This study examined pre- and post-implementation of a same-day post-detoxification residential admission policy within a Veteran Health Administration (VHA) facility to determine improved outcomes consistent with the larger literature. A single facility sample of participants who received detoxification from alcohol pre- and post-policy change was identified utilizing administrative and health record data. Chi-square testing and independent samples T-testing evaluated changes between a 2018 pre-policy cohort and a 2019 post-policy cohort. Policy implementation of same-day admissions to residential treatment after detoxification resulted in statistically significant change in instances of waiting, wait times for participants who waited, no-show, and readmissions during the six months following inpatient discharge. Mortality, cancellation rates, and discharge type did not differ significantly. These findings further support previous research that outlines the relationship between efficient post-detoxification continuity of care and increased positive outcomes.

Reliability of self-report outcome assessment is often called into question with the severely mentally ill population. In the context of inpatient care, demand characteristics may further complicate self-report measures. Although clinician-completed outcome measures, such as the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E), have become industry standard with this population, self-report assessment may be useful under certain conditions. This study sought to explore the relationship between a clinician-completed, the BPRS-E, and a self-completed measure, the SOQ, within the SMI inpatient population. A total of 357 adult participants with a minimum of three assessment iterations were analyzed. The results of the analysis indicated both measures correlated at all assessment iterations (admission, 90-, 180-, 270-, 360+ days), but when divided into SOQ admission clinical and subclinical groups only the clinical group maintained the correlation at all points. A logistical regression analysis indicated that membership in the subclinical group can be predicted by one subscale (Mood Disturbance) and three items (Hallucinations, Uncooperativeness, and Conceptual Disorganization) from the BPRS-E. The change trajectories of both measures were essentially identical; however, when divided into SOQ admission clinical and subclinical scores the SOQ and BPRS-E change trajectories were significantly different from each other and clinical versus subclinical on the same measure were significantly different. Further examination of the subclinical SOQ group revealed two distinct groups, scores that eventually had reliable change and exceeded the cutoff score and those that never did. A logistical regression analyses revealed that membership in these two groups can be reliably predicted by two BPRS-E items (Somatic Concerns and Suspiciousness), in that as each item increases the likelihood of membership in the group that never exceeds the cutoff score also increases. These results suggest that although the SMI inpatient population present with profound limitations, it may be possible to predict those who will eventually provide reliable self-report outcome assessments and those who will not. Although further research is necessary, these results are promising and may provide decision points for clinicians on when and when not to trust self-report outcome assessment with the SMI inpatient population.

No description available.

No description available.

No description available.

The purpose of this survey study was to evaluate the current practice of inpatient group therapy in general hospital psychiatric units in a southeastern state and to determine whether there was a need for a more systematic method of designing, implementing, and evaluating general hospital group therapy. A second major purpose was to test a model to determine if it could be used to evaluate current practices of general hospital psychiatric group therapy on a more global basis. The history of group therapy and current nationwide statistical data relating to general hospital psychiatric units were summarized. A survey which addressed unit operations, unit staffing patterns, types of patients, and general practices regarding psychiatric unit group therapy was administered to 35 general hospital psychiatric unit administrators in a southeastern state. A standard interview protocol was developed and administered on-site to six group therapy practitioners. These interviews gathered information relative to specific unit group therapy practices, evaluated whether Group Pentagon components were utilized in group therapy practices, and identified factors influencing unit group therapy practice. An analysis of the available literature indicated there was little information relative to the practice of group therapy on general hospital psychiatric units. The literature analysis also revealed no consistent model or procedures for the design, implementation, and evaluation of group therapy in general hospital psychiatric units. The survey and interviews demonstrated that group therapy programs appeared fragmented, varied across units, and did not appear to be designed, implemented, or evaluated in a consistent manner. During the interviews, the practitioners described the lack of many of the conditions necessary for the provision of effective group therapy on their general hospital psychiatric units. The literature review analysis, survey, and interviews indicated the components of the Group Pentagon were not utilized in general hospital group therapy programs. The Group Pentagon provided a useful model for evaluating overall group therapy programs, as well as reviewing specific group therapy procedures. Finally, this research established a protocol for evaluating general hospital and potentially other group therapy practices. / Ed. D.

Depressionssjukdomar är en ökande sjukdomsbörda som idag omfattar 340 miljonermänniskor världen över och beräknas till att vara den näst största år 2020.Upplevelsen av fenomenet depression beskrivs som en emotionell kamp kopplad tillomvärldens tyckande och där utanförskap, nedstämdhet och skam är dominerandekänslor i personens liv. Sjuksköterskans vårdprofession utgör ett viktigt stöd i och hosomvårdnadsarbetet kring personer med depression och vars kompetens möjliggör eneffektiv och positiv vårdtid. Syftet med studien utgick från att belysa sjuksköterskorsomvårdnadsåtgärder kring personer med depression i slutenvård. En litteraturstudiegenomfördes och resultatet baseras på elva vetenskapliga artiklar. Efter analys avartiklarna framkom tre distinkta teman: utbildning som omvårdnadsåtgärd, socialtstöd som omvårdnadsåtgärd och självstärkande omvårdnadsåtgärder. I resultatetpåvisades det att utbildning hos sjuksköterskor avgjorde kvalitén på insattaomvårdnadsåtgärder samt att det i sin tur genererade kunskap och förståelse omkringfenomenet depression hos patienterna. Härifrån kunde förståelsen och vetskapen omsjukdomsbilden tjäna som avlastning och ett tillfälle till återhämtning och ro. Vidarekunde detta lugn användas som tillfälle att återbygga relationer. Framtida forskninginom området bör fokusera på att göra omvårdnaden till en tvärvetenskaplig disciplin,speciellt rörande psykosociala sjukdomar, så som depression. / Depression is an increasing benefactor to the worldwide burden of disease with about340 million being affected and estimates to be the second major benefactor by 2020.The experience of depression is described as an emotional struggle related to worldlyopinions which symptomizes in three dominant feelings such as alienation, dejectionand shame. The nursing profession constitutes a crucial element of support in andduring healthcare work with patients diagnosed with depression. The purpose of thisstudy was to highlight nurses’ caring measures for inpatients with depression. Themethod was a literary overview and the result constitutes of eleven articles. Theanalysis of said result composed of three distinct themes; education as a caringmeasure, social support as a caring measure and self-reinforcing caring measures.Education of both nurses and patients improved the experienced care and generated amore equal relationship. The social support strengthened the patients’ confidence andserved as relief which generated an opportunity for recovery and peace. Lastly theself-reinforcing measures were a non-dramatic way to deal with the depression anddepended solely on the person’s perspective. Future research need to focus on makingthe nursing profession more interdisciplinary in regards to psychosociologicaldiseases, such as depression.

Bakgrund: Specialistsjuksköterskans profession omfattar kompetens och kunskap som förvärvats genom studier i ämnet på avancerad nivå. För att synliggöra det förvärv ingår det att sjuksköterskan ser på sig själv och sin profession som självständig. Tidigare studier tyder på att trots att specialistsjuksköterskan har sin utgångspunkt i det egna kunskapsområdet är det inte alltid tydligt i möten med andra professioner. Det finns även ett synsätt som lever kvar beträffande sjuksköterskans profession som ett bihang till läkaren vilket gör utgör ett hinder till att arbeta självständigt. Syfte: Att beskriva specialistsjuksköterskans erfarenhet av att självständigt utöva sin professionella kompetens inom psykiatrisk slutenvård. Metod: Halvstrukturerade intervjuer genomfördes med sex kvinnliga specialistsjuksköterskor inom sluten psykiatrisk vård på en och samma klinik. Kvalitativ innehållsanalys valdes som metod vid analysen av materialet. Resultat: Specialistsjuksköterskorna upplevde att de hade möjligheter att påverka sin situation och således kunna utföra ett självständigt arbete. De beskrev att samarbetet med de övriga professionerna upplevdes oftast som stärkande och att det främjade patientarbetet. Respondenterna beskrev också specialistutbildningen som en bidragande faktor till ökad självständighet. Diskussion: Resultatet diskuteras utifrån det vårdvetenskapliga konsensusbegreppet vårdande som teoretisk referensram samt utifrån relevant vetenskaplig forskning. / Background: Specialist nurse profession includes skills and knowledge acquired through the study of the subject at the advanced level. In order to highlight the acquisition include the nurse looks at herself and her profession as an independent. Previous studies suggest that although the specialist nurse has its starting point in their own field of knowledge, it is not always clear in meetings with other professions. There is also an approach that persists regarding nursing profession as an appendage to the doctor which is an obstacle to work independently. Aim: To describe the specialist nurse experience to independently exercise their professional skills in psychiatric inpatient care. Method: Semi-structured interviews were conducted with six females specialist nurses in inpatient psychiatric care at the same clinic. Qualitative content analysis was chosen as the method in the analysis of the material. Results: Specialist nurses felt that they had the opportunity to influence their situation and thus be able to carry out and independent work. They described the cooperation with the other professions often perceived as strengthening and it promoted the work with patients. Respondents also described the specialized training as a contributing factor to increased independence. Discussions: The results are discussed from the health scientific consensus term care as a theoretical framework and on the basis of relevant scientific research.

Class of 2009 Abstract / OBJECTIVES: The purpose of the study was to determine the rate of Clostridium difficile infections (CDI) in hospitalized patients and the various factors that were associated with the risk of developing CDI by examining patient discharge data for hospitals in 37 states in the United States using Healthcare Cost and Utilization Project (HCUP). METHODS: Patient discharge information for all patients obtained using HCUP census for the years 2002-2005, either for primary or secondary (all-listed) occurrences of CDI using the ICD-9-CM code (008.45) specific for intestinal infections due to C. difficile, were included in the study. Regression analysis, either Generalized Linear Model log-link or power-link, or a logistic regression was employed to control for the multiple independent variables. RESULTS: The incidence rate for CDI was 9.4% for the years 2002-2005. Among the concomitant diagnoses and procedures, essential hypertension, volume depletion, congestive heart failure, urinary tract infection and venous catheterization were the top 5. The length of stay (LOS) for CDI was associated with being Black, Hispanic or Other race category, number of diagnoses and procedures, primary expected payer of Medicaid, private insurance and other (including worker’s compensation, CHAMPUS,CHAMPVA etc), and all groups classified based on median household income category for patient’s zip code. Predictors of CDI related to inpatient total hospital charges were being female, race (other than black), number of diagnoses and procedures, Death, LOS, patient location and with self-pay and no charge categories as primary expected payer. Predictors of higher CDI related inpatient hospital deaths were age, female sex, Hispanic race, number of diagnoses and procedures, LOS and having Medicaid, self-pay or other as primary expected payer. CONCLUSIONS: LOS, inpatient total hospital charges, and inpatient mortality were dependent on several patient and other characteristics.

Class of 2009 / OBJECTIVES: To determine and characterize the relative impact of patient demographics on hospital inpatient charges, length of stay, and inpatient mortality in patients with ovarian cancer from 2002-2005. METHODS: A retrospective database analysis of AHRQ’s Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample databases was conducted spanning from January 1, 2002, to December 31, 2005.Data were collected regarding age, race, payer status, median household income, location of hospital (urban/rural), comorbidities, procedures, total charges, length of stay, and inpatient mortality. Multivariate and gamma regression methods were utilized to examine incremental risks associated with length of stay, total charges, and inpatient mortality, after controlling for all other variables. RESULTS: Overall, data from 246,012 hospital admissions were obtained. The average length of stay of patients was 6.58 days (SD = 7.22), the average number of diagnoses was 7.18 (SD = 3.36), the average number of procedures performed was 2.71 (SD = 2.66). A total of 14,485 (5.9%) patients died during hospitalization. The average total charge was $29,698 (SD = $42,951). The IRR was 0.886 (95%CI, -0.105 to -0.04) for patients who were Hispanic, and 1.089 (95%CI, 0.017–0.153) for patients who were Black compared to patients who were white. When compared to patients who lived in large, metropolitan areas, the IRR was 0.88 (95%CI, -0.146 to - 0.109) for patients located in smaller, metropolitan areas, and the IRR was 0.74 (95%CI, -0.335 to -0.268) for patients located in non- urban areas. CONCLUSIONS: Patient demographics were found to have associations, both directly and indirectly, with length o