Nursing process in mental health: an integrative literature review

integrative literature review between 1990 and 2013, in the PubMed, Scopus, CINAHL and LILCACS bases. Descriptors: nursing processes, mental health, nursing care.

Results:

19 papers were identified. Limited and partial usage of the nursing process in care established by a therapeutic relationship that respects the patient’s individuality. We observe care proposals systematized for patients that present pathological aspects in the limits between the physical and psychical, which might be a response to the influence of the practice based on evidences.

Conclusion:

it was found an antagonistic movement between care based on the relationship and located in the standardization of diagnoses that respond to physical malaise. A lack of evidence was verified for the usage of the nursing process in mental health, and we point at the necessity for the creation of new possibilities for dialogue between relational and biological perspectives.

Descriptors:
Nursing Research; Mental Health; Nursing Care; Nursing Processes; Search

Authors (year)	Objective	Method	Results	Conclusion
Olaogun et al./2011⁽¹⁸18 Olaogun A, Oginni M, Oyedeji TA, Bbahiwe B, Olatubi I. Assessing the use of the NANDA - International Nursing Diagnoses ate the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria. Int J Nurs Terminol Classif [Internet]. 2011[cited 2015 Jun 10];22(4):157-61. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1744-618X.2011.01190.x/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾	To describe the use of NANDA-I ^® nursing diagnoses in the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC).	Non- experimental - Exploratory descriptive transversal.N = 67	154 diagnoses were found. The most frequent in the psychiatric ward was a self-esteem deficit (23.3%).9% of the diagnoses were not driven by the methodology problem/etiology/signs and symptoms.	Nurses use NANDA-I ^® taxonomy diagnoses, but with deficiencies in the application of the nursing process, including evaluation and reassessment based on nursing models; When they use an evaluation model, it is medical.
Piedrahita et al./2011⁽¹⁹19 Piedrahita LE, Garcia MA, Mesa JS, Rosero IS. Identificación de los factores relacionados con el intento de suicidio, en niños y adolescentes a partir de la aplicación del proceso de atención de enfermería. Colomb Med [Internet]. 2011[cited 2015 Jun 10];42(3):334-41. Available from: http://www.bioline.org.br/pdf?rc11056 http://www.bioline.org.br/pdf?rc11056... ⁾	To identify the factors related to the suicide attempt in children and adolescents hospitalized in the mental health unit of the Del Valle University Hospital and in their families, based on the functional health standards of Marjory Gordon.	Non- experimental – Descriptive N = 16.	Characterization of subjects through health standards. To provide the response of protective factors by family members. Identification of identified risk factors in children and adolescents and family risk factors.	Functional health patterns are considered a tool for the evaluation and identification of the factors involved in the suicide attempt, which facilitates the analysis of information and the selection of priority problems in order to guide nursing interventions.The present study comprised the first phase of the nursing process.
Jesus et at./2010⁽²⁰20 Jesus IS, Sena ELS, Meira EC, Gonçalves LHT, Alvarez AM. Sistematized care for elders with dementia living in a long-stay institution. Rev Gaúcha Enferm [Internet]. 2010[cited 2015 Jun 10];31(2):285-92. Available from: http://www.scielo.br/pdf/rgenf/v31n2/12.pdf http://www.scielo.br/pdf/rgenf/v31n2/12.... ⁾	To systematize a basic nursing care model based on NANDA-I ^® to be tested with people with dementia affection or medical diagnosis of dementia in a long-term institution for the elderly.	Non-experimental – Descriptive exploratory N = 9	Determination of grouped diagnoses in: 1) Diagnoses related to motor behavior; 2) to cognition; 3) to communication; 4) to other physical problems. Presentation of interventions and expected results related to the diagnosis in order to minimize the difficulties related to physical and behavioral disabilities.	Observation that the effectiveness is increased if care is incorporated into the institution’s routine. For care derived from lightweight technologies, it is necessary to prepare the workers.
Bartlett et al./2008⁽⁷7 Bartlett R, Bland A, Rossen E, Kautz D, Benfield S, Carnevale T. Evaluation of the outcome-present state test model as a way to teach clinical reasoning. J. Nurs. Educ. 2008; 47(8):337-44.⁾	To quantify the students’ abilities from a postgraduate degree in Psychiatric Nursing and Mental Health in the application of the nursing process using the clinical reasoning web and the Outcome-Present State Test model.	Non- experimentalTransversaldescriptiveexploratory. N = 43.	Improved reflection on clinical reasoning, although the students presented few nursing diagnoses. The instrument favored the connection between the evaluation of the current health status and the expected results, which delimited the interventions from the patients’ strengths identification.	The instrument became an important evaluation tool and favored the articulation between the NANDA-I ^® language - NIC^* * NIC: Nursing Interventions Classification; - NOC^ NOC: Nursing Outcomes Classification; . Necessity to confirm the effectiveness of the Outcome-Present State Test model and clinical reasoning web, since the sample was limited.
Mattos et al./2011⁽²¹21 Mattos CMZ, Garces SBB, Costa FTL, Rosa CB, Bunelli AV, Hansen D, et al. Processo de enfermagem aplicado a idosos com Alzheimer que participam do projeto estratégias de reabilitação. Estud Interdiscip Envelhec [Internet]. 2011[cited 2015 Jun 10];16(supl):433-47. Available from: http://seer.ufrgs.br/index.php/RevEnvelhecer/article/view/17921 http://seer.ufrgs.br/index.php/RevEnvelh... ⁾	To apply NP^* ***** NP: Nursing Process. to aged Alzheimer’s patients participating in the UNICRUZ project, highlighting its importance.	Non- experimental– quanti study – qualitative. N = 6	Presentation of sociodemographic profile, physical examination, description of diagnoses and interventions found without individual case discrimination.	NP^* ***** NP: Nursing Process. directed the treatment with resolution of the issues that influence the prognosis of the patient and allowed the referral, which contributed to a multiprofessional care. For this application, specific and appropriate scientific knowledge is required.
Montgomery et al./2009⁽²²22 Montgomery P, Rose D, Carter L. Patient health outcomes in psychiatric mental health nursing. J. Psychiatr Ment Health Nurs [Internet]. 2009[cited 2015 Jun 10];16(1):32-45. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2008.01327.x/abstract http://onlinelibrary.wiley.com/doi/10.11... ⁾	To examine critically the empirical evidence about the extent of nursing interventions in mental health associated with positive patient outcomes.	Studies with secondary data – Review Integrative of the literatureN = 25	It brought the evidence of five domains to the evaluation of the expected results: Symptoms , self - care, functionality, quality of life and satisfaction.	There is a strong lack of evidence to support the adoption of measures of expected nursing outcomes.

Authors (year)	Objective	Method	Results	Conclusion
Adamy et al./2013⁽²³23 Adamy EK, Krauzer IM, Hillesheim C, Silva BA, Garghetti FC. A inserção da sistematização da assistência de enfermagem no contexto da pessoa com necessidades especiais. Rev Pesqui Cuid Fundam. 2013;5(3):53-65.⁾	To develop SNC^* * SNC: Systematization of Nursing Care; with the members of a special education institution and family.	Convergent Assistance Research	The study followed a family (a girl and her two siblings, all with special needs) through SNC^* * SNC: Systematization of Nursing Care; . The total of 50 nursing diagnoses were found and 119 interventions were articulated to the diagnoses. The study presents a description of the diagnoses and priority interventions for each case.	The focus of the interventions was educational, and the application of SNC^* * SNC: Systematization of Nursing Care; was limited due to the difficulties of the learning process and other physical changes presented by the patients. The application of SNC^* * SNC: Systematization of Nursing Care; improved the studied subjects’ quality of life.
Coombs et al./2013⁽²⁴24 Coombs T, Curtis J, Crookes P. What is the process of a comprehensive mental health nursing assessment? results from a qualitative study. Int Nurs Rev [Internet]. 2013[cited 2015 Jun 10];60(1):96-102. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1466-7657.2012.01036.x/abstract http://onlinelibrary.wiley.com/doi/10.11... ⁾	To describe the attributes of the comprehensive nursing assessment process in mental health and how it is described by nurses in this area.	Grounded Theory	Three themes emerged: 1. Engaging the patient - focus on the nurse-patient relationship. 2. Tell me what the problem is? - focus on evaluation from the perspective, considering the patient's strengths. 3. Continuous process - focus on moments of interaction between nurse and patient.	The comprehensive evaluation process is unobtrusively inserted in NP ^ Nursing Process. steps. The patient engagement is fundamental for the construction of an empathic therapeutic relationship.
Hirdes eKantorski/2002⁽²⁵25 Hirdes A, Kantorski LP. Care systematization in psychiatric nursing within the psychiatric reform context. J Psychiatr Ment Health Nurs [Internet]. 2002[cited 2015 Jun 10];9(1):81-6. Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1351-0126.2001.00446.x/abstract http://onlinelibrary.wiley.com/doi/10.10... ⁾	To develop an instrument to be used by the multidisciplinary team from the psychiatric reform reference.	Grounded Theory	NP^ Nursing Process. was the method used to operationalize care based on the theoretical framework of psychiatric reform. This method was assumed for the collective and multiprofessional discussion, orienting the Therapeutic Projects.	Nursing care from NP^ Nursing Process. was feasible, operational and adequate to the new paradigm of mental health. NP^ Nursing Process. is a simple and technical method of assimilation, and non-technical assimilated it to guide the Therapeutic Project.
Hummelvolt eSeverinsson/2001⁽²⁶26 Hummelvolt JK, Severinsson E. Coping with everyday reality: mental health professionals’ reflexions on the care provided in an acute psychiatric Ward. Aust. N. Z. J. Ment Health Nurs. 2001;10(3):156-66.⁾	To explore the reflections and interpretations of the nursing team about their work in a psychiatric inpatient unit for acute patients.	Descriptive - exploratory with hermeneutical analysis.	Three themes emerged: 1 - Dealing with uncertainty: factors that contribute to the tension in work situations. 2 - Caring for the patient: description of the caring process. 3 - Coping strategies: development of care through the interaction between patient and nurse.	Professionals deal with external and internal uncertainties, which influence the care process, using the therapeutic relationship. Nursing care requires coping strategies
Goosens et al./2007⁽²⁷27 Goosens PJJ, Achterberg TV, Klein EAMK. Nursing processes used in the treatment of patients with bipolar disorder. Int. J. Ment. Health Nurs. 2007;16(3):168-77.⁾	To examine the nursing care offered to patients with Bipolar Affective Disorder.	Systematic review of the literature.	Quantitative studies: focus on the search for better answers after the development of the care plan in the acute phase. Qualitative studies: focus on the patient with investigation of their care needs. Experience reports: focus on themes (NP management^ Nursing Process. , NP^ Nursing Process. in bipolar affective disorder, safety interventions, pharmacological interventions and self-management interventions).	Weak evidence for the efficacy of NP^ Nursing Process. for patients with bipolar affective disorder. The number of articles found was limited. The description of the studies has a combination of therapy and interventions without the clear specification of which intervention contributed to each effect analyzed as a result.
Escalada et al./2013⁽²⁸28 Escalada Hernández P, Munõz Hermoso P, Marro Larrañaga I. Atención de enfermería a pacientes psiquiátricos. NANDA-NIC-NOC: una revisión de la literatura. Rev Rol Enfermería [Internet]. 2013[cited 2015 Jun 10];36(3):166-77. Available from: https://medes.com/publication/83931 https://medes.com/publication/83931... ⁾	Scope review.	To provide the synthesis of the most relevant studies describing nursing work in mental health from NANDA-I® language.	14 were included and divided into two groups: 1 - Examining the NANDA-I® diagnosis and the most frequent interventions. 2 - Care plan for psychiatric patients using the NANDA-I® language.	The most prevalent diagnoses were: disturbed thinking process and impaired social interaction. This review showed the lack of evidence regarding the use of the NANDA-I® language in the mental health field.
Coombs et al./2001⁽²⁹29 Coombs T, Curtis J, Crookes P . What is a comprehensive mental health nursing assessment? a review of the literature. Int J Ment Health Nurs [Internet]. 2011[cited 2015 Jun 10];20(5):364-70. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0349.2011.00742.x/abstract http://onlinelibrary.wiley.com/doi/10.11... ⁾	To detail how the comprehensive assessment of mental health nursing is described in the literature and its implications for teaching and research activities.	Literature review.	Categorized results:1 - Speech from mental health assessment is revealed.2 - What information do nurses seek?3 - Evaluation, interdependent or independent activity?4 - How do mental health nurses collect information as part of the assessment?5 - Evaluation process documentation.	Evidence of the existence of gaps in the assessment of mental health made by nurses in the fields of physical and social assessment.

Authors (year)	Objective	Method	Results
Toledo et al./2011⁽³⁰30 Toledo VP, Ramos NA, Wopereis F. Processo de enfermagem para pacientes com anorexia nervosa. Rev Bras Enferm [Internet]. 2011[cited 2015 Jun 10];64(1):193-7. Available from: http://www.scielo.br/pdf/reben/v64n1/v64n1a29.pdf http://www.scielo.br/pdf/reben/v64n1/v64... ⁾	To report the experience of applying NP^* * NP: Nursing Process. to an anorexia nervosa patient, using the nursing diagnoses of NANDA-I® taxonomy II, the nursing interventions and outcomes.	Case with description of nursing history, mental state examination and physical examination. The care plan was developed considering the reality of the patient and institution, which made possible their active participation in care planning. Nursing history became the starting point for the constitution of nurse-patient relationship.	When NP^* * NP: Nursing Process. is correctly applied, it brings great benefit to the patient, organizes the nurse's activities and results in a practice with greater autonomy. The NP^* * NP: Nursing Process. provided an improvement in the patient's quality of life during hospitalization
Ruymán Brito-Brito et al./2009⁽³¹31 Ruymán Brito-Brito P, Rodriguez-Ramos M, Talaver CPG. Caso clínico: duelo complicado en atención primaria: Planificación de los cuidados. Enferm Clin. 2009;19(6):345-8.⁾	To describe a complicated case of mourning using NP^* * NP: Nursing Process. .	It presents nursing history and nursing assessment from Marjory Gordon's functional health standards. Afterwards identification of the nursing diagnosis (NANDA-I®) priority: complicated mourning. Planning and implementation of Nursing Outcomes Classification Nursing Interventions Classification - Nursing Outcomes Classification.	It is noteworthy that the election of the diagnosis took into account the stress factors associated with mourning. Regarding the interventions elaborated, the importance of the patient's participation in the diagnosis of mourning was emphasized, the willingness to elaborate telling the life story becomes fundamental as a care. Specific knowledge about grief is required for the nursing process development.
Hirdes e Kantorski/2000⁽³²32 Hirdes A, Kantorski LP . Sistematização do cuidado de enfermagem psiquiátrica. Texto Contexto Enferm. 2000;9(2):94-105.⁾	To report the systematization of psychiatric nursing care provided to two patients suffering from psychic suffering.	Presentation of nursing history and assessment from psychopathology and social issues. Establishment of nursing problems, the proposal of actions and evaluation using the NP^* * NP: Nursing Process. from Irving's theoretical proposal.	The NP^* * NP: Nursing Process. was shared with the interdisciplinary mental health team and became organizer of the therapeutic project. NP^* * NP: Nursing Process. , supported by Irving's frame of reference and theoretically supported by the presuppositions of psychiatric reform, produces integral care and ethics in mental health.

Authors (year)	Objective	Method	Results
Courey/2006⁽³³33 Courey T. Mental health needs of children and adolescents at camp: are they being assessed and treated appropriately by the camp nurse? J Child Adolesc Psychiatr Nurs. 2006;19(4):215-23.⁾	To focus on the importance of recognizing and addressing the mental health needs of children and adolescents using skills and practice patterns of psychiatric nursing and mental health.	Presents a proposal to apply the standards of psychiatric nursing and mental health to camps, with the use of NP^* * NP: Nursing Process. in six steps, according to the American Nursing Association (evaluation, diagnosis, expected results, planning, implementation and evolution).	NP^* * NP: Nursing Process. has become a response to the mental health needs of children and adolescents. The nursing care in the camps must be related to other factors and requires of the nurses experience in pediatrics, medical clinic, emergency and mental and psychiatric health.
Poggenpoel/1994⁽³⁴34 Poggenpoel M. Psychiatric nurse: pacient interaction facilitating mental health. Curations. 1994;17(1):51-7.⁾	To formulate a model of care for psychiatric nursing using concepts derived from the nurse-patient interaction.	It assumes the Whole Person theory as part of the model of psychiatric nursing that has as its scientific basis the nurse-patient interaction for the evaluation, diagnosis and prescription of nursing and proposes the use of the Psychiatric Nurse - Patient Interaction Facilitating Mental Health.	The proposition of a NP^* * NP: Nursing Process. model using the model Psychiatric Nurse - Patient Interaction Facilitating Mental Health favors the structuring of basic prognoses.
Morrison/1992⁽³⁵35 Morrison EG. Inpatient practice: an integrated framework. J. Psychosoc. Nurs. Ment. Health Serv. 1992;30(1):26-9.⁾	To provide an integrated conceptual model for practice, using as theoretical references Peplau (1952), Bowen (1976) and NP^* * NP: Nursing Process. with the purpose of guiding the complex practice of nursing in mental health in a patient hospitalization sector.	Synchronism between the phases of the therapeutic relationship developed by Peplau(36) and the NP^* * NP: Nursing Process. phases. It affirms that the integration of these two models favors evaluation and extended action, since the therapeutic relationship has its focus of action towards the patient, and NP^* * NP: Nursing Process. has its development focused on the nurse’s practice.	The use of integrated theoretical frameworks favor the establishment of care capable of responding to the complex demands of mental health patients.

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[1] CORRESPONDING AUTHOR: Ana Paula Rigon Francischetti. Garcia E-mail: apgarcia@unicamp.br