“Providing Structure” as a Psychiatric Nursing Intervention: A Review of the Literature

Abstract

Regarding PS, three elements were mentioned: to impose and maintain rules and limits; to assess the condition of the patient; and to interact with the patient. The goals for PS related to patient security, making expectations explicit, and recovering from illness. Major findings were reviewed, but little was found about the effectiveness of PS.

An Observational Study of Providing Structure as a Psychiatric Nursing Intervention

“…The present observational study can be considered part of the development phase for the creation of a complex “providing structure” intervention. First, we identified the evidence base for such an intervention via the aforementioned review and analysis of the literature (Voogt et al., in press). In the present study, we initiated the development of a framework and theory for providing structure as a psychiatric nursing intervention.…”

“…Based on the literature review and closer inspection of the included studies, three elements of providing structure could be discerned, namely to impose and maintain rules and limits, to assess the condition of the patient, and to interact with the patient (Voogt, Nugter, Goossens, & Van Achterberg, in press). With regard to the imposing and maintenance of rules and limits, two continua could be distinguished: (a) the continuum from general to specific structure (Garritson, ; Ransohoff, Zachary, Gaynor, & Hargreaves, ; Sebastian, Kuntz, & Shocks, ; Silver Curran, ; Vatne & Fagermoen, ; Yonge, ), and (b) the continuum from least to most restrictive forms of structure (Caplan, ; Delaney, ; Kozub & Skidmore, ; Morales & Duphorne, ; O'Brien, Woods, & Palmer, ; O'Brien, ; Vatne & Fagermoen, ).…”

“…On the basis of literature review, three goals and several effects of providing structure could be identified, which ranged from most to least restrictive: to attain external security for the patient, to make mutual expectations within the treatment relationship explicit, and to attain the feeling that the patient better fits into the world and is recovering from illness (Voogt et al., in press).…”

“…In order to do this, the nurse uses interaction, assesses the patient's condition, and imposes and maintains rules and limits in a balanced manner. (Voogt et al., in press)Although in this provisional definition clear interrelations between the interaction between patient and nurse, the assessment of the patient's condition, and the imposing and maintenance of rules and limits existed, it remained unknown how these three elements interrelated, how nurses assessed the condition of the patient, and how nurses determined the amount of structure needed. For actual nursing practice, a balanced use of the different elements of providing structure appeared to be necessary.…”

“…In order to do this, the nurse uses interaction, assesses the patient's condition, and imposes and maintains rules and limits in a balanced manner. (Voogt et al., in press)…”