Whose structure is it anyway?

Development of the Psychiatric Nursing Intervention Providing Structure: An International Delphi Study

BACKGROUND

Psychiatric nurses commonly refer to "providing structure" (PS) as a key intervention. But no consensus exists about what PS entails. PS can be understood as a complex intervention. In four previous studies, a definition, activities, and context variables were described that were presented to experts in a Delphi study.

OBJECTIVE

To reach consensus about the definition of PS, its activities, and context variables.

DESIGN

In a qualitative study, a Delphi study is used to gather the opinions of experts. The Delphi study consisted of three rounds with statements to score in each round.

RESULTS

Experts reached consensus about a definition of PS, its activities, and context variables. Eleven statements related to the definition were accepted. Fourteen statements of a total of 17 statements related to the specific activities reached sufficient agreement, and 4 statements related to context variables were accepted.

CONCLUSIONS

A definition could be given of PS with 4 general PS activities, 15 specific activities, and 3 context variables. Psychiatric nurses can use the information about PS to reflect on the use of PS activities within their own working environment, and these insights can help nurses develop their professional growth.

The patient's perspective on "providing structure" in psychiatric inpatient care: an interview study

PURPOSE

To gain insight into the patients' experiences on providing structure (PS) as a nursing intervention during psychiatric inpatient care.

DESIGN AND METHOD

Interviews were conducted with patients (n = 17) from two inpatient wards within a mental healthcare organization. For data analysis, a qualitative coding process was followed.

FINDINGS

The patients' expectations for PS were described. One expectation seemed to reflect key concern: the need to maintain autonomy.

PRACTICAL IMPLICATIONS

The study reveals the patients' views about PS. When the importance of PS is mentioned, nurses can refer to our description of PS. We were able to further stipulate the required activities of PS and provide for an adapted definition of PS.

An observational study of providing structure as a psychiatric nursing intervention

PURPOSE

To observe the actions of psychiatric nurses when providing structure and identify results in order to better understand providing structure as a complex nursing intervention.

DESIGN AND METHOD

Participant observation data were collected on a dual diagnosis ward and a crisis intervention ward in a mental healthcare organization. A total of 52 events were selected that involved providing structure.

FINDINGS

Three phases in the processing of providing structure were identified: the start of the interaction, the interaction phase, and the end of the interaction. For each phase in the intervention, both critical nurse and patient responses were coded.

PRACTICAL IMPLICATIONS

The results of this observational study contribute to a formalization of the nursing intervention "providing structure" in the Nursing Interventions Classification.

"Providing structure" as a psychiatric nursing intervention: a review of the literature

PURPOSE

The focus is on a nursing intervention called "providing structure" (PS). This label does not exist in the Nursing Interventions Classification. The following three questions were asked: (a) How is PS defined? (b) What are the goals of PS? and (c) What is the evidence regarding the effectiveness of PS?

DESIGN AND METHOD

A systematic literature review. Forty articles, predominantly qualitative studies of PS, were selected for review.

FINDINGS

Regarding PS, three elements were mentioned: to impose and maintain rules and limits; to assess the condition of the patient; and to interact with the patient. The goals for PS related to patient security, making expectations explicit, and recovering from illness. Major findings were reviewed, but little was found about the effectiveness of PS.

The Defining Characteristics of Support: Results of a Research Project

Support is a central concept in nursing practice; not only for psychiatric nurses, but for all nurses. Yet, the ambiguity about the definition of support is troubling. More importantly, nurses are "doing things" to and for patients, but are these interventions truly supportive? What kinds of support do our patients want and need? As nursing advances towards a scientific basis for practice, we must be clear about the what and why of our actions (Sebastian, 1990). As nurses become more outcome oriented, we must know what patients value in their treatment. This study is an initial attempt to clarify for psychiatric nurses the concept of support; may it be the first of many.