Changing Concepts in Psy[1].Nursing Panel-TVM

7/30/2019 Changing Concepts in Psy[1].Nursing Panel-TVM

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International Conference on

Challenges in Clinical Nursing Research

Government College of Nursing

Thiruvananthapuram

9th January, 2010


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I. Changing concepts of Mental

Health Nursing

- ServiceSetting Asylum Psychiatric hospital and

Mental health care setting.


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Health Nursing

- Service

Type of care Custodial care in closed

wards

Caring with empathy;

open door policy

therapeutic community.


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Health Nursing

- Service

Core role of nurses Administering

antipsychotics.

Assisting for ECT/Insulin

coma therapy.

Psychosocial therapies

&Alternative therapies.


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Changing concepts of Mental health

Nursing - Service

NurseDoctor

relationship

Doctor is prescriber and

nurse is a provider .

M.D.A .nurse is a

coordinator.


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Nursing - Service

Role of patient Passive recipient of

the services.

Active participation in

collaborative treatment.


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Nursing - Service

Pathology of Mental Illness Childhood traumatic

experience

(psychodynamic

model).

Genes neuro chemical

transmitters,

biochemical

changes,brain pathology

included(psychobiologic

al model)


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Nursing Service

Pathology of Mental

Illness

Family is a source of

illness .

Family is a source of

support.


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Nursing Service

Treatment Seclusion andrestraints are

common.

Seclusion and restraints areuncommon.

Pathology of Mental Illness Illness chronicity was

more, patients were

suffering from EPS.

Atypical antipsychotics,

No EPS.


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Nursing - Service

CBR.

Long termhospitalization.

Institutionalized

care services.

Earlydischarge;maximum of

6 wks . Emphasis is on

de institutionalization.

Eg.TRADA in

Chunkapura,Kottayam,

Kerala


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Nursing - Service

Role extension ofpsychiatric

nursing

Psychiatric nursingin mental hospitals.

Psychosocialnursing in

general

hospitals.


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Changing concepts of Mental Health

Nursing - Service

Mental HealthPriority

HFA had MentalHealth Care as 8th

component.

15th October, 2002SC ordered

comprehensive

mental health care

services and

enforced licensed

& regulatory

supervisions


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Changing concepts of Mental Health

Nursing - Service

Service approach Mental health care

through general

health care delivery

system.

11th Five Year

Plan 2007-

2012, DMHP

in 200 districts12th Five Year

Plan (2012-

2019) DMHP

in 193 districts


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Nursing - ResearchStudies related to ECT,Neurosis ISEP,

Alcoholism.

Studies are related to anger control

management, effect of empathy training ,

yoga therapy , ADL training.


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Nursing - ResearchDescriptive Research Experimental ,pre experimental ,Quasi

experimental research design.


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Nursing - ResearchStudies were with the nurses and the care

takers in the hospital .

Studies are with patients ; testing out

different health care models. Both in

hospital and community studies were

conducted.


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Nursing - Research

Emphasis was on utilising research

findings.

Emphasis is on EBNP


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Nursing - Research

Traditional practice , authority and hospital

policies.

EBNP; care bundle.


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Nursing - Research

Research phobia and cyber phobia Research familiarity is there. Use of

websites is common


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Nursing - Research

Very few studies .Integration of practice

with research process was not there.

Integration and synthesis of research

findings in psychiatric nursing practice.

30 study centres are seen.


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Nursing - Research

Few mental health nursing journals for

literature review were accessible

E-journals are helpful.


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Nursing - ResearchNOSIE observation scale had inter rater

reliability.

Interview method , qualitative study

phenomenological research are carried out.


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Nursing - ResearchMean, chi-square, t -test were mainly

used.

Multiple regression , Scheffe analysis are

possible.


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II. Priority areas of Clinical Mental Health

Nursing Research

Uniqueness in psychiatric nursing practice

are

Psychiatric patients with aggression,

regression, depression without insight

Validation of nursing service from patients

cannot be ruled out.


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Nursing Research

Psychiatric hospital policies repriment

family membersMultidisciplinary approach


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Nursing Research

Diversed therapeutic interventions such as

physical therapy, chemotherapy,psychological therapies, social therapies,

behaviour therapy and nursing therapy etc.


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Research priorities

Evolving a truly indigenous research

approach in psychiatric nursing is the

priority.

Following alien concepts and methods are

inappropriate in our socio-cultural context.


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Need for identifying priority

Cost effectiveness

Duration of hospitalization

Family burden

Wide consultation


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Need for identifying priority

Time required

Utilization of scarce central resources

Continuity of care services


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Suggestions to priority

Hierarchy of Evidence

Research design

Systematic review

Randomized controlled trial

Cohort study

Case control study

Cross sectional analytic study

Descriptive/narrative study


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The best evidence for interventions comes

from systematic reviews and meta analysis of

all relevant RCTs. As we move down this

hierarchy in evidence, we usually have lessgood information available.



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Collaborative / multidisciplinary /

multi-speciality

Multi-centre studies

Intersectoral collaborative studies, linking with

other national programs

(Agarwal et al)


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Population

Geriatric (WHO)

Poor women (NRHM)

Children (NRHM)

Urban and Rural slum (NHP)

Tribals (NHP)

Disabled (NHP, NMHP)


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Setting

Rural community under served areas

District Health Centres / Hospital

GHPU


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Setting

OPD (Subcentre PHC, CHC, District and Urbancentres)

In patient psychiatric units

Schools and colleges


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Tools

Interview Guides

Interview schedule


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Tools

Observation checklist and Rating scale.

Questionnaire

Measurement

Visual Analogue


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Sampling methods

Stratified Random Sampling

Simple Random Sampling (Lot, Table)

Cluster sampling

Census

Convenience sampling


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Sample size

Statistical methods

Power analysis

Data collection

Interviewing

Observation

Self report


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Study variables

Stress

Anxiety

Promotion of healthy life styles (NRHM)

Mainstream Ayush (NRHM 2005-2012) inmental health care system


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Study variables

Revitalize local health traditions (NRHM)

Reduction in consumption of tobacco and alcohol

etc (NRHM) Focused on IEC

Role efficacy of Accredited Social Health Activists(ASHA) (NRHM)


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Research area in clinical practice

Suicide behaviour

Phenomenology and outcome of schizophreniaand acute psychotic disorders.

Urban MH development of appropriate modelsfor MH Care.


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Research area in clinical practice Mental Health service needs in disaster

management

Child and adolescent mental health

Mental health of Special group such as womenand elderly, HIV

Life style changes in prevention of mental illness


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Evaluate the effectiveness of psychiatric

nursing intervention

Social action programmes and its effectiveness

on counter acting the stigma.


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Stress management programmes

Effective parenting

Marital and family enrichment.


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Research recommendations (NINR&NIH,USA.)

Changing life style behavior for health

Managing the effects of chronic illness to improve

quality of life.


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Research recommendations (NINR&NIH,USA.)

Identifying effective strategies to reduce health

disparities.

Harnessing advanced technologies to serve human

needs.

Enhancing the end of life experience for patients andtheir families.


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Areas of Focus

Opinion about mental illness

Counselling / intervention / STP etc

School mental health and Community mental

health


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Areas of Focus

Child and adolescent problems

Life skill education

Stress, coping, social supports, family support.

Psychiatric rehabilitation


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Areas of Focus (contd)

Skills training for ADL

Disaster management

Training of primary care givers

Psycho social aspects for de-addiction and MR


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Areas of Focus (contd)

Psychiatric nursing intervention in neurology and

neurosurgery settings (Bio Psychiatric nursing)

Other issues related to welfare, development,

education and health.

S ti t i it


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Priority in Education and Administration

Audits, survey and feedback from students tomonitor the standards as well as to enhance thequality of teaching.

Manpower requirement in the governmental andnon governmental agencies for mental health.

S ti t i it


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Priority in Education and Administration

Follow up studies on areas like crisis and disaster.

Effectiveness of community-based mental healthservices extension services in rural tribal andslum areas, training of Para professionals, non

professionals and personnel from voluntaryagencies.

Setting standards for psychiatric nursingintervention



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From Nations priority of view:

Strategies to be worked out to prevent the

current loss to India of highly trained

professionals through migration and

misplacement.



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From Nations priority of view:

Infrastructure improvement in hospitals to

prevent custodial mode of care.

Information and communication

technologies into psychiatric nursing care :

(Tele nursing, Nursing Informatics).


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CONCLUSION

Research should not just satisfy the urge ofResearcher to do research, but it should

always be directed at improving knowledge,

attitude, procedures and how they could

be applied in day to day work.

A i ?


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Any questions?


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Changing Concepts in Psy[1].Nursing Panel-TVM