Advanced-practice psychiatric nursing and health care reform.
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Biomedical subjects
Publications and source records attributed to S Talley.
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Prescriptive authority is of increasing interest to advanced practice psychiatric nurses. A growing number of states have passed legislation authorizing prescriptive authority for this specialty group. In preparing for an orderly assimilation of this intervention into psychiatric nursing's existing scope of practice, it is important to understand some of the unique issues facing the specialty. This report provides an overview of prescriptive practice legislation, legal issues associated with prescribing psychotropic medication to psychiatric clientele, and prescriptive activities common to the specialty practice of psychiatry. Issues for the specialty of psychiatric nursing are reviewed and recommendations are offered for an action plan.
One hundred seven patients in an acute care setting who had lay sitters to provide the constant observation judged necessary to meet their safety needs were studied to determine the effect of psychiatric liaison nurse specialist (PLNS) consultation on nursing care and the use of sitters. After placement in either a suicidal or nonsuicidal group, subjects were randomly assigned to receive consultation or not. Outcome variables of number of sitter shifts, number of nursing note observations, number of patient and sitter incidents and length of hospital stay were considered. Multiple analysis of variance indicated no significant differences among the groups for number of sitter shifts or number of nursing note observations. A significant main effect for group on length of hospital stay was found with suicidal patients having a significantly shorter hospital stay. Number of patients and sitter incidents were too small for analysis.
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Psychiatric emergency services have evolved into more comprehensive programs during the past two decades. With this evolution other disciplines have gained access to the services and integrated their expertise and philosophy into the daily care of patients. Nursing has been an integral part of this process and contributed its perspective in nursing care. This paper outlines the development of psychiatric emergency services with a special emphasis on the contribution of nursing specialists who have developed their role within the psychiatric emergency service. What has been unique about the nursing contribution is the attention to individualizing patient care and modifying treatment approaches to meet the patients' needs and interests in psychiatric treatment. Additionally, nursing has complemented the physician's role by developing expertise in assessment that is both psychologically and biologically oriented. Nursing's future contribution to psychiatric emergency services should address mechanisms for tracking patients who enter the psychiatric emergency service system with an emphasis on linkage with other programs or resolution of the crisis episode.
Overcoming resistance to the stigma of psychiatric care is a first step in merging mental health care with primary care. The practitioner's role in socializing clients who could potentially benefit from psychiatric care is vital in gaining acceptance for mental health care. The socialization process should address reasons for mental health care, elaborate on the client's choices in selecting a suitable therapist and reassure the client that the primary care provider will maintain a collaborative relationship with the therapist. For those clients or situations that cannot be referred to a specialist, psychiatric consultation models are useful alternatives for the primary care provider. Regularly scheduled meetings with a psychiatric consultant provide time to discuss clients, assessment techniques, intervention strategies or impediments to the delivery of mental health care. Increased knowledge of mental health practices will improve case finding and implementation of psychotherapeutic plans.
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