Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit

Healthcare Professionals' Experiences of Recovery-Oriented Collaboration Between Mental Health Centres and Municipalities: A Qualitative Study

Collaboration within mental health centres and with municipalities in Western European healthcare has presented challenges due to structural and cultural disparities. The Danish healthcare system faces obstacles that impact mental healthcare services, particularly in cross-sectorial cooperation. Our aim was to investigate healthcare professionals' experiences of recovery-oriented collaboration within a mental healthcare setting across hospitals and municipalities to gather a deeper understanding of this issue. Twenty-four employees were purposively sampled from mental health centres in Copenhagen and focus group interviews were conducted to explore their perceptions of working together. Inductive content analysis was used to analyse the data and identify themes and categories. The participants emphasised challenges in communication and coordination to improve collaboration within across the two sectors. This study can contribute to a greater understanding of collaboration between mental health centres and municipalities. It aims to inspire improvements in communication, coordination, and the optimisation of mental health service delivery across sectors.

Perspectives on Recovery-Oriented Care in Mental Health Practices: Health Professionals Experiences

In several Western countries, mental health professionals work in accordance with the principles of recovery-oriented practices, but there is little research into what opportunities there are for fostering recovery-oriented practices in mental health settings. To investigate how central elements of recovery-oriented practices are reflected in health professionals experiences of care and treatment in mental health. Four focus group interviews with nurses and other health professionals are conducted and analysed using manifest content analysis to carry out a low-level analysis of the participants' experiences in mental healthcare. The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). The participants gave informed consent after verbal and written information. The main theme, 'recovery-oriented practices framed within institutional structural conditions', was based on three subthemes: 1) users need help to find meaning during hospitalisation and find hope, 2) health professionals experience it as an obligation that users achieve personal recovery, and 3) user perspectives versus the mental health practices' structural logic. This study sheds light on health professionals experiences with a recovery-oriented practice. The health professionals believe in this as a positive approach and see it as an important obligation to help the user find their own aims and hopes. On the other hand, it can be difficult to work in recovery-oriented practices. It requires an active commitment from users; for many, this can be difficult to live up to.

Healthcare Professionals' Experiences with Patient Participation in a Mental Healthcare Centre: A Qualitative Study

INTRODUCTION

Patient participation is a cornerstone of the debate concerning healthcare professionals and patients of mental health centres. It constitutes an objective in government health policy in Scandinavia and other Western countries. However, little is known about the experiences of healthcare professionals in mental healthcare practices involving patients under their treatment and care.

OBJECTIVE

This study aimed to explore the experiences of healthcare professionals with patient participation in the context of a mental health centre.

METHODOLOGICAL DESIGN

Four focus group interviews with healthcare professionals reflected differing experiences with unfolding patient participation in clinical practices in four wards of a mental health centre. A content analysis developed and framed themes.

RESULTS

Patient participation was based on structural conditions, which shows that predetermined structural methods predominantly control involvement. The structural methods are seen as promoting participation from the patient's perspective. At the same time, the methods also enable taking account of the individual patient's wishes and needs for involvement.

DISCUSSION AND CONCLUSION

This study illuminates the meaning of patient participation in a mental health centre based on the social interactions among nurses and other healthcare professionals. The approach can contribute to dealing with the challenges of incorporating patient participation as an ideology for all patients in a psychiatric context, which is important knowledge for healthcare professionals.

Exploring sustainable care pathways - a scoping review

BACKGROUND

Patients with mental health problems experience numerous transitions into and out of hospital.

AIM

The review studies assessing clinical care pathways between psychiatric hospitalization and community health services.

METHODS

We used publications between 2009-2020 to allow a broad scoping review of the published research. Sixteen review-articles were identified, 12 primary studies were chosen, both on care pathways in the transition between psychiatric hospital and community.

RESULTS

Organizational issues: Systems and procedures to ensure clear responsibilities and transparency at each stage of the pathways of care.

RESOURCES

Information-technology in objectively improving patient outcome. Information/documentation: Providing patients with adequate structured information and documented plans at the appropriate time. Patient/families: Continuous collaborative decision-making. Clinical care and teamwork: Collaboration between mental health and other professionals to guarantee that planned activities meet patient need.

ETHICAL ISSUES

Respectful communication and patient-centred, non-humiliating care.

CONCLUSIONS

System and procedures ensure clear responsibilities and transparency. Information technology support decision-making and referral and objectively improve patient outcomes in care pathways. Collaboration between mental health and other professionals guarantee that planned activities meet patients' needs along with regular meetings sharing key information. Around-the-clock ambulant-teams important to transition success. Informed-shared decision-making between parties, support patient participation and respectful communication.

Requirements for an electronic handover system for interprofessional collaboration between psychotherapists and occupational health professionals - a qualitative study

BACKGROUND

An electronic handover system provides a potential way to bridge the interface between psychotherapy and occupational health. This qualitative study therefore aimed assessing (1) content-related and (2) functional requirements that psychotherapists and occupational health professionals expect from an electronic handover system to exchange relevant information about their patients with common mental disorders.

METHODS

Five focus groups with psychotherapists and occupational health professionals (occupational physicians and members of company integration management) were conducted via video conference using an interview guide. The focus groups were transcribed and content-analysed using MAXQDA.

RESULTS

With regard to content-related requirements, information that serve to assess employee's ability to work was described as particularly relevant by occupational physicians and members of company integration management (e.g. restrictions in certain work areas or ability to work under time pressure). Psychotherapists indicated that information about the employee's working conditions is particularly relevant. This includes description of work tasks or conflicts at the workplace. Concerning functional requirements, all professional groups attached importance to data security and functions to improve communication and collaboration (e.g. the use of standardised handover forms).

CONCLUSION

This study provides insight into the desired content-related and functional requirements by psychotherapists, occupational physicians and members of company integration management for an electronic handover system. However, the theoretical and practical development of such a system requires several additional steps, such as the involvement of further relevant stakeholders (e.g. patients, software developers).

Recovery-Oriented Practices in a Mental Health Centre for Citizens Experiencing Serious Mental Issues and Substance Use: As Perceived by Healthcare Professionals

INTRODUCTION

Recovery-oriented practices have become a means of promoting user recovery during hospitalisation, but we do not know much about the concrete means of practicing recovery-orientation for the most vulnerable users with serious mental difficulty and substance use.

AIMS

We investigated the concrete means of practicing recovery-orientation in care work and the elements, dimensions, outcomes, or steps of it in a special department of mental health centres.

METHOD

Focus group interviews were conducted with 16 health professionals with experience with users with serious mental difficulty and substance use. Qualitative content analysis was undertaken.

RESULTS

The main theme was "holistic recovery on structural terms" based on two themes and four subthemes. The first theme was "recovery based on an individual approach" with subthemes "detective-find hope" and "how to do recovery-oriented practice". The next theme was "recovery subject to structural framework" with subthemes "tension between different interests" and "symptoms as a barrier".

CONCLUSIONS

recovery-oriented practice is understood as an approach where health professionals emphasise forming relationships based on trust, being hopeful for the users' future, spending time with users, and respecting users' experiences and knowledge from their own life. There are cross-pressures between different interests. The desire to meet the users' perspectives and respect these perspectives but at the same time live up to mental health centre purposes to stabilise the users' health and achieve self-care.

Healthcare Professionals' and Users' Experiences of Intersectoral Care between Hospital and Community Mental Healthcare

This paper explores healthcare professionals’ and users’ experience of coherent intersectoral care between hospital mental healthcare and community mental healthcare. A total of 20 healthcare professionals, primarily nurses, and 14 users with a range of mental illnesses participated in nine focus group interviews (FGIs). Participants were encouraged in the FGIs to reflect upon their experience of coherency in intersectoral care. The analysis of FGIs was informed by a phenomenological-hermeneutic approach in a research group from 2016–2019. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to ensure complete and accurate reporting of the study. The analysis led to the generation of several themes from a professional perspective and from a user perspective, addressed barriers to coherent intersectoral care. The healthcare professionals experienced barriers such as a lack of common language and knowledge of partners. The users did not feel involved and lacked coherence in their recovery processes and, as such, intersectoral care was often experienced as being lost in a maze.

Mental health nurses' attitudes towards consumer involvement in nursing handover pre and post an educational implementation

Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery-focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses' attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single-group pre-post-test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016-2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi-media education handover package. We found that training had a significant influence on mental health nurses' attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well-planned education can influence nurses' attitudes about involving consumers in the nursing handover processes.

Improving the practice of handover for psychiatric inpatient nursing staff

AIM

The aim of this project was to embed SBAR as a communication framework into inpatient point of care nurses handover practices on 27 inpatient psychiatric units, and to ensure that the information given/received provided staff with the confidence to provide safe patient care.

METHODS

A plan-do-study-act quality improvement framework was used to improve the adoption of SBAR in practice. Resources were developed that were relevant to the psychiatric setting; staff were educated, audits and a survey were completed.

RESULTS

The use of SBAR in practice increased from 4% pre intervention to 79% post intervention. Satisfaction with the information received during handover increased from 34% to 41%.

CONCLUSION

Findings of this project demonstrate that the standardization of handover practices and the implementation of a consistent communication framework across the organization can improve the effectiveness of shift handover, increase staff satisfaction, and improve safety of both staff and patients.

Care pathways in the transition of patients between district psychiatric hospital centres (DPCs) and community mental health services

RATIONALE AIMS AND OBJECTIVES

Patients with mental health problems experience numerous transitions into and out of hospital. Primary care providers have mixed success in identifying and managing patients' needs. This study explores health personnel's experience of care pathways in patient transition between inpatient and community mental health services.

METHODS

A descriptive qualitative design was chosen. Four focus group interviews with 12 informants from 7 different communities were conducted. Interviews were analyzed thematically.

RESULTS

Two main themes were identified: integrated care and patient activation. The participants shared their experiences on topics that can affect smooth care pathways in mental health. Six promoting factors were identified for successful patient transition: opportunities for information sharing, implementation of systematic plans, use of e-messages, around-the-clock care, designating one responsible health person in each system for each patient, and the involvement of patients and their families. The following barriers were all found to impede the patients' transition between levels of care: the lack of a single responsible person at each health care level, insufficient meetings, the absence of systematic plans, difficulties in identifying the right staff at different levels, delays in information sharing, and the complexity of welfare systems negatively affecting patient dignity.

CONCLUSIONS

Systems and procedures should be developed to ensure clear responsibilities and transparency at each stage of the pathways of care. A single person should take charge of ensuring sufficient connection and communication between inpatient and community mental health services. Finally, both patient and staff in community services should be linked through a direct telephone number with around-the-clock availability.

Views of mental health consumers about being involved in nursing handover on acute inpatient units

The involvement of consumers in handover with nurses has been identified as reducing miscommunication and a reduction in adverse events in generalist nursing settings. Mental health (MH) care is complex, and handover practices need to fit with the philosophy of recovery-focussed practice. Recovery-focussed practice recognizes the person at the centre of care as an expert in their own treatment and decision-making. The aim of the present study was to explore the views of consumers with a mental illness, without prior involvement in nursing handover, about their need to be involved in nursing handover on an acute mental health inpatient unit. Using an exploratory descriptive, qualitative design (n = 11), participants who were receiving care in an acute inpatient unit were recruited using purposive convenience sampling. Data were collected using semistructured interviews and analysed using thematic analysis. Participants' diagnoses were schizophrenia (n = 6), bipolar affective disorder (n = 4), and depression (n = 1). Two themes emerged from the interviews: (i) behind closed doors; and (ii) being involved. Several subthemes were also identified. The first theme, behind closed doors, had two subthemes: (i) it is about us; and (ii) knowing their thoughts. The second theme had three subthemes: (i) clarifying issues; (ii) setting expectations; and (iii) when and how. Nursing handover on the acute inpatient unit offers a good opportunity for consumers to take an active role in the delivery of nursing care. There is a need to rethink the way nursing handover occurs to include consumers.

Developing a guideline for structured content and process in mental health nursing handover

The process of handover has received recent attention within Australian health care, as evidence linking patient safety with the quality of handover emerges. Such links between clinical handover and patient safety have been reported elsewhere in the literature, where it is posited that the safe care of patients relies not only on the expertise and judgment of individual clinicians, teamwork, and effective management, but hinges to a large extent on the quality of information transferred from team to team. The present qualitative, descriptive study used participant observations, focus groups, and interviews to investigate the nursing handover in two acute mental health inpatient units in New South Wales, Australia. Data collected as part of that investigation contributed to the development of a handover guideline that incorporates the key components of structure, content, and leadership. The research indicated a link between these components, and further revealed the necessity to have other forums, such as supervision and clinical review, to ensure that handover serves its intended purpose in an efficient manner.

The Talk About the Psychiatric Patient

Essential to psychiatric nursing practice and care, verbal handovers and ward rounds are reporting systems for communication that shapes psychiatric staff's ability to recognize, understand, and construct patients, as well as patients' ability to construct themselves. Given the centrality of such language in psychiatric practice, the aim of this study was to describe how psychiatric staff talk about patients in psychiatric wards, what their talk encompasses, and what consequences it might pose for patient care. Empirical data were collected from audio recordings of staff discussions of patients during nine verbal handovers and three ward rounds in six different general psychiatric wards in mid and southern Sweden. Findings showed that to describe patients' mood, characteristics, and behavior, nurses used culturally common words and concepts related to three themes-good patients, bad patients, and to stay or be discharged-and six subthemes-looking well, looking poorly, desirable patients, undesirable patients, continuing work, and being discharged. However, since assessments of and decisions about patients' conditions and care used everyday language and did not involve patients' participation, opportunities for patients to participate in their own care were rare.