Potilaslähtöinen psykiatrinen hoitotyö laitosympäristössä

Abstract The aim of this study was to describe psychiatric nursing in a hospital environment and to produce a model of nursing based on patient initiatives. The study was qualitative and the method was grounded theory. The data were collected by observing psychiatric nursing in a hospital environment and by interviewing nurses, nursing students and psychiatric patients. The purpose of the study was to produce knowledge for psychiatric nursing practice and nursing research. The data were collected using theoretical sampling which means that the sample's size was not limited at the beginning of data collection, but was decided during data collection according to the saturation. These data were collected by interviewing (N = 52) nurses (n = 29), nursing students (n = 7) and psychiatric patients (n = 16) in a hospital environment and by observing different nursing situations (N = 10) on video. The data were analysed in the first phase by continuous comparative analysis. According to the result of the analysis the basic process or core category of psychiatric nursing is the patient's capability to manage in daily life in a hospital environment. The patient's ability, the assessment of the needs of psychiatric nursing, the planning of psychiatric nursing and the helping methods used were connected to the patient's capability to manage. In the practice of psychiatric nursing was found to consist of different kinds of nursing, which were called collaborative, educational and confirmatory psychiatric nursing. Collaborative psychiatric nursing facilitates patient initiatives and allows patient's responsible participation in his/her own care. Educational nursing is implemented according to the ideal model of nursing and the patient is a responsible recipient in his/her own care. Confirmatory nursing rests on an authoritarian model and the patient is a responsible recipient of care. In the second phase the data were analysed by deductive content analysis techniques. The theoretical framework consisted of the types of psychiatric nursing. According to the results of content analysis 13% the nurse' and patients' utterances illustrated collaborative type of nursing, 37% educational type, and 50% confirmatory psychiatric nursing. The nurses and patients descriptions of psychiatric nursing were similar in direction. Finally, on the grounds of empirical results of this study and earlier researches the model of patient initiatives in nursing in a hospital environment was formulated. The model serves as point of departure for further testing and developing the model for developing instrument for assessing and evaluating psychiatric nursing in practice