Quality of Care in Psychiatric Nursing

Introduction

Various studies have defined the quality of care in severe psychiatric nursing. Few of them discussed below can support the view where a positive link between the psychiatric quality nursing and the corresponding impact on the mentally challenged people are figured out.

One such study was undertaken in which 456 permanent registered nurses were deployed to different psychiatric units for comparison with 11,071 registered nurses who worked as permanent employees in various departments of the medical facility. The comparison carried out revealed that non-psychiatric nurses reported better quality of patient care than the psychiatric nursing where more number of older, experienced and proportion of male nurses was found.

The quality of psychiatric nursing care was reflected through a greater concern regarding the acceptance of patients and higher incidence of adverse events. Nurses was exposed to extreme conditions where they faced a lot of verbal abuse, physical injuries, and complaints which was absent in other nursing types. Such issues certainly detriment the quality of care imparted to mentally challenged patients (Hanrahan N P, Aiken L H, 2008).

To highlight another standpoint of quality of care, patient’s perception can also be an important aspect in determining the nursing practice. In a study conducted by Beech P, Norman I J , incidents of high and low quality nursing care were perceived as per the response of 2 patients with mental health problems.

Results from a Critical Incident Technique, in which quantitative analysis was used among 239 indicators of high- and low-quality psychiatric nursing cares grouped under six main categories, it was found that the most impactful indicator of high-quality nursing was ‘active listening’.

On the other hand low-quality nursing was attributed to wrong nurses’ actions, or their utter failure to explain reasons behind their actions. Actions were mainly negative and attributed to the negative group behaviour on ward atmosphere, inadequate knowledge and the unconstructive and unsuitable consequences of inadequate staffing (Beech P, Norman I J, 1995).

Quality of nursing can also be measured through the role of the nurse practitioner directed towards consumer satisfaction which can elaborate the quality of nursing imparted to the patients. As per the data analyzed in one of the studies, two main themes were explores, firstly the quality of the service provided, and secondly the unique role of the nurse. The findings of the study supported the fact that specific aspects of the nurse practitioner role are positively perceived by consumers of services, thereby a healthy relationship between nurse practitioner and helps in improvisation of the provision of effective care and treatment (Wortans J, Happell B, Johnstone H, 2006).

Uses of Concept

The rapidly changing health care system requires a proper quality check that ensures positive changes in the in service systems including quality patient care as well. The quality measures of nursing practice aim to render information about the care at nursing homes. The quality measurement can be carried out through the case management process where the key areas of measurement are effective coordination of care processes, quality outcomes, adequate human and financial resources, organizational and individual attitude in achieving the nursing goals etc (Smith P A, 2003).

The ultimate combination of physical health care and psychiatric knowledge and skills possessed by experiences and enthusiastic psychiatric nurses is quintessential for rendering high-quality, cost-effective patient care which are few attributes that add on to the quality measurement scale. To impose a regular supervision on quality standards; the respective patient care units must perform audits for compliance and identification of areas for improvement. Such exercise would enable in generating awareness about quality norms and encourage nurses to adopt best psychiatry nursing practices.

The nursing concept in totality includes numerous perspectives, such as an ethnographic study conducted by B Sturm, was completely dedicated in finding out the practice of CHNs and a platform where the nursing issue can be brought out. The major ones were the conflict which is observed by many nurses who were sincere on their part to deliver high-quality care to the patients with mental illness.

The nursing practice faced a dilemma whereby, the administrative constraints hindered there efforts in applying an ethical care. The stringent regulatory functions imposed by insurers augmented the pace of stricter payment restrictions which hampered the quality of care delivered in the nursing practice (B Sturm, 2003).

In studying the nursing concept, it is utmost important to find out about the relationship between job satisfaction of nurses and the reasons for turnover. To elucidate this, a study randomly sampled 72 nursing homes from 5 states i.e., Colorado, Florida, Michigan, New York, and Oregon. A special job satisfaction instrument was used to validate the nursing measures. Logistic regression was used as a statistical tool for examining the collected data.

As a result High overall job satisfaction was linked with low scores on thinking about leaving, thinking about a job search, searching for a job, and turnover. Overall training, rewards, and workload were the prime factors associated with measuring the important aspects of nurse aides’ jobs (Castle G N, Engberg J, Anderson R, Men A, 2007). There has been observed a remarkable nursing shortage that is one of the major causes of health care practices worldwide. Nurse staffing is facing a significant cost challenge that requires a careful planning and application of management control systems (Carol A, 2003).

Defining Attributes of Psychiatric Nursing

Caring is the mainstay of nursing. Nurses’ caring behaviour has been discussed and defined through various attributes that facilitate nursing. Absence of nursing attributes, automatically imply a non-caring nursing behaviour. To elaborate more on the concept of what is nursing and what is not, let’s have a closer look. Caring is another form of sympathy, a nurse must be kind enough to understand the feeling of the sufferer. Patience is often, connected with attendance upon the sick which is an imperative component of caring. Caring is also associated with carefulness; person who is attending the patient must be meticulous enough and cautious to give proper medication and attention to the patient. Professionalism is another attribute to psychiatric nursing which is displayed in the nursing appearance, language, and behavior etc. Non-caring aspects of nursing include improper language, coming to work disturbed and disheveled, failing to abide by the medical norms or the standards laid down by the organizations and even overlooking the nursing standards are a part of the non-caring nursing.

Timeliness aids in enhancing the nursing performance, right action at right time is the crux of caring attitude. On the other hand non-caring attitude incorporates irrational, untimely decisions, hopeless, cynical and dispassionate attitude. Honest, sincere, heartfelt communication is the best sign of a caring nursing behaviour, rendering of the responsibilities to the best of one’s ability constitutes a positive caring perspective whereas absence of sense of responsible and earnest service, leads to a non caring nursing practice.

Model Case

A perfect model in psychiatric nursing can be one which has the following components involved, firstly an in-depth assessment including an analysis of the situation , patients thinking process, behavioral perspectives whether dysfunctional or adaptative, etc. components of assessment include a mental status examination whereby patients activity, attitude, appearance, mood, perception, thoughts, insight, psychosocial criteria’s, relationship, beliefs and many other factors are deeply analyzed and assessed. Secondly, the expected outcomes individualized to the patient are identified, thirdly after identifying the patient’s problem, a planning chart if finalized where priorities are set, goals are determined, and nursing action are planned, and the next step includes implementation of the nursing plan and evaluation of the plan. But in actual practice, psychiatric nursing does not follow such actions, for instance, A contrary case to the apt nursing model was found in the research conducted by Wiman E, Wikbald K (2004), who tried to study the encounters between the psychiatric nursing team and the patient and explore whether the theory of caring and non -caring is justified in psychiatric nursing.

In the study, data was collected by videotaping caring interactions between the nurses and the patient, after which a detailed and in-depth analysis of the videotape was done. As per the results, nurses verbal and non-verbal communications were not found appropriate and they were seen adopting a wait and see policy. The uncaring aspect involving instrumental behaviour was discovered while one of the caring aspects that are utter dedication and courage to take up the challenge was explored. However, the research was more dominated by the uncaring factors in meeting up the psychological needs of the patient (Wiman E, Wikbald K 2004).

The qualities of a good nurse can be reflected when a nurse carries out the orders of the physician efficiently, watchfulness and maintaining silence helps to create a better environment which can be facilitated through nursing help, kindness, commonsense, carefulness, neatness, handiness and cheerfulness are the imperative qualities that should be present in a nurse. Apart from this nurse must respect staff as professional and set an exemplary example, be organized yet creative and flexible in approach, should act as an effective decision-maker, be motivating, should have a good sense of humor, should be loyal, honest, rational, reliable and accessible and above all should be a terrific communicator.

References

B Sturm. 2003. Ethics and care: an ethnographic study of psychiatric community health nursing practice1. Archives of Psychiatric Nursing, Volume 18, Issue 3, 106 – 115.

Beech P, Norman I J. 1995. Patients’ perceptions of the quality of psychiatric nursing care : findings from a small-scale descriptive study. Journal of Clinical Nursing, Vol 4, 117-23

Castle G N, Engberg J, Anderson R, Men A. 2007. Job satisfaction of nurse aides in nursing homes: Intent to Leave and Turnover. The Gerontologist 47: 193-204.

Carol A. 2003. Decreasing nurse staffing costs in a hospital setting: development and support of core staff stability. Journal of Nursing Care Quality. 18(3): 226-240.

Hanrahan N P, Aiken L H. 2008. Psychiatric nurse reports on the quality of psychiatric care in general hospitals. Quality Management Health Care; 17(3), 207- 210.

Wiman E, Wikbald K.2004. Caring and uncaring encounters in nursing in an emergency department. J Clin Nurs, 13(4): 442-9.

Wortans J, Happell B, Johnstone H. 2006. The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction. Journal of psychiatry Mental Health Nursing, 13(1), 78-84.