Psychiatric nursing in the community: the application of new technologies to an organization in transition

Abstract

This thesis is a detailed account of an Organizational Development programme within a District Health Authority. The study, set in an action research framework, applies selected technologies to an organization in transition from a hospital based to a community based service in psychiatric and mental handicap nursing. Beginning with a review of the development of psychiatric nursing, the study suggests that the emergent community nursing services are faced with a series of paradoxes and are not equipped to deal with their new role. Following a series of pilot studies a problem orientated case method is applied in tandem with in-service training and developing operational philosophies. There is particular development which relates to incidents arising during the course of the study where new elements require attention. These are significantly to do with casework supervision and identifying short term casework. Data from problem orientated casework is presented in detail and the teams are analysed at the beginning and end of the study for evidence of change. A number of featurs are identified in the casework data, 1) clients do well in terms of problem resolution when in contact with community nurses, 2) nurses show evidence of a wide range of intervention techniques in casework, 3) problem orientated data allows an auditing of casework activity to monitor shortfalls in provider performance, 4) nurses are given considerable freedom of action to commission their referrals. The study offers problem orientated approaches and audit procedures as a means of setting an ideological base for practice and recommends that casework supervision and in-service training be an integral part of community nursing development.