Bridging therapy in hospital- and community-based psychiatric nursing care : a comparative study.

This study presents a detailed account of Bridging Therapy - an innovative intervention aimed at providing relatively comprehensive psychiatric nursing care for mentally ill patients. Starting at hospitalisation, Bridging Therapy continues as planned nursing care based on detailed assessment of the patient's short- and longer-term needs both before and after discharge to the community, delivered where possible by the same nurse, or by members of the same nursing team. Bridging Therapy thus presents a remedial model for current fragmented patterns of nursing care, based on an eclectic approach to psychotherapy and nursing process known as the "flexible integrative approach" (FIA).The study recognises problems caused by lack of patient outcome measures in psychiatric nursing; and approaches this by developing an appropriate assessment instrument, the Behaviour Adjustment Inventory (BAI), which is initially tested in concurrent use with a well-validated psychometric instrument (the GHQ); with a second well-validated instrument (the EPI) acting as an initial screening device. The BAI assesses patients' initial status on admission and subsequent responses to Bridging Therapy on a five-point scale, used in conjunction with detailed clinical criteria of behaviour and attitude change. Clinical evaluation of patients in the contrasted contexts of Sheffield and Cairo is described. In each context, experimental (Bridging Therapy) and control (non-Bridging Therapy) groups are studied (Sheffield total N = 22: Cairo total N = 18). Assessment of initial condition was carried out on admission to hospital; recovery status on discharge, and at the close of therapeutic follow-up in the community. Results indicate similar levels of recovery for Sheffield and Cairo groups, with a more pronounced tendency to recovery in the experimental (Bridging Therapy) groups; however, this difference does not reach statistical significance.Psychometric findings are augmented by qualitative descriptions of the implementation process. Two detailed nursing studies from each context are presented. The investigation highlights the complexity of the research problem, including important transcultural considerations; identifies multifactorial issues governing patient care; and supports further research into Bridging Therapy as a potential remedy for current gaps in psychiatric nursing care, both in Britain and Egypt. Relevant materials concerning historical/structural aspects of mental health care and varieties of psychotherapy (Chapters 1 through 3) are included because of their contextual importance both to British and Egyptian workers.