Le Q-sort, un outil pour la recherche en soins le cas des représentations chez les infirmiers en psychiatrie de l'âge avancé [Q-sort, a useful research method in care in cases of psychiatric nursing of the aged]

Q-sort is a research method which allows defining profiles of attitudes toward a set of statements, ordered in relation to each other. Pertaining to the Q Methodology, the qualitative analysis of the Q-sorts is based on quantitative techniques. This method is of particular interest for research in health professions, a field in which attitudes of patients and professionals are very important. The method is presented in this article, along with an example of application in nursing in old age psychiatry.

Community Health Nursing: Current Practice and Possible Futures (PDF 298 KB)

Community Health Nursing: Current Practice and Possible Futures

The Changing Face of Psychiatric Nursing –Care or Control?

This report has been written as part of the project “Toward improved quality – developing nurse’s continuing vocational training in hospitals and inpatient units”. Its overall goal is to ensure high quality, ethically appropriate and therapeutically effective interventions to enable nurses to manage distressed and disturbed patients in European psychiatric hospitals and inpatient units. In this large-scale, multinational projects there are all together six European countries involved: Finland, Ireland, England, Portugal, Italy and Lithuania. The project work plan were during autumn 2006 and spring 2007. The content of this publication was produced in the first stage of the project aiming to collect the preliminary source material for the project. The literature review was carried out in the project stage, providing the groundwork for the next steps for the project. This project aims to develop an interactive multinational portal with training material. Therefore, it is important to share an understanding of basic information, psychiatric nurse’s continuing vocational education, laws and ethical codes and patient restriction used in mental health care. In this publication, the purpose of the material produced here is to understand nurses’ educational need related to vocational continuing education and to be used in further project stages as an empirical data collection. The data were collected as a preliminary source material for latter phases where nurse’s perceptions of the current practice, nurse’s attitudes to mental illness, prevalence of use of seclusion room and existing and desired vocational training provision will be collected in six different European countries. The following organisations are involved in this project: University of Turku, Dublin City University, St. Vincent Hospital, National Council for the Professional Development of Nursing and Midwifery, University of Padova, Klaipeda College - Health Faculty, Klaipeda Psychiatric Hospital, Escola Superior de Enfermagem de Lisboa, Centro Hospitalar Psiquiátrico de Lisboa, Omnia Vocational Institution the Espoo Region, Kellokoski psychiatric hospital, Hyvinkää hospital area, Pirkanmaa Hospital District, Kingston University & St. George’s Medical School and South West London & St. George’s Mental Health NHS Trust. A wide variety of different countries, organisations and individuals in this project give us a strong confidence that theoretical, practical, ethical and political issues around the topic of interest will be taken account during this project lifetime. We are aware the content of this book will be partially outdated almost as soon as it has been published. We still hope that this publication will encourage nurses and different professions working in mental health care field to have a basic understanding of similarities and differences between different European countries related in mental health care. We also hope that this publication will inspirate and motivate nurses in maintaining and developing the quality of psychiatric care in Europe.

Adoption of information technology based patient education in psychiatric nursing

The overall goal of the study was to describe adoption of information technology (IT)-based patient education (PE) developed for patients and nurses use in psychiatric nursing. The data were collected in three phases during the period 2000-2006 in a variety of psychiatric settings in Finland. Firstly, the development process of IT-based PE for patients with schizophrenia spectrum psychosis was described. Secondly, nurses’ adoption of IT-based PE and the variables explaining adoption were demonstrated. Moreover, use of daily IT-based PE in clinical practice and factors associated with use were identified and described. And thirdly, nurses’ experiences of the IT-based PE after one year clinical use were evaluated. IT-based PE program was developed in several stages based on users’ needs and it included information and multimedia applications. Altogether, almost 500 IT-based PE sessions were carried out by the nurses on the study wards and revealed nurses’ activity in educating patients using IT to vary and depend on the hospital in which they worked. Almost 80% of all the possible IT-based PE sessions involved 93 patients and 83 nurses. Less than 2% of the IT-based PE sessions were interrupted and less than 10% suffered disturbances due to the patients or external causes. Moreover, the patients whose education took more days had poorer mental status than those whose education was carried out over a shorter period. After a year’s experience, advantages and disadvantages were described by the nurses for both patients and nurses of the IT-based PE. IT-based PE can be used even on closed acute psychiatric wards with patients with serious mental health disorders. However, technology adoption requires time, and therefore, it must fit in with clinical practice. Collaboration between users and developers is needed when developing user-centered methods in the area of mental health services. Moreover, it is important to understand factors that affect IT adoption in healthcare settings. IT-based PE is one option in interactive and co-operative health care practice between patients and nurses. Therefore the staff should begin to refer patients to established, credible and well-maintained Internet sites that provide information on common psychological problems. Even if every nurse should be trained and engaged to carry out IT-based PE, by targeting the training especially for the most active nurses aids them to support the less active ones. Adoption should also be understood from a perspective that includes aspects related to the context where it is implemented and examine how and in what circumstances it works.

Evaluation of an e-learning course: coercion practices in psychiatric nursing

The goal of the study was to evaluate an e-learning course entitled “Nursing interventions to manage distressed and disturbed patients” and intended for psychiatric nurses, using Kirkpatrick’s evaluation model. The aim was to describe nurses’ reactions, learning, behaviour change and impacts resulting from this e-learning course. This dissertation comprises four papers, and the data were collected 2008-2012 from three different sources; electronic databases, an e-learning platform and psychiatric hospitals. First, a systematic literature review was conducted to understand the effectiveness of e-learning. Second, an RCT study was implemented to investigate the impact of the e-learning course on nurses’ job-satisfaction, knowledge and attitudes (N=158). Third, to complete the picture of nurses views of the e-learning course related to knowledge transfer, the nurses’ perspective was studied (N=33). Lastly, the effects of the e-learning course from nursing managers’ perspective in psychiatric hospital organisations were studied (N=28). The systematic review showed that although the nurses were satisfied with the e-learning, no effects were found in the RCT study of nurses’ job satisfaction. The RCT study showed no effects on nurses’ learning related to knowledge increase, but there was change in attitudes. The managers described the changes in the nurses’ knowledge and attitudes. Among the nurses behaviour changed with knowledge transfer from the e-learning course to practice and they pointed out development issues related to their work. The final impacts of the e-learning course revealed advantages and disadvantages of the e-learning course and its implications for nurses’ work. This dissertation provides new insight into nurses’ reactions, learning, behaviour change and impacts resulting from an e-learning course in their continuing education. In order to improve nurses’ continuing education systematic evaluation is needed, for which Kirkpatrick’s evaluation model is a useful tool.

Nursing papers presented at the Psychiatric Nursing Institute.

Mode of access: Internet.

Stressful times call for team-based measures:psychiatric nursing in the UK National Health Service

Background: Team-based working is now an inherent part of effective health care delivery. Previous research has identified that team working is associated with positive mental health and well-being outcomes for individuals operating in an effective team environment. This is a particularly important topic in the health services context, although little empirical attention has been paid to mental-health services. Psychiatric nurses work on a day-to-day basis with a particularly stressful and demanding client group in an environment which is characterised by high demands, uncertainty, and limited resources. This paper specifically focuses on psychiatric nurses working in National Health Service (NHS) and casts some light on the ways in which effective team-based working can help to alleviate a number of occupational stressors and strains. Method: A questionnaire method (2005 NHS Staff Survey) was employed to collect data from 6655 psychiatric nurses from 64 different NHS Trusts. The hypotheses were concerned with four overall measures from the survey; effective team working, occupational stress, work pressure and social support. Hypothesis 1 stated that effective team working will have a significant negative relationship with occupational stress and work pressure. Further, Hypothesis 2 stated that social support from supervisors and co-workers will moderate this relationship. Findings: Data was treated with a series of regression analyses. For Hypothesis 1, working in a real team did have main effects on work pressure and accounted for 1.6 per cent of the variance. Using the Nagelkerke R square value, working in a real team also had main effects on occupational stress an accounted for approximately 2.8 per cent of the variance. Further, the Exp (B) value of 0.662 suggests that the odds of suffering from occupational stress are cut by 33.8 per cent when a psychiatric nurse works in a real team. Results failed to provide support for Hypothesis 2. The analysis then went on to adopt a unique approach for assessing the extent of real team-based working, distinguishing between real teams, and a number of pseudo team typologies, as well as the absence of teamwork all together. As was hypothesised, results demonstrated that psychiatric nurses working in real teams (ones with clear objectives, where-by team members work closely with one another to achieve team objectives and meet regularly to discuss team effectiveness and how it can be improved) experienced the lowest levels of stress and work pressure of the sample. However, contrary to prediction, results indicated that psychiatric nurses working in any type of pseudo team actually experienced significantly higher levels of stress and work pressure than those who did not report as working in a team at all. Discussion: These findings have serious implications for NHS Mental Health Trusts, which may not be implementing, structuring and managing their nursing teams adequately. Indeed, results suggest that poorly-structured team work may actually facilitate stress and pressure in the workplace. Conversely, well-structured real teams serve to reduce stress and work pressure, which in turn not only enhances the working lives and well-being of psychiatric nurses, but also greatly improves the service that the NHS provides to its users.

Expérience de familles cohabitant avec un proche atteint de trouble mental persistant faisant partie d'un programme de services individualisés (PSI) en Catalogne

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

OBJECTIVE Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo. METHOD An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5. RESULTS Knowledge of the precautions received a high score (4.69); adherence received (3.86) and obstacles (3.78), while intermediaries and the scales of organizational factors received low scores (2.61). There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000). The training scale for prevention of HIV exposure (p = 0.007) was statistically different between the nurses and nursing assistants. CONCLUSION The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections.

The core characteristics and nursing care activities in psychiatric intensive care units in Sweden

Internationally, research on psychiatric intensive care units (PICUs) commonly reportsresults from demographic studies such as criteria for admission, need for involuntary treatment, andthe occurrence of violent behaviour. A few international studies describe the caring aspect of thePICUs based specifically on caregivers’ experiences. The concept of PICU in Sweden is not clearlydefined. The aim of this study is to describe the core characteristics of a PICU in Sweden and todescribe the care activities provided for patients admitted to the PICUs. Critical incident techniquewas used as the research method. Eighteen caregivers at a PICU participated in the study bycompleting a semistructured questionnaire. In-depth interviews with three nurses and two assistantnurses also constitute the data. An analysis of the content identified four categories that characterizethe core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours, andtemporarily coercive measure. Care activities for PICUs were also analysed and identified as controlling– establishing boundaries, protecting – warding off, supporting – giving intensive assistance, andstructuring the environment. Finally, the discussion put focus on determining the intensive aspect ofpsychiatric care which has not been done in a Swedish perspective before. PICUs were interpreted asa level of care as it is composed by limited structures and closeness in care.