability of nurses to identify these needs. The population consisted of 92 Finnish patients and 69 Finnish nurses. The study was carried out using a questionnaire designed on the basis of the need theory presented by Yura and Walsh. The results of the statistical analyses were presented in the form of frequencies, cross-tabulations and chi-square tests. The patients' most common needs were related to vital functions (44%), followed by those related to functional health status (38%) and environmental needs (36%). The last item on the list of expressed needs concerned reactions to functional health status (31%). Over 70% of the surgical patients suffered from problems related to sleep and rest. Less than 60% of them suffered from acute pain. Medical patients, in turn, had more frequent needs related to vital functions than did surgical patients. Three out of four medical patients suffered from acute pain. Sleep and rest disturbances, stress, bad mood and listlessness were also common problems. The nurses underestimated all patient needs, apart from environmental needs, which they regarded as the main concern of patients. There was a statistically significant difference between patients' and nurses' assessments for 38% of all needs. Moreover, there were differences in assessments between the surgical and medical wards included in the study.

Measuring nursing outcomes in a psychiatric setting

Recent developments in health care reform suggest the importance of outcome data regarding the nature, costs, and documented effectiveness of various health care services. While psychiatric nurses believe in the value of the care they provide, the present climate requires that research be conducted to elaborate the outcomes of psychiatric nursing care. This article describes a pilot study conducted on two adult inpatient units of a teaching hospital. On the experimental unit, nurses used North American Nursing Diagnosis Association (NANDA) nursing process documentation that related to specific patient outcome criteria. On the control unit, nurses used a medical systems approach to documentation. Study results and important unanticipated findings are reported with implications for future nursing research and practice.