Free Nursing Dissertations - (morris Ah 2002). It Is Possibly For This Reason That Many Of The Studies
(Morris AH 2002). It is possibly for this reason that many of the studies such as this one are actually Aman in their origins. the Aman system being much more easily accessible when cost orientation is considered.
This paper makes the case very eloquently for the potential of day care psychiatric admission (where appropriate), not only on the grounds of cost, but also on the grounds that it is better for the patient, in many cases and also it is often better for the carers as well. The paper makes the point that:
Inpatient treatment relieves symptoms more rapidly than day hospital treatment but may lead to increased burden on carers one year later.
The authors suggest that up to 40% of acute psychiatric disturbance may be appropriately cared for in a day case unit rather than by formal admission to an in-patient ward. This is a similar level of finding to other workers in the field. (Schene A et al 1993) and (Kluiter H et al 1992).
This study (and others) point to the fact that with appropriate case selection (the criteria for case selection is not actually specified in the paper), the clinical and social outcomes for both day case and inpatients, are broadly similar.
This paper makes one very salient point that some Trusts will try to discharge inpatients at the earliest opportunity. The authors regard this as false economy as there is a much higher readmission rate amongst patients who are discharged early than those who are kept in for longer periods. (Moriarty, J et al. 2000).
This study is likely to be statistically valid because it had nearly 90 patients in each leg of the trial and they were followed up over a three year period. Short term variations were thus avoided.
The statistical analysis of the data is of an excellent standard and we can therefore have a fair degree of confidence in the author’s findings.
This study is also notable as it also takes account of some of the factors that may impinge of the overall clinical care of the patient, such as staff stress (Holloway F 1995) and staff burn-out, (Schaufeli, W et al. 1998), which appear to be a well recognised phenomenon. It is often qualified, but seldom quantified, in research papers. (Wykes T 1995)
If we turn our attention now to this specific issue, there is a wealth of literature which looks at the stresses involved with the provision of care in the NHS. One of the better ones is a paper by Cotrell (2000). This paper provides a comprehensive overview of the consequences of the inherent stresses in the mental health nursing field together with a review of the possible interventions that may be appropriate.
The whole area of stress in NHS staff in general, and the mental health services in particular, is one that is receiving more attention and recognition in recent years than in the past.
