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Journal of Psychiatric and Mental Health Nursing, 2009, 16, 32–45Patient health outcomes in psychiatric mental
health nursing
P. M O N T G O M E R Y 1 r n , p h d , D . R O S E 2 r n , p h d & L . C A R T E R 3 p h d
1
Associate Professor, 3Assistant Professor, School of Nursing, Laurentian University, Sudbury, ON, Canada
2
Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
Correspondence: MONTGOMERY P., ROSE D. & CARTER L. (2009) Journal of Psychiatric and Mental
P. Montgomery Health Nursing 16, 32–45
School of Nursing Patient health outcomes in psychiatric mental health nursing
Laurentian University
Ramsey Lake Road This integrative literature review examined evidence concerning the relationship between
Sudbury
psychiatric mental health nursing interventions and patient-focused outcomes. Empirical
ON
studies, published between 1997 and 2007, were identified and gathered by searching
Canada P3E 2C6
relevant databases and specific data sources. Although 156 articles were critically appraised,
E-mail: pmontgomery@
laurentian.ca
only 25 of them met the inclusion criteria. Findings from this review showed that the most
frequently used outcome instruments assessed psychiatric symptom severity. Most of the
instruments targeted two symptom categories: altered thoughts/perceptions and altered
mood. Other outcome instruments were categorized in the following domains: self-care,
functioning, quality of life and satisfaction. The most important finding of this review is the
lack of consistently strong evidence to support decisions concerning which outcome instru-
ment or combination of instruments to recommend for routine use in practice. Based on
this review, additional research to conceptualize, measure and examine the feasibility of
outcome instruments sensitive to psychiatric mental health nursing interventions is
recommended.
Keywords: evidence-based practice, nursing
Accepted for publication: 2 July 2008
et al. 2005, Curran & Brooker 2007). In addition, there
Introduction
is a lack of agreement about the dimensions of quality care,
In Canada, Health Outcomes for Better Information and lack of valid and reliable outcome measures, and reticence
Care (HOBIC) is an initiative of the Ontario Ministry of to let go of a professional attitude of knowing what is best
Health and Long-term Care. Identifying nursing indicators for the patient (Stuart 2001, McGrath & Tempier 2003).
and health outcomes across the healthcare system to facili- Decisions about how to intervene have been strongly
tate better care and enhance accountability is timely for influenced by generally accepted practices and beliefs
psychiatric mental health nursing, hereafter referred to as rather than systematic empirical support (Gerolamo 2004;
mental health nursing. Compared with other health fields, Brimblecombe et al. 2007; Curran & Brooker 2007).
mental health nursing has lagged behind in examining Despite the significance of evaluating patient out-
interventions and patient-focused health outcomes. This is comes, lack of supports and resources has impeded the
partly attributed to the diverse patient population. Patients’ use of measurement in demonstrating mental health nurs-
psychiatric presentations and their care needs are not ing’s contribution to patient health (Mill Barrell et al.
always straightforward in terms of type, combination, 1997, Repper & Brooker 1998, Brooker et al. 1999,
intensity and duration of services (Slade 2002, Forchuk Brimblecombe et al. 2007). With HOBIC’s commitment to
32 © 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
, Patient health outcomes
centralized information about patient outcomes, the oppor- research. This method was determined as suitable in view
tunity exists for mental health nursing to identify specific of the issues of measuring outcomes in mental health
outcomes reflective of its inputs and/or interventions. nursing (Stuart 2001, McGrath & Tempier 2003, Yakimo
Therefore, this paper critically examined the empirical evi- et al. 2004). Rather than converting findings into numeri-
dence about the extent to which mental health nursing cal data, the objective is to combine empirical and theo-
interventions were associated with positive patient out- retical data to understand nursing phenomenon. The
comes. The specific objectives of this literature appraisal process includes five stages: problem identification,
were to identify nursing literature that demonstrates an literature search, data evaluation, data analysis and pre-
effect on patient outcomes and to identify the instruments sentation. This review’s problem statement was: ‘What
used to measure each outcome. are the outcome indicators that have been shown to be
The theoretical framework that guided the collection of sensitive to input from nurses working with psychiatric
relevant literature was a combination of the foundational patients?’
works of Doran (2003), and Irvine et al. (1998). Three The literature search involved three strategies. A com-
components of the framework – structure, process and puterized literature search of electronic databases from
outcomes – assisted in understanding nursing’s contribu- January 1997 to November 2007 (e.g. CINAHL,
tion to patient outcomes. A similar orientation was used MEDLINE, EMBASE, PsychINFO, Evidence-Based
in Gerolamo (2004) literature review of adult psychiatric Mental Health, Cochrane, and Joanna Briggs Institute)
inpatient outcomes. Her review of articles, published was conducted. The literature search strategy used specific
between 1991 and 2004, was guided by a model that key words: outcome, intervention, patient, psychiatric and
included structure (organization of nursing care), process nursing. Only English references were included. All the
(nursing interventions) and outcome variables. The in- issues of the following journals were electronically
cluded 47 studies reported outcome data in the domains of searched for the previously mentioned time period:
hospital readmission, symptom and functioning improve- Archives of Psychiatric Nursing, International Journal of
ment, satisfaction and self-injurious behaviours. Despite Psychiatric Nursing Research, Issues of Mental Health
Gerolamo’s recommendation that such a model is appro- Nursing, Journal of Psychiatric and Mental Health
priate to conceptualize the relationship between nursing Nursing, Psychiatric Services, Journal of the American Psy-
interventions and outcomes, the challenge is the lack of chiatric Nurses Association and Evidenced-Based Nursing.
strong empirical evidence linking outcomes to nursing Meta-review references were electronically searched for
practice variables. the terms ‘CINAHL’, ‘psychiatric’, ‘nurse’ and ‘nursing’.
Most of the published literature pertinent to the struc- The decision to use these parameters for the meta-reviews
tural component is non-experimental. While there are a was made to identify nursing’s contribution to patient out-
number of descriptive and correlational studies, most of comes within a programme, treatment approach or a multi-
them do not meet the appraisal criteria of higher level disciplinary team approach. In some studies, primary care
scientific evidence (Stuart 2001, Bowers et al. 2003). As an nurses delivered interventions commonly associated with
example of this, in a review of the literature dating back to the domain of mental health nursing.
1965 and examining the effectiveness of community mental Two researchers reviewed the initially identified titles
health nurses, only 11 studies used an experimental design and abstracts. The total number of records obtained was
(Brooker et al. 1996). The level of rigour was questioned in greater than 3000. If unable to determine if the identified
relation to these studies. In terms of process, in Ontario, reference addressed the core question, the full paper was
mental health nurses function in independent, dependent, reviewed. In total, the number of potentially relevant
and interdependent roles within inpatient and community sources retrieved was 183. Theoretical references were
settings. Regardless of role, nursing has identified the included if they presented a concept analysis or literature
qualities of patient outcome measures to be applicable, review concerning a patient outcome. Empirical references
acceptable, practical, integral and sensitive to nursing were included if they met the following two criteria: they
intervention (Speer 1996, Berman et al. 1998). described a mental health nursing intervention with adult
patients on a one-to-one basis for which client charts may
have been kept; and they reported results that examined the
Methods
effects of nursing interventions on patient outcomes (Doran
This literature review was guided by a nursing integrative 2003). A total of 156 studies were appraised by two inde-
review methodology proposed by Whittlemore & Knafl pendent researchers using the Critical Appraisal Skills
(2005), a systematic process of synthesizing and inter- Program (CASP, McGill University Health Centre 2006)
preting published experimental and non-experimental forms. These standardized evaluations of health research
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd 33
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