Nursing Care and Psycho Social Interventions (PSI)

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.