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The corona crisis falls in the middle of the WHO’ s Year of the Nurse and the Midwife. With the publication of these interviews taken before the Covid-19 outbreak, we would like to express our gratitude and recognition for the nurses’ vital work.

Fritz Frauenfelder is Deputy Director of the Nursing, Therapy and Social Work (PTS) Board at the Psychiatric University Hospital Zurich (PUK). His research focuses on inpatient psychiatry. He is particularly interested in standardized nursing terminology.

Interview: Ursula Reis

What is your role in the Nursing, Therapy and Social Work (PTS) Board?

Fritz Frauenfelder: The PTS Directorate is responsible for all the nurses as well as for other non-medical therapists (for example occupational, physical and music therapists) and for the social workers. The total number of employees is around 1200. I am mostly concerned with strategic issues relating to professional development, human resources management and training.

Thanks to the dual management model at the PUK, the PTS directorate is involved in the operational management of each clinic. For me, this means that I deal with a broad spectrum of psychiatric care, from child and adolescent to adult and forensic psychiatry. The diversity of topics, the strategically oriented activities and the related management work fascinates me. The dual management model ensures inter-professional cooperation at all levels of hierarchy. This avoids misunderstandings, increases transparency and facilities the finding of solutions. Over all, it has positive effect on the efficient and effective implementation of tasks. This requires that we work together as partners on the management level.

I am directly responsible for the research and development department and for the data and system management. With our research activities, we monitor innovative development projects to obtain the necessary evidence. Such findings are fundamental for further decision-making processes. Specialists in everyday clinical practice initiate most innovations in a systematic process. For example, we are currently doing a study on non-drug strategies for falling asleep. Sleeping problems are common with mental disorders. Patients directly benefit from such applied research. Ultimately, our research results contribute to the further development of psychiatry.

Why are nursing classifications an important instrument in nursing?

Fritz Frauenfelder: Studies have shown that the use of standardized nursing terminology can lead to more continuity and effectiveness in patient care. The great benefit is that standardized terms are defined and embedded in a consistent structure. This ensures that all nursing professionals involved in the documentation will understand the same thing about the phenomena or actions described. The use of a standardized nursing language is an indispensable prerequisite to find evidence, both when conducting a scientific study and or deciding on effective care for an individual patient case.

The nursing classifications NANDA-I and Nursing Interventions Classification (NIC) are by far the most established and scientifically sound nursing terminologies worldwide. Through various studies, we have been able to show that the two classifications NANDA-I and NIC cover nursing in inpatient adult psychiatry to a large extent [1-5]. We used these findings to define five dimensions of care for inpatient adult psychiatry: Risk management, understanding, dealing with dysfunctions, physiological support and environment. We intend to use these dimensions as an orientation framework for the education and further training of psychiatric nurses. Yet, further research is needed. Some missing diagnoses and interventions must be defined and integrated into the corresponding classifications.

I am talking to you today on the occasion of the “Year of the Nurse and Midwife” which the WHO has proclaimed worldwide for the year 2020. What do you think is needed to strengthen nursing in Switzerland?

Fritz Frauenfelder: We need excellent employees at all levels and in all areas of care, whether in direct contact with patients, management, training or research and development. I am personally convinced that in the health sector, we can achieve sustainable cost savings by focusing on quality – in the sense of best practice, with the patients at the center of attention. We need nursing staff with very good and evidence-based training to cope with the work involved. Particularly in management roles, there is a growing need in Switzerland for professionals who do not only have the necessary personality traits but also academic knowledge. Saying so, I not only mean nurses in classical managing positions, but also those working in close contact with patients (for example Advanced Practice Nurses) and in nursing education.

To strengthen nursing, we need to emphasize on the promotion of talent and support career development, especially in the institutions. If we help our employees to find their personal career perspectives, considering their specific strengths and weaknesses as well as their wishes and needs, we will make the jobs more attractive. This applies to all nursing staff, regardless of hierarchical level, age and expertise. In addition, we need to think about new ways of organizing work schedules in nursing, especially in connection with shift work. Work schedules must be up to date and meet the current needs of employees, in particular to balance work and family life.

If we succeed in shaping a culture of learning and innovation, where outstanding performance in embraced, where courage and openness are valued and merits are accepted but not rested on, we will create the essential basis for a positive development.

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Ursula Reis is a subject specialist at the Main Library – Medicine Careum

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[1] Frauenfelder F, Müller-Staub M, Needham I, Van Achterberg T. (2011). Nursing phenomena in inpatient psychiatry. Journal of Psychiatric and Mental Health Nursing, 2011; 18, 221-235.

[2] Frauenfelder F, Müller-Staub M, Needham I, van Achterberg T. (2013). Nursing interventions in inpatient psychiatry. Journal of Psychiatric and Mental Health Nursing, 2013; 20, 921-931.

[3] Frauenfelder F, van Achterberg T, Needham I, Müller Staub M. (2016). Nursing Diagnoses in Inpatient Psychiatry. International Journal of Nursing Knowledge, 2016; 27(1), 24-34.

[4] Frauenfelder F, van Achterberg T, Müller-Staub M. (2018). Documented Nursing Interventions in Inpatient Psychiatry. International Journal of Nursing Knowledge, 2018; 29(1), 18-28.

[5] Frauenfelder F, van Achterberg T, Müller Staub M. (2018). Nursing diagnoses related to psychiatric adult inpatient care. Journal of Clinical Nursing 2018; 27(3):e463-e475.