Acute Care Psychiatric Settings Research Articles

(062) Examining Barriers and Facilitators of COVID-19 Vaccination in an Acute Care Psychiatric Setting

(062) Examining Barriers and Facilitators of COVID-19 Vaccination in an Acute Care Psychiatric Setting

Rewriting burnout as metaphor

Abstract Today’s healthcare professionals shoulder consequences of budget cuts, staff shortages, longer hours and a growing, aging patient population. To address support for both patients and staff in this challenging context, the kidney dialysis unit of a major Italian hospital was chosen for a three-phase pilot study of Metaphoric Affect Processing (MAP). MAP is a metaphor-based interview technique designed to enhance wellbeing in hospital settings by facilitating the identification, verbalization and regulation of affect as metaphor. The subject of this article is Phase 1 of the study, which focused on mitigation of burnout symptoms among peritoneal and hemodialysis nurses. In Phase 1, nurses were offered weekly group sessions of MAP training. All participants learned to use codified, “poetic” dialogue to explore, share and metaphorically “rewrite” present-moment feelings. By the end of training, a number of nurses also qualified as MAP facilitators themselves. Nurses’ pre-training burnout levels were measured in subcategories of depressive anxiety, loss of empathy, and reduced sense of personal achievement. Assessment after MAP training confirmed nurses’ self-reports of having engaged metaphor to address these aspects of burnout, reducing stress levels, increasing empathy among colleagues and expanding perspective. Phase 1 outcomes suggest that MAP may be an effective intervention to boost wellbeing for healthcare workers at high risk for burnout, and merits further study. This article also offers an overview of MAP’s early development with patient populations in cancer treatment and acute care psychiatric settings.

Evaluation of dextromethorphan with select antidepressant therapy for the treatment of depression in the acute care psychiatric setting.

IntroductionDextromethorphan (DXM), an N-methyl-D-aspartate receptor antagonist, may have ketamine-like antidepressant effects. Dextromethorphan is extensively metabolized via cytochrome P450 (CYP) 2D6, and its half-life in extensive metabolizers is 2 to 4 hours. The purpose of this study was to evaluate the effects of DXM in combination with a moderate-to-strong CYP2D6 inhibitor antidepressant on depression in an acute care psychiatric setting.MethodsThis was a single-center, retrospective chart review of adult patients with a depressive disorder diagnosis. Patients who received select antidepressant therapy with or without scheduled DXM were included. The primary outcome was the difference in time to improvement of depressive symptoms, which was an average composite of physician documentation, nurse documentation, and first time to 24 hours without as-needed anxiolytics or antipsychotics. The study group consisted of patients who received DXM with select antidepressant therapy, whereas the control group included those who received only select antidepressant therapy.ResultsA total of 40 patients were included. The median time to clinical improvement was 3.00 days and 2.83 days for the study group and control group, respectively (P = .986). The incidence of perceptual disturbances and delusions was higher in the study group as compared with the control group (55% and 35% vs 30% and 25%, respectively).DiscussionDextromethorphan was not associated with a rapid antidepressant effect. The commonly used dose of 30 mg daily may have been too low to have an effect; additionally, the most frequently utilized select antidepressant, bupropion, has moderately less CYP2D6 inhibition than fluoxetine and paroxetine.

Evaluation of oral antipsychotic supplementation of select second-generation long-acting injectable antipsychotics in an acute-care psychiatric setting.

IntroductionLong-acting injectable (LAI) antipsychotics were developed to increase medication adherence in patients with schizophrenia. The US Food and Drug Administration (FDA)-approved LAI dosing provides guidance regarding oral antipsychotic supplementation. Previous studies have concluded concomitant use of oral and LAI antipsychotics requires further investigation. The aim of this study was to examine oral antipsychotic supplementation among patients receiving select second-generation LAIs.MethodsPatients were included if they were admitted to an inpatient psychiatric unit and received a second-generation LAI. The primary outcome was to determine the percentage of patients receiving oral antipsychotic supplementation prescribed in accordance with FDA recommendations. Secondary outcomes described oral supplementation prescribed in an inconsistent manner with FDA recommendations and identified patient-specific predictors associated with oral supplementation prescribed consistent with FDA recommendations.ResultsOf the 422 patients evaluated, 376 patients met inclusion criteria. Oral supplementation was prescribed in a manner consistent with FDA recommendations in 30% of patients. The following predictors were associated with oral supplementation prescribed in accordance with FDA recommendations: LAI initiation (odds ratio 1.868, 95% confidence interval 1.120-3.125) and the use of the once-monthly paliperidone LAI (odds ratio 20.278, 95% confidence interval 10.472-39.873).DiscussionIn the patient population evaluated, oral supplementation of LAI antipsychotics were prescribed in 30% of patients in a manner consistent with FDA recommendations. Of the patients who were prescribed oral antipsychotic supplementation inconsistent with FDA labeling, 223 patients were prescribed oral supplementation longer than the recommended duration and 8 patients received oral supplementation for a shorter duration than recommended.

A Conceptual Model for Nurses’ Decision-making with the Aggressive Psychiatric Patient

Violence in the acute care psychiatric setting is an ongoing serious problem. Maintenance of a safe therapeutic environment is a paramount responsibility of nurses practicing in this area. Ethical and legal standards demand that the nurse intervenes in aggressive situations in a manner that employs the least intrusive and restrictive measures necessary to provide safety. Therefore, accurate and effective decision-making in aggressive situations, which can escalate rapidly, is of great importance. This paper discusses a theoretical model for decision-making in selecting interventions with aggressive psychiatric patients. This model may provide a basis for the development of training and education programs for effective decision-making in this area.

Enclosed Versus Open Nursing Stations in Adult Acute Care Psychiatric Settings: Does the Design Affect the Therapeutic Milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.

Smoking Bans in Acute Care Psychiatric Settings: A Machiavellian Smoke Screen?

Do smoking bans therefore create healthier patients? Campion, McNeill, and Checinski (2006) believe that they do and hospital administrators reason that their role in promoting health requires them to forbid smoking on hospital property (Bloor, Meeson, & Crome, 2006).

BOREDOM IN ACUTE PSYCHIATRIC CARE

Patients hospitalized in acute care psychiatric settings often complain of boredom. Neither historical context nor geographical settings seem to make a difference. Boredom can be found in contemporary studies and older studies, in studies in the United States and the United Kingdom (Raphael, 1974; Raphael & Peers, 1972; Shields, Morrison, & Hart, 1988; Thomas, Shattell, & Martin, 2002). Boredom does not seem to correlate to how long a person has been in the hospital or model of health care delivery. Perhaps you can understand how patients would get bored after a 2-3 month stay as was customary in the past, but not today, with short 3-5 day hospitalizations. How do patients have time to be bored?

Arts-based strengths: a solution-focused intervention with adolescents in an acute-care psychiatric setting

Arts-based strengths: a solution-focused intervention with adolescents in an acute-care psychiatric setting

Dartmouth Assessment of Lifestyle Instrument (DALI): a substance use disorder screen for people with severe mental illness.

Despite high rates of co-occurring substance use disorder in people with severe mental illness, substance use disorder is often undetected in acute-care psychiatric settings. Because underdetection is related to the failure of traditional screening instruments with this population, the authors developed a new screen for detection of substance use disorder in people with severe mental illness. On the basis of criterion ("gold standard") diagnoses of substance use disorder for 247 patients admitted to a state hospital, the authors used logistic regression to select the best items from 10 current screening instruments and constructed a new instrument. They then tested the validity of the new instrument, compared with other screens, on an independent group of 73 admitted patients. The new screening instrument, the Dartmouth Assessment of Lifestyle Instrument (DALI), is brief, is easy to use, and exhibits high classification accuracy for both alcohol and drug (cannabis and cocaine) use disorders. Receiver operating characteristic curves showed that the DALI functioned significantly better than traditional instruments for both alcohol and drug use disorders. Initial findings suggest the DALI may be useful for detecting substance use disorder in acutely ill psychiatric patients. Further research is needed to validate the DALI in other settings and with other groups of psychiatric patients.

Evaluation of the human becoming theory in practice in an acute care psychiatric setting.

Using a descriptive evaluation research method, this study evaluated Parse's theory of human becoming in practice in the psychiatric setting. A pre- mid- post-implementation design served to generate qualitative data from nurses, patients, unit nurse managers, hospital nurse supervisors, and nurse documentation that illuminated changes in the quality of nursing care on three diverse pilot units. Major themes of change supported by all data sources were shifting views of human beings, altered ways of listening, altered foci of nurse-person discussions, and personal transformations. Identified themes surfaced strikingly different qualities of change for each pilot unit. Recommendations related to the successful implementation of Parse theory-based practice are presented.

Detection of substance use disorders in severely mentally ill patients

Severe mental illness is frequently complicated by substance use disorder. Approximately half of the severely mentally ill patients treated in acute care psychiatric settings have abused one or more of these substances. Despite the high rate of comorbidity, substance use disorders are generally not detected in acute care psychiatric settings, leading to incorrect diagnoses and ineffective treatments. The reasons for nondetection are complex, and research is needed to refine instruments and procedures for the detection of substance abuse in the severely mentally ill population. Nevertheless, clinicians can make better use of existing techniques of multimodal assessment to increase significantly the rate of accurate detection.

The Attending Nurse: a new role for the advanced clinician.

The Attending Nurse Model as a unique role for the advanced practitioner was implemented and evaluated in an acute care psychiatric setting with an adolescent patient population. Program evaluation results demonstrated that the Attending Nurse role increased general satisfaction and role clarity while decreasing role tension. In addition, the role increased communication with patients' family members. Comparisons are made between the traditional primary nurse and the Attending Nurse roles.