The use of a medical support group on a medical/psychiatric unit

Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic Review

OBJECTIVE

The goal of this review was to assess the relationships among aims, designs, and outcomes of integrated inpatient medical and psychiatric care units (IMPUs) and gather the evidence base on the effectiveness of these units.

METHODS

Using online searches of Embase, Medline, Web of Science, PsycINFO, Scopus, CINAHL, Cochrane, and Google Scholar, the authors identified and reviewed literature describing the aims and outcomes of specific IMPU designs.

RESULTS

The search yielded 55 studies, in which the authors identified 39 IMPUs that focused on patients with mood, psychotic, somatic symptom, substance use, organic, and personality disorders and a broad array of medical diagnoses. Most units were psychiatric-medical units and had medium medical and psychiatric acuity capabilities. The studies reviewed provided little information on the cost-effectiveness of various IMPU designs. Although some comparative studies indicated reductions in hospital length of stay (LOS), these studies were generally of low quality and rarely reported other intended outcomes.

CONCLUSIONS

IMPUs may help shorten LOS. IMPUs should focus care on patients with complex conditions and high acuity to maximize health system value. Implementing compulsory admission facilities; qualified psychiatric, medical, and nursing staff involvement; and cross-disciplinary training may improve IMPUs' capacity to treat high-acuity patients. Future research should relate IMPU designs to intended outcomes.

Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

BACKGROUND

The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC.

METHODS

Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing.

RESULTS

One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10-6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations.

CONCLUSION

Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.

A feminist critique of psychiatric nursing discourse

This theoretical research explores the discourse, language, texts, and practices that are part of the everyday work world of psychiatric nursing. How information is created, what becomes established knowledge, and how it is disseminated are the foci of this particular discourse. Psychiatric nursing "science" has developed from the work of nursing theorists and researchers in an attempt to raise the status of nursing. The result has been that this knowledge wields power. Most of this knowledge is based on positivist assumptions to predict and control patients' behavior. Drawing upon the work of postmodernists and the sociology of knowledge experts in discourse analysis, this paper concludes that, because information is humanly constructed, nurses have the power to alter knowledge, and thereby to bring about alternative ways of knowing and subsequent social and political change.

Nursing-led group modalities in a psychiatric inpatient setting: a program evaluation

This examination of group practice activities conducted by nurses in an inpatient setting combined retrospective examination of practices and concurrent analysis of what is actually done on the units. The most striking finding of this evaluation of institutional nursing-led or co-led group activities was the significant decline in the number of groups. Second, and a related finding, was the need to standardize the format for documenting group activities and outlining the scope and function of these groups. And finally, the need for concise evaluation criteria and measures to document the achievement of stated patient outcomes was very apparent.

Reorganization of community psychiatric services by professional nurses

This article describes the reorganization of one part of an individual, home visiting service for mentally dysfunctional women into a group intervention. Deinstitutionalization has been followed by escalating health care costs, cost containment, and restructuring of services, affecting the already constrained resources for community psychiatric services. Faced with these challenges, a nursing staff, under the administration of a clinical specialist psychiatric nurse, began reorganization of a home visiting service with one trial group. The model group used the prior success reports of groups that were adapted prospectively with a focus on immediate needs and led by nurses for women. The aims were to enhance social supports of the clients while reducing their relapse rates and to reduce the personnel time and cost. Evaluation found that these objectives were met. Thus, the involvement of nurses in the assessment, planning, implementation, and evaluation of its services demonstrates success in the redesign and reorganization of community psychiatric services.