Psycho Social Interventions In Nursing Care

Psycho-social Interventions (PSI),Goals and Purposes of Psycho-social Interventions,What are Psycho-social Interventions,Implementation of Psycho-social Interventions,Use of Psycho-social Interventions by Health Care Providers,New Trends in Psycho-social Interventions,Effectiveness of Psycho-social Interventions.

Psycho-social Interventions (PSI)

    According to Rössler and Haker (2003) in their review of the
literature on the topic of psychosocial interventions, there is a paucity of
research in this area. The authors noted that in their search of the databases
Medline and PsycINFO (2002/2003) (search date June 20, 2003), only 3% and 1.2%,
respectively, of the psychiatric articles addressed psychosocial interventions. 

    A further concern was noted by authors Saks, Jeete, Granholm, and others (2002)
and by LL Street and Luoma (2002) about the ethics of psychosocial intervention
research, especially in regard to the issue of having control groups.

Goals and Purposes of Psycho-social Interventions

    Psychosocial intervention (PSI) is often an inadequately defined
concept. According to Gazzola and Muskin (2003): “The goals of all psychosocial
interventions are determined by the stress on the individual and the coping
skills available to that individual” (p. 373). 

    An intervention can be
considered to be in the psychosocial category if the intervention is designed
to give people the opportunity to participate more fully in their interactions
with their community and with society at large.

What are Psycho-social Interventions 

    Psychosocial interventions are those used by people to deal with
stressors in their lives. There are many types of interventions, and the ones
used are often determined by what techniques are available and/or fit the
unique needs of the individual/family. 

    Most authors on this subject agree that
it is essential that trust and a therapeutic alliance be established in order
for PSI to be successful (Rossler & Haker, 2003; Gamble & Hart, 2003;
Schein, Bernard, Spitz, & Muckin, 2003). 

    Relapse is often seen with PSI,
such as the return to addictive behaviors (ie., smoking and illicit drug use)
after treatment is finished (Scheinet al.). The objective of all psychosocial
interventions is to integrate affected people into the community, and as such,
increase their sense of autonomy. 

    The importance of a person’s right to
self-determination regarding which PSI meets their unique needs cannot be
overstressed.

Implementation of Psycho-social Interventions

    Gamble and Hart (2003) explained how PSI can be implemented in an
acute psychiatric inpatient unit. 

    They listed the following as psychosocial
interventions: engagement and outcome oriented assessment, the family’s
assessment of the patient’s needs, psychological management of psychosis cognitive
behavioral therapies, coping strategy enhancement, self-monitoring approaches
and training in problem solving, and medication interviewing motivational
techniques. 

    They stated, however, that there is a great deal of resistance by
staff in acute care settings to implement PSI. Some of this is related to
staffing levels, its time-consuming nature, and inexperience either in the
techniques or in general. 

    Using a case example, they demonstrated that both
patients and their families can benefit greatly from the use of psychosocial
interventions in the acute care setting. 

    In their article, JA Baker, O’Higgins,
Parkinson, and Tracey (2002) indicated that the Department of Health, United
Kingdom (UK), identified the provision of psychosocial interventions as a
priority in the treatment of the severely mentally ill, PSI being seen as the
only training that improved clinical skills (United Kingdom Central Council,
1999). 

    They also confirmed what other researchers have indicated that there is
often difficulty with the implementation of psychosocial interventions,
partially related, they believe, to lack of organizational support for such
measures (Tarrier, Barrowclough, Haddock, & McGovern, 1999). 

    In response to
this identified problem, Baker and colleagues designated a specific care
pathway for the implementation of these types of interventions on an acute
inpatient care unit in the UK. The model was based on research and
evidence-based practice and was one of the first systematic approaches to deal
with this issue. 

    All members on the health delivery team participated in the
implementation of this approach from its exploration phase through
implementation and final evaluation phase. The outcomes were positive and
received a certificate of excellence Lilly award. The authors do, however,
indicate that the model needs further testing and implementation (JA Baker et
al.).

Use of Psycho-social Interventions by Health Care Providers

Often in today’s high-tech world of medical care, the use of
psychosocial interventions by health care providers is sorely limited. Schein
and colleagues (2003) stated that they believe that health care providers,
specifically physicians, often find it hard to keep up with the rapidly
increasing onslaught of technology, and therefore focus on the specific illness
they are treating rather than the individual as whole. 

    Although much evidence
has been collected on the power of the mind over body. the referral of the
medically ill patient to clinicians trained in the area of psychosocial
interventions is frequently forgotten and therefore not done. The impact of the
use of psychosomatic interventions in coping with physical illness has been
documented. 

    Dreher (1998) reviewed the literature of preop preparation on
postop outcomes, including a meta-analysis of over 200 prior studies, and found
that there were significant outcomes related to things like decrease in need
for pain medication and faster wound healing.

New Trends in Psycho-social Interventions

    Rössler and Haker (2003) also mentioned that there is an emerging
trend for online self-help groups to increase interactions and therapeutic
alliances between clients and practitioners via the Internet. This will
continue to be a growing trend as the use of technology increases in the 21st
century.

Effectiveness of Psycho-social Interventions

    Huibers, Buerskens, Bleijenberg, and van Schayek (2004) conducted a
literature review to determine the effectiveness of PSI when used by general
practitioners (GPs). Studies were eligible for inclusion if they were published
before January 2002 and were in the categories of controlled clinical studies,
controlled patient preference trials, and randomized control trials.

    A total of
eight studies met the criteria and addressed different psychosocial
interventions. The results indicated that depression was effectively impacted
by GP problem solving behaviors, but that the data was limited or conflicting
on other interventions included in the review, such as counseling to help
patients stop smoking or cognitive behavioral group therapy. 

The authors
indicated that further research is needed on the use of PSI by general
practitioners.

    Overall, the subject of psychosocial interventions has received
little research attention. It will be crucial that these important treatment
techniques be a focus for future study and nurses are uniquely qualified to
conduct and publish research in this area.