Psychiatric hospitalization and process description: what will nursing add?

1. Inpatient treatment programs operating in the managed care environment must clearly articulate their treatment outcomes and the processes of care that are connected to these outcomes. 2. The work of inpatient psychiatric nurses can be organized and articulated through the therapeutic processes of the Four S Model: Safety, Structure, Support, and Symptom Management. 3. Nurses are vital contributors to the inpatient treatment process, but will be marginalized if they are unable to articulate how their interventions contribute to the positive treatment outcomes.

Suicidal inpatients' perceptions of therapeutic and nontherapeutic aspects of constant observation.

OBJECTIVE: Constant observation is a staff-intensive, costly intervention that entails continuous supervision of suicidal inpatients until they no longer express suicidal intent or behavior. This study explored patients' experiences of constant observation to determine whether they derived any therapeutic benefits beyond the intended protective benefit. METHODS: A qualitative research approach was used in which 20 suicidal psychiatric inpatients who had experienced constant observation within the past two weeks were interviewed by researchers not involved in the observation procedure. Thirteen hospital staff members and seven minimally trained lay workers or sitters provided constant observation. RESULTS: Thirteen of the 20 participants emphatically expressed positive feelings toward the observers, particularly when they perceived them as friendly and willing to help. Therapeutic benefits other than protection were largely related to observers' attitudes and behaviors. Patients reported that their dysphoria, anxiety, and suicidal thoughts were decreased by observers who were optimistic, who acknowledged the patient as a human being, who provided distraction with activities and conversation, and who gave emotional support. Nontherapeutic aspects described by participants were observers' lack of empathy, lack of acknowledgment, and failure to provide information about constant observation, as well as a lack of privacy and a feeling of confinement. CONCLUSIONS: The findings support the conclusion that constant observation is not just a protective intervention but one that has therapeutic potential. It can be enhanced if observers engage inpatients in actively supportive interventions. However, observers' perceived attitudes and behaviors can cause patients distress, which reaffirms the need for careful supervision of observers.

The experience of terminating an abusive relationship from an Anglo and African American perspective: a qualitative descriptive study.

A common question asked about abused women is, "Why don't they leave?" This qualitative study explored the experiences of 15 African American and 15 Anglo American women who had terminated abusive relationships. The constant comparative method of analysis of audiotaped interviews revealed a 3-phase process of leaving: being in, getting out, and going on. Participants endured abuse until they could relinquish the fantasy of a happy relationship. Differences in relationship power and public response to abuse distinguished the experiences of Anglo and African American participants. Findings support the notion of leaving as a social process with similarities across both groups. However, critical differences in responses suggest that leaving is a culture-bound experience.

Suicidal inpatients' experience of constant observation.

Suicidal inpatients' perspectives on the experience of constant observation by staff or lay workers were sought through interviews using open-ended questions with 14 patients for whom constant observation ranged from 16 hours to 3.5 days. Interview transcripts were analyzed using phenomenological methods to determine common themes. The three major themes that emerged from participants' responses were physical protection, restoration of hope, and distressing incidents. Participants reported that constant observation was beneficial because it contributed to their physical safety and restored hope. They also reported that the absence of supportive interactions, frequent staff changes, and lack of privacy adversely affected their experience.

Sources of social support and conflict in hospitalized depressed women.

The purpose of this study was to (a) describe the number and types of social relationships of 39 women hospitalized for unipolar depression and (b) examine differences in the provision of social support and level of conflict among these types of relationships. Paired t tests were used to compare support and conflict from six types of relationships. The number and range of relationships reported were comparable to those of nondepressed women. Unexpectedly, women reported low amounts of conflict. Spouse/partners, household, and close relationships were perceived as sources of the most support. However, spouse/partner and household members also provided the most conflict, while close relationships provided the least. These close relationships play a pivotal role in the provision of social support. Furthermore, close female relationships appear to provide the benefits of support without the cost of conflict.

Seven days and counting: how inpatient nurses might adjust their practice to brief hospitalization.

1. Inpatient nurses can help create a seamless health care system by designing groups and specific interventions that begin at the time of admission and continue after discharge. 2. Inpatient nurses must clearly articulate how they intervene for the benefit of patients and how they engineer the coordinated staff effort that maintains the basic safety and structure of the environment. 3. Nurses should learn how to organize and report observations so they formulate a concise assessment summary while also collecting data that are useful to the unit's outcome evaluation.

Trends in adolescent psychiatric hospitalization.

This article explores the recent increase in adolescent psychiatric inpatient admissions. Factors fueling the tendency to hospitalize are discussed, and the concept of medicalization of adolescent behavior problems is related to this trend. Reflecting the medicalization concept, several questions and hypotheses regarding parental decision-making as it is related to adolescent hospitalization are presented. Through further investigation, a better understanding of the factors influencing or determining need for adolescent psychiatric hospitalization can be gained.