Hospital & community psychiatry最新文献

Objective: The study attempted to increase understanding of nursing staff members' beliefs and concerns about work safety and patient assault.

Methods: A study conducted at a university-affiliated psychiatric facility in California in the late 1980s was replicated in five other psychiatric settings. Data were collected using the Attitudes Toward Patient Physical Assault Questionnaire, containing 31 statements designed to elicit nurses' beliefs about safety concerns, staff performance, and legal issues related to assaults.

Results: A total of 557 nursing staff members at the six sites responded to the questionnaire; 84 percent were female. The majority (76 percent) had been physically assaulted at least once, but 71 percent reported feeling safe in their work environment most of the time. Compared with female staff members, males tended to believe that assaults were to be expected, that assaulted staff have personality traits that make them vulnerable to assault, and that legal action against assaultive patients might jeopardize their jobs. Recently hired staff were more confident that their facilities did not admit unmanageable patients and that the environment was adequate to prevent assaults. Staff who had been assaulted more frequently tended to believe that assaults were to be expected.

Conclusions: The study highlights a nationwide concern among nursing staff about safety. Ensuring a safe working environment requires better training, more adequate staffing, and a security plan to protect staff, patients, and others.

Although managed care is an established force in the private sector, there is growing interest and experimentation with this concept in the public sector. This interest has been generated by the increased demand for services, the shrinking resource base due to cutbacks in state budgets, and the fragmentation of care that has accompanied the shift from a centralized, hospital-based model to a decentralized, community-based model for treating individuals with serious mental illness. But despite this interest, no consensus exists about the form or functions of managed care in the public arena. Simply importing private-sector versions of managed care is inadequate given the substantial differences in the patient population and service delivery mechanisms. The authors present a functional analysis of managed care in the public sector. Drawing on their conceptualization of managed care, they outline a functional approach to evaluating the strengths and weaknesses of treatment systems, innovations such as privatization and capitation, and recent health care reform proposals.

Between 1960 and 1990, the population of Jamaica's single mental hospital was reduced by 58 percent, from more than 3,000 to less than 1,300. Services were reoriented from mental-hospital-based custodial care to rehabilitative, community-based care with no appreciable increase in the mental health budget. Despite several changes in government over the past 30 years, continuity of public policy and fiscal support has allowed ongoing development of the island's community mental health services. The national community mental health service, which had a case-load of about 14,000 patients in 1990, relies on specially trained psychiatric nurse practitioners who provide crisis management, medication management, and supportive psychotherapy; make home visits; and carry out treatment plans developed by the community psychiatrist. Community acceptance of mentally ill persons has been enhanced by public education programs and media coverage of advances in treatment.

Objective: In a follow-up to a survey ten years earlier, the authors investigated current administrative relationships between academic departments of psychiatry and state hospitals.

Methods: A 20-item questionnaire was sent to the chairs of the 110 medical school departments of psychiatry with accredited psychiatric residencies.

Results: Eighty-two departments, or 75 percent, responded. Seventy-one percent of the respondents reported that their department had a relationship with a state hospital; 79 percent of these relationships involved the education of psychiatric residents. Most respondents rated the quality of the relationship favorably (4 or 5 on a 5-point scale). Almost all respondents believed that residents can obtain a high-quality education in a state hospital. More than half of the departments responding to a question about the importance of a state hospital rotation rated it of major importance in their residency program.

Conclusions: Many medical school departments of psychiatry remain closely involved with state hospitals and recognize the hospital as an important part of residents' education. Administrators have gained much experience about how to develop and implement mutually beneficial relationships.