The study identified priorities of the Patient Assessment Data (PAD) using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS © ;) derived from 644 psychiatric nurses’ responses who were practicing in specific units: Acute Care Units (ACU), General Care Units (GCU), Long-term Care Units (LCU), physically Complicated Disease Care Units (CDCU), and Dementia Care Units (DCU). Secondary analysis of the PsyNACS © ; on-line survey data using four levels of “importance” was used to determine the priorities: 1) unnecessary; 2) quite important; 3) important and 4) very important. The Mean Factor Points (MFP) and the Welch’s ANOVA were calculated. PsyNACS © ; score of 3 or higher indicates the PAD as priority. The results showed that in the ACU PAD1, “Psychological symptom”, “Stress coping”, and “Mood disorder and aggression”, and PAD2 “Information of adherence”, and “Information of the psychiatry rehabilitation”, and PAD7 “Situation of the family and social life”, “Relationship to the health care providers”, and “Relationships with others” are high priority (high importance). Other PADs showed results below PsyNACS © ; score of 3. The GCU had PAD 3 “Balance of water”, the LCU had PAD 4 “Intention/Point of view”, and “Thoughts of the patient” and PAD 7 “Disease and family”. The CDCU showed PAD 2 “Blood test”, PAD 3 “Excretion situation”, and PAD 5 “General health condition”, “Respiratory and chest symptom”, and “Vital signs”, and the DCU had PAD 1 “Cognition function”, and “Delirium and derangement capacity to register failure”, PAD 3 “Function of eating”, PAD 6 “Egestion and cleanliness” and PAD 8 “Activity and sleeping”, and “Mobility capability”. These classifications indicated levels of importance in the CAD comprising the PAD below the score of “2”. Japanese psychiatric hospitals specify assessments according to functional areas. By prioritizing the CAD for each PAD, more effective and efficient assessments can be performed according to practice unit.
In the psychiatric health care environment of Japan, the average hospital stay is much longer than those of other countries. Long-term hospitalization is a problem in psychiatric hospitals in Japan [
Psychiatric hospitals in Japan have many types of units, such as the Acute Care Units (ACU), General Care Units (GCU), wherein patients whose conditions become stable are admitted for functional maintenance and recovery prior to being discharged, Long-term Care Units (LCU), Physically Complicated Disease Care Units (CDCU) and Dementia Care Units (DCU) [
The aim of this study is to determine the priority Cluster Assessment Data (CAD) of each of the Patient Assessment Data (PAD); (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior of the PsyNACS© for each type of psychiatric unit.
Selection of hospitals included psychiatric general care unit and long term care units, and a plurality of unit functions were selected. Psychiatric units in general hospitals which included various treatments other than psychiatric units were excluded.
The respondents were experienced psychiatric nurses who were employed by single psychiatric hospitals with 200 or more beds. They were from the ACU, GCU, LCU, CDCU, and DCU in their respective hospitals. In addition, these nurses must have had clinical experiences of more than 5 years as professional nurses, and with clinical experiences in psychiatric units of not less than three years (excluding licensed practical nurse). The subjects were chosen as recommended by the hospital administrators.
The managers of the psychiatric units were contacted to facilitate the dissemination of the information. The information packet was prepared and mailed to them. The survey information included reasons for the study and for participation in the on-line survey using Survey Monkey© conducted within a three-month period, from February to April 2015.
The collection of data used the PsyNACS© Questionnaire and the Demographic Data Sheet. The Demographic Data sheet required respondents to provide their personal data, e.g. age, gender, place of work, years of experience as a nurse in general and years of experience in Psychiatric Units, etc. Educational attainment was not included.
PsyNACS© is composed of three sections: The general data set composed of nine Patient Assessment Data (PADs), with each PAD having 2 to 5 Cluster Assessment Data (CADs). There were thirty-one CADs which were comprised of selected items. The “level of importance” for each item was evaluated using a Likert scale: (1 point) Unnecessary, (2 points) Quite important; (3 points) with the following valuations Important; and (4 points) Very important. Mean factor points (MFP), derived from the total score factor divided by number of items, was calculated. The average of three points or more of the evaluation of the respondents indicate that the CAD was evaluated as “important” by the professional psychiatric nurses. Considering each of the practice units, the “level of importance” of each CAD that was evaluated by the practicing professional psychiatric nurses were grouped into five practicing units. Subsequently, the data were subjected to Welch’s ANOVA to establish the priority of the CAD according to the unit functions. The Welch’s ANOVA procedure is frequently recommended as the major alternative to the ANOVA F test [
This research study was approved by the University of Tokushima Hospital Clinical Study Ethical Review Board. Return of the survey implied that the subjects gave consent to participate in the study, who were notified that privacy would be protected.
The questionnaire was sent to 644 psychiatric professional nurses in Japan, but only 435 valid responses were received (response rate was 67.5%). The respondents’ age, clinical experiences as a nurse, experience in psychiatric nursing, and type of unit functions that respondents were working are shown on
The analytical results of the comparison of “levels of importance” of each PAD by practice unit functions are shown in
PAD1 scores for “Psychological symptom” in ACU (3.29 ± 0.47, p < 0.05), GCU (3.19 ± 0.38, p < 0.05) and LCU (3.17 ± 0.53, p < 0.05) were significantly higher than those in DCU (2.93 ± 0.52). Stress and coping scores for those in the ACU (3.49 ± 0.44) was significantly higher than that in CDCU (3.25 ± 0.44, p < 0.05). The score of “Mood disorder and aggression” in ACU (3.58 ± 0.43) was significantly higher than those in CDCU (3.34 ± 0.45, p < 0.05) and DCU (3.38 ± 0.46, p < 0.05).
In PAD2, the score “Information of adherence” in ACU (3.47 ± 0.34) was significantly higher than that in the DCU (3.27 ± 0.39, p < 0.05). Blood tests showed no significant difference was observed among them.
| Mean | SD | Min | Max | |
|---|---|---|---|---|
| Age (years) | 44.55 | 7.50 | 26 | 62 |
| Clinical experience as nurse (years) | 20.40 | 8.20 | 5 | 47 |
| Clinical experience in psychiatry nursing (years) | 17.08 | 8.01 | 3 | 47 |
| The types of unit functions | n | % | ||
| Psychiatric acute care unit | 109 | 25.06 | ||
| Psychiatric general care unit | 75 | 17.24 | ||
| Psychiatric long term care unit | 134 | 30.80 | ||
| Complicated disease care unit | 51 | 11.72 | ||
| Dementia care unit | 66 | 15.17 |
SD = Standard Deviation, Min = Minimum, Max = Maximum.
In PAD3, the score for “Function of eating” in CDCU (3.43 ± 0.38) was significantly higher than those in LCU (3.25 ± 0.37, p < 0.05) and GCU (3.21 ± 0.36, p < 0.05). The score of “Function of eating” in DCU (3.44 ± 0.43) was significantly higher than those in LCU (3.25 ± 0.37, p < 0.05) and GCU (3.21 ± 0.36, p < 0.05). The score of “Excretion situation” in CDCU (3.16 ± 0.42) is significantly higher than that in LCU (2.94 ± 0.40, p < 0.05). The scores of “Balance of water” in GCU (3.37 ± 0.44, p < 0.05), ACU (3.34 ± 0.45, p < 0.05) and LCU (3.26 ± 0.46, p < 0.05) were significantly higher than that in DCU (3.05 ± 0.50).
In PAD4, the scores of “Intention/point of view” were more than three points in ACU, GCU and LCU, and these were at a level of two points (Quite important) in the other practice unit functions. However, there was no significant difference reached.
In PAD5, the score of “General health condition” in CDCU (3.35 ± 0.37) was significantly higher than the scores obtained in the ACU (3.16 ± 0.35, p < 0.05) and GCU (3.12 ± 0.39, p < 0.05). The score of “Respiratory and chest symptom” in CDCU (3.18 ± 0.48) was significantly higher than those in ACU (2.82 ± 0.50, p < 0.05), LCU (2.78 ± 0.49, p < 0.05) and GCU (2.76 ± 0.51, p < 0.05), and DCU (2.99 ± 0.49) was significantly higher than LCU (2.78 ± 0.49, p < 0.05). The score of “Vital signs” in CDCU (3.32 ± 0.43) was significantly higher than those in LCU (3.05 ± 0.36, p < 0.05) and GCU (3.01 ± 0.42, p < 0.05).
In PAD6, the scores of “Activity of daily living (ADL)” in GCU (2.91 ± 0.45, p < 0.05), ACU (2.85 ± 0.43, p < 0.05) and LCU (2.82 ± 0.45, p < 0.05) were significantly higher than those in CDCU (2.53 ± 0.59). The scores for ADL in GCU (2.91 ± 0.45) was significantly higher than those in DCU (2.64 ± 0.61, p < 0.05). The score of “Appearance” in GCU (2.83 ± 0.39, p < 0.05) was significantly higher than those in CDCU (2.63 ± 0.35).
In PAD7, the score of “Relationship to the health care providers” in ACU (3.27 ± 0.40) was significantly higher than those in DCU (3.05 ± 0.49, p < 0.05). However, the score of “Relationships with others” in ACU (3.40 ± 0.45) was significantly higher than those in the CDCU (3.12 ± 0.48, p < 0.05).
In PAD8, the score of “Mobility capability” in the DCU (3.31 ± 0.47) was significantly higher than those in the LCU (3.12 ± 0.34, p < 0.05).
In PAD9, the scores of “Interest toward sexuality” in ACU (2.69 ± 0.43, p < 0.05), GCU (2.68 ± 0.49, p < 0.05) and LCU (2.61 ± 0.47, p < 0.05) were significantly higher than those in the DCU (2.33 ± 0.67). The score of “Sexual function” in ACU (2.95 ± 0.47) was significantly higher than those in LCU (2.76 ± 0.55, p < 0.05), CDCU (2.39 ± 0.76, p < 0.05) and DCU (2.08 ± 0.96, p < 0.05). The scores of “Sexual function” in LCU (2.76 ± 0.55, p < 0.05) and GCU (2.73 ± 0.67, p < 0.05) were significantly higher than those in the DCU (2.08 ± 0.96). Similarly, the score in the LCU (2.76 ± 0.55) was significantly higher in the CDCU (2.39 ± 0.76, p < 0.05).
The assessment priorities for each of the types of units and associated ‘important’ factors vary by unit. The following will be discussed in each unit function.
Psychological symptom, Stress coping, Mood disorder and aggression, Information of adherence, Information of