The Psychiatric hospital最新文献

An acute care psychiatric hospital faces the dilemma of maintaining a safe and secure environment for its patients while gradually providing them with enough independence to assume responsibility for the management of their own behaviors. When patients leave the hospital building, grounds, or an off-ground activity without prior authorization from the attending physician or if they do not adhere to restrictions during a medical/therapeutic pass, they are placing themselves, the hospital, and others in a high-risk situation. An analysis and review of the closed medical records of patients who had eloped were conducted to determine if a pattern existed among them. The medical records studied included clinical notes, assessments, physician's orders, precautions and restrictions, lengths of stay, notes on the hospital environment, and patient-specific demographic data. The findings suggest that there are some consistent factors related to patient elopements that, when recognized, may help clinicians decrease this highly disruptive behavior.

Psychiatric partial hospitalization has existed in the shadows of both traditional inpatient hospitalization and outpatient therapies. Despite documented effectiveness, the modality has only recently received increased attention and growth, both driven by concerns about the costs of mental healthcare. This paper reviews historical factors affecting the use of this treatment setting, outcome research in the field, and anticipated future growth trends.

Partial-hospitalization services for children and adolescents continue to be an underutilized component of the mental health delivery system. With little treatment-effectiveness research available, there is limited incentive for shifts in reimbursement policies or for traditional referral sources to alter referral patterns. This paper provides an overview of published effectiveness research, a discussion of methodological difficulties, and an example of ongoing research for critique. Clearly, research in child and adolescent partial hospitalization must begin to address the lack of available effectiveness data. Partial-hospitalization advocates must compare both various program models and treatment of specific populations. In addition, studies comparing outcome of partial-hospitalization programs with outcome from other treatment modes are essential. The entire continuum of care must be subjected to rigorous and scientific study. The next decade will no doubt bring a large number of treatment-effectiveness studies, now lacking, for comprehensive analysis of options and outcomes.

Strength-focused assessment and treatment planning are presented as a partner to diagnostic evaluation of symptoms, syndromes, and clinical history. It is not advocated as a replacement, but as an extension of what we now do. However, we must not underestimate the new attitude inherent in the search for barely visible coping moments and coping momentum. It's a new attitude more than a new technique for both the patient and the practitioner.

Reported are the results of two uncontrolled outcome studies that evaluate the effectiveness of inpatient psychiatric treatment of children and adolescents suffering from clinical depression. Study 1 employed a sample of 7 children and measured outcome with the Depression Self-rating Scale (DSRS), the Hopelessness Scale for Children (HSC), and the Global Asssessment of Functioning (GAF) scale, which were administered to each child upon admission and again at discharge. Inpatient treatment involved multiple interventions, including individual psychotherapy, medication, milieu therapy and token economy, and other procedures. At discharge, statistically significant improvements were found on the patients' GAF and HSC scores, but not on their DSRS scores. Study 2 used a sample of 15 adolescents, also admitted for clinical depression. Administered at each patient's admission and discharge, the Beck Depression Inventory (BDI), Generalized Contentment Scale (GCS), and Index of Self-esteem (ISE) were used to measure outcome. The multi-modal treatment program offered to the sample in Study 2 was similar to that offered the sample in Study 1. At discharge all three outcome measures reflected statistically significant improvements in the patients studies; therefore, these results provide addmtional support for the inpatient treatment of depressed children and adolescents.

Efforts to adapt the problem-oriented record to the complex biopsychosocial determinants of illness and therapeutics are especially difficult with the seriously and persistently ill patient who requires more than a minimal hospital stay and for whom standards of care have not been developed. By focusing on a treatment system's capacity to achieve its goals, this report demonstrates one method for linking quality assurance behaviors with quality of care and integrating the work of the hospital psychiatrist and multidisciplinary team into the medical record. The vehicle for implementing this method is a multidisciplinary treatment-planning form currently used in the charts of an extended-length-of-stay treatment service. Its evolution and rationale are described, and an example form follows this report.

Natural disasters do not always lead to post-traumatic stress disorders (PTSD) for their victims, although stress-related symptoms are commonly reported as results of such disasters. The impact of a natural disaster on the treatment of a hospitalized psychiatric population has never been systematically evaluated. In the fall of 1986, severe river flooding caused evacuation of a 160-bed psychiatric facility. One hundred and twenty-one hospitalized patients were taken to nearby hospital facilities, and many were separated from their primary therapists, fellow patients or both. A mail survey two months post-evacuation assessed stress-related symptoms, the patients' opinions of the impact of the flood on their treatment and functioning, and the patients' views of the evacuation procedures. Patients also responded to questions about their cognitive and affective reactions during each phase of the disaster. Clear evidence of PTSD was not found with this population; however, the findings underscore the importance of keeping patients with familiar staff and peers when possible. Differences between this study and previous disaster studies are noted, and suggestions for coping with natural disasters in inpatient or residential psychiatric facilities are offered.

The precipitating events that preceded the admission of 50 children to an inpatient psychiatric program were studies and defined. These events, while varying in their particulars, could be grouped into three broad conceptual categories: 1) emotionally related events; 2) severe-conduct events; and 3) school-related events. The emotionally related events were the most numerous: suicide threats or attempts preceded the admission of 22% of the sample. The study findings are discussed in terms of their developmental, treatment, and preventive significance and are compared with the findings obtained from a previous study with adolescent patients.

Demands for quality nursing care in both psychiatric and general hospitals are increasing as the nation experiences a shortage of registered nurses (RNs). The average national turnover rate in the healthcare industry is almost 23%, and nurses account for 50% of that percentage (1). Because a stable, competent nursing staff is essential to meet the mandates of physicians and patients for quality inpatient care, the failure of a hospital to provide high-quality nursing in today's competitive healthcare climate may cause physicians and patients to go elsewhere. The nursing shortage and high nursing turnover rates have had a negative effect on both general and psychiatric hospitals. The focus of the study described in this article was on a specific psychiatric hospital, and the objective was to determine how hospital management might respond to the current nursing personnel challenges. An action research model was used to determine what employment factors were viewed by nursing personnel as most valuable and how satisfied the nurses were with these factors in their workplace. The results are reviewed.