A nurse-managed inpatient program for patients with chronic mental disorders

Area of Science:

• Psychiatric Nursing
• Mental Health Services
• Healthcare Management

Background:

• Deinstitutionalization created a need for specialized care for chronic refractory mental illness.
• Existing care models may not adequately address the complex needs of this patient population.
• Therapeutic milieu principles offer a framework for structured patient environments.

Purpose of the Study:

• To describe a nurse-managed program for inpatients with chronic refractory mental illness.
• To evaluate the program's effectiveness using defined outcome measures over a 6-month period.
• To assess the impact of a therapeutic milieu approach on patient care and resource utilization.

Main Methods:

• A multidisciplinary treatment team, led by a psychiatric nursing clinical specialist, was implemented.
• Nurse practitioners and the clinical specialist served as case managers and primary care providers.
• Program evaluation included cost-effectiveness, polypharmacy, neuroleptic usage, and restraint minimization.

Main Results:

• The nurse-managed program demonstrated cost-effective, quality care delivery.
• A significant reduction in polypharmacy and overall neuroleptic usage was observed.
• Implementation of a 'restraint-appropriate environment' successfully minimized restraint use.

Conclusions:

• Nurse-managed programs, utilizing therapeutic milieu principles, can effectively treat chronic refractory mental illness.
• This model supports quality care, cost-efficiency, and reduced medication dependence.
• Psychiatric nursing leadership is crucial for successful implementation and positive patient outcomes.