A Decade of Published Evidence for

Psychiatric and Mental Health Nursing

Interventions
^md

Jaclene A. Zauszniewski, PhD, RN-BC, FAAN

Abir Bekhet, PhD, RN, HSMI
Sara Haberlein, BSN-RN

Abstract

Current psychiatric nursing practice remains grounded in tradition, unsystematic trial and error,
and authority. Although some of the wisdom that has been passed down over time is
questionable, it continues to influence nursing practice today. This state-of-the-evidence review
examined features of intervention studies published between January 2006 and December 2010
in five psychiatric nursing journals; it compared findings with those from a previous study of
comparable literature published between 2000 and 2005. The analysis included studies that
evaluated strategies, procedures, or practices that promote mental health or prevent mental
illness. Of the 553 data-based articles, 71% tested interventions; 54% were conducted in the
United States. Intervention studies reflected psychological (38%) social (17%), and biological
(1%) dimensions of the biopsychosocial model. Some studies involved two dimensions and 17%
included all three dimensions. Studies involved nurses, students, or staff (15%), mentally ill
(50%), or mentally healthy persons (35%) ranging in age from childhood through older
adulthood. The 10 year review showed continuing progress toward increased dissemination
compared to earlier years; less focus on nurses, students, and staff; an increase in international
studies; and greater emphasis on holistic interventions. In this article, the authors note a need for
more randomized, controlled trials and studies to compare effectiveness across interventions.

Citation: Zauszniewski, A. J., Bekhet, A., Haberlein, S. (August 27, 2012) "A Decade of
Published Evidence for Psychiatric and Mental Health Nursing Interventions" OJIN: The Online
Journal of Issues in Nursing Vol. 17 No. 3.

DOI: 10.3912/OJIN.Vol17No03HirshPsy01

Keywords: State-of-the science, psychiatric nursing, evidence-based practice, biopsychosocial

model interventions, clinical trials, dissemination, mental health, mental illness, global health

The Study

Current psychiatric nursing practice is still grounded in tradition, unsystematic trial and error,
and authority. The need for quality psychiatric care based on the best and most current research
is well documented. However, historically, psychiatric nursing practice has been influenced by
traditional wisdom passed down through generations by word of mouth and in published
textbooks (Zauszniewski & Suresky, 2003). Much of this nursing care has been based on
personal experience and the experiences of nurses and others who have gone before them.
Current psychiatric nursing practice is still grounded in tradition, unsystematic trial and error,
and authority. Some psychiatric nursing knowledge comes from ‘Old Wives’ Tales,’ reflecting
the perspectives of women from the past. This ‘received wisdom’ is often taken for granted and
reflexively put into practice. Even though some of the wisdom that has been passed down over
time is questionable, it continues to influence psychiatric nursing practice today.

In this article, research evidence is reviewed to provide a basis for its use in clinical practice.
This ‘state-of-the-evidence’ review examined literature from January 2006 through December
2010 and compared these findings with those from a previous study of comparable literature
published between 2000 and 2005 (Zauszniewski, Suresky, Bekhet, & Kidd, 2007). Boyd’s
(2011) biopsychosocial model provided the framework for organizing intervention studies into
three categories: biological, psychological, and social (See Figure). The model takes a holistic
approach and consists of three separate but interdependent domains: biologic, psychological, and
social (Boyd, 2011). Although the domains differ, they interact with each other. Indeed, after
considering patients' circumstances and other factors, selection of a nursing approach involves
integrating biologic, psychological, and social interventions into a comprehensive plan of care.
Nursing interventions are defined as activities that assess dysfunction, enhance and promote
health, and assist patients to regain or improve their coping abilities and/or prevent further
disabilities (ANA, 2000).

Evidence-Based Practice

This section will discuss the need for evidence-based practice. It will also address the importance
of using evidence-based practice in providing daily nursing care.

Calls for Evidence-Based Practice

Using best evidence for clinical decision making has many benefits... Yet very few health care
professionals implement the latest evidence in their clinical practice. Evidence-based practice is
the systematic use of current best evidence to make clinical decisions for patient care (Sackett,
Straus, Richardson, Rosenberg, & Haynes, 2000). Using best evidence for clinical decision
making has many benefits, including improving patient outcomes, providing professional
development opportunities, contributing to recruitment and retention of staff, and saving health
care dollars (The Sarah Cole Hirsh Institute, 2005; Fineout-Overholt, Melnyk, & Schulz, 2005).
Acknowledgement of the value of evidence-based nursing practice dates back to the mid-1990s
(Upton & Upton, 2006). Yet very few health care professionals implement the latest evidence in
their clinical practice (Cretin, Farly, Dolter, & Nicholas, 2001; Jolley, 2002; Melnyk et al.,
2004).

Several landmark documents relevant for psychiatric nursing have recently been published: the
Report of the Surgeon General on Mental Health (U.S. Department of Health and Human
Services [DHHS], 1999); Healthy People 2010, the National Health Promotion and Disease
Prevention Objectives (Healthy People, 2000); and the President’s New Freedom Commission
on Mental Health (2003) which included the goals of achieving excellence in mental care
delivery and the accelerating of research. These documents point to the need for evidence-based
practice and provide a framework for accelerating the provision of evidence-based nursing
practice.

Nursing leaders have long called for examination of theory, research, and curriculum in
psychiatric nursing. Nursing leaders have long called for examination of theory, research, and
curriculum in psychiatric nursing. These leaders have recommended evaluating what we teach,
scrutinizing ‘sacred cows’ that reflect ritualistic practices, and letting go of tradition and
dogmatic approaches that may have been of value in the past but are inconsistent with current
evidence that informs modern day practice and research. They have warned that psychiatric
nursing may become irrelevant if we fail to bring it into the 21st century (Mohr, 2009). Stuart
(2001) concluded that nurses are not contributing to evidence-based practice and few
interventions meet that standard. This situation will not change until the content of what is taught
in psychiatric nursing rises to levels established in other disciplines, such as psychiatry and
psychology, and serves as a foundation for generating research.

...nurses can no longer view clinical studies as academic exercises to be discarded on graduation
and not applied to the clinical setting.Rice (2008a) has pointed out that although a major portion
of the evidence-based practice (EBP) movement is directed toward developing clinical
guidelines, a critical element focuses on the therapeutic relationship and clinical judgment
associated with providing care. Also, he pointed out that nurses can no longer view clinical
studies as academic exercises to be discarded on graduation and not applied to the clinical
setting. Furthermore Rice (2008b) noted that the need to apply current research evidence to
clinical problems is reflected in professional codes and institutional mission statements.

With the arrival of evidence-based practice as the new standard of care, all health care providers
are urged to use the latest research evidence. However, in order for clinicians to implement
interventions based on the highest level of evidence, they must understand the levels of research
evidence and the different classification systems. Developing evidence-based practice ability
requires familiarity with the language and terminology of clinical research (Rice, 2009). For
example, all health care providers need to be able to discuss concepts. such as effect size, which
must be understood to determine whether findings of studies are clinically meaningful (Rice,
2009).

Using the Evidence

In order for evidence-based practice to occur, practicing nurses must take responsibility for
searching, critiquing, and synthesizing the empirical literature related to their practice.The focus
on evidence-based practice represents a substantial paradigm shift in the discipline of nursing
and in the specialty of psychiatric and mental health nursing. Though the nursing discipline has
been grounded in theory and research, nursing practice has, as noted above, been largely
influenced by expert opinion and tradition. There is now broad recognition that nursing practice
must be based on the best available evidence. Of course, the transition to evidence-based practice
in psychiatric nursing, as in all nursing specialties, is challenging. In order for evidence-based
practice to occur, practicing nurses must take responsibility for searching, critiquing, and
synthesizing the empirical literature related to their practice.

Stein (2009), however, has noted that nurse scientists’ selection of journals for publication of
their findings is a concern. The most rigorous research findings from studies of mental health
issues are published primarily in journals that often are not read by practicing psychiatric and
mental health nurses. A number of factors influence an author’s selection of a journal for
publishing; authors may believe that findings need to be in journals that (a) are accessible to
colleagues from multidisciplinary clinical specialties; (b) have a ‘high impact,’ and (c)
demonstrate high quality scholarship that supports decisions for tenure and promotion (Stein,
2009). Although all these reasons are reality based and justifiable, the question remains, what is
our obligation as psychiatric and mental health nurse scientists to our practicing colleagues and
the children, adolescents, and adults who receive their nursing care? Stein has noted that, as a
practice profession, our primary objective as nurse scholars and scientists should be to improve
the health and well being of populations of all ages, and across the globe, through provision of
optimal, high-quality nursing care. Thus, Stein has observed that we might need to re-evaluate
our current emphasis on journal impact factors and promotion criteria in the interest of the more
compelling issue of the extent to which the work holds potential for improving nursing practice
and patient health.

Method

Our review focused on intervention studies published in peer-reviewed psychiatric nursing

journals thought to be those most read by practicing psychiatric/mental health nursing
professionals. These journals included Archives of Psychiatric Nursing; Issues in Mental Health
Nursing; Journal of the American Psychiatric Nurses Association; Journal of Psychosocial and
Mental Health Services; and Perspectives in Psychiatric Care.

The review assessed the frequency and types of data-based, intervention research published in
the journals. A study was determined to be an intervention study if nursing strategies,
procedures, or practices were examined for their effectiveness in enhancing or promoting health
or preventing disability or dysfunction (ANA, 2000). Each of the co-authors searched the five
journals for studies. All three co-authors had to agree that a study met this criterion in order for it
to be included in the analysis. Both qualitative and quantitative studies were included. There
were 553 data-based articles published from January 2006 through December 2010. However,
only 83 (15%) evaluated or tested psychiatric nursing interventions. Of these 83 intervention
studies, 12 tested interventions for nurses, nursing students, nursing staff, or mental health
professionals, while 71 focused on interventions to promote mental health in clients of care. The
setting, target population, and intervention domain were analyzed in each study.

Findings

This section describes the findings from the 83 intervention studies that were found in the five
psychiatric nursing journals between January 2006 and December 2010. The 12 studies that
included nurses, student nurses, and mental health personnel, as well as the 71 that involved
recipients of mental health services or care are presented in this section. First, the research
settings in which the studies were conducted and descriptions of the targeted populations are
described. Next, the interventions tested within the studies are presented using the categories of
the bio-psycho-social framework. Finally, the research designs used in the intervention studies
are evaluated.

Research Settings

Forty-five of the 83 intervention studies published from 2006 to 2010 were conducted in the
United States (US). Seven of the total were conducted in Korea. Five studies each were done in
Taiwan and Canada; four each in the Netherlands and Australia; and two each in the United
Kingdom, Singapore, and Turkey. One study each was conducted in Norway, Jordan, Finland,
Thailand, Switzerland, Scotland, and Portugal.

Targeted Populations

Four of the 83 intervention studies that appeared in these five psychiatric nursing journals during
the period 2006-2010 examined the effect of interventions on student nurses, while eight studies
focused on nurses, nursing staff members, or mental health professionals. Seventy one of the
studies examined the effect of the interventions on clients. Examples of studies describing each
of these three groups are described below.

Student nurses. In four studies, student nurses were the participants. Saarikoski, Warne, Aunio,
and Leino-Kilpi (2006) studied the effectiveness of group supervision during clinical placements
on 32 student nurses in Finland. In addition, O’Brien and colleagues (2008) studied the
usefulness for 257 undergraduate nursing students in Australia of clinical facilitators in settings
where the students had clinical placements. Happell (2009) also studied undergraduate nursing
students in Australia to explore the relationship between the quantity of theoretical preparation in
mental health and 784 nursing students’ attitudes toward people with a mental illness and toward
mental health nursing; their sense of preparedness for practice; and their satisfaction with their
clinical experience. Finally, Kameg, Clochesy, Mitchell, and Suresky (2010) compared the
effectives of two educational delivery methods—high fidelity human simulation (HFHS) and
traditional lecture—on the self-efficacy for communication skills of a sample of 38
undergraduate students.

Nurses, nursing staff, and mental health professionals. Eight studies of nurses, nursing staff, or
mental health professionals were found. One study focused on improving communication skills
by examining the effects on 263 nurses in Turkey (not all were psychiatric nurses) of in-service
communication training to enhance their empathic skills (Ancel, 2006). Two other studies
focused on improving nurses’ knowledge and competence in clinical practice. The first of these
studies, conducted by Tran, Stone, Fernandez, Griggiths, and Johnson (2009), evaluated an
intervention to improve knowledge of alcohol and substance abuse among medical/surgical
nurses (n = 120) in Australia. The second study evaluated a program to improve knowledge of
tobacco dependence in a sample of psychiatrists, psychiatric nurses, psychologist, and social
workers, along with other counselors (n = 71) in the US (Williams, et al, 2009). A study by
Engin and Cam (2009) evaluated a self-awareness training program for 22 psychiatric nurses in
Turkey.
The remaining four studies also included nurses and nursing staff. One study, conducted in
Taiwan, investigated the effects of an education program, designed to increase psychiatric
nurses’ awareness of their potential for creativity, problem-solving, facing adversity, and
emotional control on both their potential abilities and their job satisfaction (Chen, Lee, Weng, &
Chen, 2010). A second study tested an intervention with 21 nurses to support care for suicidal
patients with schizophrenia (Meerwijk et al., 2010). A third study evaluated the efficacy of the
Early Recognition Method for improving the interaction between forensic mental health nurses
and their patients and for decreasing the patients’ violence (Fluttert, van Meijel, Nijman, Bjørkly,
& Grypdonck, 2010). The study was conducted with 116 forensic mental health nurses working
on 16 wards of a large, Dutch forensic hospital. Finally, one study evaluated the effectiveness of
a behavioral response team (BERT) to help staff members deal with behaviors of patients with
psychiatric illnesses who had been hospitalized on nonbehavioral-health units (Loucks, Rutledge,
Hatch, & Morrison, 2010).

Clients of care. A total of 71 intervention studies that did not focus on nurses, student nurses,
nursing staff, or mental health professionals, but rather focused on clients, were also published in
the five psychiatric nursing journals between January 2006 and December 2010. A variety of
diagnoses were represented in the studies. The most frequent were major depressive disorder,
bipolar affective disorder, schizophrenia, schizoaffective disorder, borderline personality
disorder, tics, eating problems, Alzheimer’s, dementia, and substance abuse. Other studies
focused on adolescents, adults, or elders who were not mentally ill but were experiencing stress,
physical illness, pregnancy, incarceration, victimization, or bereavement; these latter samples did
not include persons with a diagnosed mental disorder.

In terms of study participants’ ages, one study included children who were mentally healthy.
There were six studies of adolescents; one focused on adolescents with a mental illness and five
involved adolescents considered mentally healthy. There were 35 studies of adults, including 26
studies of adults with mental illness, eight of adults who were not mentally ill, and one study that
included both mentally ill and mentally healthy adults. Ten studies focused on elders, including
three studies of elders with mental illness and seven of elders without mental illness. In this five-
year review, 13 studies involved ‘mixed’ populations. These 13 studies included one study of
mentally healthy children and adolescents; two studies of mentally healthy adolescents and
adults, and 10 studies of adults and elders. Of these ten, seven involved adults or elders who had
a mental illness and three involved the mentally healthy. Six studies did not identify the age of
their subjects. Of these six studies, four subjects were mentally ill and two were mentally
healthy. There were no published studies in the five journals that included adolescents, adults,
and elders.

Intervention Domains

Using the biopsychosocial model provided by Boyd (2011), the interventions studied were
classified, by consensus of the co-authors, into one of the three domains (biological,
psychological, and social) or various combinations of the domains (See Figure). Of the 71
studies, 56% (n=40) tested interventions that reflected only one of the biopsychosocial
dimensions. One study tested a biological intervention, 27 tested psychological interventions,
and 12 tested social interventions. The remaining 31 studies (44%) tested interventions in
overlapping domains, including three that were bio-psychological, 12 that were psychosocial,
four that were bio-social, and 12 that addressed all three bio-psycho-social domains. Examples of
studies in each of the domains and combinations of domains are described in the paragraphs that
follow. The sample studies were selected by the co-authors to illustrate both qualitative and
quantitative methods and various study designs, as well as to provide examples from all five
psychiatric nursing journals used in this analysis.

Figure. Numbers of Intervention Studies Categorized Within the Biopsychosocial Model

The biological domain focuses on the physical aspects of the patient... Interventions in the
Biological Domain. The biological domain focuses on the physical aspects of the patient,
including self-care, activity and exercise, sleep, nutrition, relaxation, hydration,
thermoregulation, pain, and medication management. Interventions commonly used included
psychopharmacology, light therapy, and transcranial magnetic stimulation.

Rosedale (2009) conducted and tested an intervention from the biological domain. This
phenomenological study examined the effects of repeated transcranial magnetic stimulation
(rTMS) in nine moderately depressed adults who had failed to respond to treatment with
antidepressants. After receiving rTMS, study participants were asked to describe the experience
of having rTMS during an open-ended, audiotaped interview. The findings from their narratives
included self-reported changes of feeling less depressed and more optimistic in imagining
themselves in new situations or relationships.

...the psychological domain,... includes emotion, behavior, and cognition. Interventions in the
Psychological Domain. Many psychiatric nursing interventions are in the psychological domain,
which includes emotion, behavior, and cognition. Interventions in this category include
counseling, conflict resolution, bibliotherapy, creative-expressive therapy, reminiscence,
behavior therapy (behavior modification and token economy), cognitive interventions, psycho-
education, health teaching, and spiritual interventions

One study utilizing an intervention from the psychological domain examined a cognitive
intervention for 65 adult ‘voice hearers’ (persons with schizophrenia or schizoaffective disorder)
via a two-group, randomized, controlled trial that used repeated measures. The findings showed
that almost 1 in 3 persons who had experienced auditory hallucinations reported a reduction in
the number and severity of those hallucinations following the cognitive intervention (England,
2008).

[The Social] domain consists of the patient’s environment and the ways in which aspects of the
environment affect the patient’s response to stress. Interventions in the Social Domain. This
domain consists of the patient’s environment and the ways in which aspects of the environment
affect the patient’s response to stress. Interventions in this domain utilized people who were
close to the patient, such as families, friends, and social groups, as well as special attention to
community interactions. These interventions included supportive counseling, environmental
manipulation, vocational rehabilitation, social skills training, milieu therapy (containment,
validation, structured interaction, and open communication), home visits, and community
caregiver education.

Crockford, Kerfoot, and Currie (2009) tested an intervention from the social domain. This study
examined the impact of a smoking room in a psychiatric inpatient unit on the behavior of 90
inpatients (most common diagnosis: psychotic disorders, i.e., schizophrenia). The study involved
a survey of nursing staff and a retrospective chart review of documented behaviors before and
after the smoking room was opened; no randomization and no control group were used. The staff
survey and chart review findings differed regarding the impact of having a smoking room on a
psychiatric ward. The staff survey suggested a beneficial impact on unit atmosphere, less time
spent discussing smoking privileges, and more appropriate use of off-unit privileges. However,
the chart review failed to demonstrate a significant change in disruptive behavior.

Combinations of domains. Many researchers combined more than one domain in their
interventions (See Figure). Nineteen (27%) of the 71 studies tested interventions that included
two of the three dimensions. Three of these studies were biopsychological, four biosocial, and 12
psychosocial interventions. In addition, 12 studies (17%) tested interventions with all three
domains -- biological, psychological, and social. Examples of intervention studies reflecting two
domains are described below, followed by one study that tested an intervention reflecting all
three domains.
Apostolo and Kolcaba (2009) studied and tested an intervention from the biopsychological
domain. This study by examined the effects of guided imagery on comfort, depression, anxiety,
and stress in 60 psychiatric inpatients with depressive disorders. The study involved an
intervention group and a ‘usual care’ comparison group; all consecutively admitted patients with
depressive disorder were eligible. The diaphragmatic breathing and progressive muscle
relaxation involved in this guided imagery intervention constituted the biological component,
while the cognitive component involved the creation of positive images. Measures were taken
before and after the 10-day intervention. The intervention group was tested first, followed by the
comparison group. The findings showed that the intervention group had significant
improvements in their perception of increased comfort and decreased depression, anxiety, and
stress compared to the usual care group.

Kang and Yoo (2007) studied an intervention from the biosocial domain. This study examined
the effectiveness of breathing and stretching exercises in the context of a support group for 27
middle-aged women who had lost a loved one within the past six months. Seventeen received the
intervention and ten did not, thus serving as a control group. Measures of stress, grief, and
immune response were taken before and after the 10-session intervention. The findings showed
significant decreases in stress and grief for those in the intervention group, but no significant
difference in immune response.

Ballard (2008) conducted a study in the psychosocial domain that examined the effectiveness of
treatment malls in improving the psychosocial rehabilitation of persons with psychiatric
illnesses. The treatment mall was designed to teach and strengthen psychological and
social/vocational skills within a centralized, educational setting in which participants were self-
directed learners and the psychoeducation was person centered. The study involved a
convenience sample of 120 participants (no control group). Research observations were made
after their participation in the treatment mall (no pre-test). The findings indicated that 82% of the
participants found the treatment mall helpful in preparing for discharge and 92% expressed
satisfaction with the use of the treatment mall approach.

Interventions in the biopsychosocial domain involve all three components – biological,

psychological, and social. There were 12 studies that fit this description. One study in the
biopsychosocial domain examined a collaborative model for treating depression in 41
homebound elders. Pharmacological and psychosocial interventions were implemented
simultaneously. Thirty-six participants choose to participate in the mental health intervention and
five choose to receive usual care. Significant improvements were noted in depressive symptoms
for elders who received the intervention (Knight & Housemen, 2008).

Research Designs

The review of published intervention studies in the five psychiatric nursing journals (2006-2010)
revealed the methodological characteristics described below. In 39 studies (55%) there was no
randomization or use of a control group; nine studies (13%) had no randomization, but did have
a control group; three studies (4%) allowed participants to choose whether to participate in the
intervention or control group. Twenty studies (28%) had random samples and used a control
group. Sample sizes varied widely, ranging from 4 to 333, with an average of 60. Thirty-nine
studies (55%) had only an intervention group; 31 (44%) had an intervention group and a control
group; and one study (1%) involved comparison of two interventions with a control condition.

Seven studies (10%) collected only qualitative data; 60 studies (84%) collected only quantitative
data; and four studies (5.6%) collected both quantitative and qualitative data. Eighteen studies
(25%) had only one data collection point post-intervention; 47 studies (66%) had two data
collection points (before and after the intervention); and six studies (8%) examined the effects of
the intervention over time using repeated measures.

Discussion and Conclusion

This review of psychiatric and mental health nursing intervention research was limited to studies
published in five journals that are commonly read by a wide range of psychiatric and mental
health nurses working in clinical practice, education, or research. All psychiatric and mental
health nurses recognize the need for high quality care that is based on the best and most current
research (Zauszniewski, et al. 2007). This review provides evidence of continued movement
toward dissemination of the findings of intervention research from 2006 through 2010. In
conducting this study, we used methods of collecting information about intervention studies that
were similar to those in a previous review conducted from 2000 through 2005 (Zauszniewski et
al., 2007) so that comparisons over time could be made.

There were 553 data-based articles published from January 2006 through December 2010, as
compared to 486 data-based articles published from 2000 through 2005 (Zauszniewski et al.,
2007) in these five psychiatric nursing journals. However, because the two review periods
differed, with six years covered for in the 2000-2005 review and only five in the 2006-2010
review, the average number of published studies in these two time frames was calculated,
revealing a small increase, specifically an average of five data-based articles per year, from the
earlier to the current time frame.

The increase in the number of international intervention studies published... indicates that an
increasing number of countries now share an interest in disseminating studies that test
interventions for psychiatric and mental health nursing practice. From 2006 through 2010, 54%
of intervention studies were conducted in the US and 46% were international. This compares
with 72% of studies published in the US and 28% published internationally in the previous
review (Zauszniewski et al., 2007). The increase in the number of international intervention
studies published in the five psychiatric nursing journals indicates that an increasing number of
countries now share an interest in disseminating studies that test interventions for psychiatric and
mental health nursing practice. This publication of findings from intervention studies conducted
outside the US facilitates global sharing of evidence for psychiatric and mental health nursing
practice.

Of the 83 intervention studies found in the five journals from 2006 through 2010, nurses, student
nurses, nursing staff, or other mental health professionals were recipients of an intervention in 12
studies. The 2000 to 2005 review (Zauszniewski et al., 2007) did not report the number of
studies involving these groups. However, a review conducted from 2000 through 2002
(Zauszniewski & Suresky, 2003) found that 52 (23%) of 227 studies published in these same five
psychiatric journals involved nurses, student nurses, or mental health staff. Although there is a
downward trend in the publication of studies of psychiatric nurses, student nurses, and mental
health staff, studies of nurses, student nurses, nursing staff, or mental health professionals
continue. Although these studies do not focus directly on the care provided for clients, they can
inform the development of role expectations and the improvement of care delivered by
psychiatric and mental health nurses.

...over time, the focus on a single intervention domain has decreased, with an increased focus on
the testing of more holistic interventions that capture all three domains. Our analysis revealed an
increase in published studies of interventions for psychiatric patients or clients in the five
selected psychiatric nursing journals. From 2006 through 2010, 71 studies evaluated nursing
interventions in these populations. This compares with 77 published from 2000 through 2005 in
the five journals. Taking into account the difference between the two review periods (five versus
six years), there was a small increase in the number of published intervention studies from the
previous reporting period. The number of intervention studies involving adolescents, adults, or
elders was similar in the two review periods even though the current review covered five years,
while the previous review covered six years. Further, there was a dramatic increase in
intervention studies in the bio-psycho-social domains from 1 (2000-2005) to 12 (2006-2010)
(See Table). Thus, it appears that over time, the focus on a single intervention domain has
decreased, with an increased focus on the testing of more holistic interventions that capture all
three domains (See Table).

Table. Comparison Within the Domains Between 2000-2005 and 2006-2010 Analyses

Domain 2000-2005 2006-2010

N = 77 N = 71
Biological 8 (11%) 1 (1%)
Psychological 44 (57%) 27 (38%)
Social 7 (9%) 12 (17%)
Bio-Psychological 4 (5%) 3 (4%)
Psycho-Social 9 (12%) 12 (17%)
Bio-Social 4 (5%) 4 (6%)
Bio-Psycho-Social 1 (1%) 12 (17%)

There was a higher percentage of quantitative intervention studies in the 2006-2010 review
period than in the earlier review period (84% compared to 64%), while the percentage of
qualitative studies decreased from 26% in 2000-2005 (Zauszniewski et al., 2007) to 10% in this
review. However, more than half (55%) of the intervention studies in the current review did not
involve randomization or the use of a control group, and only one study was labeled by its author
as a randomized, controlled trial. Rice (2008b) has noted that studies lacking control and
randomization provide less credible evidence for clinical interventions. Thus, although more
recent intervention studies have tended to be quantitative rather than qualitative, their lack of
control conditions and randomization diminishes the quality of the evidence. As a result, there
continues to be limited scientific support for many psychiatric nursing interventions (Beebe,
Adams, & El-Mallakh, 2011; Rice, 2011).
Effective partnerships between researchers and practitioners to coordinate research agendas with
the development and testing of interventions in clinical practice settings are critical. To address
the need for increased evidence supporting the effectiveness of intervention studies, a multi-
pronged approach that involves collaboration among clinicians, educators, and researchers is
needed (Zauszniewski et al., 2007). Researchers must be committed to conducting high-quality
investigations of nursing interventions (Beebe et al., 2011) and disseminating their findings in
journals read by nurses in practice settings (Zauszniewski et al., 2007). Effective partnerships
between researchers and practitioners to coordinate research agendas with the development and
testing of interventions in clinical practice settings are critical (Buccheri, Trygstad, Buffum, &
Gerlock, 2010; Horsfall, Cleary, & Hunt, 2011).

In summary, this state-of-the-science review of published intervention research in the psychiatric

and mental health nursing journals that are most commonly read by practicing nurses, educators,
and researchers in the United States has revealed an increase in the number of data-based studies;
a greater number of studies from outside the US; less focus on studies of nurses, nursing
students, and other mental health professionals as compared with clients who receive their care
or services; and a greater emphasis on testing holistic interventions that contain biological,
psychological, and social dimensions. Ongoing assessments of the dissemination of psychiatric
and mental health nursing intervention research will be critical for documenting continuing
progress toward evidence-based, psychiatric nursing practice.

Acknowledgements

The authors acknowledge the editorial assistance of Elizabeth Tornquist of the University of
North Carolina at Chapel Hill. The authors thank the Sarah Cole Hirsh Institute at the Bolton
School of Nursing, Case Western Reserve University for searching the literature to identify
studies for this review.

Author

Jaclene A. Zauszniewski, PhD, RN-BC, FAAN

E-mail: jaz@case.edu

Dr. Zauszniewski is the Kate Hanna Harvey Professor in Community Health Nursing and
Associate Dean for Doctoral Education at the Frances Payne Bolton School of Nursing of Case
Western Reserve University (CWRU), Cleveland, Ohio. She received a PhD and MSN from
CWRU, Cleveland, Ohio; a MA in Counseling and Human Services from John Carroll
University, Cleveland, Ohio; a BA in psychology from Cleveland State University, Cleveland,
Ohio; and a diploma in nursing from St. Alexis Hospital School of Nursing, Cleveland, Ohio.
With 37 years of nursing practice, including 28 years in the field of psychiatric-mental health
nursing, Dr. Zauszniewski has experience as a staff nurse, clinical preceptor, head nurse,
supervisor, patient care coordinator, nurse educator, and nurse researcher. Her program of
research focuses on the identification of factors and strategies to prevent depression and to
preserve healthy functioning during depressive episodes across the lifespan. She is best known
for her research examining the development and testing of nursing interventions to teach
resourcefulness skills to elders with chronic illness and caregivers. She has received research
funding from the National Institutes of Nursing Research and Aging, National Institutes of
Health; Sigma Theta Tau International; American Nurses Foundation; Midwest Nursing
Research Society; and the State of Ohio Board of Regents.

Abir Bekhet, PhD, RN, HSMI

E-mail: Abir.Bekhet@marquette.edu

Dr. Bekhet is an Assistant Professor at Marquette University, College of Nursing, Milwaukee,

Wisconsin. She received her BSN and MSN from Alexandria University, Faculty of Nursing,
Alexandria, Egypt. She received her PhD from Case Western Reserve University, Cleveland,
OH. Her clinical experience in psychiatric nursing is with persons having schizophrenia, bipolar
disorder, obsessive-compulsive disorder, and depressive disorder. She has taught psychiatric
mental health nursing to undergraduate and direct entry students. Dr. Bekhet’s program of
research focuses on the effects of positive cognitions and resourcefulness in overcoming
adversity in vulnerable populations. Her research has been funded by Sigma Theta Tau
International and American Psychiatric Nursing Foundation; and she is a past recipient of the
MNRS Mentorship Grant Award. Most recently, she received the Award for Excellence from the
CWRU Nursing Alumni Association and the 2012 Way-Klinger Young Scholar Award from
Marquette University.

Sara Haberlein, BSN, RN

E-mail: sara.haberlein@marquette.edu

Ms. Haberlein is a graduate student in the Pediatric Nurse Practitioner program and research
assistant at Marquette University. She received her BSN from the University of Wisconsin -
Milwaukee (UWM). Since graduating from UWM, Sara has worked as a RN in the Neonatal
Intensive Care Unit at Children’s Hospital of Wisconsin (Milwaukee, WI).

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