Benefits of psychiatric consultation-liaison nurse interventions for older hospitalized patients and their nurses.

Characteristics, changes in psychiatric symptoms, and discharge disposition of older hospitalized patients (> or =60 years) with depression or delirium after intervention by a Psychiatric Consultation-Liaison Nurse (PCLN) in an urban teaching hospital were described. A retrospective cohort design was employed using data from 103 clinical consultation records on older patients consecutively evaluated by the PCLN during a 12-month period. The Geriatric Depression Scale and the Confusion Assessment Method were administered by the PCLN at the first patient visit and again to screen-positive patients immediately before discharge. Thirty percent of the patients scored in the range for clinically significant depression and 33% screened positive for delirium at baseline. PCLN interventions for these patients were multifaceted and tailored to individual needs. A paired t-test comparing the change score revealed a significant decrease in depression (p <.001). The proportion of those who screened positive for delirium went from 33% to 0% (p <.001, Chi-square test). Twelve percent of the screen-positive patients for either depression or delirium had improved discharge options than had been predicted at the time of the initial PCLN contact. A two-item consultee questionnaire also revealed benefits for the staff nurses caring for these older patients in three domains. PCLN services may benefit older hospitalized patients referred for depression and delirium and may contribute to positive staff nurse outcomes as well.

Psychiatric-mental health nursing at the interface: revisioning education for the specialty.

In the emerging health care environment, families and communities are facing a broad range of conditions that require more integrated views of wellness and illness, mind and body, and the biomedical and the behavioral. This also calls for an enhanced care delivery system. Three interfacing areas of practice have particular significance for the psychiatric-mental health nursing workforce: enhanced primary care, public health or population-focused health interventions, and managed care. This paper addresses the broad range of knowledge, skills, and competencies that are required for the future of advanced practice psychiatric-mental health nursing and describes interactive learning experiences and new pedagogies to deliver them.

Measuring depression in hospitalized, medically ill, older adults.

Studies have consistently shown high prevalence rates of depression associated with negative medical, functional, and psychosocial outcomes in hospitalized, medically ill, older adults. Several issues pose challenges to measurement of depression in this population. In particular, symptoms simultaneously attributable to both medical illness and psychiatric problems may confound measurement of depression, and there is no distinct boundary between normal and abnormal symptoms. This article critiques prevalence research methods used to measure depression in hospitalized, medically ill, older adults and makes recommendations regarding future measurement approaches in both research and clinical practice. Through the identification of appropriate methods for measurement of depression in this population, psychiatric nurses can make a valuable contribution in this area of research as well as enhance effective case-finding and evaluation of depression in older, hospitalized, medically ill patients in the clinical setting.

Perceived self-efficacy, functional ability, and depressive symptoms in older elective surgery patients.

BACKGROUND: Decline in functional ability as a consequence of medical illness or surgery has been associated with the development of depressive symptoms in older patients. Little is known about the influence of psychological variables on the relationship between postoperative functional ability and depressive symptoms in older adults. Inclusion of perceived self-efficacy in a theoretical model of the relationship of functional ability and depressive symptoms would extend knowledge and inform health care providers about specific risk factors for the development of postoperative depressive symptoms in older elective surgery patients. OBJECTIVES: The purpose of this longitudinal study was to test a theoretical path model of the effects of perceived self-efficacy and functional ability on depressive symptoms in older adults after major elective surgery. METHOD: Seventy-six older adult inpatients (60% women; mean age = 72.3 years, SD = 5.06) who had undergone elective total hip replacement surgery participated in a face-to-face interview 4 to 5 days after surgery (Time 1) and a telephone interview 6 weeks after surgery (Time 2). Perceived self-efficacy was measured by the Self-Efficacy Expectation Scale, functional ability by the Functional Status Index, and depressive symptoms by the Geriatric Depression Scale. RESULTS: Path analysis revealed that Time 1 perceived self-efficacy had a direct, negative effect on Time 2 depressive symptoms. Time 1 perceived self-efficacy also had an indirect effect on Time 2 depressive symptoms through its positive effect on Time 2 functional ability. CONCLUSIONS: The findings suggest that interventions to enhance older patients' perceived self-efficacy while hospitalized after elective total hip replacement surgery may enhance functional ability, which in turn may decrease the likelihood of depressive symptoms postoperatively.

Nursing standard of practice protocol: depression in elderly patients. NICHE faculty.

Depression is a highly prevalent but underrecognized and undertreated mental health problem in community-dwelling, medically ill, and institutionalized older adults. Untreated depression is associated with serious negative consequences for the elderly patient. Nurses in various practice settings can reduce the negative effects of depression through early recognition, intervention, and referral of patients with depression. This article presents an overview of depression in late life with emphasis on age-related assessment considerations, clinical decision-making, and nursing intervention strategies for elders with depression. A standard of practice protocol for use by nurses in a variety of practice settings is also presented.

Improving the postoperative care of acutely-confused older adults.

Delirium (acute confusional states) is the most common organic mental problem in older hospitalized surgical patients. In this review, clinical features, postoperative etiologies, associated negative outcomes, barriers to recognition and treatment, and principles of nursing management are described. An empirically-based, practical resource for surgical nurses is presented to improve safe patient management.

Depression in hospitalized medically ill elders: evolution of the concept.

Recent research confirms high prevalence rates of major depression and appreciable depressive symptoms in hospitalized medically ill elders. Evidence also exists supporting that depressive symptoms, when combined with medical illness, have additive effects on patient function and well-being, in addition to raising the older person's risk of death from suicide as well as from nonsuicidal causes. Appropriate nursing identification and management of this problem is currently hindered by an unclear description of depression in these patients. The focus of this article will be a synthesis of the existing knowledge of depression in elderly patients hospitalized with medical illness. An evolving concept of depression will be described that is amenable to clinical nursing research with this population.

Social factors and depression in late life.

Depression is a common mental health problem facing the elderly that is often overlooked and subsequently untreated by health care professionals. Recognition of the problem can be aided by knowledge of the causes or at least the factors associated with it. Identification of specific social factors has important implications for geropsychiatric nursing practice, education, and research. The major social factors associated with depression in late life are reviewed. The contributions of social factors to the onset, course, and duration of depression are presented. Future research directions are also discussed.

Psychiatric consultation-liaison nursing interventions with nurses of hospitalized AIDS patients.

Acquired Immune Deficiency Syndrome (AIDS) is a devastating medical illness of epidemic proportions with cases continuing to increase at an alarming rate. Hospital nurses at all levels and in all specialized areas of practice are affected by the challenge of caring for AIDS patients, who have overwhelming physical and psychosocial needs. Psychiatric consultation-liaison nurses (PCLNs) in general hospital settings have had to adapt to the needs of the rising AIDS population in their practice. Yet little information exists in the literature about the nature of consultations received from nurses concerning AIDS patients or the subsequent PCLN interventions. A report of the consultative activities related to AIDS patients of a PCLN in a tertiary care center, specifically interventions with managerial and staff nurses, is discussed. The report is derived from a retrospective review and analysis of the author's consultation records of clinical experiences with nurses and AIDS patients over a 6-year period.