Margaret Knight

Constant observation: implications for nursing practice.

1. Constant observation is an increased level of observation and supervision in which continuous one-to-one monitoring techniques are utilized to assure the safety and well-being of an individual patient or others in the patient care environment. 2. Individuals who provide constant observation vary widely among health care facilities; but ultimately are the responsibility of the registered nurse. There are many areas that must be addressed by institutions when considering the use or implementation of constant observation. These include: measuring the associated costs, risk management, role development, orientation of employees, and performance evaluation. 3. The changing health care environment and public concern over the quality of health care and risk management require nursing administrators to consider risk-benefit and cost-benefit analyses related to constant observation. There is continued need for protocol and policy development, as well as for guidelines and orientation of staff regarding constant observation.

Fall risk in patients with acute psychosis.

Patients receiving acute care for the treatment of psychotic disorders are at risk for falling. Complex medication regimens initiated to manage psychomotor agitation, lability, and aggression can contribute to physiological instability that may not be identified easily by clinicians. This quality improvement initiative identified prescribing practices associated with risk for falling and established a simple mechanism to monitor pharmacological treatment, which resulted in a reduction of the fall rate from 6.0 to 0.46.

Making healthy connections: introducing nursing as a career choice to middle school students

The current economic climate has resulted in many experienced nurses returning to the workforce. Despite this, the nursing shortage is looming in our future and the recruitment of a diverse nursing workforce reflective of the population remains a high priority. The Merrimack Valley in northeastern Massachusetts has two large cities, Lawrence and Lowell, in which the Hispanic and the Southeast Asian populations are disproportionately higher than state and national levels. Through the University of Massachusetts Lowells Bring Diversity to Nursing Project, partnerships with both city school systems were developed and after-school programs aimed at highlighting nursing as a career choice were initiated. Mr. Thompsons Heart is the focus of a middle school, pre-entry program developed by faculty. Introducing career choices in middle school gives students fundamental information about careers and how to begin investigating them. Mr. Thompsons Heart introduces nursing as a career choice combining career information with a focus on developing healthy lifestyle habits. Multiple hands on activities create excitement and interest in the nursing profession.

Access to mental health care among older adults.

Many older adults experience common mental health problems that can have a negative impact on physiological health, functional status, and quality of life. Lack of access to mental health care for community-dwelling older adults is a significant problem. Busy primary care practices, few mental health professionals, inadequate problem recognition, and flaws in the health care system all contribute to restricted access to mental health care. As the population of adults 65 and older continues to grow, the need for mental health care for this group will increase. Strategies to improve access to mental health care must be targeted at the individual level, the provider level, and the system level.

Providing Physical Care to Persons With Serious Mental Illness: Attitudes, Confidence, Barriers and Psychological Empowerment

ABSTRACT The prevalence of metabolic syndrome (MetS) in people with serious mental illness (SMI) has been well documented in the mental health literature. Despite the adoption of various guidelines for monitoring risk factors for diabetes and cardiovascular risk in this population, limited translation has occurred in actual practice (Hermes, Sernyak, & Rosenheck, 2013). The Institute of Medicine (IoM) (2009) has noted a lag time in the application of knowledge within clinical settings. Evidence‐based practice was deemed as a means of improving healthcare outcomes through the use of science supported standards of care. Evidence‐based practice (EBP) is a process to guide clinical decision making that involves the clinicians experience, well documented research findings, and the patients values and choices (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). The IoM has established that by the year 2020, 90% of clinical decisions should be based upon current and scientifically based information (IoM, 2009). Psychiatric‐mental health nurses are challenged to utilize EBP for clients with MetS in assessing their health status and discussing the findings, educating them about their current risk and life style modifications to mitigate risk, and finally, partnering with them to maximize health and quality of life.

Metabolic Syndrome: Psychiatric–Mental Health Nurses' Knowledge of Risks and Care Practices

Comorbidity of serious mental illness (SMI) and metabolic syndrome contributes to the reduced lifespan of individuals with SMI. Integration of physical and mental health care has been slow. The current study explored the level of knowledge of metabolic syndrome and practices of psychiatric-mental health nurses related to metabolic syndrome risks. Using a knowledge survey and adapted Mental Health Nurse Physical Health Attitude Scale, the researchers surveyed 175 psychiatric nurses through an online social media website. Of respondents, 52% identified all five risk factors for metabolic syndrome. However, only 70.8% knew all recommended physiological monitoring markers. There was no significant relationship between knowledge score and integration of physical health care activities in practice; however, knowledge regarding metabolic syndrome risk factors was high. Currently, integration of this knowledge into care is lagging. Nurse educators must integrate assessment, planning, intervention, and evaluation of physical health status and related needs of individuals with SMI. [Journal of Psychosocial Nursing and Mental Health Services, 54(11), 44-53.].

Nursing Care for Lifestyle Behavioral Change

The purpose of this pilot study was to determine if metabolic risk factors can be stabilized or improved with weekly motivational interviewing/coaching and medical follow-up care focused on lifestyle behavioral change in individuals with serious mental illness. Individuals were followed for 18 weeks following discharge from an inpatient psychiatric service. All individuals were prescribed an antipsychotic medication and had at least two risk factors for metabolic syndrome. Weight, waist circumference, blood pressure, LDLs, triglycerides, and blood glucose levels were evaluated during the study period. In addition, each individual selected a lifestyle behavior to improve over the 18-week period. Weekly motivational interviewing, and staggered health promotion appointments were designed to keep individuals focused on health and behavior change. While some individuals showed improvement, others showed deterioration in the physiological markers for metabolic syndrome. Only a small number completed the 18-week study. The nature of current psychiatric care is focused on rapid stabilization and discharge; individuals with serious mental illness may have difficulty focusing on lifestyle behavioral change while transitioning to independent living following an acute exacerbation of mental illness.