Bridging the Gap Between Individualized Inpatient Safety Planning and Postdischarge Efficacy.

INTRODUCTION: Implementation of programs that increase both psychiatric patient education and their involvement in treatment programming can lead to positive outcomes postdischarge. Patients involved in programs focusing on skills, recovery, and that are individualized show a reduction in symptoms as well as an increase in engagement, treatment, and recovery posthospitalization. AIMS: This quality improvement project examines (1) the effectiveness of a safety planning group on an inpatient psychiatric unit for developing individualized safety plans, (2) the usefulness of the safety plans upon discharge, and (3) how helpful the patient found them. METHODS: A standardized safety plan was presented during 1-hour groups on an adult inpatient unit. Completed safety plans scored using a rubric to determine how patients individualized the content. One week postdischarge, patients were contacted to determine location and use of the safety plan since discharge. RESULTS: Patient's (n = 124) safety plans were relatively individualized when compared to the standardized safety plan (mean [SD] = 32.85 [8.27] on a 44-point rating). Of those patients who were contacted postdischarge (n = 76), 73 (96.1%) had a copy of their safety plan 1-week postdischarge while 28 (36.8%) reported using their safety plan since discharge. Many of the patients who used their safety plan reported that it was helpful (n = 19; 67.9%). CONCLUSIONS: Developing a safety plan can be a helpful tool for individuals admitted to a psychiatric inpatient unit.

Leading Nursing Excellence Through a System Magnet® Program Director Council.

American Nurses Credentialing Center Magnet® designation is prestigious to healthcare institutions. Setting the expectation for all hospitals within a system to be Magnet designated is a lofty but achievable goal. Nursing leaders at the University of Pittsburgh Medical Center set organization-wide designation as a goal in 2010. A robust system-wide Magnet Program Directors Council facilitated this effort by standardizing practices and supporting members through the journey.

Impact of Ankle-Foot Orthosis on Gait Efficiency in Ambulatory Children With Cerebral Palsy: A Systematic Review and Meta-analysis.

OBJECTIVE: Children with cerebral palsy experience functional limitations because of excessive muscle weakness, spasticity, and impaired motor control. They are prescribed ankle-foot orthoses to assist with ambulation. Our objective was to analyze stride length and dorsiflexion data comparing the effectiveness of "ankle-foot orthoses" with "barefoot or shoes only" on ambulatory children with cerebral palsy. DESIGN: An electronic literature search was conducted. Studies were screened by two reviewers based on our inclusion criteria: prospective cohort study or randomized clinical trial, participants younger than 18 yrs with a primary diagnosis of cerebral palsy, ankle-foot orthoses with a control group, 20 combined participants in the experimental and control groups for cohort studies, and 10 participants for randomized clinical trials. RESULTS: Seventeen studies were selected. Pooled results of the meta-analyses showed that stride length was significantly better in the ankle-foot orthoses group as compared with the control group (mean difference between groups = 0.05 m (95% confidence interval = 0.04-0.06). The dorsiflexion angle (5 studies, 124 participants) was improved in patients with ankle-foot orthoses as compared with barefoot or shoes only (mean difference between groups = 8.62 degrees (95% confidence interval = 8.05-9.2). CONCLUSIONS: Children with cerebral palsy using ankle-foot orthoses had improved stride length and dorsiflexion angle during gait in a pooled meta-analyses of cohort studies and clinical trials.

Motivational Interviewing to Increase Outpatient Attendance for Adolescent Psychiatric Patients.

Motivational interviewing (MI) is a therapeutic technique that has been demonstrated to increase adherence to various treatment regimens. Nonattendance at outpatient appointments is associated with read-mission to psychiatric hospitals. The purpose of the current study was to examine the effectiveness of MI in promoting treatment adherence and increasing pediatric attendance rates at patients' first follow-up appointment after inpatient admission. A sample of 111 patients discharged from one of two child and adolescent units at an urban, inpatient psychiatric hospital in Southwestern Pennsylvania participated in the MI discharge process. Compared to hospital population data from 1 month prior to the current study, the MI discharge process demonstrated an increase of approximately 10% in attendance at the scheduled follow-up appointments and a decrease of approximately 4% in cancellations and no-show appointments. It was concluded that particularly for adolescents, MI may be a valuable treatment approach grounded in partnerships with health care providers, patients, and families to enhance outpatient appointment attendance. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 31-35.].

Music Therapy as a Nonpharmacological Intervention for Anxiety in Patients with a Thought Disorder.

Music therapy has been identified as a non-pharmacological adjunct therapy to treat anxiety. This QI project aimed to assess the effects of music therapy on anxiety in a sample of patients hospitalized with a thought disorder. Participants were assessed pre- and post-group using a visual analog scale for anxiety. The intervention significantly reduced VAS scores from 3.1 pre-intervention to .897 immediately post-intervention (p = 0.008). This data suggests that music therapy may be beneficial in the short term for this population and is a low risk intervention that provides positive outcomes without the risks associated with medications, seclusion, and restraint.