Sunita McGowan

Types of Patients in a Psychiatric Intensive Care Unit

Objective: This paper reports the findings of a descriptive study of a patient population over a three-month period on an eight bed psychiatric intensive care unit (PICU) in Western Australia. The report provides a quantitative insight into the profile of patients in PICUs. It provides information on patients’ diagnoses, presenting signs, symptoms and/or behaviours, legal codes assigned to patients, treatment interventions and management. Method: Data were collected prospectively from August to October 1999. A total of 122 patients were admitted to the PICU during the review period. Data were entered into an Access program then exported to SPSS (Version 9 for Windows) for analysis and frequency distributions were obtained. Results: The results confirmed that the majority of patients admitted to the PICU were assessed as a high level of risk or needed containment. This finding is in line with the admission criteria developed by staff working in the PICU. It also supports the view that staff working in these units require expertise and confidence to communicate with and manage potentially aggressive and highly aroused patients. Conclusion: This study demonstrates the importance of ongoing evaluations of patient populations in promoting best practice initiatives in psychiatric care.

A Practice-Research Model for Collaborative Partnership

The ability to integrate education, practice and research initiatives is well documented and the nursing literature presents several collaborative models that have emerged between educational institutions and service agencies to achieve this aim. However, a collaborative partnership agreement does more than integrate these initiatives; it is a vehicle by which the theory-clinical practice gap is bridged and best practice outcomes are achieved. This paper outlines an innovative collaborative partnership agreement between Fremantle Hospital and Health Service and Curtin University of Technology in Perth, Western Australia. The partnership engages academics in the clinical setting in two formalised collaborative appointments. This partnership not only enhances communication between educational and health services, but fosters the development of nursing research and knowledge. The process of the collaborative partnership agreement involved the development of a Practice-Research Model (PRM) of collaboration. This model encourages a close working relationship between registered nurses and academics, and has also facilitated strong links at the health service with the Nursing Research and Evaluation Unit, medical staff and other allied health professionals. Links have also been established with other health services and agencies in the metropolitan area. The key concepts exemplified in the application of the model include practice-driven research development, collegial partnership, collaborative ownership and best practice. Many specific outcomes have been achieved through implementation of the model, but overall the partnership between registered nurses and academics in the pursuit of research to support clinical practice has been the highlight. This has resulted in changes and innovations in current nursing practice and, importantly, dissemination of best practice outcomes.

Emergency Department Mental Health Triage and Consultancy Service: an advanced practice role for mental health nurses.

Abstract This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. Therefore, a training program was employed to prepare a number of experienced mental health nurses to work at an advanced practitioner level. The four-month training program developed at Fremantle Hospital in Western Australia provided support, guidance and clinical supervision. In the first 12 months of the service, five mental health nurses completed the program, thus creating a pool of nurses who were able to provide the service. The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.

Community mental health care: documenting the role of the nurse.

Abstract In Australia, the process of deinstitutionalisation has resulted in the closure or downsizing of many large stand-alone psychiatric hospitals. The aim of modern community mental health care is to provide treatment and rehabilitation for people, who have a mental illness, in their local community. This aim is supported by the Australian National Mental Health Strategy that outlines the importance of health professionals, carers, and consumers working together to obtain the best therapeutic outcomes. This study was undertaken to obtain information regarding the current role of the community mental health nurse (CMHN). All community mental health nurses working in the Adult Program at the Directorate of Mental Health Services, Fremantle Hospital and Health Service in Western Australia participated in the study. The study was completed in November 2000. The results showed that the CMHNs’ role focused on six main areas. These areas included the day-to-day management of clients, working with carers and their families; crisis work for both existing and first time contacts; as well as liaison and advocacy work. The finding of this study demonstrate CMHN’s work most often with acutely ill and psychotic patients and their families. Therefore, CMHN’s play a pivotal role in promoting and sustaining the philosophy of community mental health care. In addition, the liaison work within the community completed by CMHN’s is vital to address the mental health needs of the community and to reduce the stigma associated with mental illness. The documented findings of this study provide challenges for the further expansion of the CMHN’s role and the development of best practice initiatives in community mental health care.