Neilson T, Peet M, Ledsham R, Poole J
St Georges Hospital, Community Health Sheffield Trust, England.
J Adv Nurs. 1996 Dec;24(6):1201-6. doi: 10.1111/j.1365-2648.1996.tb01026.x.
The Nursing Care Plan (NCP) is routinely used to direct the nursing care of psychiatric in-patients, but the impact of NCPs on patient care and clinical outcome is not firmly established. NCPs from 246 patients, chosen at random from admissions to acute psychiatric wards, were analysed. The NCPs were scored for quality and also specifically for the presence of recorded risk assessment and appropriate level of nursing supervision. NCPs were evaluated in relation to psychiatric risk factors present prior to admission, and in relation to risk behaviour during hospitalization. Quality of NCP records was generally poor, with scores in all areas assessed being approximately half of the possible maximum. Patients with a perceived high risk of suicide prior to admission had significantly better NCP quality than other patients, but about a third of these high risk patients had no recorded risk assessment or supervision level in the nursing notes. Patients who had actually self-harmed within 4 weeks prior to admission were more likely to have a recorded risk assessment but did not score more highly than the rest of the patient population on any other measures of NCP quality. Patients who had made suicidal threats prior to admission but who were not deemed to be of high suicide risk before admission had significantly lower quality NCPs and were less likely to have a record of supervision level than the rest of the patients. The highest rate of supervision records occurred in patients who had shown dangerous behaviour prior to admission. Outcome in terms of two risk behaviours during admission (self-harm and violence) was not related to whether or not risk assessment and supervision levels had been recorded. Patients admitted compulsorily to hospital were more likely to have a supervision level recorded but were also more likely to abscond. It is concluded that issues of psychiatric risk were not adequately addressed in this sample of NCPs. Furthermore, the data raise serious questions about the usefulness of the NCP in helping to predict and prevent risky behaviour amongst psychiatric in-patients.
护理计划（NCP）通常用于指导精神科住院患者的护理，但NCP对患者护理和临床结果的影响尚未得到确凿证实。对从急性精神科病房入院患者中随机选取的246例患者的NCP进行了分析。对NCP的质量进行了评分，还特别针对记录的风险评估和适当的护理监督水平进行了评分。根据入院前存在的精神风险因素以及住院期间的风险行为对NCP进行了评估。NCP记录的质量普遍较差，所有评估领域的得分约为可能的最高分的一半。入院前被认为自杀风险高的患者的NCP质量明显高于其他患者，但这些高风险患者中约有三分之一在护理记录中没有记录风险评估或监督水平。入院前4周内实际有过自残行为的患者更有可能有记录的风险评估，但在NCP质量的任何其他衡量标准上，其得分并不高于其他患者群体。入院前有过自杀威胁但入院前未被视为高自杀风险的患者的NCP质量明显较低，且比其他患者更不可能有监督水平的记录。监督记录率最高的是入院前表现出危险行为的患者。入院期间两种风险行为（自残和暴力）的结果与是否记录了风险评估和监督水平无关。被强制住院的患者更有可能有监督水平的记录，但也更有可能逃跑。结论是，在这个NCP样本中，精神风险问题没有得到充分解决。此外，这些数据对NCP在帮助预测和预防精神科住院患者中的风险行为的有用性提出了严重质疑。
