Home‐visit nurses' attitudes for providing effective assistance to clients with schizophrenia

Abstract

There were two objectives of this study. The first was to identify the attitudes of home-visit nurses towards clients with schizophrenia that lead to the provisions of effective care and positive client outcomes for clients with schizophrenia. The second was to develop a framework to understand how nurses acquire nursing attitudes that lead to such provisions. Seven expert home-visit nurses who had successfully prevented rehospitalization of clients with schizophrenia for more than 2 years were interviewed. In the semistructured interviews, the nurses described their experiences in assisting one or two clients. Data were analyzed qualitatively. The central theme was having equal footing with the client. An effective nursing attitude was acquired through recognizing one's own preconceptions of clients with schizophrenia through two steps: encountering unexpected client behaviours and becoming aware of one's problematic care. For these clients, it was essential that the nurses reflect on their preconceptions towards clients with schizophrenia and alter these preconceptions by working with the clients and believing in their innate ability to live in the community. The findings suggest that the field of mental health home-visit nursing might benefit from adding these educational components in order to cultivate effective nursing attitudes for assisting clients with schizophrenia.

Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura

“…Nursing practice in HC is influenced both by patient profile and by the logic peculiar to homes. In HC, nurses offer care to a diverse profile, with a predominance of patients under palliative care (12)(13)22,27,33,50,52,55) and the elderly (16,(28)(29)35) being noticed in this review, although analyzed articles have also reported care actions for children (11,19,25) and young individuals (28) with complex needs, as well as mentally challenged persons (14,27) . Review of the articles revealed that nurses conduct various actions in HC, such as: interpersonal support; health education for patients, family members; and caregivers; performance of technical procedures; and clinical and administrative supervision, as demonstrated in Chart 1.…”

“…Relationship of help/Interaction (14,(17)(18)(19)(20)(24)(25)(29)(30)35,42,44,46,(48)(49)54) Emotional, mental, or psychological support (37,40,42,46,51,55) Communication (12,18,21,51,56) Relationship of trust (10,22,26,42,56) Negotiation (16,21,26,52) Respect (11,41,56) Dialog (20,26) and listening (18) Educational actions Guidelines for families, caregivers, and/or patients (13,19,25,27,29,32,36-40,44-46, 48,51,53) Development of teaching strategies (48) Learning about social resources (51) Training of patients, family, and neighbor network and other sectors for risk prevention in emergencies (38) Guidelines for other nurses (40) Care actions Medication management or infusion …”

“…Reflection is essential for recognizing weaknesses and/or limits in situations that demand resignification of work in home care. As an example, it was observed that nurses' actions in the field of mental health and reflection on them enable nurses to acquire skills that help clients with mental illness (14) . Reflective practice is important for developing competent work in the home context, which makes it impossible for nurses to work with strictly mechanized actions in this context, with no qualification and little humanization (35) .…”

“…Furthermore, nurses' actions in HC involve reflective, not mechanistic, practice (35) . Thus, the need for reflection on the development of work in the home environment was identified (10,(14)(15)20,35) . Reflection is essential for recognizing weaknesses and/or limits in situations that demand resignification of work in home care.…”

“…Results indicate that while some HC nurses basically perform patient visits and predefined care, or perform care in association with clinical supervision, others, described as administrative nurses, primarily conduct clinical and administrative supervision (43) . Home visits were mentioned as important aspects of this professionals practice (14,37,41,50) , requiring planning (37) and organization (41) , for example, when making decisions on the ideal moment for the next visit to patients and families, a process that is difficult for both novice and veteran nurses (50) . Care planning in the home context is defined as a complex practice with various goals, including the relationship and assessment of demands and capacities of patient and family, workload, and resources for home care (13) .…”