ANA OJIN About Logo
OJIN is a peer-reviewed, online publication that addresses current topics affecting nursing practice, research, education, and the wider health care sector.

Find Out More...


Letter to the Editor

A Decade of Published Evidence for Psychiatric and Mental Health Nursing Interventions

m Bookmark and Share
 

Jaclene A. Zauszniewski, PhD, RN-BC, FAAN
Abir Bekhet, PhD, RN, HSMI
Sara Haberlein, BSN-RN

Abstract

Current psychiatric nursing practice remains grounded in tradition, unsystematic trial and error, and authority. Although some of the wisdom that has been passed down over time is questionable, it continues to influence nursing practice today. This state-of-the-evidence review examined features of intervention studies published between January 2006 and December 2010 in five psychiatric nursing journals; it compared findings with those from a previous study of comparable literature published between 2000 and 2005. The analysis included studies that evaluated strategies, procedures, or practices that promote mental health or prevent mental illness. Of the 553 data-based articles, 71% tested interventions; 54% were conducted in the United States. Intervention studies reflected psychological (38%) social (17%), and biological (1%) dimensions of the biopsychosocial model.  Some studies involved two dimensions and 17% included all three dimensions. Studies involved nurses, students, or staff (15%), mentally ill (50%), or mentally healthy persons (35%) ranging in age from childhood through older adulthood. The 10 year review showed continuing progress toward increased dissemination compared to earlier years; less focus on nurses, students, and staff; an increase in international studies; and greater emphasis on holistic interventions. In this article, the authors note a need for more randomized, controlled trials and studies to compare effectiveness across interventions.

Citation: Zauszniewski, A. J., Bekhet, A., Haberlein, S. (August 27, 2012) "A Decade of Published Evidence for Psychiatric and Mental Health Nursing Interventions" OJIN: The Online Journal of Issues in Nursing Vol. 17 No. 3.

DOI: 10.3912/OJIN.Vol17No03HirshPsy01

Keywords: State-of-the science, psychiatric nursing, evidence-based practice, biopsychosocial model interventions, clinical trials, dissemination, mental health, mental illness, global health

The Study

 Current psychiatric nursing practice is still grounded in tradition, unsystematic trial and error, and authority. The need for quality psychiatric care based on the best and most current research is well documented. However, historically, psychiatric nursing practice has been influenced by traditional wisdom passed down through generations by word of mouth and in published textbooks (Zauszniewski & Suresky, 2003). Much of this nursing care has been based on personal experience and the experiences of nurses and others who have gone before them.  Current psychiatric nursing practice is still grounded in tradition, unsystematic trial and error, and authority. Some psychiatric nursing knowledge comes from ‘Old Wives’ Tales,’ reflecting the perspectives of women from the past. This ‘received wisdom’ is often taken for granted and reflexively put into practice. Even though some of the wisdom that has been passed down over time is questionable, it continues to influence psychiatric nursing practice today.

In this article, research evidence is reviewed to provide a basis for its use in clinical practice. This ‘state-of-the-evidence’ review examined literature from January 2006 through December 2010 and compared these findings with those from a previous study of comparable literature published between 2000 and 2005 (Zauszniewski, Suresky, Bekhet, & Kidd, 2007). Boyd’s (2011) biopsychosocial model provided the framework for organizing intervention studies into three categories: biological, psychological, and social (See Figure). The model takes a holistic approach and consists of three separate but interdependent domains: biologic, psychological, and social (Boyd, 2011). Although the domains differ, they interact with each other. Indeed, after considering patients' circumstances and other factors, selection of a nursing approach involves integrating biologic, psychological, and social interventions into a comprehensive plan of care. Nursing interventions are defined as activities that assess dysfunction, enhance and promote health, and assist patients to regain or improve their coping abilities and/or prevent further disabilities (ANA, 2000).

Evidence-Based Practice

This section will discuss the need for evidence-based practice. It will also address the importance of using evidence-based practice in providing daily nursing care.

Calls for Evidence-Based Practice

Using best evidence for clinical decision making has many benefits... Yet very few  health care professionals implement  the latest evidence in their clinical practice. Evidence-based practice is the systematic use of current best evidence to make clinical decisions for patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Using best evidence for clinical decision making has many benefits, including improving patient outcomes, providing professional development opportunities, contributing to recruitment and retention of staff, and saving health care dollars (The Sarah Cole Hirsh Institute, 2005; Fineout-Overholt, Melnyk, & Schulz, 2005). Acknowledgement of the value of evidence-based nursing practice dates back to the mid-1990s (Upton & Upton, 2006). Yet very few  health care professionals implement  the latest evidence in their clinical practice (Cretin, Farly, Dolter, & Nicholas, 2001; Jolley, 2002; Melnyk et al., 2004).

Several landmark documents relevant for psychiatric nursing have recently been published: the Report of the Surgeon General on Mental Health (U.S. Department of Health and Human Services [DHHS], 1999); Healthy People 2010, the National Health Promotion and Disease Prevention Objectives (Healthy People, 2000); and the President’s New Freedom Commission on Mental Health (2003) which included the goals of achieving excellence in mental care delivery and the accelerating of research. These documents point to the need for evidence-based practice and provide a framework for accelerating the provision of evidence-based nursing practice.

Nursing leaders have long called for examination of theory, research, and curriculum in psychiatric nursing. Nursing leaders have long called for examination of theory, research, and curriculum in psychiatric nursing. These leaders have recommended evaluating what we teach, scrutinizing ‘sacred cows’ that reflect ritualistic practices, and letting go of tradition and dogmatic approaches that may have been of value in the past but are inconsistent with current evidence that informs modern day practice and research. They have warned that psychiatric nursing may become irrelevant if we fail to bring it into the 21st century (Mohr, 2009). Stuart (2001) concluded that nurses are not contributing to evidence-based practice and few interventions meet that standard. This situation will not change until the content of what is taught in psychiatric nursing rises to levels established in other disciplines, such as psychiatry and psychology, and serves as a foundation for generating research.

...nurses can no longer view clinical studies as academic exercises to be discarded on graduation and not applied to the clinical setting.Rice (2008a) has pointed out that although a major portion of the evidence-based practice (EBP) movement is directed toward developing clinical guidelines, a critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. Also, he pointed out that nurses can no longer view clinical studies as academic exercises to be discarded on graduation and not applied to the clinical setting. Furthermore Rice (2008b) noted that the need to apply current research evidence to clinical problems is reflected in professional codes and institutional mission statements. 

With the arrival of evidence-based practice as the new standard of care, all health care providers are urged to use the latest research evidence.  However, in order for clinicians to implement interventions based on the highest level of evidence, they must understand the levels of research evidence and the different classification systems. Developing evidence-based practice ability requires familiarity with the language and terminology of clinical research (Rice, 2009). For example, all health care providers need to be able to discuss concepts. such as effect size, which must be understood to determine whether findings of studies are clinically meaningful (Rice, 2009).

Using the Evidence

In order for evidence-based practice to occur, practicing nurses must take responsibility for searching, critiquing, and synthesizing the empirical literature related to their practice.The focus on evidence-based practice represents a substantial paradigm shift in the discipline of nursing and in the specialty of psychiatric and mental health nursing. Though the nursing discipline has been grounded in theory and research, nursing practice has, as noted above, been largely influenced by expert opinion and tradition. There is now broad recognition that nursing practice must be based on the best available evidence. Of course, the transition to evidence-based practice in psychiatric nursing, as in all nursing specialties, is challenging. In order for evidence-based practice to occur, practicing nurses must take responsibility for searching, critiquing, and synthesizing the empirical literature related to their practice.

Stein (2009), however, has noted that nurse scientists’ selection of journals for publication of their findings is a concern. The most rigorous research findings from studies of mental health issues are published primarily in journals that often are not read by practicing psychiatric and mental health nurses. A number of factors influence an author’s selection of a journal for publishing; authors may believe that findings need to be in journals that (a) are accessible to colleagues from multidisciplinary clinical specialties; (b) have a ‘high impact,’ and (c) demonstrate high quality scholarship that supports decisions for tenure and promotion (Stein, 2009). Although all these reasons are reality based and justifiable, the question remains, what is our obligation as psychiatric and mental health nurse scientists to our practicing colleagues and the children, adolescents, and adults who receive their nursing care? Stein has noted that, as a practice profession, our primary objective as nurse scholars and scientists should be to improve the health and well being of populations of all ages, and across the globe, through provision of optimal, high-quality nursing care. Thus, Stein has observed that we might need to re-evaluate our current emphasis on journal impact factors and promotion criteria in the interest of the more compelling issue of the extent to which the work holds potential for improving nursing practice and patient health.

Method

Our review focused on intervention studies published in peer-reviewed psychiatric nursing journals thought to be those most read by practicing psychiatric/mental health nursing professionals. These journals included Archives of Psychiatric Nursing; Issues in Mental Health Nursing; Journal of the American Psychiatric Nurses Association; Journal of Psychosocial and Mental Health Services; and Perspectives in Psychiatric Care.

 The review assessed the frequency and types of data-based, intervention research published in the journals. A study was determined to be an intervention study if nursing strategies, procedures, or practices were examined for their effectiveness in enhancing or promoting health or preventing disability or dysfunction (ANA, 2000). Each of the co-authors searched the five journals for studies. All three co-authors had to agree that a study met this criterion in order for it to be included in the analysis. Both qualitative and quantitative studies were included. There were 553 data-based articles published from January 2006 through December 2010. However, only 83 (15%) evaluated or tested psychiatric nursing interventions. Of these 83 intervention studies, 12 tested interventions for nurses, nursing students, nursing staff, or mental health professionals, while 71 focused on interventions to promote mental health in clients of care. The setting, target population, and intervention domain were analyzed in each study.

Findings

This section describes the findings from the 83 intervention studies that were found in the five psychiatric nursing journals between January 2006 and December 2010. The 12 studies that included nurses, student nurses, and mental health personnel, as well as the 71 that involved recipients of mental health services or care are presented in this section. First, the research settings in which the studies were conducted and descriptions of the targeted populations are described. Next, the interventions tested within the studies are presented using the categories of the bio-psycho-social framework. Finally, the research designs used in the intervention studies are evaluated.

Research Settings

Forty-five of the 83 intervention studies published from 2006 to 2010 were conducted in the United States (US). Seven of the total were conducted in Korea. Five studies each were done in Taiwan and Canada; four each in the Netherlands and Australia; and two each in the United Kingdom, Singapore, and Turkey. One study each was conducted in Norway, Jordan, Finland, Thailand, Switzerland, Scotland, and Portugal.

Targeted Populations

Four of the 83 intervention studies that appeared in these five psychiatric nursing journals during the period 2006-2010 examined the effect of interventions on student nurses, while eight studies focused on nurses, nursing staff members, or mental health professionals. Seventy one of the studies examined the effect of the interventions on clients. Examples of studies describing each of these three groups are described below.

Student nurses. In four studies, student nurses were the participants. Saarikoski, Warne, Aunio, and Leino-Kilpi (2006) studied the effectiveness of group supervision during clinical placements on 32 student nurses in Finland. In addition, O’Brien and colleagues (2008) studied the usefulness for 257 undergraduate nursing students in Australia of clinical facilitators in settings where the students had clinical placements. Happell (2009) also studied undergraduate nursing students in Australia to explore the relationship between the quantity of theoretical preparation in mental health and 784 nursing students’ attitudes toward people with a mental illness and toward mental health nursing; their sense of preparedness for practice; and their satisfaction with their clinical experience. Finally, Kameg, Clochesy, Mitchell, and Suresky (2010) compared the effectives of two educational delivery methods—high fidelity human simulation (HFHS) and traditional lecture—on the self-efficacy for communication skills of a sample of 38 undergraduate students.

Nurses, nursing staff, and mental health professionals. Eight studies of nurses, nursing staff, or mental health professionals were found. One study focused on improving communication skills by examining the effects on 263 nurses in Turkey (not all were psychiatric nurses) of in-service communication training to enhance their empathic skills (Ancel, 2006). Two other studies focused on improving nurses’ knowledge and competence in clinical practice. The first of these studies, conducted by Tran, Stone, Fernandez, Griggiths, and Johnson (2009), evaluated an intervention to improve knowledge of alcohol and substance abuse among medical/surgical nurses (n = 120) in Australia. The second study evaluated a program to improve knowledge of tobacco dependence in a sample of psychiatrists, psychiatric nurses, psychologist, and social workers, along with other counselors (n = 71) in the US (Williams, et al, 2009). A study by Engin and Cam (2009) evaluated a self-awareness training program for 22 psychiatric nurses in Turkey.

The remaining four studies also included nurses and nursing staff. One study, conducted in Taiwan, investigated the effects of an education program, designed to increase psychiatric nurses’ awareness of their potential for creativity, problem-solving, facing adversity, and emotional control on both their potential abilities and their job satisfaction (Chen, Lee, Weng, & Chen, 2010). A second study tested an intervention with 21 nurses to support care for suicidal patients with schizophrenia (Meerwijk et al., 2010). A third study evaluated the efficacy of the Early Recognition Method for improving the interaction between forensic mental health nurses and their patients and for decreasing the patients’ violence (Fluttert, van Meijel, Nijman, Bjørkly, & Grypdonck, 2010). The study was conducted with 116 forensic mental health nurses working on 16 wards of a large, Dutch forensic hospital. Finally, one study evaluated the effectiveness of a behavioral response team (BERT) to help staff members deal with behaviors of patients with psychiatric illnesses who had been hospitalized on nonbehavioral-health units (Loucks, Rutledge, Hatch, & Morrison, 2010).

Clients of care. A total of 71 intervention studies that did not focus on nurses, student nurses, nursing staff, or mental health professionals, but rather focused on clients, were also published in the five psychiatric nursing journals between January 2006 and December 2010. A variety of diagnoses were represented in the studies. The most frequent were major depressive disorder, bipolar affective disorder, schizophrenia, schizoaffective disorder, borderline personality disorder, tics, eating problems, Alzheimer’s, dementia, and substance abuse. Other studies focused on adolescents, adults, or elders who were not mentally ill but were experiencing stress, physical illness, pregnancy, incarceration, victimization, or bereavement; these latter samples did not include persons with a diagnosed mental disorder.

In terms of study participants’ ages, one study included children who were mentally healthy. There were six studies of adolescents; one focused on adolescents with a mental illness and five involved adolescents considered mentally healthy. There were 35 studies of adults, including 26 studies of adults with mental illness, eight of adults who were not mentally ill, and one study that included both mentally ill and mentally healthy adults. Ten studies focused on elders, including three studies of elders with mental illness and seven of elders without mental illness. In this five-year review, 13 studies involved ‘mixed’ populations. These 13 studies included one study of mentally healthy children and adolescents; two studies of mentally healthy adolescents and adults, and 10 studies of adults and elders. Of these ten, seven involved adults or elders who had a mental illness and three involved the mentally healthy. Six studies did not identify the age of their subjects. Of these six studies, four subjects were mentally ill and two were mentally healthy. There were no published studies in the five journals that included adolescents, adults, and elders.

Intervention Domains

Using the biopsychosocial model provided by Boyd (2011), the interventions studied were classified, by consensus of the co-authors, into one of the three domains (biological, psychological, and social) or various combinations of the domains (See Figure). Of the 71 studies, 56% (n=40) tested interventions that reflected only one of the biopsychosocial dimensions. One study tested a biological intervention, 27 tested psychological interventions, and 12 tested social interventions. The remaining 31 studies (44%) tested interventions in overlapping domains, including three that were bio-psychological, 12 that were psychosocial, four that were bio-social, and 12 that addressed all three bio-psycho-social domains. Examples of studies in each of the domains and combinations of domains are described in the paragraphs that follow. The sample studies were selected by the co-authors to illustrate both qualitative and quantitative methods and various study designs, as well as to provide examples from all five psychiatric nursing journals used in this analysis.

Figure. Numbers of Intervention Studies Categorized Within the Biopsychosocial Model 
 

The biological domain focuses on the physical aspects of the patient... Interventions in the Biological Domain. The biological domain focuses on the physical aspects of the patient, including self-care, activity and exercise, sleep, nutrition, relaxation, hydration, thermoregulation, pain, and medication management. Interventions commonly used included psychopharmacology, light therapy, and transcranial magnetic stimulation.

Rosedale (2009) conducted and tested an intervention from the biological domain. This phenomenological study examined the effects of repeated transcranial magnetic stimulation (rTMS) in nine moderately depressed adults who had failed to respond to treatment with antidepressants. After receiving rTMS, study participants were asked to describe the experience of having rTMS during an open-ended, audiotaped interview. The findings from their narratives included self-reported changes of feeling less depressed and more optimistic in imagining themselves in new situations or relationships.

...the psychological domain,... includes emotion, behavior, and cognition. Interventions in the Psychological Domain. Many psychiatric nursing interventions are in the psychological domain, which includes emotion, behavior, and cognition.  Interventions in this category include counseling, conflict resolution, bibliotherapy, creative-expressive therapy, reminiscence, behavior therapy (behavior modification and token economy), cognitive interventions, psycho-education, health teaching, and spiritual interventions

One study utilizing an intervention from the psychological domain examined a cognitive intervention for 65 adult ‘voice hearers’ (persons with schizophrenia or schizoaffective disorder) via a two-group, randomized, controlled trial that used repeated measures. The findings showed that almost 1 in 3 persons who had experienced auditory hallucinations reported a reduction in the number and severity of those hallucinations following the cognitive intervention (England, 2008).

[The Social] domain consists of the patient’s environment and the ways in which aspects of the environment affect the patient’s response to stress.  Interventions in the Social Domain. This domain consists of the patient’s environment and the ways in which aspects of the environment affect the patient’s response to stress. Interventions in this domain utilized people who were close to the patient, such as families, friends, and social groups, as well as special attention to community interactions. These interventions included supportive counseling, environmental manipulation, vocational rehabilitation, social skills training, milieu therapy (containment, validation, structured interaction, and open communication), home visits, and community caregiver education.

Crockford, Kerfoot, and Currie (2009) tested an intervention from the social domain. This study examined the impact of a smoking room in a psychiatric inpatient unit on the behavior of 90 inpatients (most common diagnosis: psychotic disorders, i.e., schizophrenia). The study involved a survey of nursing staff and a retrospective chart review of documented behaviors before and after the smoking room was opened; no randomization and no control group were used. The staff survey and chart review findings differed regarding the impact of having a smoking room on a psychiatric ward. The staff survey suggested a beneficial impact on unit atmosphere, less time spent discussing smoking privileges, and more appropriate use of off-unit privileges. However, the chart review failed to demonstrate a significant change in disruptive behavior.

Combinations of domains. Many researchers combined more than one domain in their interventions (See Figure). Nineteen (27%) of the 71 studies tested interventions that included two of the three dimensions. Three of these studies were biopsychological, four biosocial, and 12 psychosocial interventions. In addition, 12 studies (17%) tested interventions with all three domains -- biological, psychological, and social. Examples of intervention studies reflecting two domains are described below, followed by one study that tested an intervention reflecting all three domains.

Apostolo and Kolcaba (2009) studied and tested an intervention from the biopsychological domain. This study by examined the effects of guided imagery on comfort, depression, anxiety, and stress in 60 psychiatric inpatients with depressive disorders. The study involved an intervention group and a ‘usual care’ comparison group; all consecutively admitted patients with depressive disorder were eligible. The diaphragmatic breathing and progressive muscle relaxation involved in this guided imagery intervention constituted the biological component, while the cognitive component involved the creation of positive images. Measures were taken before and after the 10-day intervention. The intervention group was tested first, followed by the comparison group. The findings showed that the intervention group had significant improvements in their perception of increased comfort and decreased depression, anxiety, and stress compared to the usual care group.

Kang and Yoo (2007) studied an intervention from the biosocial domain. This study examined the effectiveness of breathing and stretching exercises in the context of a support group for 27 middle-aged women who had lost a loved one within the past six months. Seventeen received the intervention and ten did not, thus serving as a control group. Measures of stress, grief, and immune response were taken before and after the 10-session intervention. The findings showed significant decreases in stress and grief for those in the intervention group, but no significant difference in immune response.

Ballard (2008) conducted a study in the psychosocial domain that examined the effectiveness of treatment malls in improving the psychosocial rehabilitation of persons with psychiatric illnesses. The treatment mall was designed to teach and strengthen psychological and social/vocational skills within a centralized, educational setting in which participants were self-directed learners and the psychoeducation was person centered. The study involved a convenience sample of 120 participants (no control group). Research observations were made after their participation in the treatment mall (no pre-test). The findings indicated that 82% of the participants found the treatment mall helpful in preparing for discharge and 92% expressed satisfaction with the use of the treatment mall approach.

Interventions in the biopsychosocial domain involve all three components – biological, psychological, and social. There were 12 studies that fit this description. One study in the biopsychosocial domain examined a collaborative model for treating depression in 41 homebound elders. Pharmacological and psychosocial interventions were implemented simultaneously. Thirty-six participants choose to participate in the mental health intervention and five choose to receive usual care. Significant improvements were noted in depressive symptoms for elders who received the intervention (Knight & Housemen, 2008).

Research Designs

The review of published intervention studies in the five psychiatric nursing journals (2006-2010) revealed the methodological characteristics described below. In 39 studies (55%) there was no randomization or use of a control group; nine studies (13%) had no randomization, but did have a control group; three studies (4%) allowed participants to choose whether to participate in the intervention or control group. Twenty studies (28%) had random samples and used a control group. Sample sizes varied widely, ranging from 4 to 333, with an average of 60. Thirty-nine studies (55%) had only an intervention group; 31 (44%) had an intervention group and a control group; and one study (1%) involved comparison of two interventions with a control condition.

Seven studies (10%) collected only qualitative data; 60 studies (84%) collected only quantitative data; and four studies (5.6%) collected both quantitative and qualitative data. Eighteen studies (25%) had only one data collection point post-intervention; 47 studies (66%) had two data collection points (before and after the intervention); and six studies (8%) examined the effects of the intervention over time using repeated measures.

Discussion and Conclusion

This review of psychiatric and mental health nursing intervention research was limited to studies published in five journals that are commonly read by a wide range of psychiatric and mental health nurses working in clinical practice, education, or research. All psychiatric and mental health nurses recognize the need for high quality care that is based on the best and most current research (Zauszniewski, et al. 2007). This review provides evidence of continued movement toward dissemination of the findings of intervention research from 2006 through 2010. In conducting this study, we used methods of collecting information about intervention studies that were similar to those in a previous review conducted from 2000 through 2005 (Zauszniewski et al., 2007) so that comparisons over time could be made.

There were 553 data-based articles published from January 2006 through December 2010, as compared to 486 data-based articles published from 2000 through 2005 (Zauszniewski et al., 2007) in these five psychiatric nursing journals. However, because the two review periods differed, with six years covered for in the 2000-2005 review and only five in the 2006-2010 review, the average number of published studies in these two time frames was calculated, revealing a small increase, specifically an average of five data-based articles per year, from the earlier to the current time frame.

The increase in the number of international intervention studies published... indicates that an increasing number of countries now share an interest in disseminating studies that test interventions for psychiatric and mental health nursing practice. From 2006 through 2010, 54% of intervention studies were conducted in the US and 46% were international. This compares with 72% of studies published in the US and 28% published internationally in the previous review (Zauszniewski et al., 2007). The increase in the number of international intervention studies published in the five psychiatric nursing journals indicates that an increasing number of countries now share an interest in disseminating studies that test interventions for psychiatric and mental health nursing practice. This publication of findings from intervention studies conducted outside the US facilitates global sharing of evidence for psychiatric and mental health nursing practice.

Of the 83 intervention studies found in the five journals from 2006 through 2010, nurses, student nurses, nursing staff, or other mental health professionals were recipients of an intervention in 12 studies. The 2000 to 2005 review (Zauszniewski et al., 2007) did not report the number of studies involving these groups. However, a review conducted from 2000 through 2002 (Zauszniewski & Suresky, 2003) found that 52 (23%) of 227 studies published in these same five psychiatric journals involved nurses, student nurses, or mental health staff. Although there is a downward trend in the publication of studies of psychiatric nurses, student nurses, and mental health staff, studies of nurses, student nurses, nursing staff, or mental health professionals continue. Although these studies do not focus directly on the care provided for clients, they can inform the development of role expectations and the improvement of care delivered by psychiatric and mental health nurses.

...over time, the focus on a single intervention domain has decreased, with an increased focus on the testing of more holistic interventions that capture all three domains. Our analysis revealed an increase in published studies of interventions for psychiatric patients or clients in the five selected psychiatric nursing journals. From 2006 through 2010, 71 studies evaluated nursing interventions in these populations. This compares with 77 published from 2000 through 2005 in the five journals. Taking into account the difference between the two review periods (five versus six years), there was a small increase in the number of published intervention studies from the previous reporting period. The number of intervention studies involving adolescents, adults, or elders was similar in the two review periods even though the current review covered five years, while the previous review covered six years. Further, there was a dramatic increase in intervention studies in the bio-psycho-social domains from 1 (2000-2005) to 12 (2006-2010) (See Table). Thus, it appears that over time, the focus on a single intervention domain has decreased, with an increased focus on the testing of more holistic interventions that capture all three domains (See Table).

Table. Comparison Within the Domains Between 2000-2005 and 2006-2010 Analyses

Domain

2000-2005

N = 77

2006-2010

N = 71

Biological

8 (11%)

1 (1%)

Psychological

44 (57%)

27 (38%)

Social

7 (9%)

12 (17%)

Bio-Psychological

4 (5%)

3 (4%)

Psycho-Social

9 (12%)

12 (17%)

Bio-Social

4 (5%)

4 (6%)

Bio-Psycho-Social

1 (1%)

12 (17%)

There was a higher percentage of quantitative intervention studies in the 2006-2010 review period than in the earlier review period (84% compared to 64%), while the percentage of qualitative studies decreased from 26% in 2000-2005 (Zauszniewski et al., 2007) to 10% in this review. However, more than half (55%) of the intervention studies in the current review did not involve randomization or the use of a control group, and only one study was labeled by its author as a randomized, controlled trial. Rice (2008b) has noted that studies lacking control and randomization provide less credible evidence for clinical interventions. Thus, although more recent intervention studies have tended to be quantitative rather than qualitative, their lack of control conditions and randomization diminishes the quality of the evidence. As a result, there continues to be limited scientific support for many psychiatric nursing interventions (Beebe, Adams, & El-Mallakh, 2011; Rice, 2011).

Effective partnerships between researchers and practitioners to coordinate research agendas with the development and testing of interventions in clinical practice settings are critical. To address the need for increased evidence supporting the effectiveness of intervention studies, a multi-pronged approach that involves collaboration among clinicians, educators, and researchers is needed (Zauszniewski et al., 2007). Researchers must be committed to conducting high-quality investigations of nursing interventions (Beebe et al., 2011) and disseminating their findings in journals read by nurses in practice settings (Zauszniewski et al., 2007). Effective partnerships between researchers and practitioners to coordinate research agendas with the development and testing of interventions in clinical practice settings are critical (Buccheri, Trygstad, Buffum, & Gerlock, 2010; Horsfall, Cleary, & Hunt, 2011).

In summary, this state-of-the-science review of published intervention research in the psychiatric and mental health nursing journals that are most commonly read by practicing nurses, educators, and researchers in the United States has revealed an increase in the number of data-based studies; a greater number of studies from outside the US; less focus on studies of nurses, nursing students, and other mental health professionals as compared with clients who receive their care or services; and a greater emphasis on testing holistic interventions that contain biological, psychological, and social dimensions. Ongoing assessments of the dissemination of psychiatric and mental health nursing intervention research will be critical for documenting continuing progress toward evidence-based, psychiatric nursing practice.

Acknowledgements

The authors acknowledge the editorial assistance of Elizabeth Tornquist of the University of North Carolina at Chapel Hill. The authors thank the Sarah Cole Hirsh Institute at the Bolton School of Nursing, Case Western Reserve University for searching the literature to identify studies for this review.

Author

Jaclene A. Zauszniewski, PhD, RN-BC, FAAN
E-mail: jaz@case.edu

Dr. Zauszniewski is the Kate Hanna Harvey Professor in Community Health Nursing and Associate Dean for Doctoral Education at the Frances Payne Bolton School of Nursing of Case Western Reserve University (CWRU), Cleveland, Ohio. She received a PhD and MSN from CWRU, Cleveland, Ohio; a MA in Counseling and Human Services from John Carroll University, Cleveland, Ohio; a BA in psychology from Cleveland State University, Cleveland, Ohio; and a diploma in nursing from St. Alexis Hospital School of Nursing, Cleveland, Ohio. With 37 years of nursing practice, including 28 years in the field of psychiatric-mental health nursing, Dr. Zauszniewski has experience as a staff nurse, clinical preceptor, head nurse, supervisor, patient care coordinator, nurse educator, and nurse researcher. Her program of research focuses on the identification of factors and strategies to prevent depression and to preserve healthy functioning during depressive episodes across the lifespan. She is best known for her research examining the development and testing of nursing interventions to teach resourcefulness skills to elders with chronic illness and caregivers. She has received research funding from the National Institutes of Nursing Research and Aging, National Institutes of Health; Sigma Theta Tau International; American Nurses Foundation; Midwest Nursing Research Society; and the State of Ohio Board of Regents.

Abir Bekhet, PhD, RN, HSMI
E-mail: Abir.Bekhet@marquette.edu

Dr. Bekhet is an Assistant Professor at Marquette University, College of Nursing, Milwaukee, Wisconsin. She received her BSN and MSN from Alexandria University, Faculty of Nursing, Alexandria, Egypt. She received her PhD from Case Western Reserve University, Cleveland, OH. Her clinical experience in psychiatric nursing is with persons having schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depressive disorder. She has taught psychiatric mental health nursing to undergraduate and direct entry students. Dr. Bekhet’s program of research focuses on the effects of positive cognitions and resourcefulness in overcoming adversity in vulnerable populations. Her research has been funded by Sigma Theta Tau International and American Psychiatric Nursing Foundation; and she is a past recipient of the MNRS Mentorship Grant Award. Most recently, she received the Award for Excellence from the CWRU Nursing Alumni Association and the 2012 Way-Klinger Young Scholar Award from Marquette University.

Sara Haberlein, BSN, RN
E-mail: sara.haberlein@marquette.edu

Ms. Haberlein is a graduate student in the Pediatric Nurse Practitioner program and research assistant at Marquette University. She received her BSN from the University of Wisconsin - Milwaukee (UWM). Since graduating from UWM, Sara has worked as a RN in the Neonatal Intensive Care Unit at Children’s Hospital of Wisconsin (Milwaukee, WI).

References

American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2000). Scope and standards of psychiatric mental health nursing practice.  Washington, DC: American Nurses Publishing.

Ançel, G. (2006). Developing empathy in nurses: An inservice training program. Archives of Psychiatric Nursing, 20(6), 249-257. doi:10.1016/j.apnu.2006.05.002

Apóstolo, J., & Kolcaba, K. (2009). The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders. Archives of Psychiatric Nursing, 23(6), 403-411. doi:10.1016/j.apnu.2008.12.003

Ballard, F. (2008). Benefits of psychosocial rehabilitation programming in a treatment mall. Journal of Psychosocial Nursing and Mental Health Services, 46(2), 26-32.  doi:10.3928/02793695-20080201-01

Beebe, L., Adams, S., & El-Mallakh, P. (2011). Putting the "evidence" in evidence-based practice: Meeting research challenges in community psychiatric settings. Issues in Mental Health Nursing, 32(8), 537-543. doi:10.3109/01612840.2011.573124

Boyd, M. A. (2011). Psychiatric Nursing: Contemporary practice. 5th. Ed (pp. 57-58). Philadelphia: Lippincott, Williams, & Wilkins.

Buccheri, R., Trygstad, L., Buffum, M.D., & Gerlock, A.A. (2010). Developing an evidence-based practice for psychiatric nursing. Journal of Psychosocial Nursing & Mental Health Services, 48(5), 3-5. doi:10.3928/02793695-20100331-01

Chen, K.-H., Lee, S., Weng, L.-C., & Chen, Y.-J. (2010). The effects of potentiality education on potentiality and job satisfaction among psychiatric nurses in Taiwan. Perspectives in Psychiatric Care, 46(2), 85-97. doi: 10.1111/j.1744-6163.2010.00244.x

Cretin, S., Farly, D.O., Dolter, K.J., & Nicholas, W. (2001). Evaluating an integrated approach to clinical quality improvement. Medical Care, 39 (Suppl. 2), 1170-1184.

Crockford, D., Kerfoot, K., & Currie, S. (2009). The impact of opening a smoking room on psychiatric inpatient behavior following implementation of a hospital-wide smoking ban. Journal of the American Psychiatric Nurses Association, 15(6), 393-400. doi: 10.1177/1078390309353347

Engin, E., & Cam, O. (2009). Effect of self-awareness education on the self-efficacy and sociotropy–autonomy characteristics of nurses in a psychiatry clinic. Archives of Psychiatric Nursing, 23(2), 148-156. doi: 10.1016/j.apnu.2008.05.003

England, M. (2008). Significance of cognitive intervention for voice hearers. Perspectives in Psychiatric Care, 44(1), 40-47. doi: 10.1111/j.1744-6163.2008.00146.x

Fineout-Overholt, E., Melnyk, B. M., & Schulz, A. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21st century. Journal of Professional Nursing, 21(6), 335-344.

Fluttert, F., van Meijel, B., Nijman, H., Bjørkly, S., & Grypdonck, M. (2010). Detached concern of forensic mental health nurses in therapeutic relationships with patients: The application of the early recognition method related to detached concern. Archives of Psychiatric Nursing, 24(4), 266-274. doi: 10.1016/j.apnu.2009.09.002

Happell, B. (2009). Influencing undergraduate nursing students' attitudes toward mental health nursing: Acknowledging the role of theory. Issues in Mental Health Nursing, 30(1), 39-46. doi:10.1080/01612840802557113

Horsfall, J., Cleary, M., & Hunt, G.E. (2011). Developing partnerships in mental health to bridge the research-practitioner gap. Perspectives in Psychiatric Care, 47(1), 6-12. doi:10.1111/j.1744-6163.2010.00265.x.

Jolley, S. (2002). Raising research awareness: A strategy for nurses. Nursing Standard, 16(33), 33-39.

Kameg, K., Howard, V., Clochesy, J., Mitchell, A., & Suresky, J. (2010). The impact of high fidelity human simulation on self-efficacy of communication skills. Issues in Mental Health Nursing, 31(5), 315-323. doi: 10.3109/01612840903420331

Kang, H.-Y., & Yoo, Y.-S. (2007). Effects of a bereavement intervention program in middle-aged widows in Korea. Archives of Psychiatric Nursing, 21(3), 132-140. doi: 10.1016/j.apnu.2006.12.007

Knight, M., & Houseman, E. (2008). A collaborative model for the treatment of depression in homebound elders. Issues in Mental Health Nursing, 29(9), 974-991. doi: doi:10.1080/01612840802279049

Loucks, J., Rutledge, D., Hatch, B., & Morrison, V. (2010). Rapid response team for behavioral emergencies. Journal of the American Psychiatric Nurses Association, 16(2), 93-100. doi: 10.1177/1078390310363023

Meerwijk, E., Van Meijel, B., Van Den Bout, J., Kerkhof, A., De Vogel, W., & Grypdonck, M. (2010). Development and evaluation of a guideline for nursing care of suicidal patients with schizophrenia. Perspectives in Psychiatric Care, 46(1), 65-73. doi: 10.1111/j.1744-6163.2009.00239.x

Melnyk, B.M., Fineout-Overholt, E., Feinstein, N.F., Li, H., Small, L., Wilcox, L., & Kraus, R. (2004). Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldview on Evidence Based Nursing, 1(3), 185-193.  

Mohr, W.K. (2009). Urgent intervention needed. Archives of Psychiatric Nursing, 23(5), 401. doi:10.1016/j.apnu.2009.04.003

New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD.

O'Brien, L., Buxton, M., & Gillies, D. (2008). Improving the undergraduate clinical placement experience in mental health nursing. Issues in Mental Health Nursing, 29(5), 505-522. doi: 10.1080/01612840801981355

Rice, M.J. (2008a). Psychiatric mental health evidence-based practice. Journal of the American Psychiatric Nurses Association, 14(2), 107-111. doi:10.1177/1078390308315798

Rice, M.J. (2008b). Evidence-based practice in psychiatric care: Defining levels of evidence. Journal of the American Psychiatric Nurses Association, 14(3), 181-187. doi:10.1177/1078390308321220

Rice, M.J.  (2009). Effect size in psychiatric evidence-based practice care. Journal of the American Psychiatric Nurses Association, 15(2), 138-142. doi:10.1177/1078390309335007

Rice, M.J. (2011). Evidence-based practice principles: Using the highest level when evidence is limited. Journal of the American Psychiatric Nurses Association, 17(6), 445-448. doi:10.1177/1078390311426289

Rosedale, M. (2009). Transcranial magnetic stimulation (TMS): An entirely novel form of treatment in psychiatry and a groundbreaking opportunity for psychiatric mental health nursing. Journal of the American Psychiatric Nurses Association, 15(5), 299-302. doi:10.1177/1078390309348899

Saarikoski, M., Warne, T., Aunio, R., & Leino-Kilpi, H. (2006). Group supervision in facilitating learning and teaching in mental health clinical placements: A case example of one student group. Issues in Mental Health Nursing, 27(3), 273-285. doi: doi:10.1080/01612840500502791

Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W. & Haynes, R.B. (2000). Evidence-based medicine: How to practice and teach EBM. London: Churchill Livingstone.

Sarah Cole Hirsh Institute for Best Nursing Practices Based on Evidence (2005). Certificate in Implementing Best Nursing Practices Based on Evidence. Cleveland: Case Western Reserve University, Frances Payne Bolton School of Nursing.

Stein, K.F. (2009). Evidence-based psychiatric and mental health nursing: Responsibilities and their distribution. Journal of the American Psychiatric Nurses Association, 15(3), 170-171. doi:10.1177/1078390309339158

Stuart, G. W. (2001). Evidence-based psychiatric nursing practice: Rhetoric or reality. Journal of the American Psychiatric Nurses Association, 7(4), 103-114.

Tran, D. T., Stone, A. M., Fernandez, R. S., Griffiths, R.  D., & Johnson, M. (2009). Changes in general nurses’ knowledge of alcohol and substance use and misuse after education. Perspectives in Psychiatric Care, 45(2), 128-139. doi: 10.1111/j.1744-6163.2009.00213.x

Upton, D., & Upton, P. (2006). Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom. Journal of Allied Health, 35(3), 127-133.

U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. 2nd ed. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2012). Healthy people 2020: Improving the health of Americans. Retrieved from www.healthypeople.gov/2020/default.aspx

U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville: MD: U.S. Public Health Service.

Williams, J.M., Steinberg, M.L., Zimmermann, M.H., Gandhi, K.K., Lucas, G., Gonsalves, D.A., Pearlstein, I., McCabe, P., Galazyn, M., & Salsberg, E. (2009). Training psychiatrists and advanced practice nurses to treat tobacco dependence. Journal of the American Psychiatric Nurses Association, 15(1), 50-58. doi: 10.1177/1078390308330458

Zauszniewski, J.A., & Suresky M.J. (2003). Evidence for psychiatric nursing practice: An analysis of three years of published research. Online Journal of Issues in Nursing. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/HirshArticle/EvidenceforPsychiatricNursingPractice.html

Zauszniewski, J.A., Suresky M.J., Bekhet, A., & Kidd, L. (2007). Moving from tradition to evidence: A review of psychiatric nursing intervention studies. Online Journal of Issues in Nursing, 12 (2) doi:10.3912/OJIN.Vol12No02HirshPsy01 Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No2May07/HirshInstituteArticle/ReviewofPsychiatricNursingInterventionStudies.html


© 2012 OJIN: The Online Journal of Issues in Nursing
Article published August 27, 2012


Related Articles

From: 
Email:  
To: 
Email:  
Subject: 
Message: