Psikiyatri Servisinde Çalışan Hemşirelerin Bakım Vermekte Zorlandıkları Klinik Durumların Belirlenmesi

Abstract

Amaç: Psikiyatri servislerinde çalışan hemşireler ani, komplike ve yönetilmesi güç klinik durumlarla karşılaşabilmektedirler. Bu çalışmada ülkemizdeki bölge psikiyatri hastanelerinden birinde çalışmakta olan hemşirelerin hastaya bakım verirken zorlandıkları klinik durumların belirlenmesi amaçlanmıştır. Yöntem: Kesitsel desendeki bu çalışmaya, bir bölge ruh sağlığı ve hastalıkları hastanesinde çalışan 52 hemşire katılmıştır. Verilerin toplanmasında Kişisel Bilgi Formu, araştırmacılar tarafından literatür taraması sonucunda geliştirilen ve kapsam geçerliliği yapılan Psikiyatri Servisinde Karşılaşılan Klinik Durumlar Anketi kullanılmıştır. Veriler Pearson korelasyon testi, Independent t test ve tek yönlü ANOVA ile analiz edilmiştir. Bulgular: Araştırmaya katılan hemşireler yaklaşık 16 yıllık mesleki ve 8 yıllık psikiyatri servisinde çalışma deneyimine sahiptir. Çoğu (%63,5) akut serviste çalışmaktadır. Psikiyatri hastalarına hemşirelik bakımı verirken en çok zorluk yaşanan klinik durumlar “başkalarına zarar verme riski ve girişimi” (2,60±0,85), “kendine zarar verme riski ve girişimi” (2,54±0,92) ile “intihar riski ve girişimi” (2,48±0,92)’dir. Hemşirelerin yaşları ve psikiyatri servisinde çalışma süreleri ile psikiyatri hastasının bakımında karşılaşılan klinik durumlarla ilgili zorlanma düzeyleri arasında negatif yönde orta/zayıf düzeyde ilişkiler bulunmuştur (p<0,05). Sonuç: Psikiyatri servisinde çalışan hemşirelerin en çok hastanın güvenliğini tehdit eden klinik durumlarda riski belirleme ve yönetmede zorlandıkları, bu sonucun psikiyatri servisinde çalışma süresinden etkilendiği ortaya çıkmıştır. Konuyla ilgili kanıt temelli uygulama kılavuzlarının geliştirilmesi, deneyimli hemşirelerin genç meslektaşlarına mentorluk yapması önerilmektedir.

Keywords

• Hasta Bakım Yönetimi
• Hasta Güvenliği
• Kendine Zarar Verme

Determination of Clinical Situations Where Nurses Working in the Psychiatric Ward Have Difficulty in Providing Care

Abstract

Objective: Nurses working in psychiatric wards may encounter sudden, complex, and difficult-to-manage clinical situations. This study aimed to determine the clinical situations that nurses working in one of the regional psychiatric hospitals in our country find challenging while providing patient care. Methods: This cross-sectional study included the participation of fifty-two nurses working in a regional mental health and diseases hospital. A Personal Information Form and a Clinical Situations in Psychiatric Wards Questionnaire, developed by the researchers based on literature review and validated for content, were used for data collection. Data were analyzed using Pearson correlation test, Independent t-test, and one-way ANOVA. Results: The nurses participating in the study had approximately 16 years of professional experience and 8 years of experience working in psychiatric wards. Most (63.5%) work in acute care units. The most challenging clinical situations encountered while providing nursing care to psychiatric patients were "risk and attempt of harming others" (2.60±0.85), "risk and attempt of self-harm" (2.54±0.92), and "risk and attempt of suicide" (2.48±0.92). Negative moderate/weak correlations were found between nurses' ages and duration of work in psychiatric wards and their levels of difficulty with clinical situations encountered in psychiatric patient care (p<0.05). Conclusion: It was revealed that nurses working in psychiatric wards have the most difficulty in identifying and managing risks in clinical situations that threaten patient safety, and this result is influenced by the duration of work in psychiatric wards. It is recommended to develop evidence-based practice guidelines on the subject and for experienced nurses to mentor their younger colleagues.

Keywords

• Aggression
• Patient Care Management
• Patient Safety
• Psychiatric Ward
• Self-Harm

References

1. Abram MD, Jacobowitz W. (2021). Resilience and burnout in healthcare students and inpatient psychiatric nurses: A between-groups study of two populations. Archives of Psychiatric Nursing, 35, 1-8. doi: 10.1016/j.apnu.2020.10.008
2. Al‐Maraira OA, Hayajneh FA. (2020). Correlates of psychiatric staff's attitude toward coercion and their sociodemographic characteristics. Nurs Forum, 55, 603-610. doi:10.1111/nuf.12476
3. Arsat N, Lah NASN, Thomas DC, Soong SF, Chong LT, Sawatan W, et al. (2023). The effect of work setting and demographic factors on caring behaviour among nurses in the public hospitals and public health services, Sabah, Malaysia. BMC Nurs, 22, 194. doi:10.1186/s12912-023-01359-w
4. Büyüköztürk Ş, Kılıç Çakmak E, Akgün ÖE, Karadeniz Ş, Demirel F. (2024). Eğitimde bilimsel araştırma yöntemleri (35. Baskı). Ankara: Pegem Akademi Yayıncılık.
5. Cornaggia CM, Beghi M, Pavone F, Barale F. (2011). Aggression in psychiatry wards: A systematic review. Psychiatry Research, 189, 10-20. doi: 10.1016/j.psychres.2010.12.024
6. Cutler NA, Sim J, Halcomb E, Moxham L, Stephens M. (2020). Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study. Journal of Clinical Nursing, 29, 4379-4386. doi: 10.1111/jocn.15480
7. Davis L. (1992). Instrument review: Getting the most from your panel of experts. Applied Nursing Research, 5, 104-107. doi: 10.1016/S0897-1897(05)80008-4
8. di Giacomo E, Iozzino L, Ferrari C, Strozza C, Large M, Nielssen O,et al. (2020). Prevalence and risk factors of violence by psychiatric acute inpatients: Systematic review and meta-analysis—A 2019 update. B Carpiniello,

9. A Vita, C Mencacci (Ed.), Violence and mental disorders. Comprehensive approach to psychiatry in (First ed.,181–202). Springer. doi: 10.1007/978-3-030-33188-7_10
10. Hayward P, Tilley F, Derbyshire C, Kuipers E, Grey S. (2005). "The ailment" revisited: Are "manipulative" patients really the most difficult? Journal of Mental Health, 14, 291-303. doi: 10.1080/09638230500136423
11. Huckshorn KA. (2014). Reducing seclusion and restraint use in inpatient settings: a phenomenological study of state psychiatric hospital leader and staff experiences. Journal of Psychosocial Nursing and Mental Health Services, 52, 40-47. doi: 10.3928/02793695-20141006-01
12. Hurley J, Lakeman R, Linsley P, Ramsay M, McKenna‐Lawson S. (2022). Utilizing the mental health nursing workforce: A scoping review of mental health nursing clinical roles and identities. International Journal of Mental Health Nursing, 31, 796-822. doi:10.1111/inm.12983
13. Idvall E, Berg A, Katajisto J, Acaroglu R, Luz MDAD, Efstathiou G, et al. (2012). Nurses’ sociodemographic background and assessments of individualized care. Journal of Nursing Scholarship, 44 ,284-293. doi:10.1111/j.1547-5069.2012.01463.x
14. Jang SJ, Son YJ, Lee H. (2022). Prevalence, associated factors and adverse outcomes of workplace violence towards nurses in psychiatric settings: A systematic review. International Journal of Mental Health Nursing, 31, 450-468. doi: 10.1111/inm.12951
15. Jones J, Lowe T. (2003). The education and training needs of qualified mental health nurses working in acute adult mental health services. Nurse Education Today, 23, 610-619. doi: 10.1016/s0260-6917(03)00101-1
16. Joubert PD, Bhagwan R. (2018). An empirical study of the challenging roles of psychiatric nurses at in-patient psychiatric facilities and its implications for nursing education. International Journal of Africa Nursing Sciences, 9, 49-56. doi: 10.1016/j.ijans.2018.08.001
17. Kaçmaz ED, Çam O. (2019). Psikiyatri hastalarına bakım veren hemşirelerin bakım odaklı hemşire-hasta etkileşim düzeylerinin incelenmesi. Psikiyatri Hemşireliği Dergisi, 10, 65-74. doi: 10.14744/phd.2018.83702
18. Karagöz Y. (2016). SPSS ve AMOS 23 uygulamalı istatistiksel analizler. Ankara: Nobel Akademik Yayıncılık.
19. Karakaya SPY, Alparslan ZN. (2022). Sample size in reliability studies: A practical guide based on cronbach's alpha. Psychiatry and Behavioral Sciences, 12, 150-157. doi: 10.5455/PBS.20220127074618
20. Kes E. (2018). Bir üniversite hastanesinin psikiyatri kliniğinde hemşirelik hizmetlerinde iş örneklemesi uygulaması. (Yayımlanmamış Yüksek Lisans Tezi). Karabük Üniversitesi Sağlık Bilimleri Enstitüsü, Karabük.
21. Kılıç S. (2013). Örnekleme yöntemleri. Journal of Mood Disorders, 3, 44-6. doi: 10.5455/jmood.20130325011730
22. Lesinskiene S, Jegorova N, Ranceva N. (2007). Nursing of young psychotic patients: analysis of work environments and attitudes. Journal of Psychiatric and Mental Health Nursing, 14, 758-764. doi: 10.1111/j.1365-2850.2007.01187.x
23. Merecz D, Rymaszewska J, Mościcka A, Kiejna A, Jarosz-Nowak J. (2006). Violence at the workplace- A questionnaire survey of nurses. European Psychiatry, 21, 442-450. doi: 10.1016/j.eurpsy.2006.01.001
24. Oflaz F, Boyacıoğlu NE, Yılmaz S, Sukut Ö, Doğan N, Enginkaya S. (2021). Psikiyatri birimlerinde çalışan hemşirelerin profili: İstanbul örneği. Psikiyatri Hemşireliği Dergisi, 12, 188-197. doi: 10.14744/phd.2021.59672
25. Sobekwa ZC, Arunachallam S. (2015). Experiences of nurses caring for mental health care users in an acute admission unit at a psychiatric hospital in the Western Cape Province. Curationis, 38, 1-9. doi: 10.4102/curationis.v38i2.1509
26. Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, et al. (2019). Patient safety in inpatient mental health settings: A systematic review. BMJ Open, 9, e030230. doi: 10.1136/bmjopen-2019-030230
27. Tomotaki A, Fukahori H, Sakai I. (2020). Exploring sociodemographic factors related to practice, attitude, knowledge, and skills concerning evidence‐based practice in clinical nursing. Japan Journal of Nursing Science, 17, e12260. doi:10.1111/jjns.12260
28. Vandewalle J, Malfait S, Eeckloo K, Colman R, Beeckman D, Verhaeghe S, et al. (2018). Patient safety on psychiatric wards: A cross-sectional, multilevel study of factors influencing nurses' willingness to share power and responsibility with patients. International Journal of Mental Health Nursing, 27(2), 877-890. doi: 10.1111/inm.12376
29. Varcarolis EM, Fosbre CD. (2020). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care. Elsevier Health Sciences.
30. Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, et al. (2021). Aggression on the psychiatric ward: Prevalence and risk factors: A systematic review of the literature. PloS One, 16, e0258346.
31. World Health Organization (WHO), WHO Patient Safety. (2010). The conceptual framework for the international classification for patient safety. WHO/IER/PSP/2010.2
32. Yurdugül H. (2005). Ölçek geliştirme çalışmalarında kapsam geçerliği için kapsam geçerlik indekslerinin kullanılması. XIV. Ulusal Eğitim Bilimleri Kongresi (28-30 Eylül 2005, Denizli), Kongre Kitabı, 1-6.
33. Yusoff MSB. (2019). ABC of content validation and content validity index calculation. Education in Medicine Journal, 11, 49-54. doi: 10.21315/eimj2019.11.2.6