A system of patient classification in long-term psychiatric inpatients: Resource Utilization Groups T-18 (RUG T-18)

Approaches to workload in psychiatric and mental health nursing

OBJECTIVE

to investigate approaches to workload in psychiatric and mental health nursing in Brazilian and international production of knowledge Methods: integrative literature review using six databases, covering January 2005 to March 2019. Articles in full in English, Spanish and Portuguese were included.

RESULTS

the sample consisted of 23 original articles classified as quantitative or emotional. The quantitative dimension was addressed in 12 articles and included: assessing patient care needs, identifying activities performed by the team, measuring time spent and developing and validating a measurement instrument. The emotional dimension included 11 articles the focus of which was on identifying stressors in the workplace, psychosocial risks and coping strategies.

CONCLUSION

strategies were found for measuring workload and assessing the impact of stressors on nursing teams.

Cost drivers of inpatient mental health care: a systematic review

Aims. New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence. Methods. A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted. Results. The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site. Conclusions. Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely.

Using video simulated presence to reduce resistance to care and increase participation of adults with dementia

BACKGROUND

Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC).

METHODS

A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation.

RESULTS

Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance.

CONCLUSIONS

This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.

[Patient classification system in psychiatric nursing: clinical validation]

The scarcity of publications about personnel dimensioning in psychiatric nursing motivated the development of an Instrument to Classify the Level of Dependence in Psychiatric Nursing, the initial stage for the establishment of the ideal number of professionals in the nursing crew of the specialty. The purpose of this study was to look for the clinical validation through reliability and construct validity tests, as well as to verify its applicability in the management practice of nurses. Two samples were used, of which n = 40 pairs of instruments filled in Stage 1 of data collection and n = 100 instruments filled in Stage 3 of the study, with different statistical criteria being applied, among them the Kappa coefficient and the Spearman correlation. The Instrument to Classify the Level of Dependence in Psychiatric Nursing was considered reliable, with good indicators of agreement, and the construct was validated, determining the degree of dependence of mental disorder patients.