NEW YORK NURSE: July/August 2011
by Eileen Trigoboff, RN, PMHCNS-BC, DNS, DABFN, CIP, Director, Program Evaluation, Buffalo Psychiatric Center; private practice; hospital accreditation surveyor; institutional review board/research ethics liaison; expert witness; textbook author
Nurses in every area of practice use psychosocial care. Our communication is used to assess psychological functioning, social skills and environment. The outcome of that assessment is to make recommendations for further care. Active listening, empathic communications and developing trust with clients form the basis of every nurse’s intention during nursing care. There are, however, research questions about nursing interventions yet to be answered. Research such as the following examines the actual components of psychosocial nursing for client-centered and collaborative elements.
The study, Psychosocial care in mental health nursing, sought to identify the components of nursing’s psychosocial care for persons with a mental health issue to determine what aspects of care were routinely included. The unique method of this study was to record and analyze a nurse’s thinking aloud about the process of conjecture, conclusion, and recommendations for a specific client. Nurse participants were familiarized with the think aloud method during a practice session, and were then recorded during a simulated client contact. A videotape of four cases was completed. The goal of each nurse participant was to describe the client’s current condition and to recommend the next steps in the client’s nursing care.
Study participants were male and female nurses from inpatient and community settings with three categories of experience in nursing (0-5, 6-9, and 10 or more, years). Thirty-seven nurses participated.
The primary modes of psychosocial care involved giving direction and providing structure for future action, with the nurse focusing on functional needs and providing a general guide to normal behavior. This method of care was most often used by acute setting nurses, as would be expected as one prioritizes care in those settings.
The next most used mode by nurses was collaborating with the client in a person-centered manner and collecting information in a flow determined by the client. This is more in keeping with eliciting the client’s perspective and preferences and is an excellent psychosocial interaction. Reassurance and encouragement were themes that involved communicating to help the client address immediate goals, such as how to be independent or manage a stressful situation better.
The psychosocial interventions ranged from client-led to nurse-led care, which reflects the spectrum of interventions from giving support to prompting independence. Highly experienced community nurses tended to use a more complex amalgam of psychosocial interventions. This would suggest that experiential knowledge does guide judgment and decision-making when interacting with clients who have more severe problems. For our practices, we would benefit from a consensus on what is involved in providing psychosocial care. This type of research begins that consensus process.
MacNeela, P., Clinton, G., Place, C., Scott, A., Treacy, P., Hyde, A., & Dowd, H. (2010). Psychosocial care in mental health nursing: A think aloud study. Journal of Advanced Nursing 66(6), 1297-1307.