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Semyonov-Tal K. Legal consciousness of psychiatric patients in Israeli hospitals: Awareness and satisfaction. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 96:102015. [PMID: 39126812 DOI: 10.1016/j.ijlp.2024.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
The paper contributes to the literature on legal consciousness in medical settings by focusing on psychiatric patients' understanding of rights during hospitalization in Israeli psychiatric wards. It asks whether hospital personnel act as agents who promote patients' legal consciousness and whether patients are aware of their legal and social rights during hospitalization. The data for this study were derived from the Patient Experience Survey of Psychiatric Public Hospitals, a comprehensive survey conducted by the Israel Ministry of Health in 2017. The survey included two variables that were used to measure patients' legal consciousness: legal consciousness with hospitalization rights and legal consciousness with social rights. To predict legal consciousness and patient satisfaction, a logistic regression model was employed. The analysis reveals low rates of patients' awareness of hospitalization and social rights, varying between 55 and 66%, respectively. Variations in awareness are not strongly associated with patients' socioeconomic and demographic attributes or with hospital characteristics but are somewhat associated with hospitalization conditions. The data also reveal that awareness of legal rights (whether hospitalization rights or social rights) is likely to increase satisfaction with the hospitalization experience. The analysis underscores a significant finding. Patients' awareness of their legal rights during hospitalization is limited. Interestingly, this awareness is more influenced by the conditions of hospitalization than by the patients' socio-demographic attributes. This research also provides insights into the potential role of legal awareness in shaping patients' attitudes toward treatment and enhancing their satisfaction during hospitalization.
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Tingley D, Ashworth R, Torres Sanchez D, Mac Mahon GH, Kusel Y, Rae BM, Shorthouse T, Bartley A, Howell G, Hurley J. Is the Invisibility of Dementia a Super-Power or a Curse? A Reflection on the SUNshiners' Questionnaire into the Public Understanding of Dementia as an Invisible Disability: A User-Led Research Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:466. [PMID: 38673377 PMCID: PMC11050154 DOI: 10.3390/ijerph21040466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
The SUNshiners group includes people in the early stages of dementia with an interest in dementia activism and research. The group found that despite the growing awareness of invisible disabilities, there is very limited research into the pros and cons of the invisibility of dementia. Our paper explores the SUNshiners research which stemmed from varied individual experiences of disclosing diagnoses. The group designed and developed a short survey to explore what the public knew about dementia and what they thought about the invisibility of dementia. A mixture of open- and closed-ended questions were used to gain meaningful data. A total of 347 people completed the survey (315 online and 32 paper-based), which was then co-analysed. The findings suggest that the majority of the public felt that the invisibility of dementia was negative; that knowing someone had dementia when first meeting them would be beneficial; that people living with dementia should maintain the right to vote; and that people living with dementia do not automatically require a consistent, regular carer. Common themes from the open-ended answers included capacity, severity of dementia, and access to support. The findings support the disclosure of dementia diagnosis; however, more action is needed to tackle stigmatised views, particularly as the SUNshiners felt that people do not have enough dementia education to support a positive disclosure experience. They shared their experiences of the group and the project's benefits, but also the losses they have faced. Our paper aims to be as accessible as possible.
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Affiliation(s)
- Danielle Tingley
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Rosalie Ashworth
- Neuroprogressive and Dementia Network, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK;
| | - Dalia Torres Sanchez
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Grace Hayes Mac Mahon
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Yvette Kusel
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Brigitta Maria Rae
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Tracey Shorthouse
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Alan Bartley
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Gabrielle Howell
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
| | - Joanne Hurley
- SUNshiners Group, Kent and Medway Partnership Trust (NHS), Community of Mental Health for Older Adults, Folkestone Health Centre, Folkestone CT20 1JY, UK
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Meeting in the middle: experiences of citizenship in community-engaged psychosis research. JOURNAL OF PUBLIC MENTAL HEALTH 2023. [DOI: 10.1108/jpmh-10-2022-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Purpose
Previous research has highlighted the importance of engaging people with lived experience (PWLE) in the knowledge creation process. However, diverse approaches to engagement exist. In addition, tensions remain in community-engaged research (CER), including how to address structural inequalities in research settings. This study aims to consider how CER interacts with citizenship within and beyond the research context.
Design/methodology/approach
This study discusses the authors’ experiences as a majority-PWLE of psychosis research team in Canada, including successes and challenges the authors experienced building their team and navigating research institutions. This study also reflects on the authors’ pathways through citizenship, prior to and during the research process. This study discusses divergent models of CER and their applicability to the cyclical process of citizenship and community participation.
Findings
Relationships between academic and peer researchers developed organically over time. However, this study was limited by structural barriers such as pay inequality and access to funding. The authors recognize that there are barriers to full citizenship and acknowledge their resources and privilege of being well supported within their communities. Team members built on a foundation of citizenship to access participation in research. This led to opportunities to engage in community spaces, and for PWLE to participate in research as partners and leaders. This study also found that citizenship is a way of giving back, by building a sense of social responsibility.
Originality/value
Academic and peer researchers can reflect on the authors’ experiences to build more inclusive research teams and communities by using a citizenship approach to research participation.
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Shue SA, Traylor M, Kukla M, Salyers MP, Rollins AL, Henry N, Eliacin J, Garabrant J, McGuire AB. Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:283-295. [PMID: 36495371 DOI: 10.1007/s10488-022-01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/05/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units. METHOD VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory. RESULTS The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement. CONCLUSION Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.
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Affiliation(s)
- Sarah A Shue
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA.
| | - Morgan Traylor
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
| | - Marina Kukla
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Nancy Henry
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Johanne Eliacin
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Jennifer Garabrant
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Alan B McGuire
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
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Hennessy B, Hunter A, Grealish A. A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings. J Psychiatr Ment Health Nurs 2022; 30:398-434. [PMID: 36519519 DOI: 10.1111/jpm.12889] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Research indicates many people accessing mental healthcare have trauma history and often experience re-traumatization in acute mental health inpatient settings. Treatment for trauma is not routinely explored as a treatment option in mental health inpatient settings and consequently mental health professionals do not draw connections between the person with trauma history and their presenting mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People in acute mental health inpatient units are not asked about their previous trauma histories on admission and their trauma history is not taken into consideration during interventions in particular coercive practices such as seclusion, restraint, forced medication, and involuntary admission. This paper provides an understanding on how to address trauma-related issues within in-patient settings and identifies practical examples of how to reduce the risk of re-traumatization. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Staff induction and training development needs can be used to help mental health professionals to be more confident and competent in assessing and identifying the history of trauma so that they can improve recognition, provide post-disclosure support, and avoid the potential for re-traumatization for inpatients. Physical environments need to be welcoming, homely, and have comfortable furnishing. They also require adequate space for inpatients to move around freely and have a quiet space to go to de-escalate themselves when required. ABSTRACT INTRODUCTION: Rates of re-traumatization among mentally ill-health patients have risen significantly over the past decade and clinical guidelines place mental health nurses at the heart of their care. AIM To gather, analyse, and synthesize the evidence on people's experiences on re-traumatization in acute mental health inpatient settings. METHOD A systematic search for qualitative studies (CINAHL, MEDLINE, ASSIA, PsycINFO, and EMBASE) was conducted. Two authors independently assessed eligibility and appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. RESULTS Fourteen papers were included for thematic synthesis. Three themes emerged: (1) Quality of staff interaction; (2) Specific interventions, (Sub-theme nature of symptoms); and (3) Nature of the environment. DISCUSSION Our findings demonstrate that patients are experiencing re-traumatization in acute mental health inpatient settings and that there is little being done to prevent it from occurring. IMPLICATIONS FOR PRACTICE This study is the first to analyse the factors that contribute to re-traumatization and make recommendations to mental healthcare professionals to reduce the harmful practices in place in inpatient settings. It is suggested that training staff in trauma-informed care and allowing patients to be experts in their own care can reduce the rates of re-traumatization.
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Affiliation(s)
- Brid Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Dames NB, Keller DS. The lived experience. Colorectal Dis 2022; 24:1613-1615. [PMID: 36111427 DOI: 10.1111/codi.16322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Nicola B Dames
- Association of Coloprotology of Great Britain and Ireland (ACPGBI), Patient Liaison Group (PLG), Glasgow/Oxford, UK
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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Grove JL, April LY, Evan MK. Social Support as Protective Factor for Suicidal Ideation during Treatment for Substance Abuse: Differential Effects across Treatment Modalities. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2022. [DOI: 10.1016/j.crbeha.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mental Health Peer Worker Perspectives on Resources Developed from Lived Experience Research Findings: A Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073881. [PMID: 35409560 PMCID: PMC8998053 DOI: 10.3390/ijerph19073881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023]
Abstract
Lived experience research is potentially useful for assisting the recovery journeys of people experiencing mental health challenges, when presented in user-friendly formats. Consumer peer workers are ideally placed to introduce such resources to the people they work with. This study sought to explore the perspectives of expert consumer peer workers on the potential use of lived experience research resources in peer work practice. In particular: (1) what research topics would be most useful; and (2) what considerations are important for developing user-friendly and useful resources using findings from this research. A hybrid Delphi study was conducted. Eighteen expert peer workers participated in online group interviews, which included a semi-structured discussion and modified nominal group technique. These were followed by two rounds of surveys, which focused on prioritising the identified topics. Participants identified 47 topics suitable for lived experience research resources, 42 of which reached consensus as useful for consumers. A priority list of topics for use in peer work was identified through examination and grouping of peer worker rankings of the usefulness of resources for their work with consumers. The highest priority topics were as follows: developing and maintaining social networks; how peer workers can support consumers in their recovery journey; having choice with medications and participating in the decision-making process; and knowing your rights and responsibilities. Participants noted, however, that the usefulness of each topic ultimately depended on individual consumer's needs. They highlighted that a variety of formats and presentation were required to reach diverse consumer groups.
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Carroll L, Casey H, Adams R, O’Connor S, O’Reilly Á. COVID-19 on an acute psychiatric unit: an interdisciplinary, trauma-informed response. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-04-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
There is a high prevalence of trauma among mental health clients, with risk of re-traumatisation when admitted to a Department of Psychiatry (DoP) (Kimberg and Wheeler, 2019). The COVID-19 pandemic poses challenges to therapy service operations in DoPs, with infection control measures impacting opportunities for therapeutic and social engagement. A trauma-informed care (TIC) lens was used when adapting services in Tallaght University Hospital DoP in response to COVID-19.
Design/methodology/approach
An interdisciplinary approach was taken to adapt therapy services during early stages of the pandemic. Changes were informed by TIC principles to minimise re-traumatisation while maintaining high-quality services. Changes included expansion of the therapeutic activity programme, changes to groups, addition of COVID-19-specific groups and increased awareness of communication support needs.
Findings
The early response to the pandemic, combined with the focus on TIC, resulted in continued, effective therapy services and positive client feedback. With clients’ involvement in their care enhanced, Individual Care Planning goals were achieved through group interventions.
Originality/value
The COVID-19 pandemic brought unprecedented changes to mental health services. This paper highlights a response to unique challenges brought by COVID-19 on a DoP.
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Klemanski DH, Barnes T, Bautista C, Tancreti C, Klink B, Dix E. Development and Validation of the Psychiatric Inpatient Experience (PIX) Survey: A Novel Measure of Patient Experience Quality Improvement. J Patient Exp 2022. [DOI: 10.1177/23743735221105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Managing patient experience is critical in transforming organizational cultures into high-quality patient-centered care systems. Patient experience measurement should ideally entail a framework for understanding a patient's interactions and perceptions across the continuum of care. The purpose of this study was to develop a psychometrically valid survey via a rigorous measurement development and validation process. Methods: An initial 28-item, five-domain survey with 2 additional open-ended prompts for narrative feedback was developed and piloted using exploratory and confirmatory factor analyses on a sample of 2438 individuals. A thematic analysis was subsequently performed based on the open-ended items to elucidate primary and secondary themes of patients’ narrative feedback. Results were used to further inform a conceptual framework and item design. Results: Factor analyses produced 4 factors (treatment team relationships, nursing team presence, treatment effectiveness, and healing environment). These 4 factors are associated with inpatient psychiatric patient experience, suggesting validity. Discussion: The Psychiatric Inpatient Experience (PIX) ysurvey integrates patient experience theory as well as aspects of patient-centered care that are important to psychiatric inpatients. It provides organization and discipline-specific feedback to facilitate opportunities for patient experience improvements.
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Affiliation(s)
- David H. Klemanski
- Yale University, New Haven, CT, USA
- Yale New Haven Psychiatric Hospital, Yale New Haven Health, New Haven, CT, USA
| | - Todd Barnes
- Yale New Haven Psychiatric Hospital, Yale New Haven Health, New Haven, CT, USA
| | - Cynthia Bautista
- Yale New Haven Psychiatric Hospital, Yale New Haven Health, New Haven, CT, USA
- Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
| | - Cristina Tancreti
- Yale New Haven Psychiatric Hospital, Yale New Haven Health, New Haven, CT, USA
| | - Beth Klink
- Yale New Haven Psychiatric Hospital, Yale New Haven Health, New Haven, CT, USA
| | - Ebony Dix
- Yale University, New Haven, CT, USA
- Yale New Haven Psychiatric Hospital, Yale New Haven Health, New Haven, CT, USA
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McGuire AB, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Myers LJ, Flanagan ME, Hunt MG, Iwamasa GY, Bauer SM, Carter JL, Salyers MP. Recovery-oriented acute inpatient mental health care: Operationalization and measurement. Psychiatr Rehabil J 2021; 44:318-326. [PMID: 34323532 PMCID: PMC8664980 DOI: 10.1037/prj0000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. METHOD The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. RESULTS A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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Fakoya OA, McCorry NK, Donnelly M. How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study. PLoS One 2021; 16:e0256900. [PMID: 34499682 PMCID: PMC8428774 DOI: 10.1371/journal.pone.0256900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Befriending is a popular way in which to intervene to combat loneliness and social isolation among older people. However, there is a need to improve our understanding about how these interventions work, for whom and in which contexts, to make the best use of the increasing investment in the provision and delivery of befriending services. METHODS A realist evaluation was undertaken as it focuses on uncovering causal processes and interactions between mechanisms and contextual characteristics. Five case studies of befriending programmes in Northern Ireland were studied, reflecting variation in contextual variables, service user and provider characteristics. Data was collected via service documentation and semi-structured interviews (n = 46) with stakeholders involved in the delivery and receipt of befriending interventions. RESULTS Eight initial programme theories were generated, which were 'tested' in the case study analysis to uncover context-mechanism-outcome relationships. Mechanisms identified included reciprocity, empathy, autonomy, and privacy which were triggered in different contexts to support the alleviation of loneliness and social isolation. Reciprocity was 'triggered' in contexts where service users and befrienders shared characteristics, the befriender was a volunteer and befriending took the form of physical companionship. Contexts characterised in terms of shared experiences between befriender and service user triggered empathy. Autonomy was triggered in contexts where befriending relationships were delivered long-term and did not focus on a pre-defined set of priorities. Privacy was triggered in contexts where service users had a cognitive/sensory impairment and received one-to-one delivery. CONCLUSION This study improves understanding about how and why befriending interventions work. Findings indicate that services should be tailored to the needs of service users and take into consideration characteristics including mobility, impairments e.g. physical, sensory and/or cognitive, as well as the influence of service characteristics including payment for befrienders, fixed/long-term befriending relationship, one-to-one support and the impact of non-verbal communication via face-to-face delivery.
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Affiliation(s)
- Olujoke A. Fakoya
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland
| | - Noleen K. McCorry
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland
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Molin J, Vestberg M, Lövgren A, Ringnér A, Graneheim UH, Lindgren BM. Rather a Competent Practitioner than a Compassionate Healer: Patients' Satisfaction with Interactions in Psychiatric Inpatient Care. Issues Ment Health Nurs 2021; 42:549-554. [PMID: 32975473 DOI: 10.1080/01612840.2020.1820645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Interactions with staff are important aspects in patients' experiences of psychiatric inpatient care (PIC). This study aimed to evaluate patients' satisfaction with their interactions with PIC staff and whether sociodemographic factors, depression and anxiety symptoms were associated with their perceptions of these interactions. In this cross-sectional study, we collected data from 84 patients receiving inpatient care in three psychiatric settings in Sweden. The patients' perceptions of interactions with staff and self-reported degrees of depression and anxiety were evaluated through questionnaires. Overall, patients were satisfied with the patient-staff interaction. However, significantly higher scores were related to staffs' practical competence than to their compassion. Older patients reported significantly more satisfaction than younger patients with their most recent meeting with staff. Tailored nursing interventions may improve staff's compassionate capacity. Further research in larger samples is needed to improve our understanding of the factors associated with how patients perceive their interactions with staff.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | | | - Anna Lövgren
- Department of Odontology, Umeå University, Umeå, Sweden
| | - Anders Ringnér
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Paediatrics, Umeå University Hospital, Umeå, Sweden
| | - Ulla Hällgren Graneheim
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
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15
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Semyonov-Tal K. Complaints and Satisfaction of Patients in Psychiatric Hospitals: The Case of Israel. J Patient Exp 2021; 8:2374373521997221. [PMID: 34179386 PMCID: PMC8205344 DOI: 10.1177/2374373521997221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The main objective of the research is to advance knowledge in the field of patient experience. First, the research provides a classification of verbal responses by patients to an open-ended question (using content analysis) into distinct categories of concerns and complaints; and second, it examines (using regression analysis) the extent to which different types of complaints exert a differential impact on the level of patient satisfaction. The content analysis reveals that patient voice extends across a wide variety of issues, including complaints regarding physical conditions of the facility, quality of food, cleanliness, caregiver attitudes, availability of medical staff, lack of communication with staff, malpractice, and lack of privacy and respect. Linear regression analysis reveals that patients who complained about the hospitalization experience, especially complaints about interpersonal relations, are less likely to express satisfaction regarding hospitalization. The findings underscore the importance of patient’s complaints for understanding patient satisfaction (or dissatisfaction) with hospitalization. Patients’ complaints, especially in the area of interpersonal relations, are found to be consequential for the patient level of satisfaction.
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16
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Schöpf-Lazzarino AC, Böhm P, Garske U, Schlöffel M, Stoye A, Lamprecht J, Mau W, Farin E. Involving patients as research partners exemplified by the development and evaluation of a communication-skills training programme (KOKOS-Rheuma). Z Rheumatol 2021; 80:132-139. [PMID: 32676754 PMCID: PMC7929963 DOI: 10.1007/s00393-020-00839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite widespread recommendations for involving patient research partners (PRPs), there is little information about how patients have been involved in research. Our aim was to describe and assess the contributions of four PRPs in a project on communication-skills training funded by Deutsche Rheuma-Liga Bundesverband e. V. (German League Against Rheumatism [GLR] is a patient organisation for people with rheumatic and musculoskeletal diseases). The PRPs' participation was beneficial with regards to content and organisation. Thanks to their participation, we could enlarge our sample by over a third, and they contributed their own ideas to the training. Four PRPs added their perspective of various regional organisations. Outside this project, they were also very active within GLR and experienced in managing their rheumatic disease. To achieve more representativeness, future studies might also employ strategies to engage individuals with less experience in dealing with their disease, e.g. newly diagnosed patients. While the collaboration between PRPs and researchers proved very successful, more regular discussions about tasks and responsibilities would be worthwhile.
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Affiliation(s)
- A C Schöpf-Lazzarino
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
- Division of General Practice/Family Medicine, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - P Böhm
- Deutsche Rheuma-Liga Bundesverband e. V., Bonn, Germany
| | - U Garske
- Deutsche Rheuma-Liga Bundesverband e. V., Bonn, Germany
| | - M Schlöffel
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - A Stoye
- Institute of Rehabilitation Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - J Lamprecht
- Institute of Rehabilitation Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - W Mau
- Institute of Rehabilitation Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - E Farin
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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17
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Rio JHM, Fuller J, Taylor K, Muir-Cochrane E. The impact of workplace culture on the accountability of mental health nurses to involve consumers in care planning: A focused ethnography. Nurs Health Sci 2021; 23:255-262. [PMID: 33389799 DOI: 10.1111/nhs.12807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 02/03/2023]
Abstract
Recovery-oriented mental health practice guidelines recommend regular consumer involvement in care plans, yet in many acute settings, these are not routinely created thereby compromising accountability. This study explored the impact of workplace culture on the capacity of mental health nurses to involve consumers in care planning and consequently to work accountably. A focused ethnography was undertaken in one Australian inpatient unit involving mental health nurses and other health professionals. Data were derived from in-depth semistructured interviews with 12 nurses and 6 months of nonparticipant observation of multidisciplinary meetings and clinical handovers. Workplace culture had an impact on mental health nurses' accountability practices. A culture that prioritized reduction in length of stay resulted in less recovery-oriented care. Health professionals who paid more attention to crisis and risk management resulted in fewer opportunities for consumer-involved care planning.
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Affiliation(s)
- Josephien H M Rio
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Riverland Mallee Coorong Local Health Network (Mental Health Services), Berri, South Australia, Australia
| | - Jeffrey Fuller
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Kerry Taylor
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Eimear Muir-Cochrane
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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18
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Al Mousa Y, Callaghan P, Michail M, Caswell G. Saudi service users' perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry. Int J Ment Health Nurs 2021; 30:300-316. [PMID: 32876391 DOI: 10.1111/inm.12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/03/2023]
Abstract
This paper presents, as part of a larger mixed-methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi-structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users' health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self-awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay's 'Cultural Originality' as well as contemporary examples of Goffman's mortification of the self.
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Affiliation(s)
- Yaqoub Al Mousa
- Al Omran General Hospital, Directorate of Health Affairs in Al Hasa Governorate, Ministry of Health, Hofuf, Saudi Arabia
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, London, UK
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
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19
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Beames JR, Kikas K, O'Gradey-Lee M, Gale N, Werner-Seidler A, Boydell KM, Hudson JL. A New Normal: Integrating Lived Experience Into Scientific Data Syntheses. Front Psychiatry 2021; 12:763005. [PMID: 34777064 PMCID: PMC8585932 DOI: 10.3389/fpsyt.2021.763005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/07/2021] [Indexed: 01/30/2023] Open
Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Katarina Kikas
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Nyree Gale
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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20
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Schmidt M, Uman T. Experiences of acute care by persons with mental health problems: An integrative literature review. J Psychiatr Ment Health Nurs 2020; 27:789-806. [PMID: 32083776 DOI: 10.1111/jpm.12624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development-oriented solutions for the improvements of these experiences. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Acute care can be understood through patients' experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post-discharge well-being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. ABSTRACT: Aim The provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure-process-outcome framework (Prospero ID: CRD42019116652). Method and results An integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. Discussion The review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients' satisfaction and their well-being after discharge, were also predominantly experienced negatively. Implications for practice Using Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the field's development.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Timur Uman
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
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21
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Honey A, Boydell KM, Coniglio F, Do TT, Dunn L, Gill K, Glover H, Hines M, Scanlan JN, Tooth B. Lived experience research as a resource for recovery: a mixed methods study. BMC Psychiatry 2020; 20:456. [PMID: 32958045 PMCID: PMC7507671 DOI: 10.1186/s12888-020-02861-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lived experience research is conducted by people who have experience of mental health issues and is therefore better placed than more traditional research to illuminate participants' experiences. Findings that focus on identifying enablers of recovery from a lived experience perspective have the potential to assist people in their recovery process. However, this lived experience research is often difficult to find, access and interpret. We co-produced user-friendly and engaging resources to disseminate findings from six lived experience research studies. This paper seeks to answer the research questions: a) Did exposure to lived experience research increase hopefulness for participants?; and b) How else did interacting with lived experience research resources influence participants' lives? METHODS Thirty-eight participants were introduced to four resources of their choosing by peer workers over a four-week period. The helpfulness of resources was evaluated using mixed methods, including a quasi-experimental analysis of change in hope, an anonymous survey and in-depth interviews. RESULTS Findings indicated that the resources promoted hope, but that increases in hopefulness may not be seen immediately. Other impacts include that the resources: encouraged helpful activities; provided a positive experience; increased valued knowledge; encouraged people to reflect on their journey and think constructively about mental health issues; helped people to feel less alone; and assisted people to explain their situation to others. CONCLUSIONS The research suggests the potential usefulness of lived experience research resources, presented in user-friendly formats, in the lives of people who experience mental health issues and implies a need to nurture this type of research.
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Affiliation(s)
- Anne Honey
- School of Health Sciences, University of Sydney, Sydney, NSW, Australia.
| | | | - Francesca Coniglio
- grid.482157.d0000 0004 0466 4031Mental Health Drug & Alcohol, Northern Sydney Local Health District, Sydney, NSW Australia
| | - Trang Thuy Do
- grid.1013.30000 0004 1936 834XSchool of Health Sciences, University of Sydney, Sydney, NSW Australia
| | - Leonie Dunn
- grid.477714.60000 0004 0587 919XSt George and Sutherland Mental Health Services, South Eastern Sydney Local Health District, Sydney, NSW Australia
| | | | - Helen Glover
- Enlightened Consultants, Brisbane, Qld Australia
| | - Monique Hines
- grid.1013.30000 0004 1936 834XSchool of Health Sciences, University of Sydney, Sydney, NSW Australia
| | - Justin Newton Scanlan
- grid.1013.30000 0004 1936 834XSchool of Health Sciences, University of Sydney, Sydney, NSW Australia
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22
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Locher C, Mansour R, Koechlin H, Büchi S. Patient-appraised beneficial moments during inpatient psychiatric treatment. BMC Health Serv Res 2020; 20:734. [PMID: 32778097 PMCID: PMC7418414 DOI: 10.1186/s12913-020-05617-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients' expectations) and extra-therapeutic. However, there is little published research on the factors and events which inpatients themselves consider to be beneficial ('beneficial moments'). METHODS Inpatients (N = 107) of a psychiatric clinic completed a questionnaire to elicit their appraisal of beneficial moments. A qualitative content analysis was applied. The coding procedure was conducted independently by two authors. RESULTS Self-appraised beneficial moments were found in five areas: therapy-specific components (number of quotations, N = 204), positive relationships (N = 140), clinical setting and environment (N = 52), inpatients' new insights (N = 36), and factors unrelated to either therapy or the clinic (N = 30). In total, 44% of the quotations were related to specific factors, 49% to common factors, and 7% to extra-therapeutic factors. CONCLUSIONS Inpatients judge both specific and common factors as crucial for the therapeutic benefit they gain during their stay at the clinic. Our results differ from meta-analytical findings, where the impact of specific factors on symptom improvement has shown to be much smaller (i.e., 17%) than appraised by patients in our study (i.e., 44%). Our study underlines the importance of a patient-centred care approach as well as shared decision making and patient-clinician communication. For clinical practice, knowledge of inpatients' perspectives on beneficial moments is crucial in order to reinforce precisely these therapeutic components.
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Affiliation(s)
- Cosima Locher
- School of Psychology, Plymouth University, Plymouth, UK. .,Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland. .,Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland. .,Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ramin Mansour
- Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland
| | - Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland
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23
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Foye U, Li Y, Birken M, Parle K, Simpson A. Activities on acute mental health inpatient wards: A narrative synthesis of the service users' perspective. J Psychiatr Ment Health Nurs 2020; 27:482-493. [PMID: 31957154 DOI: 10.1111/jpm.12595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 01/30/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Boredom is a big issue on inpatient mental health wards that is linked to poor patient satisfaction, feelings of frustration and increased incidents of self-harm and aggression. This is even more so for people detained under the Mental Health Act. Where wards have a good range of activities, for example art, music, computer games, gardening and exercise, service users felt less bored and had improved well-being. Over many years, studies have reported a lack of activities, especially during evenings and weekends. It has also been found that little is known about what activities service users want, or how activities might be meaningful for them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review found that very few studies have asked service users about what activities would be useful and why. By seeing what makes activities desirable and accessible, we can understand how to improve the experiences of service users on wards. Overall, these data help to understand what impact activities (or lack of activities) have on service users and staff experiences on these wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Through identifying the activities most appreciated and engaged with by service users and by asking service users what activities they would like available, we can inform best practice guidance for the commissioning and provision of inpatient mental health care. This will enable service provider organizations to target their effort and resources on supporting good practice and to redirect resources from less useful activities. ABSTRACT: Background Concern about the lack of activities on mental health inpatient wards is long-standing with reports consistently finding that service users receive insufficient access to a range of activities and report high levels of boredom. There is recognition that little is known about what service users want when admitted to inpatient wards. Aim This review seeks to understand service users' experiences and views in relation to the provision and availability of activities, and to explore the perceived benefits and barriers to service users. Methods We searched multiple databases (Scopus, MEDLINE, CINAHL, PsycINFO and Embase) for studies that evaluated activities on acute adult inpatient mental health wards. We identified 12 papers across a range of methodological designs from which the narrative synthesis has been analysed. Results Findings show that the provision of activities is unsatisfactory for many service users, which in turn is related to increased boredom that has a negative impact on service users' well-being. We explore the benefits and barriers to engagement, providing an insight into the aspects that make an activity important. Conclusion There are few studies exploring the needs of service users regarding activity provision; therefore, there is limited knowledge about what is meaningful for individuals.
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Affiliation(s)
- Una Foye
- Department of Mental Health Nursing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yan Li
- Department of Mental Health Nursing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mary Birken
- Division of Psychiatry, University College London, London, UK
| | - Kayleigh Parle
- Department of Mental Health Nursing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan Simpson
- Department of Mental Health Nursing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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24
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Rio JHM, Fuller J, Taylor K, Muir-Cochrane E. A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice. Int J Ment Health Nurs 2020; 29:290-298. [PMID: 31859453 DOI: 10.1111/inm.12684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 02/03/2023]
Abstract
It is mental health consumer's human right to lead a fulfilling life as they are empowered to actively manage their recovery. This can be facilitated through care planning, yet research suggests that the care plan is not routinely created, discussed, or updated in acute mental health settings. Research on care planning and the role of the mental health nurse highlights the importance of therapeutic communication in care plan development. This paper argues that the lack of meaningful care plan discussions between consumers and mental health nurses in an acute setting is a limitation to the practice of fully accountable mental health nursing care. We explore this limitation in quality care provision by examining literature on accountability and conclude that in mental health nursing, accountability is frequently enacted through an overarching focus on the organizational need to manage risks, rather than on therapeutic engagement.
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Affiliation(s)
- Josephien H M Rio
- College of Nursing & Health Sciences Flinders University, Adelaide, Australia.,Mental Health - Central Australian Health Service, Alice Springs, Australia
| | - Jeffrey Fuller
- College of Nursing & Health Sciences Flinders University, Adelaide, Australia
| | - Kerry Taylor
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
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25
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Ould Brahim L, Hanganu C, Gros CP. Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study. J Am Psychiatr Nurses Assoc 2020; 26:250-261. [PMID: 31587601 DOI: 10.1177/1078390319878773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse's role to include evidence-based responses to substance use is recommended.
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Affiliation(s)
- Lydia Ould Brahim
- Lydia Ould Brahim, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Cezara Hanganu
- Cezara Hanganu, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Catherine Pugnaire Gros
- Catherine Pugnaire Gros, MSc, RN, McGill University, Montreal, Quebec, Canada; Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal; Douglas Mental Health University Institute, Verdun, Quebec, Canada
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26
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Voss I, Bartlett R. Seeking freedom: A systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital. J Psychiatr Ment Health Nurs 2019; 26:289-300. [PMID: 31359573 DOI: 10.1111/jpm.12551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Absconding refers to patients leaving psychiatric hospitals in an unexpected and/or unauthorized way and is often recognized as a form of challenging behaviour. There is some research about the rates of absconding, risks associated with it and interventions to try and reduce it; however, relatively little is known about the experience from the perspective of patients and this evidence has not previously been systematically reviewed. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients abscond to find relief, to regain power and control over their lives and/or to address unmet needs. Absconding can therefore be viewed as a means of seeking freedom. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware that absconding is a positive act from the patient perspective and work collaboratively with them to reduce factors which motivate this behaviour. From the point of admission, nurses have an important role to play in reducing the sense of fear, isolation and powerlessness which motivates patients to abscond. Practical interventions such as giving patients the time and information necessary to be involved in decision-making, or asking about their responsibilities and commitments outside of hospital, may have a significant impact on the experience of admission and reduce the risk of absconding. Abstract Introduction Absconding from psychiatric hospitals is associated with significant risks, but is difficult to assess. It is often considered a form of challenging behaviour for mental health nurses, yet there is little evidence considering the behaviour from the patient perspective. Aim To identify and review evidence pertaining to the experience of patients who abscond from hospital, paying particular attention to their reasons for doing so. Method A systematic review and thematic synthesis of eight peer-reviewed studies. Results The meaning patients associated with absconding is best characterized as an act of seeking freedom. Within this, four sub-themes were identified: 1) seeking freedom to find relief, 2) to regain power and control over their lives, 3) to address unmet needs and 4) opportunistically. Discussion Perspectives on absconding are markedly different between nurses and patients. Nurses may view absconding as challenging or deviant behaviour, whilst patients understand it as a positive experience. This is because the hospital environment is not meeting their needs. Implications for practice Patients decide to abscond from hospital for valid and rational reasons. Mental health nurses are in a position to understand and address the issues underpinning them with a view to reducing absconding. Further research on absconding from hospital, taking the patient's perspective, is needed.
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Affiliation(s)
- Isobel Voss
- South West London and St George's Mental Health NHS Trust, London, UK
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27
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Keefe K, Cardemil EV, Thompson M. Understanding barriers and facilitators to therapeutic relationships in state psychiatric hospitals. J Clin Psychol 2019; 76:195-209. [PMID: 31583715 DOI: 10.1002/jclp.22866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE(S) This qualitative study aimed to elucidate barriers and facilitators faced by individuals with serious mental illness in establishing positive therapeutic relationships within the public sector. METHOD Twenty-two individuals, receiving inpatient treatment and near discharge from three state psychiatric facilities, participated. The sample was diverse with respect to gender (60 % male) and race/ethnicity, with a mean age of 40 years (standard deviation = 12.91). Thematic analysis and a contextualist lens were used to analyze the data. RESULTS Results indicated that inadequate meeting time, lack of clinically relevant communication, and discrepancies in client/provider perspectives, impeded positive therapeutic relationships. Facilitators to therapeutic relationships included feelings heard and understood by providers, comprehensive, timely discharge plans, and thinking broadly about aftercare. CONCLUSIONS Cultivating positive therapeutic relationships is especially difficult in resource-challenged settings. Enhanced client-provider communication and individually tailored aftercare planning can enhance inpatient therapeutic relationships, convey a greater sense of understanding of clients, and facilitate client-provider collaboration.
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Affiliation(s)
- Kristen Keefe
- Department of Psychology, Clark University, Worcester, Massachusetts
| | | | - Matthew Thompson
- Department of Psychology, Clark University, Worcester, Massachusetts
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"There Is a Cat on Our Ward": Inpatient and Staff Member Attitudes toward and Experiences with Cats in a Psychiatric Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173108. [PMID: 31461841 PMCID: PMC6747524 DOI: 10.3390/ijerph16173108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/13/2019] [Accepted: 08/24/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate inpatient and staff member attitudes toward and experiences with ward cats, and identify possible mechanisms for how cats affect patient satisfaction in a psychiatric clinic. Thirty-three inpatients diagnosed with depression or psychosis residing on wards with and without cats and 17 staff members working on wards with cats participated in semi-structured interviews using a cross-sectional study design. Data analysis included descriptive statistics and correlations. The results showed that 17 out of 19 inpatients and all the staff members liked having a cat on their ward. Further, 12 out of 14 inpatients on wards without cats would like having a cat on their ward. Inpatient perceptions of the cat’s impact on the ward atmosphere correlated significantly with their emotional relationship with the cat (p = 0.015, r = 0.561), how often they saw the cat (p = 0.002, r = 0.676), and if they liked cats in general (p = 0.041, r = 0.486). Our results highlight the positive attitudes of inpatients and staff members toward ward cats and the potential of ward cats to enhance patient satisfaction. This influence might be mediated by factors such as the frequency of contact, the relationship between each patient and the cat, and each patient’s attitude toward cats in general.
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Molin J, Graneheim UH, Ringnér A, Lindgren BM. Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care. Int J Ment Health Nurs 2019; 28:551-559. [PMID: 30501013 DOI: 10.1111/inm.12560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 02/01/2023]
Abstract
This qualitative study aimed to illuminate patients' experiences of taking part in the nursing intervention Time Together. The data were drawn from 11 individual semi-structured interviews with patients and analysed with qualitative content analysis using an inductive approach. The results show that patients taking part in Time Together felt confirmed and participated on equal terms; thus, they experienced being seen as humans among other humans. Time Together offered patients a break, and they felt strengthened, which contributed to their hopes for recovery. Furthermore, when Time Together was absent patients felt disconfirmed, which fostered feelings of distance from staff. The results support the effectiveness of the intervention, indicating that Time Together may be a tool to facilitate patients' personal recovery. However, the success of the intervention depends on staff compliance with the predetermined structure of the intervention in combination with engagement.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
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Lim E, Wynaden D, Heslop K. Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study. Int J Ment Health Nurs 2019; 28:237-246. [PMID: 30027634 DOI: 10.1111/inm.12524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 01/15/2023]
Abstract
Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants' experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Waldemar AK, Esbensen BA, Korsbek L, Petersen L, Arnfred S. Recovery-oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings. Int J Ment Health Nurs 2019; 28:318-329. [PMID: 30151987 DOI: 10.1111/inm.12537] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 11/30/2022]
Abstract
Despite an increasing attention towards recovery orientation in the mental health services, the provision of recovery-oriented practice is challenged in the inpatient wards. Moreover, the existing research within this area is modest and we currently have limited knowledge of how recovery-oriented practice is integrated into inpatient settings. A cornerstone of recovery-oriented practice is the collaboration, patient involvement, and choices, particularly when deciding and planning treatment options. Thus, this ethnographic study aimed to explore how recovery-oriented practice is reflected in the interactions between patients and health professionals around treatment in two mental health inpatient wards in Denmark. Participant observations were conducted in two mental health inpatient wards from November 2014 to January 2015. The Recovery Self-Assessment scale inspired the observation guide and the initial data analysis. Field notes were analysed deductively and inductively using qualitative content analysis. One theme with four subthemes emerged showing that interactions were characterized by an 'as-if collaboration' where 'negotiating on limited grounds' was an important feature of interactions, in which health professionals seemed to have superiority, acting on behalf of 'competing demands'. Patients had to navigate in a field of 'inconsistent guidance and postponed decisions' and faced tendencies of 'control and condescending communication'. The results suggest that recovery oriented values such as equal collaboration, choice and patients' personal preferences are reflected rhetorically in the interactions between patients and health professionals. However, they are negotiated within organizational logics and often overruled by competing demands.
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Affiliation(s)
- Anna Kristine Waldemar
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases VRR, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lisa Korsbek
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Lone Petersen
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatry West, Psychiatric Hospital Slagelse, Region Zealand Mental Health Services, Slagelse, Denmark
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Csipke E, Wykes T, Nash S, Williams P, Koeser L, McCrone P, Rose D, Craig T. Changing nurses' views of the therapeutic environment: randomised controlled trial. BJPsych Open 2019; 5:e17. [PMID: 30762512 PMCID: PMC6381414 DOI: 10.1192/bjo.2018.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although patients value evidence-based therapeutic activities, little is known about nurses' perceptions.AimsTo investigate whether implementing an activities training programme would positively alter staff perceptions of the ward or be detrimental through the increased workload (trial registration: ISRCTN 06545047). METHOD We conducted a stepped wedge cluster randomised trial involving 16 wards with psychology-led nurse training as the intervention. The main outcome was a staff self-report measure of perceptions of the ward (VOTE) and secondary outcomes measuring potential deterioration were the Index of Work Satisfaction (IWS) and the Maslach Burnout Inventory (MBI). Data were analysed using mixed-effects regression models, with repeated assessments from staff over time. RESULTS There were 1075 valid outcome measurements from 539 nursing staff. VOTE scores did not change over time (standardised effect size 0.04, 95% CI -0.09 to 0.18, P = 0.54), neither did IWS or MBI scores (IWS, standardised effect size 0.02, 95% CI -0.11 to 0.16, P = 0.74; MBI standardised effect size -0.09, 95% CI -0.24 to 0.06, P = 0.24). There was a mean increase of 1.5 activities per ward (95% CI -0.4 to 3.4, P = 0.12) and on average 6.3 more patients attended groups (95% CI -4.1 to 16.6, P = 0.23) following training. Staff feedback on training was positive. CONCLUSIONS Our training programme did not change nurses' perceptions of the ward, job satisfaction or burnout. During the study period many service changes occurred, most having a negative impact through increased pressure on staffing, patient mix and management so it is perhaps unsurprising that we found no benefits or reduction in staff skill.Declaration of interestNone.
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Affiliation(s)
- Emese Csipke
- Doctor, Senior Research Fellow,Division of Psychiatry,University College London,UK
| | - Til Wykes
- Professor Dame,Institute of Psychiatry,Psychology and Neuroscience,King's College London,South London and Maudsley NHS Foundation Trust,UK
| | - Stephen Nash
- Statistician,London School of Hygiene and Tropical Medicine,UK
| | - Paul Williams
- Statistician,Institute of Psychiatry, Psychology and Neuroscience,Kings College London,UK
| | - Leo Koeser
- Research Assistant,Institute of Psychiatry, Psychology and Neuroscience,Kings College London,UK
| | - Paul McCrone
- Professor of Health Economics,Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - Diana Rose
- Professor of User-Led Research,Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - Tom Craig
- Professor of Social Psychiatry,Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
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Wykes T, Csipke E, Rose D, Craig T, McCrone P, Williams P, Koeser L, Nash S. Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Emese Csipke
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Thomas Craig
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Williams
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Leonardo Koeser
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Nash
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Salberg J, Folke F, Ekselius L, Öster C. Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences. Int J Ment Health Nurs 2018; 27:1401-1410. [PMID: 29446512 DOI: 10.1111/inm.12439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 11/26/2022]
Abstract
A promising intervention in mental health in-patient care is behavioural activation (BA). Interventions based on BA can be used by mental health nurses and other staff members. The aim of this study was to evaluate patients' and staff members' experiences of a nursing staff-led behavioural group intervention in mental health in-patient care. The intervention was implemented at three adult acute general mental health in-patient wards in a public hospital setting in Sweden. A self-administrated questionnaire, completed by 84 patients and 34 nurses and nurse assistants, was administered, and nonparametric data analysed using descriptive statistics. Our findings revealed that both patients and nursing staff ranked nursing care and care environment as important aspects in the recovery process. Patients and staff members reported overall positive experiences of the group sessions. Patients with higher frequencies of attendance and patients satisfied with overall care had a more positive attitude towards the intervention. A more positive experience of being a group leader was reported by staff members who had been leading groups more than ten times. The most common impeding factor during implementation, reported by staff members, was a negative attitude to change. Conducive factors were having support from a psychologist and the perception that patients were showing interest. These positive experiences reported by patients and nursing staff, combined with previous research in this field, are taking us one step further in evaluating group sessions based on BA as a meaningful nursing intervention in mental health in-patient care.
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Affiliation(s)
- Johanna Salberg
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Fredrik Folke
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research, Dalarna, Falun, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Caisa Öster
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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35
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Chevalier A, Ntala E, Fung C, Priebe S, Bird VJ. Exploring the initial experience of hospitalisation to an acute psychiatric ward. PLoS One 2018; 13:e0203457. [PMID: 30180196 PMCID: PMC6122813 DOI: 10.1371/journal.pone.0203457] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background Patient-reported satisfaction with inpatient psychiatric services, within the first few days of admission, is related to positive future outcomes. Despite its predictive value, little is known about this initial experience and what underlies these appraisals. The aim of this study was to qualitatively explore the initial experience of being admitted to an inpatient psychiatric ward. Methods Semi-structured interviews were conducted with 61 recently admitted patients across five psychiatric hospitals in London, England. Participants were purposively sampled to ensure a mix of experiences including people with high and low satisfaction scores as measured by the Client Assessment of Treatment. Thematic analysis was used to identify, analyse and report patterns within the data, with content analysis applied to determine whether certain themes were more common to either negative or positive appraisals. Results Four broad themes were evident 1) ‘Best place for me right now?’ 2) ‘Different from out in society’ 3) ‘Moving from uncertainty to being informed’ and 4) ‘Relating & Alienating’. Individuals with very positive appraisals spoke most frequently of helpful relationships with both staff and other patients, and feeling cared for. They also spoke of having had previous admissions and the assessment process on entering the ward suggesting that these may be valuable experiences. Conversely, the group with very negative appraisals spoke of relationships that were alienating or where there was a perceived abuse of power. They described restrictions to their freedom, compared hospital to prison and generally had the view that hospital makes you worse. Conclusions The experience of hospital within the first few days of admission determines whether an individual has a positive or negative experience of their inpatient care. Reducing the impact of uncertainty and promoting good relationships may help services to improve the initial experience of hospital admission and ultimately improve future outcomes for patients.
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Affiliation(s)
- Agnes Chevalier
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom.,East London NHS Foundation Trust, London, United Kingdom
| | - Eleni Ntala
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Catherine Fung
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom.,East London NHS Foundation Trust, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom.,East London NHS Foundation Trust, London, United Kingdom
| | - Victoria J Bird
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom.,East London NHS Foundation Trust, London, United Kingdom
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Kristiansen ST, Videbech P, Kragh M, Thisted CN, Bjerrum MB. Patientś experiences of patient education on psychiatric inpatient wards; a systematic review. PATIENT EDUCATION AND COUNSELING 2018; 101:389-398. [PMID: 28918106 DOI: 10.1016/j.pec.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To synthesize the evidence on how patients with serious mental disorders perceived patient education on psychiatric wards and to learn more about the patient perceived benefits and limitations related to patient education and how well patient education meets the perceived needs of inpatients. METHODS Quantitative and qualitative data were categorized and synthesized. A systematic literature search was conducted. Articles were validated using validated critical appraisal tools. Data were analyzed using inductive content analysis. RESULTS Five articles met the inclusion criteria. The results concerned the specific population with bipolar disorder or schizophrenia. Two explanatory syntheses were aggregated: (I) Benefits and perceived barriers to receiving education and (II) Educational needs of mental health patients. Patients reported mechanical information dissemination and lack of individual and corporative discussions. Patients preferred patient education from different educational sources with respect to individual needs. CONCLUSION Patient education were most useful when it could be tailored to an individuaĺs specific needs and match patient preference for how to receive it. The findings did not provide evidence to support any educational methods of preference. PRACTICE IMPLICATIONS The findings may contribute to the development of educational interventions that are perceived more helpful for in-patients suffering from serious mental disorders.
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Affiliation(s)
- S T Kristiansen
- Department of Public Health, Section for Nursing, Aarhus University, Hoeegh-Guldbergs Gade 6A, Aarhus C, Denmark.
| | - P Videbech
- Mental Health Centre, Glostrup, Copenhagen University Hospital, Nordre Ringvej 29-67, 2600 Glostrup, Denmark
| | - M Kragh
- Department of Affective Disorders, Aarhus University Hospital, Skovagervej 2, 8240, Risskov, Denmark
| | - C N Thisted
- Department of Public Health, Section for Nursing, Aarhus University, Hoeegh-Guldbergs Gade 6A, Aarhus C, Denmark
| | - M B Bjerrum
- Department of Public Health, Section for Nursing, Aarhus University, Hoeegh-Guldbergs Gade 6A, Aarhus C, Denmark
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Wykes T, Csipke E, Williams P, Koeser L, Nash S, Rose D, Craig T, McCrone P. Improving patient experiences of mental health inpatient care: a randomised controlled trial. Psychol Med 2018; 48:488-497. [PMID: 28726599 PMCID: PMC5757411 DOI: 10.1017/s003329171700188x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Poorer patient views of mental health inpatient treatment predict both further admissions and, for those admitted involuntarily, longer admissions. As advocated in the UK Francis report, we investigated the hypothesis that improving staff training improves patients' views of ward care. METHOD Cluster randomised trial with stepped wedge design in 16 acute mental health wards randomised (using the ralloc procedure in Stata) by an independent statistician in three waves to staff training. A psychologist trained ward staff on evidence-based group interventions and then supported their introduction to each ward. The main outcome was blind self-report of perceptions of care (VOICE) before or up to 2 years after staff training between November 2008 and January 2013. RESULTS In total, 1108 inpatients took part (616 admitted involuntarily under the English Mental Health Act). On average 51.6 staff training sessions were provided per ward. Involuntary patient's perceptions of, and satisfaction with, mental health wards improved after staff training (N582, standardised effect -0·35, 95% CI -0·57 to -0·12, p = 0·002; interaction p value 0·006) but no benefit to those admitted voluntarily (N469, -0.01, 95% CI -0.23 to 0.22, p = 0.955) and no strong evidence of an overall effect (N1058, standardised effect -0.18 s.d., 95% CI -0.38 to 0.01, p = 0.062). The training costs around £10 per patient per week. Resource allocation changed towards patient perceived meaningful contacts by an average of £12 (95% CI -£76 to £98, p = 0.774). CONCLUSION Staff training improved the perceptions of the therapeutic environment in those least likely to want an inpatient admission, those formally detained. This change might enhance future engagement with all mental health services and prevent the more costly admissions.
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Affiliation(s)
- T. Wykes
- Institute of Psychiatry, Psychology and
Neuroscience, King's College London, London,
UK
- South London and Maudsley NHS Trust,
London, UK
| | - E. Csipke
- Division of Psychiatry,
University College London, London,
UK
| | - P. Williams
- Institute of Psychiatry, Psychology and
Neuroscience, Kings College London, London,
UK
| | - L. Koeser
- Institute of Psychiatry, Psychology and
Neuroscience, Kings College London, London,
UK
| | - S. Nash
- London School of Hygiene and Tropical
Medicine, Keppel Street, London,
UK
| | - D. Rose
- Service User Research Enterprise, Institute of
Psychiatry, Psychology and Neuroscience, King's College London,
London, UK
| | - T. Craig
- Health Services and Population Research
Department, Institute of Psychiatry, Psychology and Neuroscience, King's College
London, London, UK
| | - P. McCrone
- Health Economics, Health Services and Population
Research, Institute of Psychiatry, Psychology and Neuroscience, King's College
London, London, UK
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38
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Biringer E, Hartveit M, Sundfør B, Ruud T, Borg M. Continuity of care as experienced by mental health service users - a qualitative study. BMC Health Serv Res 2017; 17:763. [PMID: 29162112 PMCID: PMC5698968 DOI: 10.1186/s12913-017-2719-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022] Open
Abstract
Background People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care. Methods In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care. Conclusions A discrepancy between aspects of continuity that are essential for service users and their experiences of actual practice was revealed. The valid evidence generated in the present collaborative study therefore offers knowledge to policy makers, professionals and service users that may be of help in their future efforts in orienting primary care, mental health, addiction and welfare services towards recovery. Electronic supplementary material The online version of this article (10.1186/s12913-017-2719-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Biringer
- Helse Fonna Local Health Authority, P.O. Box 2170, N-5504, Haugesund, Norway.
| | - Miriam Hartveit
- Helse Fonna Local Health Authority, P.O. Box 2170, N-5504, Haugesund, Norway
| | - Bengt Sundfør
- Regional Research Network on Mood Disorders (MoodNet), Haukeland University Hospital, Division of Mental Health, P.O. Box 1400, N-5021, Bergen, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, P.O. Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0318, Oslo, Norway
| | - Marit Borg
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden, Drammen kunnskapspark, Grønland 58, 3045, Drammen, Norway
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Beckett P, Holmes D, Phipps M, Patton D, Molloy L. Trauma-Informed Care and Practice: Practice Improvement Strategies in an Inpatient Mental Health Ward. J Psychosoc Nurs Ment Health Serv 2017; 55:34-38. [DOI: 10.3928/02793695-20170818-03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/27/2017] [Indexed: 11/20/2022]
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Lim E, Wynaden D, Heslop K. Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. Int J Ment Health Nurs 2017; 26:445-460. [PMID: 28960737 DOI: 10.1111/inm.12378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/19/2022]
Abstract
Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Lloyd C, Williams PL, Vilic G, Tse S. Progressing recovery-oriented care in psychiatric inpatient units. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2017. [DOI: 10.1108/ijot-06-2017-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Chris Lloyd
- Illawarra Institute of Mental Health, University of Wollongong, Wollongong, Australia
| | | | - Gabrielle Vilic
- Metro South Hospital and Health Service, Woolloongabba, Australia
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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Simpson A, Coffey M, Hannigan B, Barlow S, Cohen R, Jones A, Faulkner A, Thornton A, Všetečková J, Haddad M, Marlowe K. Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A). HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City, University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Michael Coffey
- Department of Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Ben Hannigan
- College of Biomedical and Life Sciences, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sally Barlow
- Centre for Mental Health Research, School of Health Sciences, City, University of London, London, UK
| | - Rachel Cohen
- Department of Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Aled Jones
- College of Biomedical and Life Sciences, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Alexandra Thornton
- Centre for Mental Health Research, School of Health Sciences, City, University of London, London, UK
| | - Jitka Všetečková
- Faculty of Wellbeing, Education and Language Studies, School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Mark Haddad
- Centre for Mental Health Research, School of Health Sciences, City, University of London, London, UK
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Stapleton A, Wright N. The experiences of people with borderline personality disorder admitted to acute psychiatric inpatient wards: a meta-synthesis. J Ment Health 2017; 28:443-457. [DOI: 10.1080/09638237.2017.1340594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anna Stapleton
- School of Health Sciences, University of Nottingham, Nottingham, UK and
- Millbrook Mental Health Unit, Nottinghamshire Healthcare NHS Trust, Sutton-in-Ashfield, UK
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, UK and
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Salzmann-Erikson M, Söderqvist C. Being Subject to Restrictions, Limitations and Disciplining: A Thematic Analysis of Individuals' Experiences in Psychiatric Intensive Care. Issues Ment Health Nurs 2017; 38:540-548. [PMID: 28388251 DOI: 10.1080/01612840.2017.1299265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to describe individuals' experiences of being hospitalized in psychiatric intensive care units (PICUs). Four participants who had previously been admitted in a PICU were interviewed using open-ended questions. The data were analyzed using thematic analysis. Analysis resulted in a synthesis of the various ways patients experienced limitations: (1) Descriptions of Being Limited in the Environment, (2) Descriptions of being Limited in Interactions with Staff, (3) Descriptions of Being Limited in terms of Access to Information, and (4) Descriptions of Having Limited Freedom and Autonomy. Hospitalization is experienced as a life-changing event that shows a kaleidoscopic view of limitation. We stress that the conceptualization of limitation must be considered due to its historical origins, sociopolitical aspirations, and philosophy of care. Thus, nurse practitioners and nursing leaders are advised to put the patient's experience at the center of care, and to involve and integrate patients throughout the recovery process.
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Affiliation(s)
- Martin Salzmann-Erikson
- a Department of Health and Caring Sciences , Faculty of Health and Occupational Studies, University of Gävle , Gävle , Sweden
| | - Cecilia Söderqvist
- b School of Health, Care and Social Welfare, University of Mälardalen , Västerås , Sweden.,c Centre for Clinical Research, Västmanland County Hospital , Västerås , Sweden
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Gaudiano BA, Davis CH, Epstein-Lubow G, Johnson JE, Mueser KT, Miller IW. Acceptance and Commitment Therapy for Inpatients with Psychosis (the REACH Study): Protocol for Treatment Development and Pilot Testing. Healthcare (Basel) 2017; 5:E23. [PMID: 28475123 PMCID: PMC5492026 DOI: 10.3390/healthcare5020023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 03/31/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022] Open
Abstract
Patients with schizophrenia-spectrum disorders frequently require treatment at inpatient hospitals during periods of acute illness for crisis management and stabilization. Acceptance and Commitment Therapy (ACT), a "third wave" cognitive-behavioral intervention that employs innovative mindfulness-based strategies, has shown initial efficacy in randomized controlled trials for improving acute and post-discharge outcomes in patients with psychosis when studied in acute-care psychiatric hospitals in the U.S. However, the intervention has not been widely adopted in its current form because of its use of an individual-only format and delivery by doctoral-level research therapists with extensive prior experience using ACT. The aim of the Researching the Effectiveness of Acceptance-based Coping during Hospitalization (REACH) Study is to adapt a promising acute-care psychosocial treatment for inpatients with psychosis, and to pilot test its effectiveness in a routine inpatient setting. More specifically, we describe our plans to: (a) further develop and refine the treatment and training protocols, (b) conduct an open trial and make further modifications based on the experience gained, and
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Affiliation(s)
- Brandon A Gaudiano
- Butler Hospital, Providence, RI 02906, USA.
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
| | | | - Gary Epstein-Lubow
- Butler Hospital, Providence, RI 02906, USA.
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
| | - Jennifer E Johnson
- College of Human Medicine, Michigan State University, Flint, MI 48502, USA.
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, USA.
| | - Ivan W Miller
- Butler Hospital, Providence, RI 02906, USA.
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
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Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, Conrad AM. An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC Psychiatry 2017; 17:22. [PMID: 28095811 PMCID: PMC5240195 DOI: 10.1186/s12888-016-1164-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered. DISCUSSION This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations. CONCLUSIONS Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.
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Affiliation(s)
- Barry G. Frost
- School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308 Australia ,Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia
| | - Srinivasan Tirupati
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | | | - Megan Turrell
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia
| | - Terry J. Lewin
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Ketrina A. Sly
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Agatha M. Conrad
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
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stARTalking: Undergraduate mental health nursing education and art. Nurse Educ Pract 2016; 21:107-113. [DOI: 10.1016/j.nepr.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/01/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
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Molin J, Graneheim UH, Lindgren BM. Quality of interactions influences everyday life in psychiatric inpatient care--patients' perspectives. Int J Qual Stud Health Well-being 2016; 11:29897. [PMID: 26806313 PMCID: PMC4724788 DOI: 10.3402/qhw.v11.29897] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/14/2022] Open
Abstract
Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients' experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories-staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content-were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden;
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Abstract
BACKGROUND Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. OBJECTIVES In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. METHODS Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. RESULTS Synthesis led to the development of two themes; "substance use mediates acceptance and social inclusion" and "substance use provides perceived opportunities for control and power." CONCLUSIONS/IMPORTANCE The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.
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Affiliation(s)
- Emma Chorlton
- a Division of Health Research, Lancaster University , Lancaster , United Kingdom
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Keogh B, Callaghan P, Higgins A. Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study. J Psychiatr Ment Health Nurs 2015; 22:715-23. [PMID: 26303064 DOI: 10.1111/jpm.12265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 11/30/2022]
Abstract
ACCESSIBLE SUMMARY What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms. INTRODUCTION Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users. AIM The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital. METHOD This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users. RESULTS The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital. IMPLICATIONS FOR PRACTICE This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged.
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Affiliation(s)
- B Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P Callaghan
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - A Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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