| Description |
This present study investigated the factors involved in a five-week psychiatric nursing intervention with patients who came to a hospital emergency room for assistance with emotional problems. Sixteen patients were evaluated by psychiatric resident physicians and referred to the psychiatric nurse for a five-week treatment period. Following each patient's first appointment the referring physician and the psychiatric nurse jointly rated the patient's problems as to their severity and established treatment goals. Ten of the 16 referred patients continued contacts with the nurse throughout the five-week period. At the conclusion of the treatment period the patient's progress was evaluated by the nurse. The plan to have a separate evaluation by the referring physician at this time could not be carried out. Patients were contacted at six weeks and also at three months post treatment regarding their adjustment. There hospital records were reviews in ordered to determine if they had returned to that hospital for further psychiatric help. The data were examined in terms of the responses of the patients, the nurse, and the other hospital personnel, to the program. The number of visits was twice as great during the first week of treatment as during each subsequent week. The investigator believes that a flexible appointment schedule with provision for more than one appointment during the first week of treatment was an important consideration in meeting patient needs. There was no significant correlation between the improvement ratings and the number of contacts with the nurse, the amount of emotion expressed by patients, or the degree of nurses' involvement. However, the correlation between the amount of emotion expressed by patients and the involvement of the nurse were significant at the .01 level. The subjective ness of the ratings was considered. All of the patients had difficulties in interpersonal relationships with significant people in their lives, particularly with spouses. All of them appeared depressed and were unable to function according to their self expectations. Three families of patients involved themselves actively in contacts with the nurse. Further research is needed to determine the benefits of treating the type of patient seen in this study by individual appointments or in conjunction with other family members. The number of problems discussed decreased after the first week. The degree of emotion expressed decreased slightly and increased again during the fourth week which may have been related to the degree of rapport with the nurse and/or the discussion of termination at that time. Six of the ten patients expressed regret that their relationship with the psychiatric nurse must be terminated. One patient reacted by getting drunk and another patient, who had made a suicide attemp prior to coming to the emergency room, slashed her wrist. The investigator felt that an extension of the treatment period might have been beneficial. Due to the small sample, differences in response of patients according to sex and economic difference could not be generalized. Four of the nine psychiatric resident physicians referred patients to the nurse. Sixteen patients were referred during a period on nine weeks in which 3,115 adults were seen in the emergency room. The reason for the small number of referrals merits further investigation. The author believes that the data support the assumption that the type of service offered to patients was appropriate for a psychiatric nurse to give, and that patients did benefit in varying degrees. Further research is needed to determine the optimal period of treatment, the relative effectiveness of various treatment methods, such as including other members of the family, and the types of patients who might benefit most from this mode of treatment. |
