Developing and testing instruments for improving cooperation and patient's participation in mental health care.

The main purpose of the project was to develop computerized instruments that could be used by nurses and patients to assess their cooperation and mutual contributions to care. This paper presents a part of the project: the reliability and validity testing phase of a process of instrument development. To test the validity and reliability of the instruments, data were collected with questionnaires from nurses (n = 146) and patients (n = 286). The validity evaluated as construct validity and the reliability evaluated as internal consistency of the instruments were quite good. Construct validity was tested by factor analysis, and internal consistency was tested by Cronbach's alpha coefficient, which varied from 0.69 to 0.79. The instruments, which consisted of a software application that can be operated in a www environment, were meant to be used as tools in the psychiatric nursing context for assessing the cooperation between the nurses and patients and the patient's participation in his/her care. Furthermore, the computer programme can be used as a tool for developing and assessing the patient orientation in nursing.

Developing and testing methods for improving patient-oriented mental health care.

There is a trend in nursing policy and practice towards allowing patients to participate actively in their treatment and the services they use. The author concludes, based on an earlier qualitative study, that psychiatric patients in a hospital environment want a more active role in their treatment and that psychiatric nurses also aim at more active patient participation. In mental health care, professionals often define the needs of patients in terms of their own expertise and tend to overlook the variety of the service users' needs. The need to improve and empower psychiatric patients is a considerable challenge to present-day nursing. The purpose of this paper is to describe the theoretical background of tools used to assess patients' involvement in mental health care and the process by which credibility can be determined in rating the panel phase of instrument construction. The instruments, based on a qualitative study using grounded theory, produced a model of patient initiatives in psychiatric nursing. Content validity refers to the determination of the substantive representativeness or relevance of the items of an instrument. Face validity has been defined as validity conferred by a lay persons' acceptance that a procedure, statement or instrument appears to be sound or relevant. In the panel rating, the raters were experts. They evaluated the readability, consistency and content validity of the instruments' items. In the instrument for nurses, the content validity was 0.84 and consistency 0.91; this corresponds to 0.91 and 0.95, respectively, in the instrument for patients.

Applying ethical guidelines in nursing research on people with mental illness.

This article describes how ethical guidelines have been applied while interviewing psychiatric patients who were recovering from mental illness, especially from psychosis, to allow nurses to understand these patients' experiences. Because psychiatric patients are vulnerable, their participation in research involves ethical dilemmas, such as voluntary consent, legal capacity to consent, freedom of choice, and sufficient knowledge and comprehension. The first part of this article describes the most important ethical guidelines concerning human research. These have been published by different organizations, departments, committees and commissions for the purpose of protecting human rights and dignity whenever research participants are vulnerable persons or their capacity to consent is limited. At present, however, no special regulations govern research involving adults who have been diagnosed with a condition characterized by mental impairment. Furthermore, a relatively small body of research has documented the effects of various disorders (e.g. psychiatric conditions) on decision-making capacity per se. One basic moral and policy question is whether these individuals should ever be involved in research. The second part of this article concentrates on how the investigator made sure that participating patients had understood their role in this particular piece of nursing research. During the interviews the investigator noticed that some ethical dilemmas required further study and debate because of the lack of consensus on the proposed regulatory provisions on research involving institutionalized persons and their ability to make an informed and voluntary decision.

Videotaped recording as a method of participant observation in psychiatric nursing research.

This paper describes videotaped recording as a data collection method when conducting participant observation in a psychiatric nursing study. The videotaped episodes were part of the daily life of psychiatric nursing in a hospital environment. The advantages and limitations of using videotaped recording in nursing research will be discussed. This paper is based on two studies. The data consisted of 21 videotaped episodes of nursing report sessions or interdisciplinary team meetings in the psychiatric clinic of a university hospital. The participants consisted of patients, their significant others, nurses, doctors, social workers and physiotherapists. All videotaped material was transcribed verbatim. An essential advantage of videotaping is that most potentially useful interaction and behaviour can be captured. The advantage in terms of the credibility of videotaping was that the investigator was able to review the same videotaped situations again and again. Videotaped material is rich and provides several possibilities for analysing the data. In these studies data and source triangulation enabled the researchers to reduce personal influence on the results. The investigator must also be aware of the limitations concerning this method. The most essential limitations are mechanical problems and the influence of videotaping on behaviour. Careful ethical considerations are important concerning personal privacy, informed consent and respect for the self-determination of psychiatric patients.

Passive patients: a challenge to psychiatric nurses.

TOPIC: Psychiatric patients' participation in their care. PURPOSE: To describe psychiatric patients' participation in their own care in a hospital environment. METHODS: Data were collected by videotaping different nursing situations (n = 10) and recording interviews of the patients (n = 16), nurses (n = 29), and nursing students (n = 7) afterward. Deductive content analysis techniques were used to analyze the written data, using the following categories of psychiatric patients' participation as a theoretical framework: passive recipient, responsible recipient, and responsible participant. FINDINGS: The results showed that 64% of the patients were passive recipients of care, 22% were responsible recipients, and 14% were responsible participants. CONCLUSIONS: Patients' participation as responsible participants in their care provides a foundation for better collaboration, listening to the patient, participatory dialogue, and resource recognition.

Patient initiatives during the assessment and planning of psychiatric nursing in a hospital environment.

The qualitative study reported in this paper aims to describe the planning and assessment of psychiatric nursing in a hospital environment. The theoretical framework consists of the three types of psychiatric nursing outlined in a developmental model of nursing: confirmatory, educational and catalytic. Confirmatory psychiatric nursing is based on a hierarchical and authoritarian model. Educational psychiatric nursing is based on a professionally driven and behavioural model. Catalytic psychiatric nursing is systematic, theoretical, and research-based. Catalytic psychiatric nursing may vary, depending on the patient's needs, from confirmatory and educational to situationally determined nursing. However, it always enables patient initiatives. The purpose of this paper is to describe patient initiatives during the assessment and planning of patient care by an interdisciplinary mental health team in a psychiatric hospital environment, and the assessment and planning as described by nurses working in a hospital environment. The data, which were collected in two psychiatric hospitals by videotaping interdisciplinary teamwork situations and recording interviews of nurses afterwards, consisted of 384 pages of written text. A total of 640 sentences were identified in the text as reflecting the assessment of care by the interdisciplinary team and by the nurses working in the hospital environment. Deductive content analysis techniques were used to analyse the written data. The results showed that nursing was described by the nurses to be catalytic in 13% of the cases, while the same nurses assessed psychiatric nursing to be most commonly educational (40%) or confirmatory (47%).

Ethical dilemmas in a psychiatric nursing study.

This article describes the ethical dilemmas encountered by the authors while conducting qualitative research with psychiatric patients as participants. The ethical conflicts are explored in terms of the principles of personal autonomy, voluntariness and awareness of the purpose of the study, with illustrations from the authors' research experience. This study addresses the everyday life of psychiatric nursing in a psychiatric hospital as described by patients, nurses and nursing students. The data were collected in a university hospital in northern Finland, using videotaped observations and recorded interviews. Although no definitive resolutions are proposed to the conflicts, the article endeavours to enhance awareness of the ethically perplexing situations possibly encountered by researchers during a study process. The institution where the study was conducted has a Research Board entitled to resolve ethical questions. The Ethics Review Committee of the Medical Faculty at the University and the Research Board of the University Hospital's Department of Psychiatry reviewed and accepted this research plan. They also recommended solutions to some specific ethical problems that occurred in the course of the study. Moreover, some ethical dilemmas required further study and debate during the process.

Helping methods used by nurses in a psychiatric hospital environment.

This qualitative study aims to describe the helping methods used by psychiatric nurses in a hospital environment from as evidenced by video observations and nurses' and patients' descriptions. The data, which were collected by videotaping different nursing situations and by interviewing the nurses and patients afterwards, consisted of 520 pages of written text. A total of 569 utterances were extracted from the text to describe the helping methods used in psychiatric nursing. Each utterance constituted a classification unit. Deductive content analysis techniques were used to analyze the data. The results obtained from the nurses' and patients' descriptions and the videotaped episodes showed that the most commonly used helping methods were of the confirmatory kind (50%), while educational methods came second (37%) and catalytic methods third (13%).

Patient's capable of managing--basic process of psychiatric nursing in a hospital environment.

The aim is to describe the basic process of psychiatric nursing in a hospital environment and to produce a practical theory of psychiatric nursing by the grounded theory method. The data were collected by means of observation and interviews and analysed simultaneously, so that the preliminary results and experience gained in the field shaped the data collection process. The data were subjected to continuous comparison analysis and classified into categories by open coding. The basic process was identified by means of axial coding and theoretical memos. The selective coding consisted of related categories grouped around a core category. The basic process of psychiatric nursing involves the patient's needs for care, the helping methods available and the objectives of care. The patient needs help because of his/her inability to manage in daily life, and the role of nursing is to help the patient to manage. The basis of psychiatric nursing lies in caring for the needs of the patient by employing various helping methods. Patient management consisted of three categories, each subsuming three subcategories. Examination of the content of these led to the identification of different types of psychiatric nursing, labelled as confirming, educating and catalytic. The results suggest that collaborative methods in psychiatric nursing enable and support the patient's participation in his/her care and show that both nurses and patients consider collaboration a good helping method, although requiring a change in attitudes and activities for both the nurse and the patient. In spite of changes in psychiatric nursing, there has been no essential development, as most of the care provided is still normative and traditional and the patient is a passive recipient.

[Opinions of psychiatric patients and treatment goals]. / Psykiatrisessa sairaalahoidossa olevan potilaan käsityksiä omasta hoidostaan.

The aim of the study was to examine the opinions of psychiatric patients regarding the aims of their care and to compare these to the aims recorded by the nursing staff on the treatment plan forms. Attention was also paid to the reasons quoted by the patients for the given helping methods and their opinions on factors which promote or hamper treatment. The basic group consisted of patients who had been treated at the Department of Psychiatry in the University Hospital District of Northern Ostrobothnia for at least two weeks. The group was divided into two parts: 1) patients treated in a close ward and 2) those in an open ward. Thirty-one patients of each kind were selected by random sampling and interviewed using five open questions which concerned the aims of the treatment, their grounds for participating in the treatment concerned and factors promoting or hampering treatment. The notes on the aims of the treatment made by the nursing staff were gathered from the treatment plan forms for the patients in question. The data were analyzed by content analysis. The primary finding was that there are still discrepancies between the aims recorded in the course of treatment and patient's own opinions. The results indicate that the patients regarded social interaction as the primary reason for seeking treatment, followed by therapeutic interaction and normative factors in the ward. Factors considered to promote helping were therapeutic interaction, medical treatment, self realization and social interaction, whereas the detrimental factors were related to the patients themselves, their individual needs, the environment, the therapeutic community or the medication provided.