Health Clients (health + client)

Distribution by Scientific Domains

Selected Abstracts

Implementation of the Zuluaga-Raysmith (Z-R) Model for Assessment of Perceived Basic Human Needs in Home Health Clients and Caregivers

Beatrice Harrison Zuluaga R.N., FRCNA
The Zuluaga-Raysmith (Z-R) model is a conceptual framework that incorporates accepted concepts of universal basic human needs developed by Maslow, yet removes the hierarchical nature of these. The Z-R model recognizes the existence of a health-illness continuum and accepts that an entity (individual, family, aggregate, or community) may move freely in the direction of greater health and self-actualization or towards illness and premature death. The Z-R model identifies 10 basic needs and recognizes that a perceived deficit in any one of these needs can adversely affect the level of wellness of the entity being considered. This exploratory and descriptive study used 11 nurses as interviewers. Subjects consisted of a convenience sample of homebound clients of a home health agency in a metropolitan city, and selected caregivers (n= 27). A modified functional wellness inventory (developed in 1993 by Louvenia Carter) was used with several open-ended questions, which together related to the 10 needs of the Z-R model. Reliability coefficient of the instrument was 0.84. Descriptive statistics were used to analyze the data, using means, percentages, and frequencies. Open-ended questions were grouped according to content and ranked in order of frequency. The five most pressing needs of this small sample were income; physical health; opportunity to make a contribution; mobility; and mental, emotional, social, and spiritual health (MESSH). Nurses unanimously reported that use of the instrument and the Z-R model helped them to focus on the total person, identify strengths in their clients, identify perceived needs deficits, and therefore, with the client, facilitate the preparation of a timely and cost-effective interdisciplinary plan of care to help the entity to move to a higher level of wellness despite the presence of chronic disease, disability, or impending death. These findings suggested that further research is warranted to explore the use of the Z-R model. A replication study is in progress. [source]

Community mental health nursing: Keeping pace with care delivery?

Julie Henderson
ABSTRACT:, The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions. [source]

The relationship between risk and insight in a high-security forensic setting

P. WOODS RMN phDDip Health Care Research
It is often intimated amongst practitioners in mental healthcare that clients who display poor insight either into their mental health or behaviour present a greater risk either to themselves or others. This paper reports relationships found between the risk and insight subscales of the Behavioural Status Index. This is an instrument designed specifically for healthcare practitioners to measure health functioning amongst mental health clients, in particular those in forensic mental healthcare. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 patients in two high-security mental health hospitals. Seven factors emerged through factor analysis. The first of these contained all the insight items. Significant differences were found on a number of factors between independent groups. Generally, results indicate that patients on lower dependency wards scored more normatively on the factors, adding to instrument validity. Men were found to score more normatively than women. Clinical practice implications and ongoing European studies examining the use of the instrument in clinical practice and its association with treatment planning are discussed. [source]

Considering the care of the suicidal client and the case for ,engagement and inspiring hope' or ,observations'

J. R. Cutcliffe rmn rgn bsc (hons) phd
Psychiatric/mental health (P/MH) nursing has rightly been described as a ,broad church', and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the ,engagement and hope inspiration' position and the ,observations' position. Given the P/MH nurse's unique position in providing 24-hour, day-to-day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on ,observations' and concludes that there is a range of well-established, empirically based problems or drawbacks to this approach. Following this, it focuses on ,engagement, inspiring hope' and points out the key processes of engagement: forming a relationship, a human,human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement,inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace ,observations' with ,engagement,hope inspiration' as the principal approach to caring for suicidal mental health clients. [source]