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The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced. Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy of Thomas Kuhn to explore the impact of what Kuhn terms 'anomalies' within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing., (© 2023 The Authors. Nursing Philosophy published by John Wiley & Sons Ltd.)

Inpatient progress is monitored mostly via the observation conducted by nursing staff. These tend to be unstructured, vary in reliability between different staff members, and be dependent on what has been written in nursing notes. The Nursing Observed Illness Intensity Scale (NOIIS) was devised to provide a more objective measure of behavioural improvement and symptom reduction. The scale is completed by qualified nurses at the end of every shift, based on everyday nursing observation and interaction with patients, and scores are entered on a NOIIS 'temperature' chart. In this study, more than 6000 ratings were captured on 106 admissions to a psychiatric intensive care unit. Inter-rater reliability of the scale was found to be satisfactory, and validity against the Brief Psychiatric Rating Scale good. Scores were shown to relate to the social organization and treatment methods of the unit. Recovery curves differed significantly by diagnosis, with patients having schizophrenia showing the slowest improvement. From a clinical point of view, the NOIIS can be used to track progress, response to changes in treatment and readiness of the patient for discharge; aids staff deployment; and can be used for clinical audit. For research, the scale can be used in clinical trials of treatment outcomes., (© 2010 Blackwell Publishing.)

Accurate evaluation of patients' psychotic state is essential to decrease psychotic symptoms and protect the patient and others. The aim of this paper is to conduct a literature review in order to access the utility, reliability and validity of current rating scales that are purported to measure psychotic acuity of inpatient population. A search of a number of electronic databases was undertaken to retrieve potential articles that focus on the measurement of acute psychosis. We identified some conceptual and theoretical problems when using a scale that is monitoring the progress of discharge and assesses the outcome of treatments. The findings revealed a difficulty in finding a commonly agreed definition of acute psychosis and a problem of obtaining frequent measures, and the frequency of measurement and fluctuation in psychosis. The most dominant scales in assessing psychosis were reviewed: the Global Assessment of Functioning Scale, the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale. Several issues related to the scales' inter-rater reliability and construct validity remain unexplored. None of these scales addressed the conceptual and theoretical problems that we identified. A new scale that will measure acuity of symptoms in inpatient settings needs to be created.

The physical restraint of a disturbed person is a subject constant of psychiatry and is a challenge that particularly faces nurses working in acute inpatient settings. While other approaches to psychiatric treatment have been discarded (e.g. punishment, blood letting, trepanation, deep insulin therapy and so on) or evolved into new treatments (the use of medication), the act of physical restraint has remained largely unmodified. Given the ubiquity of physical restraint in psychiatry, particularly as a nursing procedure, the absence of a sustained body of research is notable. This essay examines some of the historical underpinnings of the use of restraint in psychiatry brought into sharp focus by the David Bennett Inquiry Report (2003) and the National Institute of Clinical Effective (NICE) guidelines (2005) on the management of violence.

In order to contextualize Altschul's interest in group dynamics we present a brief history of staff group work approaches in the UK and USA. Using case examples, the work of staff group sensitivity and group supervision is described. The difficulties of working in staff groups are highlighted and the antipathy towards group practice is discussed. It is argued that learning about conflict resolution in staff groups prepares nurses for dealing with conflicts in clinical practice. The case for re-invigorating interest in group theory and practice is presented. In presenting our reflections on staff group work, we hope not only to re-kindle the type of interest in groups that inspired Altschul but also to represent the case that it is ill conceived to attempt the work of mental health nursing without recourse to the supervisory resources of group theory, practice and support. It is through group feedback that mental health nurses and other health professionals can extend their learning about interpersonal relations, achieve quality standardization through peer feedback and reflect on practice in truly collaborative ways (Schon 1983).

Based on unobtrusive observations, a parallel is drawn between general and psychiatric intensive care nursing. The correlation between bedside skills and the incidence of physical contact between nurse and patient in each setting is considered. The phenomenon of physical attacks by patients on carers and the process of restraint in the psychiatric intensive care unit (ICU) is then examined. It is suggested that attack by and subsequent restraint of a disturbed patient may be considered in terms of an unconscious re-enactment of an early skin-on-skin object relation. It is argued that the physical holding of a psychotic patient is functional in re-establishing their bodily ego. Some thoughts are offered on how the intensive care of psychotic patients might be carried forward in the future.

Topic: The role of the nurse psychotherapist in the U.K., Purpose: To explore the barriers and future possibilities of nurse psychotherapists in the U.K., Source: A review of the literature, communication with nurse leaders in the U.K., the author's own experience., Conclusion: There is a body of nurses in the U.K. that has begun to meet regularly and uses psychodynamic theory either in clinical practice or to teach students. The plan is to develop specific standards of training and registration.

The article reports on the results of research which was conducted in to compare the views of nurses and patients regarding the administration of medication on acute psychiatric wards. Researchers found that that noisy and busy environments and overworked nurses can have an effect upon the their perspective, if not their performance. and that patients were happy with the way that staff engaged with and felt that nurses provide a good service for which they are grateful.

The article presents a study that examines the evolution of the cultural care program of Soins Culturels in Paris, France. The program of Soins Culturels for the young inpatients states three main aims: to bring life into hospitals; to integrate culture into medical treatment; and to introduce topics for action and reflection.

The article investigates the effects of patient's aggressive behavior on nursing staff and their resignations from the psychiatric wards. The relevant data was obtained from official reporting systems of National Health Service Trust, London, U.K. The author discusses psychiatric patients' behavior, reactionary defensive practices by the psychiatric professionals, and subsequent media pressure, culminating into decreased health-care standards.