A nurse-managed inpatient program for patients with chronic mental disorders.
The deinstitutionalization movement has left a legacy of need for appropriate care for inpatients with chronic refractory mental illness. This article describes a nurse managed program for such patients based on the principles of a therapeutic milieu. The program was formally defined for a 6-month period with an effort to include outcome measures for program evaluation. Multidisciplinary treatment team planning with a psychiatric nursing clinical specialist as team leader provided a format for putting therapeutic concepts into practice. The nurse clinical specialist and two nurse practitioners served as case managers as well as primary care providers. Program evaluation showed that cost-effective quality care could be achieved with a reduction in polypharmacy and overall neuroleptic usage. The notion of a restraint appropriate environment, with the goal of minimizing restraint use, was introduced and put into practice.
Kurg-Cringle
R
R
Perry Point Veterans Affairs Medical Center, Nursing Service, MD 21902.
Blake
L A
LA
Dunham
D
D
Miller
M J
MJ
Annecillo
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003688:Deinstitutionalization; D004363:Drug Utilization; D006301:Health Services Needs and Demand; D006801:Humans; D007297:Inpatients; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D008884:Milieu Therapy / Q000458:organization & administration*; D016294:Models, Nursing; D009720:Nurse Clinicians; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D011568:Psychiatric Nursing / Q000458:organization & administration*