The need for psychiatric nursing: towards a multidimensional theory of caring

Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. Although research has documented psychiatric nursing activity, little study has been made of the 'need' for psychiatric nursing within a multidisciplinary service. Employing adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals. The study was based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: 'knowing you, knowing me'. Within that complex, nurses either elected, or were required, to move--or 'toggle'--between three discrete domains of relating: the Ordinary Me (OM); the Pseudo-ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses' depth of knowing, power, use of time and use of translation distinguished these domains. The emergent theory extends current awareness of the importance of interpersonal relations in nursing. To what extent current health care policy, which emphasizes the promotion of alternative roles for nurses, will challenge this essential focus remains unclear.     

Institutionalized elders with dementia: collaboration between family caregivers and nursing home staff in Taiwan

Aims and objectives. To explore the process of development of collaborative relationship between family caregivers of institutionalized elders with dementia and nursing home staff in Taiwan. Background. Evidence suggests that family members are continuously involved in the lives of loved ones and have not given up their roles as caregivers after the institutionalization of a family member. Little is known, however, about how family caregivers develop a collaborative relationship with nursing home staff, particularly in Asian countries. Design and methods. Grounded theory methodology was used. Data were collected via interviews and observations from 11 family caregivers of patients who were suffering from dementia and living in an institution for persons with dementia in northern Taiwan. Data were analysed by constant comparative analysis. Results. Findings revealed that ‘institutional social penetration’ was the process most used by family caregivers to achieve an harmonious collaborative relationship with the nursing home staff. Institutional social penetration is a dynamic process, which includes three components: self‐disclosure, evaluation of care and penetration strategies. Family caregivers, who had developed a ‘socially penetrating’ relationship with the nursing home staff, were more likely to disclose information in more breadth and depth, to receive positive care evaluations and to adopt multiple effective penetration strategies. Conclusions. Institutional social penetration between family caregivers and nursing home staff can sensitize healthcare providers to meet the family's needs during the placement of their loved one and provide a basis for developing intervention strategies. Relevance to clinical practice. Findings of this study may help healthcare providers to understand the ways in which collaborative relationships develop between the families of elders with dementia and nursing home staff. Interventions can be developed to facilitate self‐disclosure of both the family members and nursing home staff through timely feedback and familiarising family caregivers with different penetration strategies.     

Humanism in forensic psychiatry: the use of the tidal nursing model

Humanism in forensic psychiatry: the use of the tidal nursing model
The humanist school of thought, which finds resonance in many conceptual models and theories designed to guide nursing practice, needs to be understood in the context of the total institution, where the individual is subjected to a mortification of the self , and denied autonomy. This article will engage in a critical reflection on how humanism has influenced nursing theorists and the subsequent production of conceptual models and theories, especially as they relate to the field of forensic psychiatric nursing. Although humanism provides optimism for nurse–patient relations, this article explores the incapability of such a philosophy to acknowledge the power relationships between individuals and its inability to explain the day-to-day realities experienced in forensic nursing, where the possibility of interpersonal violence reshapes nursing care. The tidal model will be discussed in detail as an example of a recently developed humanistic nursing model. Viewed from this perspective, it is clear that humanistic philosophy and its subsequent models of care are in discordance with the highly specialized field of forensic nursing.     

The evolution of an intervention — the use of Peplau's process of practice-based theory development

In 1969, at the first Nursing Theory Conference, Hildegard Peplau proposed a research methodology that would guide the development of nursing knowledge. To direct nurses in the development of practice-based theory, Peplau proposed a three-step process that would assist in this pursuit. The purpose of this paper is to describe the use of Peplau's process of practice-based theory development as it has directed a program of research in the area of depression. Peplau's ideas related to practice-based theory development came at a time in nursing when grand theories were being developed and theoretical nursing was highly valued. Peplau, ahead of her time, proposed an approach that valued the development of nursing knowledge in practice, while also combining both qualitative and quantitative methods. This research methodology deserves recognition today, as one that can guide knowledge development in psychiatric nursing.     

Developing a Restraint-Reduction Program for Child/ Adolescent Inpatient Treatment

TOPIC: Meeting mandated guidelines to reduce, if not eliminate, the use of restraints with children and adolescents hospitalized on inpatient psychiatric units. PURPOSE: To present eight promising options for restraint reduction with inpatient children and adolescents, and the research that supports their efficacy. SOURCES: Review of the literature. CONCLUSION: By combining what is known about child/adolescent restraint use with restraint-reduction research in the adult field, several options for restraint reduction can be derived.     

“三制一体”护理模式对推进精神科优质护理服务的影响

目的 探讨“三制一体”护理模式对推进精神科优质护理服务的影响。方法 选取我院2012年4月—2013年3月优质护理服务示范病区100例患者为研究组,普通病区100例同期住院患者为对照组。研究组采用新制定的服务标准,并采用“三制一体”护理模式,对照组采用传统服务标准及护理模式对患者实施护理。对两组患者住院满意度、住院患者家属满意度、住院患者健康教育知识知晓率及护理质量进行比较。结果 研究组的患者住院满意度、住院患者家属满意度、健康教育知识知晓率及护理质量与对照组比较,差异有统计学意义(P<0.05)。结论 精神科“三制一体”护理模式有利于进一步提高护理服务质量,提高患者及家属满意度,提高患者健康教育知识知晓率,是一项推进精神科优质护理服务行之有效的护理工作模式。     

Meleis's theory of nursing transitions and relatives' experiences of nursing home entry

AIM: This paper explores the extent to which Meleis's mid-range theory of nursing transitions is supported by the findings of a study exploring relatives' experiences of the move to a nursing home. BACKGROUND: Mid-range nursing theories are useful tools in helping to understand the scope of nursing practice in a range of contexts and situations. However, as yet, many formal mid-range theories have not been adequately tested. METHODS: Findings from a constructivist study of relatives' experiences of nursing home entry were re-analysed in relation to the extent to which they reflected the domains of the theory of nursing transitions. Data for the original study were generated during 37 qualitative interviews involving 48 close family members of older people who had recently moved to a nursing home, and in observational case studies in three nursing homes. FINDINGS: All domains of the theory of nursing transition were supported by the data generated within the study. However, the model failed to represent adequately the interactive and dynamic nature of relationships between formal and informal caregivers in the nursing home context. CONCLUSIONS: The theory of nursing transitions has the potential to assist nurses in identifying appropriate strategies for supporting relatives throughout the period of an older person's relocation to a nursing home. However, in order to reflect fully the experiences of relatives at this time, the theory requires adjustment to recognize the contribution made by relatives themselves to positive outcomes. This therefore raises questions as to whether the relative absence of this reciprocal and interactive dimension is an element of Meleis's theory that requires further exploration in relation to other forms of transition.     

“优质护理示范工程”中关键接触点的应用效果探讨

目的探讨在“优质护理示范工程”中运用关键接触点的管理提高住院患者满意度的效果。方法利用调查问卷的形式对142例住院患者和124名直系家属进行关键接触点的调查,对相关项目进行分析,找出影响住院患者满意度的关键接触点,制定相应的护理对策。结果护理人员整体素质明显提高,服务意识增强,护理质量得到持续改进,提高了住院患者满意度。结论在“优质护理示范工程”中实施关键接触点的管理能提高住院患者的满意度。     

"优质护理示范工程"中关键接触点的应用效果探讨

目的 探讨在"优质护理示范工程"中运用关键接触点的管理提高住院患者满意度的效果.方法 利用调查问卷的形式对142例住院患者和124名直系家属进行关键接触点的调查,对相关项目进行分析,找出影响住院患者满意度的关键接触点,制定相应的护理对策.结果 护理人员整体素质明显提高,服务意识增强,护理质量得到持续改进,提高了住院患者满意度.结论 在"优质护理示范工程"中实施关键接触点的管理能提高住院患者的满意度.     

不同性别住院精神病病人对护理人员攻击行为的特点

目的分析不同性别住院精神病病人攻击行为的特点。方法收集2002～2004年北京回龙观医院住院精神病病人针对护理人员攻击行为的相关资料进行分析。结果男女病人攻击行为发生率无显著性差异,女性病人病程短、住院时间短,短期内多次出现攻击行为,发生攻击行为的原因以精神症状支配居多,伤害方式以抓伤为主。而男性病人发生攻击行为原因中治疗护理不合作较女性突出,伤害方式多为拳击。结论年龄轻、文化程度低、首次住院的病人易出现攻击行为。不同性别的住院精神病病人攻击行为发生率无差异,攻击行为发生无昼夜区别,男女护士遭受攻击的几率基本相同。     

优质护理服务在精神科的应用效果

目的:探讨优质护理服务在精神科的应用效果。方法:将"优质护理示范病房"收治的160例住院精神病患者作为研究组,在一般精神科常规治疗与护理的基础上实施优质护理服务。将普通病房同期住院的160例精神病患者作为对照组,给予一般精神科常规治疗与护理。对两组患者的护理工作满意度、安全风险事件评估、健康教育知识知晓率进行比较。结果:研究组患者对护理工作满意度、健康教育知识知晓率显著优于对照组,安全风险事件显著低于对照组(P<0.001或P<0.05)。结论:精神科优质护理服务可以提高整体护理水平及患者对护理工作满意度,减少安全风险事件的发生,提高患者健康教育知识知晓率和依从性,是一项行之有效的护理工作模式。     

Critical realism and psychiatric nursing: a philosophical inquiry

BACKGROUND: There is a tension within contemporary psychiatric nursing between those who would embrace the knowledge and methods of psychiatry and psychology, and those who instead argue for the development of an autonomous nursing profession. This tension cannot be resolved by way of the underpinning philosophies of these positions, namely empiricism and idealism. Instead, critical realism, positioned between these philosophies offers a methodology through which to seek a new paradigm. AIM: This paper aims to determine whether psychiatric nursing has the potential to exist as an independent and autonomous profession, concerned with providing a helping response to those in mental distress. METHOD: The paper asks critical realism's transcendental question in order to identify the a priori requirements of an autonomous psychiatric nursing, independent of both psychiatry and psychology. Consideration of these a priori requirements includes selected information from contemporary texts in order to identify potentially helpful nursing responses to mental distress, as opposed to the theorising that surrounds these helping responses. FINDINGS: The theories of psychiatry and psychology are neither necessary nor sufficient in providing a foundation for an autonomous psychiatric nursing. While medications have an intrinsic helpfulness for some people, for some of their problems, for some of the time, this does not illuminate the causes of mental distress. There is an intrinsic helping response in human interpersonal communication, yet this is not specific to 'psychotherapy' and does not 'belong' solely to psychotherapists. CONCLUSION: Support is found for an autonomous and independent profession of psychiatric nursing, able to provide a helping response to those in mental distress independent of psychiatry and psychology.     

To do good might hurt bad: Exploring nurses' understanding and approach to suffering in forensic psychiatric settings

Patients in forensic psychiatric settings not only have to deal with their mental illness, but also memories of criminal activities and being involuntarily hospitalized. The aim of the present study was to explore how nurses working in forensic psychiatric services understand and approach patients' experiences of suffering. Data were generated by semistructured interviews with psychiatric nurses from two different forensic psychiatric units in Sweden. Data were analysed by means of a hermeneutic approach inspired by Ricoeur's hermeneutics. The findings are reflected in four main themes: (i) ignoring suffering; (ii) explaining suffering as a natural and inevitable part of daily life in the forensic context; (iii) ascribing meaning to suffering; and, (iv) being present in suffering. To engage in alleviating suffering is a struggle that demands courage and the strength to reflect on its character and consequences. To encounter suffering means that nurses are not only confronted with patients' suffering, but also their own reactions to those patients. If suffering is not recognized or encountered, there is a risk that actions may have a negative impact on patients.     

The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing

Nursing theories and nursing models have a low profile within psychiatric and mental health nursing in the United Kingdom. This paper describes the philosophical and theoretical background of the Tidal Model, which emerged from a 5-year study of the 'need for psychiatric nursing'. The Tidal Model extends and develops some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice. The model also integrates discrete processes for re-empowering the person who is disempowered by mental distress or psychiatric services or both. The paper reports briefly on the ongoing evaluation of the model in practice.     

Police and pastoral power: governmentality and correctional forensic psychiatric nursing

Police and pastoral power: governmentality and correctional forensic psychiatric nursing Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power - sovereign, disciplinary and pastoral - which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis.     

Development of the ethical dimension in nursing theory

Nurses encounter ethical dilemmas in their practice and need guidance in making relevant patient-care decisions. Nursing theory is believed to be the best source of such guidance. The aim of this paper is to describe the ethical dimension in nursing theory. A literature review shows the intricate relationship between ethics and nursing, yet there is lack of elaboration of ethical features in nursing theories. The identified elements of the ethical dimension include ethical theories and principles, values, ethical practice issues, moral reasoning and contextual factors. Criteria for the development and evaluation of the ethical dimension are presented, with an example using a middle range theory. The ethical components pertinent to a nursing theory need to be made explicit if theory is to guide practice. Nursing scholars are invited to elucidate the ethical dimension in their theories in order to enhance moral reasoning and provide a framework for ethical practice.     

脑卒中患者家庭主要照顾者的照顾压力及护理方案

目的:研究脑卒中患者家庭主要照顾者的照顾压力现状及其对照顾者健康状况的影响等,探讨减轻照顾者压力的护理方案。方法:2004年12月至2005年10月选择福州市3所省级综合性“三甲”医院、2所市级综合性“二甲”医院住院的脑卒中患者的家庭主要照顾者进行研究。采用自制问卷、照顾者压力量表(CSI)中文版、医院用焦虑抑郁量表(HAD)收集相关资料。结果:有照顾压力者(CSI总分≥7分)100人,占总人数的63.7%。HAD量表显示30.8%的照顾者肯定有焦虑,25.6%的照顾者肯定有抑郁。结论:照顾者身体、社交的压力最大,其次是工作、经济压力,而心理压力相对小些。照顾压力使照顾者产生焦虑、抑郁症状,使照顾者自我感觉身体健康状况变差。护理人员可以通过评估照顾者的压力和需求,给予相应的护理干预,减轻照顾者的压力。     

气管切开患儿照顾者居家照护体验的质性研究

目的探讨长期气管切开患儿照顾者的居家照护体验。方法采用半结构式访谈法,访谈13名照顾者,并依据Miles和Hurberman提出的质性研究资料分析法予以分析。结果经不断分析比对,共析出长期气管切开照顾者"照护负荷"、"精神困扰"及"益处发现"3个主题;"从束手无策到熟练掌握"、"亲职角色改变"、"社交隔离"等8个亚主题。结论临床工作者通过了解长期气管切开照顾者的照护体验,了解其身心反应、照护需求等。可在长期气管切开患儿入院时即构建个性化的延续护理方案,合理安排其出院后日常生活;培训照顾者各项专业操作,训练其心理调适技巧,而且可通过挖掘其自身资源促进照顾者体验积极心理变化等,以实现良好心理适应;促进患儿康复,提高其生活质量。