Physical restraint using,autonomy,ethics among psychiatric patients in nursing practice in China

The application of physical restraint for patients represents ethical dilemmas for psychiatric nurses in terms of maintaining the safety of all(clients and staff)while at the same time curtailing the individual’s autonomy.This article aimed to provide a sound knowledge of ethical positions and strategies for psychiatric nurses to address ethical issues of physical restraint according to the ethical principles of autonomy,beneficence,nonmaleficence,and ethical theories.Given that nursing workforce was limited and workload among psychiatric nurses was heavy,physical restraint was one of the coercive interventions managing aggressive behavior.In relation to address ethical dilemmas,it was proposed to acquire informed consent of physical restraint from the individuals and provide person‑centered care.Effective communication and negotiation with patients could help to strike a balance between patients’autonomy and nurses’accountability when using physical restraint.In addition,guidelines and targeted intervention strategies need to be developed to regulate and reduce the implementation of restraint.Finally,a collaboration among nurses,psychiatrists,and families is essential to protect patients’autonomy concerning physical restraint use.

Violence Prevention in a Psychiatric Unit

Psychiatric units are one of the most frequent settings of violence against medical staff. This affects the physical, emotional and psychological well-being of the staff and has an impact on their quality of care and the interactions with patients inside the unit. Evaluate if SDAS scores at admission in an inpatient psychiatric unit can be predictive of violence and aggression among admitted patients towards medical staff. Charts of all patients admitted during a 12 month period were retrospectively reviewed and their SDAS scores at admission registered, and all violent events reported by nurses during the same period were collected. SDAS scores significantly contributed to the prediction of the violent behavior against nurses, non dependent on psychiatric diagnosis at admission. SDAS can represent a tool that can help psychiatric nurses identify patients at risk of violence and therefore improve management of these patients.

Classroom-Based Parent Interview in Psychiatric Mental Health Nursing

A classroom-based parent interview was designed and implemented in an undergraduate psychiatric mental health nursing class to fill the gap between nursing students and parents of child or adolescent patients with mental health issues faced during clinical. The goals of this learning activity were to increase understanding of what parents experience when dealing with their child’s mental health problems and to increase student engagement and attention. The class using this learning activity consisted of three parts: 1) an assigned pre-class reading;2) a mini-lecture;and 3) a parent interview presentation. Students were pre-assigned a reading chapter and faculty-developed interview questions. During the mini-lecture, important knowledge related to mental health care of children was assessed using CourseKey software. After the mini-lecture, the parent guest speaker delivered her presentation about herself, her child’s strengths and abilities, her child’s mental health problems and their impact, and her family’s strengths based on the interview question prompts for about 30 minutes, followed by 20 minutes of a Q & A session. The set of interview questions was developed by faculty based on the competency questions of the Child Behavior Check List. Despite some limitations, this classroom-based parent interview using a flipped classroom model was found to be a meaningful learning strategy by increasing student engagement and attention, increasing retention of knowledge learned in class, and filling that gap in clinical.

The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS©)

The purpose of this study was to develop the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©. This study used the on-line survey method from February to April 2015. There were 644 respondents comprised of professional nurses with minimum qualification of 3 years’ experience being in a psychiatric unit of a stand-alone 200-bed or more Psychiatric Hospital in Japan. Assessment items were derived from 211 specific items selected from nursing textbooks, excluding the North-American-Nursing-Diagnosis-Association (NANDA). The questionnaire contained Cover Letter, Demographic Data Sheet, and the PsyNACS© questionnaire. There were 644 questionnaires accessed but only 435 were completed and valid. Item levels of importance were evaluated: 1) Unnecessary, 2) Not very important, 3) Important and 4) Very important. Data analysis used descriptive and multivariate statistics. Factor analysis (principal factor analysis, varimax rotation), the Kaiser-Meyer-Olkin (KMO) and the Bartlett’s test of Sphericity assessed the adaptive validity of the factor analysis. Factor loadings were set at 0.4 or more for the configuration of items. Internal consistency and reliability were established using Cronbach’s alpha coefficient. Mean factor points were calculated, including standard deviation, range, and confidence interval at 95%. Statistical significance was at 0.05 level. Nine Patient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD) each were categorized. Thirty one CADs comprised the Patient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS© is a classification of items assessing health care needs within the Japanese psychiatric nursing care environment, and also can be used in various psychiatric patient care situations in all psychiatric units.

Criteria for Determining the Need for Admission of People with Dementia to Dementia Nursing Wards of Psychiatric Hospitals in Japan

Purpose: This study aims to establish criteria to determine the need for admission of people with dementia to dementia nursing wards of psychiatric hospitals—based on the experience of nurses working in dementia nursing wards. Methods: Semi-structured interviews were conducted with nurses who had worked in dementia nursing wards of psychiatric hospitals for more than 3 years, to collect data related to the “condition at the time of admission and the process of hospitalization of dementia patients”. Data were analyzed using the content analysis approach. Focusing on “What is the condition of patients with dementia admitted to the dementia nursing ward?”, we created codes according to similarities in the meaning, and classified these into categories where they were evaluated to fully fit in. Results and Discussion: The analysis yielded 4 categories, and 44 codes. The four categories are as follows: [Appearance of a state where self-control is difficult] which expresses a state where behavioral and psychological symptoms of dementia (BPSD) have appeared, and the remaining three categories [Insufficient support provided], [Appearance of symptoms that make living difficult], and [Appearance of physical symptoms that require treatment] express the states that may trigger the appearance of BPSD. These show that the appearance of BPSD is a criterion for determining hospitalization. By providing support to prevent the states described in the 44 codes, nurses may help people with dementia avoid being hospitalized in dementia nursing wards in psychiatric hospitals.

The Impact of an eLearning Course on Nurses’Attitudes towards Mental Illness

Patients with mental illness are stigmatized. Health care professionals may even perpetuate stigma towards mental illness. Thus it is important to ensure that health care professionals have positive attitudes towards patients with mental illness. The aim of this study was to estimate the impact of an eLearning course on psychiatric nurses’ attitudes towards mental illness. A cluster-randomized trial (ISRCTN32869544) design was used. Twelve wards were randomly assigned to the eLearning course (ePsychNurse.Net) group or the education as a usual group. The participants (N = 228) were allocated to the intervention (n = 115) or control group (n = 113) according their baseline ward affiliation. Attitudes were rated according to the Community Attitude towards the Mentally Ill scale. Both groups were found to have positive, not stigmatized attitudes towards mental illness. No statistically significant changes were found at three-month or nine-month follow-up. It may be that by developing the ePsychNurse.Net course to include more material related to nurses’ attitudes and as nurses become more familiar with eLearning, the course may be effective in shaping nurses’ attitudes towards mental illness. On the other hand, our study’s nine- month time span may have been too short to change nurses’ attitudes.

Family members' perspective of family Resilience's risk factors in taking care of schizophrenia patients

Objectives:The study was conducted to illustrate the risk factors of family resilience when taking care of patients with schizophrenia.Methods:The research used qualitative design with an interpretive phenomenology approach,with indepth interviews.The subjects were 15 family members who cared for patients with schizophrenia at the Menur Mental Hospital,Surabaya,Indonesia.The samples were obtained by purposive sampling technique.The data was collected by interview and using field notes,then analyzed by Collaizi technique.Results:This research produced two themes,they were care burden and stigma.Care burdens felt by families were confusion about the illness,emotional,physical,time,financial and social burdens,which leads to decrease in family quality of life.Families also experienced stigma called labeling,stereotyping,separation and discrimination.Stigmas meant that families faced psychological,social and intrapersonal consequences.This decreased the family quality of life and functionality of the family,and there were opportunities for negative results to family resilience.Health workers,especially psychiatric nurses,should review care burdens and stigma to develop nursing interventions so families are able to achieve resilience.Conclusions:This research explained how care burden and stigma are risk factors that must be managed by families to survive,rise up,and become better in caring for patients with schizophrenia.Nurses have a central role in assessing the level of care burdens and stigma in order to help families achieve resilience.Further research may focus on family-based nursing interventions to lower care burden,and community-based interventions to reduce stigma.

Wang Shufen,A Psychiatric Nurse

WANG Shufen, a cheerful 26, has been a nurse at a psychiatric hospital for seven years. However, when asked about her profession, she still says "I’m a nurse," omitting "in a psychiatric hospital." Wang wanted to become a nurse after she left middle school. She applied to several nurse training schools, and