Pro re nata use in a psychiatric intensive care unit

Mullen, Antony; Drinkwater, Vincent

doi:10.1111/j.1447-0349.2011.00746.x

Cited by 10 publications

(20 citation statements)

References 25 publications

(106 reference statements)

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“…; Usher et al . ), along with unsettled behaviour, violence (Haw & Wolstencroft ), insomnia and distressing symptoms (Mullen & Drinkwater ). Environmental factors include high levels of ward acuity, staffing levels and skill mix as well as the enforcement of smoking bans in hospitals (Stewart et al .…”

Section: Introductionmentioning

confidence: 99%

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Nurses' attitudes towards the use of PRN psychotropic medications in acute and forensic mental health settings

Barr¹,

Wynaden

Heslop

2017

Int J Mental Health Nurs

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Many countries now have national mental health policies and guidelines to decrease or eliminate the use of seclusion and restraint yet the use of Pro Re Nata (PRN) medications has received less practice evaluation. This research aimed to identify mental health nurses' attitudes towards the use of PRN medications with mental health consumers. Participants were working in forensic mental health and non-forensic acute mental health settings. The "Attitudes towards PRN medication use survey" was used and data were collected online. Data were analysed using the Statistical Package Social Sciences, Version 22.0. Practice differences between forensic and other acute mental health settings were identified related to the use of PRN medications to manage symptoms from nicotine, alcohol and other drug withdrawal. Differences related to the useage of comfort rooms and conducting comprehensive assessments of consumers' psychiatric symptoms were also detected. Qualitative findings highlighted the need for increased accountability for the prescribing and administration of PRN medications along with more nursing education/training to use alternative first line interventions. Nurses administering PRN medications should be vigilant regarding the indications for this practice to ensure they are facilitating the consumer's recovery by reducing the use of all forms of potentially restrictive practices in the hospital setting. The reasons for using PRN medications and PRN administration rates must be continually monitored to avoid practices such as high dose antipsychotics use and antipsychotic polypharmacy to ensure the efficacy of the consumers' management plans on their health care outcomes.

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Section: Introductionmentioning

confidence: 99%

“…) as it often precluded other interventions such as de‐escalation through the use of effective communication techniques (Bowers et al . ; Mullen & Drinkwater ; Price & Baker ). Stewart et al .…”

Section: Introductionmentioning

confidence: 99%

Nurses' attitudes towards the use of PRN psychotropic medications in acute and forensic mental health settings

Barr¹,

Wynaden

Heslop

2017

Int J Mental Health Nurs

View full text Add to dashboard Cite

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“…). The most frequently prescribed PRN medications are hypnotics, anxiolytics, and antipsychotics (Mullen & Drinkwater ; Srivastava ; Wright et al . ).…”

Section: Introductionmentioning

confidence: 99%

“…), and they have had tendency to resort to PRN too easily (Baker et al . ; Hayes & Russ ; Mullen & Drinkwater ). It has been reported that professionals have the power to identify the need for PRN and patients’ views are not considered (Cutcliffe & Happell ).…”

Section: Introductionmentioning

confidence: 99%

“…; NICE ), but it can also provide a form of restriction and coercion in psychiatric care (Molloy et al . ; Mullen & Drinkwater ). Thus, PRN practices may be inconsistent with international recommendations that emphasize service users’ participation in deciding what medication they should receive (Hilton & Whiteford ; O'Sullivan & Rae ) and more widely in all the processes involved in mental health care (Tambuyzer et al .…”

Section: Introductionmentioning

confidence: 99%

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Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

Hipp

Kuosmanen

Repo-Tiihonen

et al. 2017

Int J Mental Health Nurs

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Pro re nata (PRN) medication is widely used and studied in psychiatric care, but our knowledge about patient participation in its administration is fragmented. The aim of this integrative review was to describe and synthesize previous knowledge of patient participation in PRN in psychiatric inpatient settings. We conducted both electronic and manual searches, using the CINAHL, Scopus, PsycINFO, and PubMed databases, and eight scientific journals. Searches were limited to the English language, to the years 2006-2016, and to selected papers using inclusion, exclusion, and quality criteria. We identified 16 relevant papers, and these showed that patient participation included patient-related starting points, including the patients' willingness to participate and their knowledge of the medication. The patients' participation in PRN practices was demonstrated by the opportunity to request PRN and to refuse any PRN that was offered. Patient participation was shown to be linked to certain situations where PRN was recommended. The role that the professionals played in patient participation included interacting with patients, providing counselling and alternatives for PRN. Our results also revealed that coercion was used administering PRN. The existing literature exposed challenges that need to be addressed if patient participation in the use of PRN medication is to be effectively achieved in psychiatric inpatient settings. Equal partnerships between patients, nurses, and physicians are an essential part of this process, and further research into PRN medication is urgently needed, particularly studies that focus on patients' experiences.

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Using Participatory Action Research to Develop a Working Model That Enhances Psychiatric Nurses’ Professionalism: The Architecture of Stability

Salzmann‐Erikson

2017

Adm Policy Ment Health

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Ward rules in psychiatric care aim to promote safety for both patients and staff. Simultaneously, ward rules are associated with increased patient violence, leading to neither a safe work environment nor a safe caring environment. Although ward rules are routinely used, few studies have explicitly accounted for their impact. To describe the process of a team development project considering ward rule issues, and to develop a working model to empower staff in their daily in-patient psychiatric nursing practices. The design of this study is explorative and descriptive. Participatory action research methodology was applied to understand ward rules. Data consists of audio-recorded group discussions, observations and field notes, together creating a data set of 556 text pages. More than 100 specific ward rules were identified. In this process, the word rules was relinquished in favor of adopting the term principles, since rules are inconsistent with a caring ideology. A linguistic transition led to the development of a framework embracing the (1) Principle of Safety, (2) Principle of Structure and (3) Principle of Interplay. The principles were linked to normative guidelines and applied ethical theories: deontology, consequentialism and ethics of care. The work model reminded staff about the principles, empowered their professional decision-making, decreased collegial conflicts because of increased acceptance for individual decisions, and, in general, improved well-being at work. Furthermore, the work model also empowered staff to find support for their decisions based on principles that are grounded in the ethics of totality.

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Pro re nata use in a psychiatric intensive care unit

Cited by 10 publications

References 25 publications

Nurses' attitudes towards the use of PRN psychotropic medications in acute and forensic mental health settings

Nurses' attitudes towards the use of PRN psychotropic medications in acute and forensic mental health settings

Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

Using Participatory Action Research to Develop a Working Model That Enhances Psychiatric Nurses’ Professionalism: The Architecture of Stability

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