Boomsma J, Dingemans C A, Dassen T W
Department of Nursing Science, University of Groningen, The Netherlands.
J Psychiatr Ment Health Nurs. 1997 Aug;4(4):295-301. doi: 10.1046/j.1365-2850.1997.00066.x.
Crisis-oriented psychiatric home care is a recent development in the Dutch mental health care system. Because of the difference between psychiatric care in the home and in the hospital, an action research project was initiated. This project was directed at the nursing process and the nurses' role and skills in psychiatric home care. The main goal of the project was to describe and to standardize nursing diagnoses and interventions used in crisis-oriented and long-term psychiatric home care. The development of supporting methods of assessment and intervention were also important aspects of this project. In this article a crisis-oriented psychiatric home care programme and the first developmental research activities within this programme are described. To support the nursing process, the development of a nursing record and an assessment-format, based on Gordon's Functional Health Patterns (FHP), took place. By means of content analysis of 61 nursing records, the most frequently stated nursing diagnoses, based upon the North American Nursing Diagnosis Association (NANDA) taxonomy, were identified. The psychiatric diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were also collected. The most common categories found were those of mood disorders and schizophrenia or psychotic disorders. Seventy-five per cent of the nursing diagnoses showed up within four FHP: role-relationship, coping-stress tolerance, self-perception/self-concept and activity-exercise. The nursing diagnosis of 'ineffective individual coping' was stated most frequently. This is not surprising because of the similarities in the definitions of this nursing diagnosis and the concept of 'crisis' to which the psychiatric home care programme is oriented. Further research activities will be focused on standardization of nursing diagnosis and the interventions that nurses undertake in this type of care.
以危机为导向的精神科居家护理是荷兰精神卫生保健系统中的一项新发展。由于居家精神科护理与医院精神科护理存在差异，因此启动了一项行动研究项目。该项目针对护理过程以及护士在精神科居家护理中的角色和技能。该项目的主要目标是描述并规范以危机为导向的长期精神科居家护理中所使用的护理诊断和干预措施。开发评估和干预的支持方法也是该项目的重要方面。本文描述了一个以危机为导向的精神科居家护理项目以及该项目内的首次发展性研究活动。为了支持护理过程，基于戈登的功能健康模式（FHP）开发了护理记录和评估格式。通过对61份护理记录进行内容分析，确定了基于北美护理诊断协会（NANDA）分类法最常提及的护理诊断。还收集了《精神疾病诊断与统计手册》（DSM-IV）的精神科诊断类别。发现最常见的类别是情绪障碍和精神分裂症或精神障碍。75%的护理诊断出现在四个FHP中：角色关系、应对-压力耐受、自我认知/自我概念和活动-锻炼。“个体应对无效”这一护理诊断提及频率最高。鉴于该护理诊断的定义与精神科居家护理项目所针对的“危机”概念相似，这并不奇怪。进一步的研究活动将集中在护理诊断以及护士在这类护理中所采取的干预措施的标准化上。
