Kurg-Cringle R, Blake L A, Dunham D, Miller M J, Annecillo C
Perry Point Veterans Affairs Medical Center, Nursing Service, MD 21902.
Arch Psychiatr Nurs. 1994 Feb;8(1):14-21. doi: 10.1016/0883-9417(94)90016-7.
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.
去机构化运动留下了对慢性难治性精神疾病住院患者进行适当护理的需求。本文描述了一个基于治疗性环境原则的针对此类患者的护士管理项目。该项目在6个月的时间内进行了正式界定，并努力纳入项目评估的结果指标。以精神科护理临床专家为团队领导的多学科治疗团队规划为将治疗理念付诸实践提供了一种模式。护士临床专家和两名执业护士担任病例管理员以及初级护理提供者。项目评估表明，通过减少联合用药和总体抗精神病药物使用量，可以实现具有成本效益的优质护理。引入并实施了以尽量减少约束使用为目标的适当约束环境的概念。
