Patient satisfaction in a forensic unit

Patients' Expressed Nursing Care Needs in a Forensic Psychiatric Setting

The aim of this study was to describe the patients' nursing care needs in a forensic psychiatric setting in line with the NANDA-I classification. Ten patients sentenced to forensic psychiatric care were interviewed. Data were analyzed by means of directed content analysis with a deductive approach, where we used "served time" as a factor in the analysis, thus creating three categories: newly arrived patients with a length of stay of only a couple of years, patients with a length of stay of around 5 years, and patients with a length of stay of more than 5 years. Thirteen NANDA-I diagnoses were identified during the analyses, distributed on seven different domains. When distributing the given NANDA-I diagnoses according to the created categories, an explanatory pattern emerged, and three themes became apparent: denial, insight, and listlessness. Considering the differences in views, the patients' own recognition of what is a problem, a potential, or a risk could improve a "working relation" and, eventually, a recovery. NANDA-I nursing diagnoses may improve individualized and person-centered care as NANDA-I makes care continuously consistent over time.

Occupational Therapy in Forensic Psychiatry: A Review of the Literature and a Call for a United and International Response

A review and critique of the literature on occupational therapy in forensic mental health settings was conducted. The results indicate that the evidence base supporting occupational therapy in a forensic mental health setting is relatively weak. Much of the literature describing the role of occupational therapy in a secure setting is over 10 years old and lacks currency, and many of the research-based articles lack methodological rigour. Research has often been conducted in isolation and over a diverse range of topics, which means that important research questions have not been studied systematically.

This paper argues that to enhance the credibility and efficacy of occupational therapy in forensic practice, a coordinated international network of therapists needs to be established. Using the strength of multi-site studies, such a group can build the evidence base for occupational therapy practice in forensic settings. In addition, better links between occupational therapy services and local universities should be formalised in order to promote ongoing research that meets rigorous research standards.

The Treatment Perspectives of Mentally Ill Offenders in Medium- and High-Secure Forensic Settings in Flanders

There is an increasing interest in mentally ill offenders' (MIOs) treatment experiences in forensic settings. This study focuses on the treatment perspectives of MIOs in treatment as well as in prison settings in Flanders. Seventeen MIOs were interviewed about the treatment they received. Data were analyzed using thematic analysis to derive key themes while acknowledging the individuality of the participants' experiences. Treatment perspectives of MIOs in both settings revolved around similar themes, including "good" staff and privacy. However, their views differed on two themes: MIOs in treatment settings reported on feelings of lacking control and experiencing too much pressure, whereas MIOs in prison settings reported the opposite. The positive experiences in prison settings may complicate the transition from prison to a forensic treatment setting. The study further underscores the major challenge to create more opportunities for MIOs to meet their needs of self-determination in secure forensic treatment settings.

Looking beyond the illness: forensic service users' perceptions of rehabilitation

The aim of this qualitative study was to explore perspectives on rehabilitation of those detained in a New Zealand forensic hospital setting. Twenty forensic service users participated in individual interviews, which were audio-taped, transcribed verbatim, and subjected to thematic analysis. The analysis identified seven themes that were broadly categorized into those that concerned the rehabilitation context (external) and those that more directly reflected the forensic service user's personal experience (internal). External themes highlighted a person-centered approach, the nature of relationships with staff, consistency of care, and awareness of the rehabilitation pathway. Internal themes related to forensic service users' self-evaluations, agency, and coping strategies. These findings are discussed within the broader context in which rehabilitation took place.

A cross sectional survey examining the association between therapeutic relationships and service user satisfaction in forensic mental health settings

BACKGROUND

This small-scale study examines an often neglected patient group (service users in forensic mental health settings). The research investigates their therapeutic relationship with staff and which therapeutic relationship factors are associated with their level of satisfaction with services.

METHODS

A cross sectional survey was undertaken in two medium secure units in the UK with seventy seven participants completing self-report measures examining service user satisfaction with services and their therapeutic relationship with staff. Multiple regression analysis was used to identify the main predictor variables associated with satisfaction with the service provided.

RESULTS

The respondents had a generally positive view of services and also of their therapeutic relationships with staff. However, the therapeutic relationship scores were lower than those recorded in community samples. One predictor variable was significantly associated with service user satisfaction; feeling respected and well regarded.

CONCLUSIONS

The therapeutic relationship domain of being respected and well regarded by staff was identified as the most significant factor among the therapeutic relationship domains when examining the association with satisfaction with services. The important role mental health clinicians play in enabling service users to recognize they are being treated respectfully is noted as service users judge the degree of honesty, caring and interest that staff show in them. Staff also need to be available and accessible while having good listening and information giving skills. The importance of having both positive therapeutic relationships and service user satisfaction in forensic settings is also discussed.

A Danish adaptation of the quality in psychiatric care-forensic in-patient questionnaire: psychometric properties and factor structure

OBJECTIVE

The aims of this study were to adapt and evaluate the psychometric properties and factor structure of the Danish version of the Quality in Psychiatric Care-Forensic In-Patient (QPC-FIP) questionnaire.

METHODS

A sample of 139 inpatients from 25 wards in Denmark who received care during 5 weeks in March and April 2012 participated in the study by completing the QPC-FIP instrument.

RESULTS

Confirmatory factor analysis revealed that the factor structure of the Danish version was equivalent to that of the original Swedish QPC-FIP. The results indicate that the concept of quality of care expressed in the QPC-FIP is equivalent among forensic inpatients in nationally different healthcare systems and cultural contexts.

CONCLUSION

The Danish version of QPC-FIP is a reliable and valid measurement instrument recommended for use in evaluating quality of care in forensic inpatient care.

'Real relationships': sociable interaction, material culture and imprisonment in a secure psychiatric unit

Research into the character of social relationships in psychiatric inpatient facilities has focused on face-to-face interaction between individuals and within groups in the communal areas of wards. Using theories developed in material culture and media studies, this article argues that patients' relationships to goods, namely, photographs, cards and gifts from family or friends, televisions and radios, are important mediators and constituents of sociability. In an ethnographic study of a medium-secure psychiatric unit, I show how these goods are put to use in private space in ways that reflect and mitigate the constraints of incarceration and stigmatization. The data were derived from 3 months of participant observation on a male and a female ward at a unit in the south of England, including a series of anthropological interviews with 19 patients. This article highlights two important findings. First, potentially isolating activities are perceived by patients as sociable, in that watching television and looking at photographs in their room helps to counter feelings of loneliness and isolation. Second, potentially sociable activities, exchanging goods or watching the communal television, are often practiced in such a way as to maintain distance between patients in acknowledgment of the constrained and volatile nature of these relationships. This suggests that patients aspire to retain a sense of the artificiality of their situation, preferring to confine their notion of 'real' relationships to those that exist outside the institution.

Service-user involvement in forensic mental health care research: areas to consider when developing a collaborative study

BACKGROUND

Although service-users are increasingly involved in the conduct of research in mental health settings, involvement in forensic mental health settings is limited.

AIMS

 This paper looks at the factors perceived by professionals and service-users as important for developing collaborative research in forensic mental health settings.

METHOD

Following a collaborative research project undertaken in three forensic mental health units, the researchers involved in the project (professionals and service-users) reviewed factors perceived as important for developing service-user research in secure settings.

RESULTS

 Three broad themes were identified. The main issues considered within these themes were detailed.

CONCLUSIONS

 Service-users in forensic mental health settings are able to have full involvement in research.

The development of a tool to measure service user satisfaction with in-patient forensic services: The Forensic Satisfaction Scale

BACKGROUND

Service-user satisfaction helps determine the quality of services. No valid measure of service-user satisfaction in forensic mental health settings has been developed.

AIMS

To develop and validate a scale designed to measure satisfaction with forensic mental health services.

METHOD

Participants were from three forensic mental health units. Items generated from focus groups were developed into a self-report scale and factor analysed. This was administered with a non-forensic satisfaction self-report scale, the Verona Service Satisfaction Scale (VSSS) and assessed for internal consistency and validity.

RESULTS

A 60-item scale was produced comprising seven subscales recording moderate to high levels of internal consistency and concurrent validity with the VSSS.

CONCLUSIONS

The scale is a promising instrument for assessing service-user satisfaction with forensic mental health in-patient services.

Service user views and expectations of UK-registered mental health nurses: A systematic review of empirical research

OBJECTIVES

To review national (UK) literature in order to (i) examine service user and carer views of UK-registered mental health nurses; (ii) identify the diversity of populations from which these views have been collected; (iii) assess the methodological rigour of the current knowledge base and (iv) evaluate the extent to which service users and carers have been involved in the development and execution of this work. This paper reports only on service users' views.

DESIGN

Systematic review.

DATA SOURCES

Electronic and evidence-based databases, reference checking and hand searching of key academic journals, national policy and user/carer organisational websites.

REVIEW METHODS

Two reviewers independently undertook study eligibility judgements and data extraction. Eligible studies were sub-classified according to service setting (inpatient/residential, community/non-residential or mixed/unspecified). Each study was assessed against key quality criteria. Data were synthesised in a narrative format.

RESULTS

One hundred and thirty two studies were included in the review. The majority were small-scale academic studies biased towards white, adult service users. Few studies provided evidence of user collaboration. Service users regard mental health nursing as a multi-faceted role delivering practical and social support alongside more formal psychological therapies. Service users report inadequate information provision, poor inter-professional communication and a lack of opportunities for collaborative care. Service users perceive inpatient mental health nurses as particularly inaccessible.

CONCLUSIONS

UK-registered mental health nurses should be equipped with both therapeutic clinical skills and generic skills associated with relationship building, engagement and communication. Future research should be conducted in collaboration with service users and include clear and effective mechanisms for the dissemination and implementation of research findings. In particular, the views of children and adolescents, the elderly and black and minority ethnic groups, currently under-represented in research, should be examined.

Happy with your care?

With the recent rise of consumerism within health care, the views of service users are becoming increasingly important. The National Service Framework for Mental Health (DoH 1999) identifies assertive outreach as a strategy to engage people with severe and enduring mental illness, who traditionally lose contact with services. Assessing the views of service users is not a new strategy for service evaluation, but in relation to assertive outreach in the United Kingdom is relatively untested. A postal client satisfaction survey was undertaken as a means of enquiry, in order to ascertain the effectiveness of the Preston Assertive Outreach service from a service user perspective after its first year of operation. The team offers a service based upon the PACT (Program of Assertive Community Treatment) model. An evaluation study of 36 questionnaires produced a return rate of 56% (21 returns). The results showed a fairly high level of client satisfaction with the service provided. Client involvement in treatment was the area of service evaluated least favourably by the service users, with General satisfaction showing the highest level of client satisfaction. From the outcome of the study it appears there are potential benefits in utilizing feedback from service users' to inform future service provision.

The voice of detainees in a high security setting on services for people with personality disorder

BACKGROUND

British government Home and Health Departments have been consulting widely about service development for people with ' dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area.

METHODS

All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured.

AIMS

To establish views on services from one subgroup of people nominated by the government department as having 'DSPD'.

RESULTS

Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and 'experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity.

CONCLUSIONS

As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences.

Medication management: an exploratory study into the role of community mental health nurses

The recent emphasis on community care for those with mental illness has changed working patterns and modified inter-professional role boundaries within multi-disciplinary teams. Clients with serious mental illness are usually prescribed medications, which have a wide range of side effects. However, it is uncertain who is responsible for monitoring clients for the side effects of their medications, ensuring clients' and carers' understandings of their prescribed medications and optimizing compliance with medication. This paper discusses the findings of the first phase of an ongoing study designed to assess the role of community mental health nurses (CMHNs) in managing clients' medication and the provision of appropriate continuing professional education. Our respondents were 14 CMHNs, seven of whom were preparing to undertake a pharmacology module as part of a higher education diploma, and seven who were to act as comparators. Data from questionnaires, interviews and clinical observations were triangulated. All respondents felt that issues surrounding clients' medication were not accorded a sufficiently high profile and that it was, in part, their responsibility to expand their roles to meet these unmet needs of clients. Administering and managing clients' medications were considered to be the main area of 'occupational territory' which distinguished CMHNs from social workers. However, the nurses felt that their practice was limited by lack of appropriate educational preparation.