ABSTRACT
OBJECTIVE: The effect of scheduled intermittent hospitalization on the hospital utilization, community adjustment, and self-esteem of persons with serious and persistent mental illness was examined in an experimental study. METHODS: Fifty-seven male veterans, aged 65 or younger, with a primary axis I psychiatric diagnosis who were frequent utilizers of inpatient care over the previous two years were randomly assigned to two groups. Patients in the experimental group were prescheduled for four hospital admissions, each lasting nine to 11 days, per year for two years. Patients in the control group had traditional access to hospital care. Psychiatric bed days, community adjustment, and self-esteem were assessed during and after the intervention. RESULTS: No differences between the groups on demographic or clinical variables were detected at study entry. The experimental group showed improvement in self-esteem, affect, and complaints of physical symptoms at one year. No statistically significant differences between groups were found in hospital utilization, financial management, substance abuse, or psychological well-being at one year. CONCLUSIONS: Scheduled intermittent hospitalization may be an appropriate and promising alternative to traditional care for revolving-door patients. This intervention could maintain patients at a higher level of wellness than traditional care and reduce the recurrence of the crises that precipitate hospitalization.
Subject(s)
Appointments and Schedules , Episode of Care , Hospitals, Veterans/statistics & numerical data , Mental Disorders/therapy , Patient Care Planning/standards , Adult , Aged , Chi-Square Distribution , Emergency Services, Psychiatric/statistics & numerical data , Follow-Up Studies , Hospitals, Veterans/standards , Humans , Length of Stay , Male , Mental Disorders/psychology , Middle Aged , Patient Compliance , Patient Readmission/statistics & numerical data , Patient Satisfaction , Psychiatric Department, Hospital/statistics & numerical data , Regression Analysis , Self Concept , Social Adjustment , Treatment Outcome , United StatesABSTRACT
The exacerbation of symptoms among chronically ill psychotic clients in the community tends to occur when clients fail to sustain effective self-care behaviors. The authors analyze the various issues that impact self-care within the context of our current nursing paradigm. They also offer a model to guide nurses in providing competent care to these clients.
Subject(s)
Psychotic Disorders/nursing , Self Care , Chronic Disease , Humans , Models, Nursing , Psychiatric NursingABSTRACT
The frequently admitted "revolving door" chronic psychiatric patient presents significant ethical, scientific, and practical challenges to mental health nurses. This article highlights ethical issues relevant to their participation in longitudinal research and describes methods implemented to successfully follow a cohort of such patients over a 2-year period.
Subject(s)
Ethics, Nursing , Mental Disorders/nursing , Mentally Ill Persons , Nursing Research/methods , Research Subjects , Chronic Disease , Humans , Longitudinal Studies , Male , Psychiatric NursingABSTRACT
A retrospective audit of patients' utilization of inpatient psychiatric care at a Department of Veterans Affairs medical center before and after implementation of a prospective payment system compared patterns of utilization by chronic and nonchronic patients. It also examined changes over time in the size of the two groups, total number of bed days used, mean number of admissions, mean length of stay, and mean cumulative two-year length of stay. Four years after implementation of the prospective payment system, chronic patients constituted 3 percent of the patient population but used 15.2 percent of all bed days. Both chronic and nonchronic patients had a similar decrease in mean length of stay over the period, but chronic patients' mean number of admissions rose by more than 70 percent. The mean cumulative two-year length of stay of chronic patients remained stable over the period while that of the nonchronic patients decreased by 33.2 percent.
