Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

Abstract

Aim: To explore and investigate differences between the views of qualified nurses working in psychiatric intensive care units (PICUs) and acute care wards on which patients are appropriate for PICU care.Background: Previous research on the area of psychiatric intensive care highlights the great differences that exist in all aspects of service provision, from unit size and staffing levels to treatment approaches and physical environment. One of the most common areas of controversy is the type of client behaviour that warrants admission to the PICU. Method: Structured interviews of 100 qualified nursing staff (in the London area, England) working on either acute or PICU wards were used to gather data on appropriate and inappropriate referral to PICUs. Comments made during the course of the interviews were also collected and subjected to content analysis.Findings: There was evidence to support the hypothesis that acute ward staff considered patients suitable for PICU care at a lower level of risk than PICU staff thought appropriate. In comparison to acute ward nurses, those working in PICUs attended to a broader range of factors when considering suitability for admission to PICU. Appropriate reasons for transfer fell into five groups: risk to others; risk of intentional harm to self; risk of unintentional harm to self; therapeutic benefit from the PICU environment; and legitimate acute ward care problem. Inappropriate reasons for transfer fell into four groups: low risk to others and/or self; illegitimate acute admission care problems; patient belongs elsewhere; policy issues. Conclusion:The study opens up a range of issues not previously studied in relation to the use of PICUs and the intricate relationship of this use with the available acute care wards and other services. These findings and their implications for the care of acute and disturbed psychiatric patients are discussed.

Achieving Equilibrium within a Culture of Stability—Cultural Knowing in Nursing Care on Psychiatric Intensive Care Units

“…In the fight against turbulence, the results make clear that strategies were questioned due to ethical considerations. Consistent with this, Bowers et al (2003) conclude that the least restrictive interventions should be pursued; Hall (2004) presents seclusion as a last resort. Morales and Duphorne (1995) advocate the use of less restrictive methods such as verbal interaction, medication as required, limit-setting, and use of quiet time.…”

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

“…At the same time, the increasing practice of keeping acute psychiatric wards locked is likely to have led to reduced transfers of patients to PICUs in order to prevent risk resulting from the patient absconding. 11,12 Finally, some new psychiatric units have opened that have no PICU provision at all, or, in other instances, PICU provision has been limited to a single site within a much larger multihospital NHS trust. The consequences and efficacy of these differing systems for managing high-risk patients has been neither compared nor evaluated on a wide scale.…”

Comparison of the quality of care in psychiatric intensive care units and acute psychiatric wards

“…violence, drugs and alcohol, Loubser et al 2009; staff opinions on admissions, Bowers et al 2003). Despite this, and the fact that PICUs are a more challenging environment, this does not appear to have compromised the quality of care that PICUs provide according to the methodology adopted.…”

“…Nurses working on acute wards are more likely to attribute problems, including violence, to drug and alcohol use than their PICU colleagues (Loubser et al 2009). Bowers et al (2003) studied the differences in the perspectives of acute and PICU nursing staff in relation to appropriate admissions for a PICU. They found that acute nursing staff took into account a smaller range of risk factors when considering admission and had a lower threshold for suitability when compared to PICU staff.…”