Clinical Judgment made by Experienced Psychiatric Visit Nurses with Patients with Schizophrenia

Abstract

This study aimed to clarify clinical judgment made by experienced psychiatric visit nurses with patients with schizophrenia.

The study used semi-structured interviews with 14 psychiatric visit nurses and also used the Steps for Coding and Theorization method to analyze their responses. Our results demonstrated that there are seven concepts of clinical judgment under three types of context that can be considered essential for patients to continue to live in their communities.

Taking into consideration the characteristics of patients with schizophrenia, including fragility to stimuli and difficulty expressing appropriate symptoms to others, visit nurses appeared to discern the proper relationship with the patient by examining “the state of home visit acceptance” during the early period of home visitation as well as “the distance to maintain a relationship at each home visit.” To judge the proper contexts for home visits, the nurses also used the following parameters both prior to and at the time of a home visit: “discomfort that they appeared different from usual and not themselves,” “the life, psychiatric symptoms, and drug-taking situation of the day,” and “the necessity of medical intervention.” Furthermore, in an effort to better understand patients’ ability to continue to live in a community, the nurses paid attention to parameters such as “rapid coordination to involve concerned persons” and “lifestyle continuation.”