Experiences Of Psychiatric Nurses Research Articles

Trends in psychiatric nursing graduate education.

T rapidly changing health care system requires expert clinician leaders to assure that changes in service systems enhance, or at least maintain, quality patient care. The number of graduates from master’s-degree programs specializing in psychiatric nursing has decreased significantly over recent years; annually there are fewer graduates in psychiatric nursing than in any of the other core mental health professions (1). This decline implies a future shortage of psychiatric nurses to fill leadership, teaching, and clinical positions in the health care system. Data from the National League for Nursing (NLN) show that the number of graduates with a master’s degree in psychiatric nursing decreased dramatically from 781 in 1980 to 443 in 1996, a period during which graduations from all types of master’s programs in nursing soared from 4,778 to 9,953. About 74 percent of psychiatric nursing enrollees were part-time students in 1996, compared with 51 percent in 1980, increasing the overall length of time between enrollment and graduation. As Figure 1 shows, the percentage of graduates with a specialty in psychiatric and mental health nursing dropped from 16.3 percent in 1980 to an all-time low of 4.5 percent in 1996. Decreased federal support for traineeships was suggested as a primary cause of the decline in the mid-1980s (2), but more recent declines may also reflect the increase in nurse practitioners, from 18 percent of all master’s-level graduates in 1991 to 43 percent in 1995. The increasing use of nurse practitioners in health care delivery is also reflected in changes in the graduate education of psychiatric nursing specialists. NLN data show that the number of psychiatric nurse practitioner programs increased from ten in 1991– 1992 to 33 in 1994–1995. The number of psychiatric nurse practitioner graduates increased from 47 in 1991 to 100 in 1996, while the number of graduates of master’s level psychiatric nursing clinical specialty practice programs decreased from 492 to 324. The failure to educate an adequate number of graduate-level psychiatric nurses will reduce the quality of psychiatric nursing education in basic nursing preparation programs and the quality of care in practice settings. In 1994 a total of 82,620, or 14.3 percent, of full-timeequivalent positions in mental health organizations were filled by registered nurses (1), the vast majority of whom received their education and clinical experience in psychiatric nursing in their basic nursing program. The unique combination of physical health care and psychiatric knowledge and skills possessed by advanced-practice psychiatric nurses is essential for providing high-quality, cost-effective patient care. Incentives must be available to increase the number of nurses with graduate degrees in psychiatric and mental health nursing to assure an adequate supply of these well-prepared and cost-effective providers. ♦

Subtle coercion in psychiatric practice.

Making nursing decision for patients who cannot communicate their own wishes and needs is a common problem in psychiatric and mental health nursing. The aim of this article is to present the findings of a qualitative study focused on situations in which patients do not cooperate with a nursing decision about what should be done for them. The design of the study utilized some steps associated with the grounded theory method. Data were collected from unstructured interviews with 10 British nurses with long experience in psychiatric nursing. By implementing the strategy of constant comparative analysis of the transcribed interviews, it was found that nurses use different types of subtle coercion in order to achieve their own goals for the patient. These goals were justified as being in the best interest of the patient. The main components of subtle coercion are part of a process consisting of: assessing a patient's competency for self-choice; acting strategically; modifying the principle af autonomy; justifying strategies; and reflecting ethically on the action taken. The study indicates that further empirical investigation of clinical situations involving subtle coercion is required. Particular attention should be paid to organizational factors and how these contribute to the use of subtle coercion. A specific question that needs to be theoretically and empirically explored is, can coercion be justified as 'ethically right' in some situations but not in others?

Validation study for impaired personal boundaries, proposed nursing diagnosis.

The authors propose a new nursing diagnosis of impaired personal boundaries based on their experience in psychiatric nursing, a concept analysis of the literature and diagnostic content validation by a panel of experts. Impaired personal boundaries are common in a number of mental disorders including, schizophrenia, borderline personality, substance abuse and enabling. Recognition of this patient problem has implications for further research and nursing interventions.

The Patient in Room 321

Elaine Creasman, LPN,a freelance writer, has experience in orthopedic, medical and psychiatric nursing. She attends First Baptist Church of Indian Rocks in Largo, Florida, and just celebrated her nineteenth wedding anniversary.

The social context of occupational stress in a caring profession

This paper examines the relationship between the structure and ideology of the psychiatric system and the actions, worldview and subjective experiences of psychiatric nurses working within both the hospital and the community settings. In contrast to previous occupational stress research, which has tended to concentrate on the perspective of staff without interpreting either the interrelationships between the experiences of caregiver and recipients or the ways in which the social context of care influences all participants' interpretations of their situation, this paper will argue that the occupational stresses facing psychiatric professionals cannot be fully understood without a clear understanding of the ambivalent role of welfare institutions within our society. This necessitates moving beyond the decontextualized, micro-level analyses advocated within the traditional occupational stress literature and drawing on alternative theoretical traditions which facilitate richer interpretations of the complex interplay between the structure and ideology of Western psychiatric systems and the motives, understandings, actions and emotions of different players within the system. With these considerations in mind, this article seeks to forge new links between the theoretical analysis of psychiatry's role within our society and the empirical investigation of occupational stress in psychiatric nursing by elucidating the interpersonal processes which enable the structural contradictions of psychiatry to find concrete expression within the fragmented understanding and inconsistent actions of the various players within the system. As the empirical research will reveal, staff attempts to ameliorate the chronic personal insecurities engendered by these contradictions often have the paradoxical effect of augmenting the problems of the psychiatric system and intensifying the very feelings they are struggling to avoid.

Stress and Contradiction in Psychiatric Nursing

This article examines the relationship between the organizational structure and ideology of the psychiatric system and the daily actions and subjective experiences of psychiatric nurses. It presents empirical data from an in-depth case study in which psychiatric nurses attempt to deal with the stresses of their work by developing various collective coping strategies which eventually become embedded in the daily routines of the institution, intensifying the very problems they were originally intended to solve. The article is divided into three main sections. The first section examines recent sociological theorizing concerning the contradictory role of the psychiatric system within modern society. The second section presents empirical data illustrating the ways in which the structural contradictions of the psychiatric sector affect the daily lives of all who participate in the system, while the final section discusses the need for organizational level interventions to relieve occupational stress in welfare institutions.

Responding to aggression; the role of significant others for student psychiatric nurses, an ethnographic study

There is much quantitative information on the level and type of aggression towards hospital staff. Junior staff are said to be particularly at risk. In an attempt to add to our knowledge on this important subject a qualitative perspective was chosen to investigate the experiences of student psychiatric nurses when on clinical placements. This paper draws on interview data to highlight the importance significant others play for students before, during and following incidents of aggression. An ethnographic methodology was chosen as it is particularly suited to small-scale research when the research focus is not fully articulated. The validity of ethnographic evidence is discussed and suggestions made for the improvement of validity in further studies while remaining within an ethnographic perspective.

The reactions of nursing staff to physical assault by a patient.

Forty nursing staff members in a Veterans Administration neuropsychiatric hospital were surveyed in a study aimed at determining victims' responses to the assault and helping to sensitize clinicians to the frequency and outcomes of assaults on nursing staff. The respondents, who had an average of six years of psychiatric nursing experience, reported being assaulted an average of seven times prior to the study period. The author summarizes the emotional, social, biophysiological, and cognitive responses of the respondents and notes that a major finding was the large number of staff who indicated they had no reactions to the assault. She speculates that staff may be unable to admit their reactions even to themselves and discusses some possible reasons for that situation.

Clinical teaching: an evaluation of a problem orientated approach to psychiatric nurse education.

In a recent paper by one of the authors (Cormack 1080) the use of the problem orientated approach to nursing, and a proposed framework for assessing nursing needs, were discussed. Subsequently one of the writers (W.R.) utilized the problem orientated approach during the psychiatric nursing experience made available to student nurses undergoing the comprehensive modular training at the Highland College of Nursing and Midwifery, Scotland. This paper presents an evaluation of the problem orientated approach which has now been developing for 2 years. This paper describes the experience of W.R. in using a problem orientated approach to nursing diagnosis and nursing care prescriptions. It is argued that such an approach, combined with patient-centred rather than classroom based nurse education, is essential to enable psychiatric nurse teachers to teach effectively. Such a patient-centred approach is also necessary to clarify the psychiatric nurses' role and to shift the emphasis of psychiatric nurse education away from psychomotor skills to interpersonal skills. While it is recognized that this evaluation does not comply with the scientific criteria of a formal research based project, it is suggested that the experience of the authors and the comments of the many students involved in the exercise accurately reflect the problems encountered and the progress achieved.

Concerns of student nurses prior to psychiatric nursing experience: an assessment and intervention technique.

Concerns of student nurses prior to psychiatric nursing experience: an assessment and intervention technique.

Out of Touch With Reality

OLIVE WILKINSON. RN., received her basic nursing education al Harrow Hospital, Middlesex, England, and has had past experience in psychiatric nursing. The events she describes in this article took place in 1966. Since her recovery, Ms. Wilkinson has done some private duty nursing.

Nurses as the Core of a Psychiatric Team

There has been a trend among hospitals to provide psychiatric services on general hospital wards rather than in separate psychiatric units. In January 1971, on a one-year trial basis, the Baltimore County Department of Health, Bureau of Mental Health, collaborated with the 300bed Franklin Square Hospital to develop a psychiatric services program. There was no separate psychiatric inpatient service. Instead, there were ten beds, located throughout the hospital, for patients who had psychiatric problems in addition to physical illness, for example suicidal tendencies. The Baltimore County Health Department provided a psychiatric nurse consultant for a half day twice a week to meet with the medicalsurgical clinical specialist of Franklin Square Hospital. The clinical specialist had had previous experience in psychiatric nursing, which enhanced the consultant-consultee

Guidelines for the Care of Confused Patients

MS. MORRIS (Presbyterian-University Hospital School of Nursing. Pittsburgh) has had experience in medical, neurosurgical, and psychiatric nursing. She is now a student in the baccalaureate program at the University of California School of Nursing in San Francisco. For two and one-half years, she was a staff nurse on the unit where Ms. Rhodes was supervising nurse. MS. RHODES (Scott and White Memorial Hospital School of Nursing, Temple, Tex.) has had extensive clinical experience as a nurse in a large state psychiatric hospital, a psychiatric admission unit at a county hospital, and as a supervising nurse on an acute psychiatric admission unit. She is now leaching psychiatric technicians at Napa College, Calif.

Guidelines for the Care of Confused Patients

disorder (such as schizophrenia) which is due to psychosocial, psychosexual, and developmental factors. At this point you may be asking why it is important for nurses to assess the type of confusion. Priarily, it is because nurses are with patients a greater amount of time than physicians and, therefore, can be instrumental in changing therapy early. If a nurse notices a patient exhibiting early signs of organic confusion, she can withhold such medications as barbiturates, which tend MS. MORRIS (Presbyterian-University Hospital School of Nursing, Pittsburgh) has had experience in medical, neurosurgical, and psychiatric nursing. She is now a student in the baccalaureate program at the University of California School of Nursing in San Francisco. For two and one-half years, she was a staff nurse on the unit where Ms. Rhodes was supervising

Recognizing Emotional Problems

Associate professor of psychiatric nursing and chairman, Department of Psychiatric Nursing, University of California School of Nursing, San Francisco, MIARION E. KALKMNAN earned a bachelor's degree at Brown University, Providence, R.I., a diploma from the Army School of Nursing, Washington, D.C., and a master's degree from Stanford University, California. She has had extensive experience in psychiatric nursing and is the author of Psychiatric Nursing (McGraw-Hill, New York, N.Y.) now in its third edition. This paper is based on a speech delivered in Lubbock, Texas, at an institute sponsored by District 8, Texas Nurses Association and the Lubbock Mental Health Association. quire nursing care outside of mental hos itals than in these hospitals. The patient who returns to the community after a perio of p olonged psychiatric treatment faces a number of difficult problems. Hopefully, he has been referred to a public health agency for follow-up or, particularly if he is on drugs, has some medical supervision. The help a public health nurse can give such patients is not the focus of this paper. Here, I prefer to focus on persons not considered patients in this sense.

A Student Learning Experience in Psychiatric Nursing in a Psychiatric Day Treatment Center

A Student Learning Experience in Psychiatric Nursing in a Psychiatric Day Treatment Center

Experience in Psychiatric Nursing

Experience in Psychiatric Nursing

The function of the psychiatric social worker at Western Psychiatric Institute.

The Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical School consists of 5 departments interrelated by the common purposes of treatment, teaching, and research. These are the medical, nursing, social service, psychology and occupational therapy departments. Each carries on a program of professional training. The medical department trains physicians and medical students in clinical psychiatry in a 3-year program. The nursing department offers a 3-month affiliation to undergraduate nurses from other hospitals, with instruction in psychiatry and experience in psychiatric nursing. It also provides experience for graduate nurses working toward a bachelor’s degree with a major in psychiatric nursing, as well as for the mental hygiene consultants, who are recipients of U. S. Public Health Service stipends. The psychology department trains clinical residents in psychology, and the occupational-therapy department provides experience for students in occupational therapy from Ohio State University. The departments work together in interpreting the different disciplines to the students. For a long time the resident staff had discussed the question of the specific function of the psychiatric social worker at the Institute. The medical staff wanted a clear statement of the distinction between the psychotherapy practiced by the residents and the casework of the psychiatric social workers. After ample discussion by the chief psychiatric social worker with individual secondand third-year residents, as to their concept of the function of the psychiatric social worker, a statement was prepared and submitted to the medical staff for their approval. The medical staff-at that time 6 psychiatrists-agreed that the statement, which is presented below, would have much

Open House at a Hospital for the Mentally Ill

NE morning eight students met together for a clinical conference in a cheerful sitting room of Kings Park State Hospital, in New York. They had begun their 12-week psychiatric nursing experience just two weeks before. They appeared to be very comfortable with each other and to share an atmosphere of warmth and mutual respect. Everyone had something to relate which concerned their experiences with their patients that week. What was I scared of at first? I certainly don't feel that way now. It's too bad that these patients are all locked away from such a beautiful day; the sky is such a bright blue. Jane (a patient) is much like people I know. She draws, and she gave me this pencil sketch. The students apparently were aware of the needs of the patients they had become acquainted with. They groped for words which would express best what they felt and thought. Toward the close of the conference, one student suggested, If we are surprised to find that mentally ill people are like ourselves in many ways, how about inviting people from the community to see what we are seeing so that they can learn too? Another said, My family asks me all kinds of questions when I go home. Sometimes I think they want to come and see for themselves. At the close of the ward class, the instructor suggested that they might present their idea to the entire class for discussion at their next meeting. They did not do this, however, so the instructor thought that they were not ready to go further at the time. Toward the end of the students' experience, one of them referred to their idea on educating the community about mental illness. She asked the class to consider inviting their families and friends to visit the hospital. A few were not enthusiastic. People just are not interested, they said. Two others said that they had been forbidden to mention their state hospital experience at home. But most of them were enthusiastically in favor of doing something. Rapidly the initial suggestion took hold. How about our having an open house and presenting a panel like they

The Story of Evelyn

Levy, Francine S.; Kravits, Carole E.; Krock, Gilda; Rafer, Sarah F.; Nowick, Esther; Males, Dolores; Nilson, Jeanne; Patterson, Marjorie Author Information