RESUMEN
In an era of health care that is driven by biological and technical advances, there is a need to safeguard the caring component of care, the humanistic part of care. With this in mind, the authors constructed a Patient-Centered Caring model consisting of three overlapping constructs: delivering customer service, understanding the illness experience, and providing trauma-informed care. These practices operate within an interprofessional competency context. The authors describe an interprofessional educational project focused on understanding the illness experience and providing trauma-informed care to faculty, staff, and administrators in an inpatient psychiatric setting. The authors discuss the project through a number of ethical lenses that may help explicate the ethics of patient-centered care and caring and can be useful in the development of interprofessional competence.
Asunto(s)
Colaboración Intersectorial , Trastornos Mentales/terapia , Atención Dirigida al Paciente/ética , Atención Dirigida al Paciente/métodos , HumanosRESUMEN
BACKGROUND: In 2015, the Co-Chairs and Steering Committee of the Research Council members recognized the need to reevaluate the council's priorities. OBJECTIVE: To determine the top priorities for the Research Council. DESIGN: Use of liberating structures: Impromptu Speed Networking, 1-2-4-all, and Crowd Sourcing. RESULTS: Identified Research Council priorities included the following: efforts to increase psychiatric mental health (PMH) research funding; serve as a connector to bring researchers together; foster research through state chapters; increase collaboration between PhDs and DNPs; and develop models for organizational support for PMH staff nurse involvement in research. CONCLUSIONS: The liberating structures used are valuable strategies for engaging groups of people to identify what matters most to the group. Through the use of these novel techniques, the American Psychiatric Nurses Association Research Council has identified priorities for the work of the council. This has led to actions planned for the coming future with the intent to move PMH nursing research forward.
Asunto(s)
Enfermería Psiquiátrica , Investigación en EnfermeríaRESUMEN
Psychiatric nurse executives and managers face an ongoing challenge to create positive professional work environments that support the recruitment and retention of the best nurses. The Pathway to Excellence program is an organizational credentialing program that designates a hospital as a workplace of choice for nursing. This article describes one psychiatric hospital's journey to become and maintain a Pathway to Excellence designation in the midst of transition. Challenges faced and novel approaches used, along the journey, are shared. The use of Appreciative Inquiry techniques has led to positive changes and heightened energy among nurses. Our experiences suggest that effective shared governance is central to a hospital's Pathway to Excellence success. We attribute the steady increase in the retention rate of nurses, in large part, to the Pathway to Excellence program.
Asunto(s)
Hospitales Psiquiátricos/normas , Satisfacción en el Trabajo , Lugar de Trabajo/normas , Humanos , Enfermeras Administradoras/tendencias , Recursos HumanosRESUMEN
BACKGROUND: Mothers of very preterm infants continue to face challenges related to providing their expressed breast milk in the neonatal intensive care unit (NICU). OBJECTIVE: This qualitative study sought to understand the experience of mothers of hospitalized very preterm infants related to their daily pumping routine during the NICU stay. METHODS: Fourteen women who were pumping breast milk for their hospitalized infants were interviewed. Sequential, semistructured, audiotaped individual interviews were conducted at 2 different time points: within 2 weeks following delivery when the mothers were pumping only, and 4 to 6 weeks once breastfeeding had been initiated. RESULTS: The central themes found were: becoming a "mother-interrupted" and negotiating a paradoxical experience of separation and connection. Unique to these findings were the paradoxical view of the pump as both a wedge and a link to their infants, the intense dislike the mothers had for the tasks required to provide their expressed breast milk, and diversionary tactics used during pumping sessions. CONCLUSION: The complexity of thoughts, actions, and behaviors revealed in the mothers' narrative accounts provides a guide to direct future breastfeeding interventions and management.
Asunto(s)
Actitud Frente a la Salud , Extracción de Leche Materna/psicología , Unidades de Cuidado Intensivo Neonatal , Relaciones Madre-Hijo/psicología , Madres/psicología , Adulto , Lactancia Materna/psicología , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Entrevistas como Asunto , Investigación Cualitativa , TexasRESUMEN
BACKGROUND: Concerns for patient safety have risen to the forefront of health care, including mental health care. Safe patient care depends, to a large extent, on high functioning teams, yet team training is lacking in basic professional training programs. To address the need for team training, one psychiatric hospital adopted the Team Strategies and Tools to Enhance Performance and Patient Safety program (TeamSTEPPS). OBJECTIVES: To describe the implementation of TeamSTEPPS throughout the organization and to describe the differences in team attributes prior to and following implementation of TeamSTEPPS. DESIGN: Quality improvement project using a pre-post survey design. RESULTS: TeamSTEPPS was successfully implemented, and changes in all team attributes trended in a positive direction with 5 of 7 subscales reaching significance (p ≤ .01). CONCLUSIONS: TeamSTEPPS provided a practical approach for our hospital to systematically weave safety throughout the culture and improve team functioning and other attributes of highly effective teams.
Asunto(s)
Hospitales Psiquiátricos/organización & administración , Seguridad del Paciente/normas , Evaluación de Programas y Proyectos de Salud/métodos , Garantía de la Calidad de Atención de Salud/organización & administración , Encuestas de Atención de la Salud/métodos , Encuestas de Atención de la Salud/estadística & datos numéricos , Hospitales Psiquiátricos/normas , Humanos , Capacitación en Servicio/métodos , Capacitación en Servicio/organización & administración , Comunicación Interdisciplinaria , Cultura Organizacional , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Seguridad del Paciente/estadística & datos numéricos , Desarrollo de Programa , Garantía de la Calidad de Atención de Salud/métodosRESUMEN
The authors describe an evolving outcomes project implemented across the adult inpatient programs at The Menninger Clinic. In the inpatient phase of the project, patients complete a computerized battery of standardized scales at admission, at biweekly intervals throughout treatment, and at discharge. In addition to providing aggregate data for outcomes research, these assessments are incorporated into routine clinical care, with results of each individual assessment provided to the treatment team and to the patient. The inpatient phase of the project employs Web-based software in preparation for a forthcoming follow-up phase in which patients will continue after discharge to complete assessments on the same computer platform. This article begins with a brief overview of related research at the Clinic to place the current project in local historical context. Then the authors describe the assessment instruments, the ways in which the assessments are integrated into clinical care, plans for follow-up assessments, the central role of information technology in the development and implementation of the project, the primary research questions, and some of the major challenges in implementing the project. The article concludes with a discussion of the ways in which the project can serve as a platform for a broad future research agenda.
Asunto(s)
Prestación Integrada de Atención de Salud/métodos , Hospitalización/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/rehabilitación , Servicios de Salud Mental/organización & administración , Psiquiatría/métodos , Proyectos de Investigación , Estudios de Seguimiento , Humanos , Informática/instrumentación , Ciencia del Laboratorio Clínico , Apoyo Social , Encuestas y Cuestionarios , Resultado del Tratamiento , Estados UnidosRESUMEN
The authors present a first look at the data from The Menninger Clinic Adult Outcomes Project. They provide descriptive data from 443 patients admitted to the Clinic between April 2008 and May 2009. Patients show significant improvement on a range of standardized measures from admission to discharge (effect sizes range from moderate to large, 0.31 to 1.44), and there are some differences among clinical programs within the hospital in the extent of change on some scales. A comparison of patients who did and did not complete discharge assessments showed minimal differences between groups on admissions variables. These results attest to the substantial impact of relatively long-term intensive inpatient treatment on improving clinical symptoms and functioning, but further studies are needed to determine the trajectory of change in the hospital and, most importantly, at follow-up.
Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/rehabilitación , Evaluación de Resultado en la Atención de Salud , Admisión del Paciente/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Adulto , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/rehabilitación , Femenino , Hospitalización , Humanos , Relaciones Interpersonales , Tiempo de Internación/estadística & datos numéricos , Masculino , Sector Privado , Escalas de Valoración Psiquiátrica , Psicología , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Delivery of quality psychiatric nursing care depends, to a certain extent, on nurses' ability to apply sound evidence to practice. Much of the needed evidence is in the form of research. The term evidence-based practice (EBP) is used to describe the application of research and other forms of clinically relevant information to practice. This article provides a historical context for EBP and describes two programs at The Menninger Clinic that support nurses on their journey to excellence and directly impact the quality of nursing care delivered at Menninger. The Evidence-based Practice Scholars Program and the Research Scholars Program are mission critical initiatives at the hospital. The Evidence-based Practice Scholars Program has led to the implementation of EBP policies and guidelines. The first project of the Research Scholars Program has been launched. The results of the program have the potential to improve the quality of nursing care as the current study will inform nurses about patients' perceptions of good nursing care and how these perceptions correspond with professional standards and scope of practice. Whether nurses are interested in being consumers of research or involved in the conduct of research, programs such as these help create a research-minded culture, much needed in contemporary health care arenas. These programs have the potential to transform nursing practice, improve the quality of nursing care, and enhance nursing job satisfaction. These are essential elements needed to sustain an environment that fosters excellence. In an era where patients and providers demand the application of research to health care, organizations must respond by investing in programs to promote excellence in this regard.
Asunto(s)
Medicina Basada en la Evidencia/métodos , Pautas de la Práctica en Medicina/organización & administración , Desarrollo de Programa , Enfermería Psiquiátrica/normas , Proyectos de Investigación , HumanosRESUMEN
The notion of the therapeutic milieu has come under fire for lack of relevance to current inpatient psychiatric care environments. Yet, in different fields of health care, scholars are suggesting a need to build healing environments. A view of the therapeutic milieu as an optimal healing environment based on continuous healing relationships, patient-centered care, safety as a systems priority, and cooperation among clinicians provides a framework to organize care in a holistic manner that supports positive health outcomes. This approach provides a platform for nurses and other clinicians to expand the view of a milieu traditionally limited to the unit environment to one that includes a broad systems context.
Asunto(s)
Trastornos Mentales/terapia , Servicios de Salud Mental , Ambiente de Instituciones de Salud/normas , Ambiente de Instituciones de Salud/tendencias , Humanos , Pacientes Internos , Trastornos Mentales/enfermería , Servicios de Salud Mental/normas , Servicios de Salud Mental/tendencias , Atención Dirigida al Paciente , Enfermería Psiquiátrica/tendenciasRESUMEN
OBJECTIVE: To understand the everyday life experiences of persons who have spasticity associated with spinal cord injury (SCI). DESIGN: Applied ethnographic design. SETTING: Patients' homes and rehabilitation clinics. PARTICIPANTS: Twenty-four people with SCI who experience spasticity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Domains identified through qualitative analysis of in-depth open-ended interviews. RESULTS: Domain analysis revealed 7 domains: physical, activity, emotional, economic, interpersonal, management, and cognitive. Descriptive subcategories within each domain were identified. Patients personalized the meaning of spasticity and expressed their understandings of the condition in ways that may not be consistent with clinical definitions. Some patients suggested that being able to control spasticity was preferable to total suppression. CONCLUSIONS: Spasticity-related interventions need to be aimed at what matters most to the patient. It is critical for clinicians to understand patients' experiences to make accurate assessments, effectively evaluate treatment interventions, and select appropriate management strategies. When providers reconfigure patients' descriptions to fit neatly with a biomedical understanding of spasticity without carefully assessing the descriptions in terms of what matters most to patients, a potential risk for misappropriating interventions may arise.
Asunto(s)
Espasticidad Muscular/psicología , Traumatismos de la Médula Espinal/psicología , Adaptación Psicológica , Adulto , Anciano , Costo de Enfermedad , Emociones , Femenino , Humanos , Relaciones Interpersonales , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Espasticidad Muscular/terapia , Dolor/etiología , Manejo del Dolor , Autocuidado , Índice de Severidad de la Enfermedad , Traumatismos de la Médula Espinal/terapiaRESUMEN
Persons with spinal cord injury (SCI) may experience a range of symptoms typically labeled "spasticity." Previous efforts to develop assessment tools that measure spasticity have failed to represent the experiences of persons who live with the condition. The purpose of this multicenter study was to develop an instrument that measures the impact of spasticity on quality of life. Based on 24 semistructured interviews, a developmental form of the Patient Reported Impact of Spasticity Measure (PRISM) was constructed. The developmental PRISM was administered to 180 persons at five sites. Subscales were developed based on factor analytic results. Evidence for the reliability and validity of the scores was evaluated. Seven subscales were developed, including one that measures the positive effects of spasticity. Results of reliability and validity assessments indicate that the PRISM subscale scores effectively measure the impact of spasticity in the population of veterans with SCI.
Asunto(s)
Procesamiento Automatizado de Datos/métodos , Espasticidad Muscular/diagnóstico , Psicometría/métodos , Traumatismos de la Médula Espinal/rehabilitación , Vértebras Cervicales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/etiología , Espasticidad Muscular/fisiopatología , Calidad de Vida , Reproducibilidad de los Resultados , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico , Encuestas y CuestionariosRESUMEN
TOPIC: Cultural competence in psychiatric advanced practice education. PURPOSE: To present a framework for educators to use when addressing culturally competent advanced psychiatric nursing practice. SOURCES: NONPF competencies, published literature, and Web resources. CONCLUSIONS: Development of cultural competence is an important link to the reduction of mental health disparities. Situating the advanced nursing practice process within a negotiating space allows for incorporation of cultural information into patient care. The framework presented in this paper provides a theoretical and practical approach to orienting students to meeting the elements of cultural competence set out in the NONPF recommendations.
Asunto(s)
Competencia Clínica , Educación de Postgrado en Enfermería/organización & administración , Modelos Educacionales , Enfermeras Practicantes , Enfermería Psiquiátrica , Enfermería Transcultural , Antropología Cultural , Actitud Frente a la Salud/etnología , Comprensión , Diversidad Cultural , Curriculum , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Trastornos Mentales/etnología , Trastornos Mentales/enfermería , Modelos de Enfermería , Negociación/métodos , Negociación/psicología , Enfermeras Practicantes/educación , Enfermeras Practicantes/organización & administración , Enfermeras Practicantes/psicología , Rol de la Enfermera/psicología , Relaciones Enfermero-Paciente , Filosofía en Enfermería , Enfermería Psiquiátrica/educación , Enfermería Psiquiátrica/organización & administración , Enfermería Transcultural/educación , Enfermería Transcultural/organización & administraciónRESUMEN
Psychiatric nurse educators are challenged to prepare graduates in meeting the needs of individuals with a mental illness within an increasingly technology-based environment. This requires the development and evaluation of educational strategies that immerse students in web-based learning. This article presents an overview of a hybrid teaching design that includes classroom teaching and asynchronous threaded discussion in a teaching module in an undergraduate psychiatric nursing course. Evaluation of student preferences, advantages and disadvantages, and learning, as well as qualitative evaluation of students' description of critical thinking, supports the value of online teaching in psychiatric nursing education.
Asunto(s)
Instrucción por Computador/métodos , Bachillerato en Enfermería/organización & administración , Internet/organización & administración , Enfermería Psiquiátrica/educación , Actitud del Personal de Salud , Instrucción por Computador/normas , Curriculum , Necesidades y Demandas de Servicios de Salud , Humanos , Conocimiento , Modelos Educacionales , Modelos Psicológicos , Investigación en Educación de Enfermería , Investigación Metodológica en Enfermería , Sistemas en Línea/organización & administración , Filosofía en Enfermería , Solución de Problemas , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Psicología Educacional , Investigación Cualitativa , Estudiantes de Enfermería/psicología , Enseñanza/organización & administración , Texas , PensamientoRESUMEN
Community health screenings and education programs have been widely used to identify individual health risks and promote early diagnosis and treatment of disease. Participation in these community activities is dependent on the initial health-seeking behaviors of the individual. Focus group interviews1 were conducted with both attendees and nonattendees of a program offering health education and screenings in various settings in a semirural area. The purpose of these group interviews was to better understand issues associated with participation. A domain analysis of the qualitative data revealed that multiple aspects of self-care orientations as well as interpersonal and environmental factors influenced participation. A paradoxical facilitator-inhibitor effect was apparent. The companionship and support inherent in a community setting was an incentive for participation, but also presented concerns about confidentiality. However, concern about getting knowledge about self-care and the fear and anxiety of learning the results of screening tests creates a push-pull dilemma that is a challenge for health care providers. Factors that influence participation in semirural community health screenings are varied and complex and suggest multidimensional approaches be used in designing programs.
Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Tamizaje Masivo , Aceptación de la Atención de Salud/psicología , Ansiedad/psicología , Confidencialidad , Miedo , Grupos Focales , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Tamizaje Masivo/psicología , Tamizaje Masivo/estadística & datos numéricos , Motivación , Investigación Metodológica en Enfermería , Investigación Cualitativa , Medición de Riesgo , Autocuidado , Vergüenza , Apoyo Social , Servicios de Salud Suburbana/estadística & datos numéricos , Encuestas y Cuestionarios , TexasRESUMEN
RATIONALE: Depression is reported as a serious adverse event of antiviral therapy used to treat patients with hepatitis C (HCV); therefore, there is a need to identify a reliable and valid measure of depressive symptoms for this population. AIMS: To determine reliability, construct validity and predictive validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a hepatitis C (HCV) population. ETHICAL ISSUES: Study reviewed/approved by the University Institutional Review Board and informed consent obtained. METHODS: Longitudinal design testing psychometric properties of the CES-D prior to treatment and 4 and 24 weeks postinitiation of treatment. Reliability was tested using Cronbach's coefficient alpha. Construct validity was tested, prior to therapy, using principal components factoring with varimax rotation. Predictive validity was tested using repeated measures analysis of variance (anova) of CES-D scores at 4 and 24 weeks postinitiation of treatment. RESULTS: Non-probability sample, 116 adult HCV patients [62 (53%) males and 54 (47%) females]. Reliability (Cronbach's alpha) = 0.88 pretreatment, 0.89 week 4 and 0.90 week 24. Construct validity testing revealed four factors: negative affect; positive affect; somatic; and depressed affect/somatic. Exception for two items, 'felt sad' and 'couldn't get going', all items loaded distinctly with correlation coefficients in the range of 0.51-0.84. Predictive validity testing revealed a statistically significant effect over time (P < 0.001) in the direction predicted (pretreatment x = 13.97; post 4 weeks x = 19.54 and 24 weeks x = 19.97). CONCLUSIONS: The CES-D is a reliable and valid instrument to screen for depressive symptoms in HCV patients. The instrument detected the predicted increase in depression associated with HCV. Examination of the sensitivity and specificity is needed to determine the most accurate cut-off score.