Factors influencing clinical decision making used by mental health nurses to provide provisional diagnosis: A scoping review

Abstract

Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision‐making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer‐reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.

Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study

“…The therapeutic ward climate was confirmed to be among the predictors of in-hospital nursing care leading to reduction in early readmission. Nursing performance is influenced by nurses' personal, environmental, and patients' factors [58]. The R-squared in the stepwise multiple regression analyses conducted in this study were not high.…”

Mental health in a general hospital: perception of the nursing team / Saúde mental em hospital geral: percepção da equipe de enfermagem

“…Therefore, studies have described the existence of difficulty in managing patients with violent behavior in the crisis period, and the interference of this situation in care due to fear, insecurity and anxiety of professionals. 7,[9][10]14,17 In care practice, there is a strong association between aggressiveness and the use of physical restraint. However, this practice requires criteria and should be the last alternative when facing mental confusion, psychomotor agitation or risk of falling out of bed, extraction of probes and catheters.…”

“…This strategy would help overcome the knowledge deficit of generalist nurses, assisting them in conducting the care process in mental health. 7,[9][10] Psychiatric nursing consultation, is defined as the provision of mental health nursing care in general hospital units. Generalist nurses or specialists from other areas working in sectors such as emergency, medical or surgical clinic, or obstetrics, ask the psychiatric nurse for consulting services to develop a care plan for patients with clinical-psychiatric comorbidity.…”

“…The interconsultant nurse does not assume direct patient care, but guides and supports the nursing team of that unit in the specific care of the psychosocial care needs of the client. 7,[9][10][11] In Brazil, some general hospitals have the psychiatric nursing interconsultation service, however, this strategy is timid in relation to the reality of other countries, which have proven to have good results, both in patient care and in the work process of the nursing team. 7,[9][10][11] Considering the increased prevalence of mental or behavioral disorders in the world population, the transition in the psychosocial care model in Brazil, and the need for qualification of general hospital nursing professionals to meet these demands, we question what is the perception of general hospital nursing professionals about mental health care?…”

“…7,[9][10][11] In Brazil, some general hospitals have the psychiatric nursing interconsultation service, however, this strategy is timid in relation to the reality of other countries, which have proven to have good results, both in patient care and in the work process of the nursing team. 7,[9][10][11] Considering the increased prevalence of mental or behavioral disorders in the world population, the transition in the psychosocial care model in Brazil, and the need for qualification of general hospital nursing professionals to meet these demands, we question what is the perception of general hospital nursing professionals about mental health care? To answer this question, the following objective was established: to know the perception of nursing professionals about mental health care in the general hospital.…”