Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

Purpose: The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital.

Description Of The Project: The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability.

The Four S Model in action for de-escalation. An innovative state hospital-university collaborative endeavor.

In this article, the Four S Model is presented as a working clinical framework for generating structured nursing interventions and treatment plans. The de-escalation process, formalized by the De-escalation/Alternative to Restraint Flowsheet, is one way in which the model is being operationalized to reduce seclusion and restraints. As shown by the flowsheet, the model allows for integration of mental health and mental illness.