Special Edition: Inpatient Psychiatric Treatment: Moving the Science Forward Final

Abstract

We begin by thanking our contributors to this special edition on inpatient psychiatric treatment. Their research and clinical innovations define areas of practice that are critical to the development of the specialty. The methods used in the data-based articles will inform our thinking about innovative research and data collection schemes; ones which will advance the science and practice of inpatient nurses. The work of inpatient nurses is rarely documented in detail. The research of Sneed, Torkelson and Alnatour maps out how inpatient nurses spend their day and the myriad of responsibilities that nurses address in the service of a safe, effective unit. The authors parse out a nurse’s day and the time spent in various role functions. They ask an important question: the impact of these role demands on nursing satisfaction. Their results yield important insights on role functions nurses believe distance them from meaningful patient contact and what aspects of their role they believe should be expanded. The authors suggest that inpatient nurses could use these data to explore how they are spending time on a typical day and then how they might realign their position closer to their image of the ideal inpatient nursing role. An alternative way to examine how inpatient psychiatric nurses deal with their job demands is by assessing the relationship of nurses’ burnout to their perceptions of the work environment (strengths/limitations). To this end, Drs. Hanrahan and Aiken apply the state of the art in work environment measurement to psychiatric inpatient treatment. They ask how nurses view their work environment and how these perceptions are related to nurses’ sense of role fulfillment. Using a large sample of psychiatric nurses, employed in 67 hospitals, they demonstrate the relationship of particular aspects of the work environment to psychiatric nurses’ degree of burnout, e.g., emotional exhaustion, depersonalization. The results highlight the importance of good staffing levels and skilled managers to achieve proximal benefits (reduce burnout), which downstream effect nurse retention and patient outcomes. For the last two decades, inpatient psychiatric nurses have focused on the issue of restraint and seclusion. Dr. Mary Johnson provides an analysis of the various strategies have been used to eliminate restraint use and reduce the incidence of aggression on inpatient units. Her integrative review of 46 studies carefully documents the evolution of two lines of research: restraint/seclusion reduction and violence/aggression reduction. By carefully summarizing the findings of these studies within the context of their methodological issues, Dr. Johnson sets a direction for future research in this area; i.e. the development of interventions that are complex enough to address the nature of staff-patient interaction yet structured enough to invite replication in a variety of inpatient settings. Amidst efforts to reduce containment measures, nurses continue to use seclusion and restraint in emergency situations. In the last decade several protocols have been developed to guide nurses on the use of seclusion/restraint. Larue, Pait, Racine, Menard and Goulet explores nurses’ adherence to these protocols, describing nursing interventions during episodes of seclusion and how they relate to best-practice guidelines. Larue et al analyze interview data from nurses involved in seclusion, to evaluate nurses’ response to aggressive incidents, their rationale, and their behavior during and post incident. The research team’s content and linguistic analysis of interviews provides a unique insight into seclusion practices highlighting when actions, assessments and responses are not congruent with the intent of the protocol. To address these critical issues of work environment, containment measures, and role demands nurses will need to find their voice; define their practice and create cultures where they might engage in the interpersonal aspects of psychiatric nursing. We are fortunate to have a series of articles that will offer direction for this endeavor. Dr Philip Barker’s Tidal Model provides an excellent guidance for, as he states, what needs to be done to enable the process of recovery. Dr Barker ties together concepts familiar to psychiatric nurses (the lived experience, the role of the narrative, empowerment), and demonstrates how they serve as a platform for inpatient nursing practice. The Tidal Model is a conceptual keel that should help nurses return to an