看護とケアのジャーナル

Requirements with Regard to Nursing Consultation by mental Health Consultation Liaison Nurses and Suggestions for their Intervention

Abstract

Mariko Kaneko, Noriko Yamauchi, Taeko Yasuda, Hazuki Igita and Yoshiko Kawano

Objective: This study aimed to analyze requirements with regard to nursing consultation by mental health consultation liaison nurses (MHCLNs) and examine suggestions for MHCLN intervention.

Methods: Subjects included 4 MHCLNs from a university hospital with approximately 1400 hospital beds located in the Tokyo metropolitan area and 143 patients and family members who either volunteered or were requested to participate by nurses. The consultation request route common to all 4 activity record formats, age and sex of the individual requesting counseling, and diagnosis and consultation data were retrospectively studied.

Results: Of the 143 subjects, 58 were male (40.6%) and 85 were female (59.4%), with a mean age of 54.2 years. Of 124 diagnoses, cancer was the most common (n = 66, 53.2%). With regard to patients’ psychiatric status, acceptance of the disease was the most common difficulty (n = 39, 27.3%), followed by adjustment disorder (n = 29, 20.3%) and mood disorder (n = 10, 7.0%). Psychiatric symptoms included anxiety (n = 75, 45.1%), depression (n = 38, 22.9%), and anger (n = 29, 17.4%).

The consultation requests came most commonly from staff (n = 66, 46.2%), followed by attending physicians, psychiatrists, or the palliative care team (n = 26, 18.2%) and administrators (n = 26, 18.3%). Twenty-two (15.7%) requests were made directly by the patient or family member. MHCLNs collaborated with psychiatrists for 74 (51.7%) subjects, whereas they did not collaborate for 68 subjects (47.6%).

Details of direct care included interviews using supportive psychotherapy (n = 92, 64.3%) combined with relaxation (n = 18, 12.5%) and an approach to partial recognition (n = 11, 7.7%). Nursing consultations totaled 127 (88.8%).

Conclusions: Among the subjects consulted by an MHCLN, those that were counseled by a nurse alone (i.e., no liaison with the psychiatry department) often had difficulty in accepting the disease or were maladjusted with symptoms such as anxiety, depression, or anger. If these symptoms can be relieved during the early stages, medication may not be required and consultation or practice may prevent deterioration in the psychiatric condition and lead to an improvement in symptoms. In patients with somatic disorders requiring psychological care, nurses highly specialized in mental health care, such as MHCLNs, are required to serve as liaison personnel. This is especially required for patients with psychological problems caused by the stress of the disease and treatment, albeit within normal limits, or for patients in a condition requiring psychiatric treatment.