Abstract
New admissions to psychiatric inpatient units can significantly impact the environment and level of safety. Maintaining safety is a core and critical responsibility of nursing, but nurses are often overlooked in the decision to admit a patient. Missed opportunities for dialogue between nurses and the admitting physician challenge nurses’ ability to proactively manage the therapeutic environment. When nurses are limited in this ability, the outcome can be an unpredictable and unstable milieu. In a 25-bed acute psychiatric inpatient unit, a formalized communication system among the multidisciplinary admission team was developed. Data collected over 1 year demonstrated improved safety. Increasing the admitting provider’s awareness of the current unit acuity and involving the nursing staff early in the admission process improved collaboration among care team members and reduced risks to maintaining milieu safety. [Journal of Psychosocial Nursing and Mental Health Services, 53(8), 30–35.]
- Bowers L., Alexander J., Bilgin H., Botha M., Dack C., James K. (2014). Safe-wards: The empirical basis of the model and a critical appraisal. Journal of Psychiatric and Mental Health Nursing, 21, 354–364.
10.1111/jpm.12085 Crossref Medline, Google Scholar - Bowers L., Allan T., Simpson A., Nijman H., Warren J. (2007). Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: The Tompkins Acute Ward Study. International Journal of Social Psychiatry, 53, 75–84.
10.1177/0020764007075011 Crossref Medline, Google Scholar - Bowers L., Chaplin R., Quirk A., Lelliott P. (2009). A conceptual model of the aims and functions of acute inpatient psychiatry. Journal of Mental Health, 18, 316–325.
10.1080/09638230802053359 Crossref, Google Scholar - Bowers L., James K., Quirk A., Wright S., Williams H., Stewart D. (2013). Identification of the “minimal triangle” and other common event-to-event transitions in conflict and containment incidents. Issues in Mental Health Nursing, 34, 514–523.
10.3109/01612840.2013.780117 Crossref Medline, Google Scholar - Delaney K.R., Johnson M.E. (2006). Keeping the unit safe: Mapping psychiatric nursing skills. Journal of American Psychiatric Nurses Association, 12, 198–207.
10.1177/1078390306294462 Crossref, Google Scholar - Delaney K.R., Johnson M.E. (2008). Inpatient psychiatric nursing: Why safety must be the key deliverable. Archives of Psychiatric Nursing, 22, 386–388.
10.1016/j.apnu.2008.09.003 Crossref Medline, Google Scholar - Delaney K.R., Johnson M.E. (2014). Metasynthesis of research on the role of psychiatric inpatient nurses: What is important to staff?Journal of the American Psychiatric Nurses Association, 20, 125–137.
10.1177/1078390314527551 Crossref Medline, Google Scholar - Delaney K.R., Perraud S., Johnson M.E. (2009). Psychiatric nursing: Creating and maintaining a therapeutic inpatient environment. In , Textbook of hospital psychiatry (pp. 389–401). Washington, DC: American Psychiatric Publishing. Google Scholar
- Endsley M.R. (1995). Toward a theory of situation awareness in dynamic systems. Human Factors, 37, 32–64.
10.1518/001872095779049543 Crossref, Google Scholar - Hamrin V., Iennaco J., Olsen D. (2009). A review of ecological factors affecting inpatient psychiatric unit violence: Implications for relational and unit cultural improvements. Issues in Mental Health Nursing, 30, 214–226.
10.1080/01612840802701083 Crossref Medline, Google Scholar - Nijman H., Bowers L., Haglund K., Muir-Cochrane E., Simpson A., Van Der Merwe M. (2011). Door locking and exit security measures on acute psychiatric admission wards. Journal of Psychiatric and Mental Health Nursing, 18, 614–621.
10.1111/j.1365-2850.2011.01716.x Crossref Medline, Google Scholar - Nijman H., Merckelbach H., Evers C., Palmstierna T., Campo J. (2002). Prediction of aggression on a locked psychiatric admission ward. Acta Psychiatrica Scandinavica, 105, 1–6.
10.1034/j.1600-0447.2002.0o426.x Crossref, Google Scholar - Rolfe G. (1996). Closing the theory-practice gap: A new paradigm for nursing. London, UK: Butterworth-Heinemann. Google Scholar
- Salzmann-Erikson M., Lutzen K., Ivarsson A.B., Eriksson H. (2011). Achieving equilibrium within a culture of stability? Cultural knowing in nursing care on psychiatric intensive care units. Issues in Mental Health Nursing, 32, 255–265.
10.3109/01612840.2010.549603 Crossref Medline, Google Scholar - Sharfstein S.S. (2009). Goals of inpatient treatment for psychiatric disorders. Annual Review of Medicine, 60, 393–403.
10.1146/annurev.med.60.042607.080257 Crossref Medline, Google Scholar - Stranges E., Levit K., Stocks C., Santora P. (2011). State variation in inpatient hospitalizations for mental health and substance abuse conditions, 2002–2008. Retrieved from http://hcup-us.ahrq.gov/reports/statbriefs/sb117.pdf Google Scholar
