Location of Power within Psychiatry: A Fifty-Year Journey as Represented in Film.

Over the last half of the twentieth century, many advances in the field of psychiatry and mental health have occurred and continue today. Among these developments are the increasing recognition of patient rights and the expanding role of psychiatric nurses. This paper presents a view of how these changes have been reflected in film over a period of fifty years in both documentary and Hollywood movies. Discussion of advances in psychiatry, as identified in the selected films, is presented against the background of social change that was occurring in the United States and Western Europe during this period.

Outcomes and feasibility of the short transitional intervention in psychiatry in improving the transition from inpatient treatment to the community: A pilot study.

Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital. We conducted a quasi-experimental pilot study to determine the feasibility of the intervention, and gain insight into the effects of the STeP. Two inpatient wards at a Swiss psychiatric hospital participated in the study, and represented the intervention and control arms. Patient recruitment and baseline assessment were performed 2 weeks prior to discharge. Follow-up data were collected 1 week subsequent to discharge. Questionnaires measured coping, admission and health-care usage, self-efficacy, working alliance, experience of transition, and the number of difficulties experienced following discharge. Fourteen and 15 patients completed the follow-up assessment in the control and intervention groups, respectively. The STeP did not affect primary or secondary outcomes; however, it was shown to be feasible, and patients' feedback highlighted the importance of post-discharge contact sessions. Further research is required to improve understanding of the discharge experience, identify relevant patient outcomes, and assess the effectiveness of the intervention in an adequately-powered randomized, controlled trial.

Nursing management of sensory overload in psychiatry ­ Theoretical densification and modification of the framework model / Der pflegerische Umgang mit Reizüberflutung in der Psychiatrie. Theoretische Verdichtung und Modifikation des Rahmenmodells

Background: Within the scope of the research project on the subjects of sensory overload and stimulus regulation, a theoretical framework model of the nursing care of patients with sensory overload in psychiatry was developed. In a second step, this theoretical model should now be theoretically compressed and, if necessary, modified. Aim: Empirical verification as well as modification, enhancement and theoretical densification of the framework model of nursing care of patients with sensory overload in psychiatry. Method: Analysis of 8 expert interviews by summarizing and structuring content analysis methods based on Meuser and Nagel (2009) as well as Mayring (2010). Results: The developed framework model (Scheydt et al., 2016b) could be empirically verified, theoretically densificated and extended by one category (perception modulation). Thus, four categories of nursing care of patients with sensory overload can be described in inpatient psychiatry: removal from stimuli, modulation of environmental factors, perceptual modulation as well as help somebody to help him- or herself / coping support. Conclusions: Based on the methodological approach, a relatively well-saturated, credible conceptualization of a theoretical model for the description of the nursing care of patients with sensory overload in stationary psychiatry could be worked out. In further steps, these measures have to be further developed, implemented and evaluated regarding to their efficacy.

Sensory overload: A concept analysis.

In the context of mental disorders sensory overload is a widely described phenomenon used in conjunction with psychiatric interventions such as removal from stimuli. However, the theoretical foundation of sensory overload as addressed in the literature can be described as insufficient and fragmentary. To date, the concept of sensory overload has not yet been sufficiently specified or analyzed. The aim of the study was to analyze the concept of sensory overload in mental health care. A literature search was undertaken using specific electronic databases, specific journals and websites, hand searches, specific library catalogues, and electronic publishing databases. Walker and Avant's method of concept analysis was used to analyze the sources included in the analysis. All aspects of the method of Walker and Avant were covered in this concept analysis. The conceptual understanding has become more focused, the defining attributes, influencing factors and consequences are described and empirical referents identified. The concept analysis is a first step in the development of a middle-range descriptive theory of sensory overload based on social scientific and stress-theoretical approaches. This specification may serve as a fundament for further research, for the development of a nursing diagnosis or for guidelines.

[Possible Signs of Sensory Overload]. / Mögliche Kennzeichen der Reizüberflutung.

Objective To identify, synthesize and structure the defining characteristics of overstimulation. Methods The literature search was conducted in relevant international databases (Pubmed, Medline, CINAHL, Psyndex, PsycArticles, PsychINFO). The literature analysis was conducted according to Mayring's method of qualitative content analysis. Results Despite the scanty data available on symptoms or effects of sensory overload, twelve literature-sources were identified, describing signs and symptoms of sensory overload. A cluster of psychopathological and behavioral characteristics of sensory overload was developed. Conclusions Further research is needed to obtain an evidence-based description of the defining characteristics of sensory overload.

Nursing management of sensory overload in psychiatry ­ development of a theoretical framework model / Der pflegerische Umgang mit Reizüberflutung in der Psychiatrie - Entwicklung eines theoretischen Bezugsrahmens

Background: The concept of "removal from stimuli" has already been examined by a Delphi-Study. However, some knowledge gaps remained open, which have now been further investigated. Aim: Examination of the concept "management of sensory overload in inpatient psychiatry" including its sub-concepts and specific measures. Method: Analysis of qualitative data about "removal from stimuli" by content analysis according to Mayring. Results: A theoretical description and definition of the concept could be achieved. In addition, sub-concepts (removal from stimuli, modulation of environmental factors, help somebody to help him-/herself) could be identified, theoretical defined and complemented by possible specific measures. Conclusions: The conceptual descriptions provide a further step to raise awareness of professionals in the subject area. Furthermore, we created a theoretical basis for further empirical studies.

[The Perception of "Reizabschirmung" (Removal from Stimuli) in Inpatient Psychiatry]. / Das Verständnis von "Reizabschirmung" in der stationären Psychiatrie.

OBJECTIVE: The aim of the study was to narrow down the topic area and to generate a heuristic understanding of "Reizabschirmung" (removal from stimuli) in the German-speaking countries based on clinical expertise. METHODS: The Delphi-Method of consensus building within an expert panel was selected. RESULTS: The consensus found on some aspects lead to a reduction of the scope of the topic and a first approximation towards a conceptual definition of "Reizabschirmung" was generated. CONCLUSIONS: The perception of "Reizabschirmung" in the German-speaking countries is presented. However, further research is needed for precise concept clarification and elaboration.

Nursing Diagnoses in Inpatient Psychiatry.

PURPOSE: This study explored how well NANDA-I covers the reality of adult inpatient psychiatric nursing care. METHODS: Patient observations documented by registered nurses in records were analyzed using content analysis and mapped with the classification NANDA-I. FINDINGS: A total of 1,818 notes were examined and contained 46 different patient responses. Twenty-nine patient responses were recognizable as NANDA-I diagnoses at the level of definitions, 15 as diagnoses-related factors, and 12 did not match with any NANDA-I diagnosis. CONCLUSIONS: This study demonstrates that NANDA-I describes the adult inpatient psychiatric nursing care to a large extent. Nevertheless, further development of the classification is important. IMPLICATIONS FOR NURSING PRACTICE: The results of this study will spur nursing research and further classification development.

Dealing with aggressive behaviour in nursing homes: caregivers' use of recommended measures.

AIMS AND OBJECTIVES: To identify groups of caregivers in terms of their use of measures for dealing with resident aggression and the differences between these groups related to their characteristics. BACKGROUND: Caregivers in nursing home are confronted with a major challenge when faced with the aggressive behaviour of residents. Therefore, the application of recommended measures is important in supporting caregivers and promoting safety for residents. DESIGN: Cross-sectional survey. METHODS: A total of 804 caregivers working in 21 Swiss nursing homes provided data. The questionnaire used was based on published recommendations regarding management of aggressive behaviour and amendments by experts. RESULTS: The most widely used measure aimed to calm down the resident and to understand the meaning of aggressive behaviour. Physical activities were applied by around 50% of the respondents, and interdisciplinary case reviews as well as standardised instruments for assessment and documentation were used by <50%. Caregiver characteristics such as employment level, support from superiors, institutionalised support for affected caregivers and training in aggression management are associated with their use of recommended measures. Furthermore, caregivers' competence in empathising with the residents' perspective in connection with their professional experience has a positive influence on applying recommended measures. CONCLUSION: Caregivers use multifaceted measures in understanding the meaning of underlying aggression, but there is a certain failure to use standardised instruments. Caregivers differ significantly in the frequency of their application of recommended measures. Support from superiors and assistance for affected caregivers positively influence their use of measures, whereas training in aggression management leads to less use. RELEVANCE TO CLINICAL PRACTICE: Findings show the importance of support from superiors and institutionalised assistance for affected caregivers. Caregiver competence in empathising with the residents' perspective is important in using person-centred approaches in the care of residents with aggressive behaviour.

[Nurses' experiences with aggressive behaviour of nursing home residents: a cross sectional study in Swiss nursing homes]. / Erfahrungen und Umgang der Pflegenden mit aggressivem Verhalten von Bewohner(inne)n: eine deskriptive Querschnittstudie in Schweizer Pflegeheimen.

The present exploratory descriptive cross-sectional study with the participation of 814 (51.8%) caregivers in 21 Swiss nursing homes provides insight into caregivers' experiences and handling of residents' aggressive behaviour. Moreover, caregiver burden with regard to resident aggression and the consequences on the caregiver-resident-relationship were investigated. The survey was carried out by means of validated questionnaire. Approximately 38% of participants experienced aggressive incidents during the last seven days prior to data collection. In most cases aggressive behaviour was caused by residents suffering from dementia and/or depression and occurred during nursing interventions involving physical contact. As a trigger for aggressive behaviour participants predominately assumed "non-understanding and excessive demand" of residents. Reassuring conversation and keeping oneself at a distance were most often used to calm the situation. Approximately 40% of participants experienced physical attacks as especially distressing and circa 23% were frightened, particularly when aggressive behaviour occurred without warning. Approximately 4% of caregivers avoided contact with residents after an aggressive incident and 12.3% perceived a disturbed relationship. It can be assumed that caregivers do not adequately perceive emotions possibly underlying aggressive behaviour in the escalation phase and therefore may not identify early signs of beginning aggression.

Factors associated with resident aggression toward caregivers in nursing homes.

PURPOSE: Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes. DESIGN: A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study. METHODS: Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied. FINDINGS: The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 30-45 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 30-45 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04). CONCLUSIONS: Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed. CLINICAL RELEVANCE: The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects.

Influence of single peer interventions on the recovery attitude of persons with a psychiatric disability.

OBJECTIVE: This study examined the influence of single peer to peer interventions on participants' recovery attitudes. METHODS: Following a 40-hour training, pairs of individuals with a psychiatric disability offered a session (2.5 hour) in outpatient and residential psychiatric institutions. These peer to peer interventions aimed at inspiring and contributing to participants' recovery process, by introducing them to constituent parts of the concept Recovery. Thirteen of the peer interventions were evaluated by measuring participants' recovery attitudes before (N = 145), just after (N = 115) and at 6 months postintervention (N = 53) using the Recovery Attitudes Questionnaire (RAQ7) and the Recovery Process Inventory (RPI). RESULTS: Wilcoxon tests demonstrated that individuals participating in a peer intervention felt significantly more certain that Recovery is possible (factor 'Recovery is possible') just after the intervention (p = 0.004), but not 6 months later; likewise, the perception of the difficulty of recovery in spite of a mental illness (factor 'Recovery is difficult and differs') was significantly lower 6 months later (p = 0.016), but not from pre to just after. CONCLUSIONS: The statistically significant effect of a single recovery-oriented peer intervention on participants' attitude that recovery is possible was not sustainable. These results suggest a possible higher sustainability of repeated or longer-lasting peer interventions.

[The association between the patient-nurse relationship and patient perception of substance use control in an addiction therapy setting: a descriptive correlation study]. / Relation entre l'alliance thérapeutique infirmière-patient, et les contrôles perçus par le patient en traitement de dépendances: une etude corrélationnelle descriptive.

The aim of this study is to explore the association between the patient-nurse working alliance and the degree of how much substance use control is perceived as burdensome in an addiction therapy setting. Imogene King's theory and the working alliance concept were used as the theoretical framework. The investigation was undertaken using a self-administered questionnaire with the short-form of the working alliance inventory (WAI) translated and validated in French and targeting a convenience sample (n=28). In this sample the working alliance was evaluated by 12 questions on a Likert-Scale and perceived as generally good (x = 61.68, max = 84). A significant negative linear relation was found between the perception of the drug-controls as burdensome, evaluated by an additional question on a visual analogue scale (VAS), and the establishment of a working alliance (r = -0.67, p-value > 0.001). Furthermore, the form of admission is important as involuntarily hospitalized patients (n = 7) (t, p-value = 0.018) form poorer working alliances, and perceive the controls as more burdensome (Z, p-value = 0.004) as opposed to voluntarily hospitalized patients (n = 21). Even though these results cannot be generalized because of the small sample (n = 28), they raise important questions for nursing practice, especially for involuntarily hospitalized patients. These patients seem to be more susceptible to any disturbance of the relationship and possible consequences need to be taken into account. In addition, drug-control might have to be reassessed. The findings also raise questions about the use of camera supervision as an alternative to nursing supervision and about the need for the primary nurses to refrain from control interventions.

Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey.

UNLABELLED: AIM.: This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated. BACKGROUND: There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses' experiences and single interactive factors between staff and patients/visitors involved. DESIGN: A cross-sectional survey. METHOD: The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised. FINDINGS: Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion. CONCLUSION: To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

Measuring patient and visitor violence in general hospitals: feasibility of the SOVES-G-R, internal consistency and construct validity of the POAS-S and the POIS.

AIMS: To investigate the feasibility of a survey measuring patient and visitor violence after translation and modification, namely the Survey of Violence Experienced by Staff (German version revised) and to validate the shortened Perception of Aggression Scale (POAS-S) and the Perception of Importance of Intervention Skills Scale (POIS) after adaptation for use in a general hospital setting. BACKGROUND: The use of different approaches and research instruments for investigating patient and visitor violence negatively influences the comparability of studies. Typically, general hospitals use self-administered surveys. However, support for these instruments' validity is insufficient. METHODS: Between November 2006-January 2007, 291 nurses working in general hospitals in the German-speaking region of Switzerland completed the SOVES-G-R, the POAS-S and the POIS (response rate=71%). Results. The participants' responses demonstrated a need for modifications to enhance the feasibility of the SOVES-G-R in two categories, namely experiences with patient and visitor violence in 'the past 12 months' and in 'the past working week'. The POAS-S revealed the same factor solution as in earlier studies, with two factors explaining 38·0% of variance. In the POIS, two factors were distinguished: (1) structured interventions and evaluation and (2) the importance of preventive measures. CONCLUSIONS: The SOVES-G-R, the POAS-S and the POIS are adequate for investigating factors influencing the occurrence of patient and visitor violence in general hospitals. Given the changes in the SOVES-G-R and the moderate size of our sample, further testing with a larger sample is recommended. RELEVANCE TO CLINICAL PRACTICE: The instruments help determine which clinical settings have a greater risk of patient and visitor violence and the specific factors that influence this risk. This can facilitate the implementation of situation-specific preventive measures against patient and visitor violence in general hospitals.

Nursing home caregivers' explanations for and coping strategies with residents' aggression: a qualitative study.

AIMS AND OBJECTIVES: This study explored caregivers' perspectives regarding the conditions and situations of resident aggression and practical strategies caregivers use to deal with aggression. BACKGROUND: Working in a nursing home is associated with a high risk to experience aggression from residents or patients. Despite existing recommendations for dealing with aggression there is a lack of information about caregivers' ways of dealing with it in practice. DESIGN: A qualitative study with focus group method was conducted. METHOD: Five focus group interviews, with a total of 30 participants, from nursing homes in Switzerland were undertaken employing a semi-structured interview guideline. For analysing the data, qualitative content analysis was employed. RESULTS: Analysis of the data produced three themes with additional sub-themes. One main theme concerns the explanations of the caregivers in regard to the occurrence of aggressive behaviour. This theme is subdivided into two areas, the contributory resident related factors and the caregiver related factors. The measures for handling aggressive behaviour are illustrated in the second theme 'dealing with residents'. The third theme refers to the strategies of the caregivers when confronted with aggressive behaviour -'self-protection' and 'coping with the situation'. CONCLUSION: Caregivers use a broad spectrum of interventions for reducing aggression, some of which are recommended by guidelines but often ignore the link between aggressive behaviour and physiological issues like pain or elimination. The caregivers only very rarely linked their practical knowledge about aggressive behaviour with theoretical knowledge. RELEVANCE TO CLINICAL PRACTICE: The results give insight into the caregivers' perspectives on factors leading to aggression and their coping strategies. Caregivers are informed about relevant reasons for aggressive behaviour and its management, but do not apply a systematic approach. Furthermore, the anxiety of caregivers involved in aggression incidents is an under examined area.

Factors associated with patient and visitor violence experienced by nurses in general hospitals in Switzerland: a cross-sectional survey.

AIMS: To explore nurses' experiences with patient and visitor violence, as well as other related factors, in Swiss general hospital settings. BACKGROUND: Patient and visitor violence is a complex occupational hazard among health care professions, with nursing in general, experiencing the highest rate of patient and visitor violence. International research has found that staff and patient attributes, interaction between staff and patients, as well as environmental characteristics are important factors associated with the occurrence of patient and visitor violence. Previous studies, however, have only partially described these factors in the general hospital setting. Mainland European general hospital settings are even less well researched. DESIGN: A retrospective cross-sectional survey was conducted in 2007. METHODS: A total of 291 nurses working in different clinical departments in general hospitals provided data. The questionnaire used was a modified German version of the Survey of Violence Experienced by Staff. RESULTS: The findings revealed that 72% of nurses had experienced verbal patient and visitor violence and 42% physical patient and visitor violence in the past 12 months. Also, 23% were physically injured and 1.4% took one or more days of sick leave. Patient and visitor violence was distressing for the nursing staff. A higher risk for patient and visitor violence was observed with registered nurses nursing anxious or cognitively impaired patients, for rehabilitation units with longer-term nurse-patient/nurse-relative interactions and for workplaces with an absence of formal procedures for patient and visitor violence. CONCLUSIONS: The results indicate that the clinical setting has little impact on the occurrence of patient and visitor violence. Patient and visitor violence appears to be influenced more by the additional factors specific to the type of interaction and situation. Research should follow up on these specific findings to further improve policies, procedures and intervention strategies. RELEVANCE TO CLINICAL PRACTICE: To prevent patient and visitor violence, Swiss general hospitals should take into consideration the risk factors associated with patient and visitor violence. Existing policies, procedures and staff education should be improved on.

[Psychometric properties of Q-DIO, an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes]. / Testtheoretische Gütekriterien des Q-DIO, eines Instruments zur Messung der Qualität der Dokumentation von Pflegediagnosen, -interventionen und -ergebnissen.

The instrument Q-DIO was developed in the years 2005 till 2006 to measure the quality of documented nursing diagnoses, interventions, and nursing sensitive patient outcomes. Testing psychometric properties of the Q-DIO (Quality of nursing Diagnoses, Interventions and Outcomes.) was the study aim. Instrument testing included internal consistency, test-retest reliability, interrater reliability, item analyses, and an assessment of the objectivity. To render variation in scores, a random strata sample of 60 nursing documentations was drawn. The strata represented 30 nursing documentations with and 30 without application of theory based, standardised nursing language. Internal consistency of the subscale nursing diagnoses as process showed Cronbach's Alpha 0.83 [0.78, 0.88]; nursing diagnoses as product 0.98 [0.94, 0.99]; nursing interventions 0.90 [0.85, 0.94]; and nursing-sensitive patient outcomes 0.99 [0.95, 0.99]. With Cohen's Kappa of 0.95, the intrarater reliability was good. The interrater reliability showed a Kappa of 0.94 [0.90, 0.96]. Item analyses confirmed the fulfilment of criteria for degree of difficulty and discriminative validity of the items. In this study, Q-DIO has shown to be a reliable instrument. It allows measuring the documented quality of nursing diagnoses, interventions and outcomes with and without implementation of theory based, standardised nursing languages. Studies for further testing of Q-DIO in other settings are recommended. The results implicitly support the use of nursing classifications such as NANDA, NIC and NOC.