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Clibbens N, Booth A, Sharda L, Baker J, Thompson J, Ashman M, Berzins K, Weich S, Kendal S. Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis. Int J Ment Health Nurs 2023; 32:1636-1653. [PMID: 37574714 DOI: 10.1111/inm.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority.
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Affiliation(s)
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
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Clibbens N, Baker J, Booth A, Berzins K, Ashman MC, Sharda L, Thompson J, Kendal S, Weich S. Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-161. [PMID: 37837344 DOI: 10.3310/twkk5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Background Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances. Aim The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work. Objectives The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes. Design This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory. Main outcome The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care. Data sources Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts. Review methods A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working. Results Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve. Strengths and limitations Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity. Conclusions Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion. Future work Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research. Study registration The study is registered as PROSPERO CRD42019141680. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - Scott Weich
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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Carlsson KS, Brommels M. Integrated Health and Social Services for People With Chronic Mental Health Problems: People Are More Important Than Processes. Insights From a Multiple Case Study in Swedish Psychiatry. Front Public Health 2022; 10:845201. [PMID: 35812519 PMCID: PMC9257072 DOI: 10.3389/fpubh.2022.845201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Three mental health organizations, one merged with, one formally cooperating with, and one without formal links to social services were analyzed through the experience of staff, patients and relatives in order to elucidate what approaches best promoted service coordination. Seventeen staff and eight patients or relatives, recruited from the three organizations, participated in semi-structured interviews, guided by pre-selected categories derived from previous research about coordination and care processes. Directed content analysis was used to identify and categorize meaning units. Both staff and patients raised the same concerns. Organized collaboration between psychiatric care and social services addressed only some of patients' challenges. More important was patient access to financial and social assistance. The organizational arrangements were not referred to, whereas case management was seen as crucial. In many instances relatives have to act as case managers. Service integration in mental health has to include, in addition to social services, other authorities like social insurance and employment agencies. A case manager knowledgeable about all welfare services is best positioned to promote that “extended integration”. Relatives often have to take this responsibility to support this fragile group of patients. This observed importance of case management is supported by previous research in mental health and primary care. The role of relatives should be acknowledged and supported by those services.
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Ahmed N, Barlow S, Reynolds L, Drey N, Begum F, Tuudah E, Simpson A. Mental health professionals' perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review. BMC Psychiatry 2021; 21:594. [PMID: 34823487 PMCID: PMC8613998 DOI: 10.1186/s12888-021-03304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO: CRD42016050457) aimed to explore the perceived barriers and enablers to implementing shared decision-making in risk assessment and risk management from mental health professionals' perspectives. METHODS PRISMA guidelines were followed in the conduct and reporting of this review. Medline, CINAHL, EMBASE, PsycINFO, AMED and Internurse were systematically searched from inception to December 2019. Data were mapped directly into the Theoretical Domains Framework (TDF), a psychological framework that includes 14 domains relevant to behaviour change. Thematic synthesis was used to identify potential barriers and enablers within each domain. Data were then matched to the three components of the COM-B model: Capability, Opportunity, and Motivation. RESULTS Twenty studies met the eligibility criteria. The findings of this review indicate that shared decision-making is not a concept commonly used in mental health services when exploring processes of risk assessment and risk management. The key barriers identified were 'power and best interest' (social influences) and 'my professional role and responsibility' (social/professional role and identity). Key enablers were 'therapeutic relationship' (social influences) and 'value collaboration' (reinforcement). The salient barriers, enablers and linked TDF domains matched COM-B components 'opportunity' and 'motivation'. CONCLUSION The review highlights the need for further empirical research to better understand current practice and mental health professionals' experiences and attitudes towards shared decision-making in risk assessment and risk management.
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Affiliation(s)
- Nafiso Ahmed
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Sally Barlow
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Lisa Reynolds
- School of Nursing, Midwifery and Allied Health, Buckinghamshire New University, 106 Oxford Rd, Uxbridge, UB8 1NA UK
| | - Nicholas Drey
- Centre for Health Services Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Fareha Begum
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Elizabeth Tuudah
- Health Service and Population Research, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Alan Simpson
- Health Service and Population Research, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, 111 Denmark Hill, London, SE5 8AZ UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, James Clerk Maxwell Building, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
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Sukhera J, Bertram K, Hendrikx S, Chisolm MS, Perzhinsky J, Kennedy E, Lingard L, Goldszmidt M. Exploring implicit influences on interprofessional collaboration: a scoping review. J Interprof Care 2021; 36:716-724. [PMID: 34602007 DOI: 10.1080/13561820.2021.1979946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.
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Affiliation(s)
- Javeed Sukhera
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kaitlyn Bertram
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shawn Hendrikx
- Western University Libraries, Western University, London, Ontario, Canada
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erin Kennedy
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Jones A, Hannigan B, Coffey M, Simpson A. Traditions of research in community mental health care planning and care coordination: A systematic meta-narrative review of the literature. PLoS One 2018; 13:e0198427. [PMID: 29933365 PMCID: PMC6014652 DOI: 10.1371/journal.pone.0198427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
CONTEXT In response to political and social factors over the last sixty years mental health systems internationally have endeavoured to transfer the delivery of care from hospitals into community settings. As a result, there has been increased emphasis on the need for better quality care planning and care coordination between hospital services, community services and patients and their informal carers. The aim of this systematic review of international research is to explore which interventions have proved more or less effective in promoting personalized, recovery oriented care planning and coordination for community mental health service users. METHODS A systematic meta-narrative review of research from 1990 to the present was undertaken. From an initial return of 3940 papers a total of 50 research articles fulfilled the inclusion criteria, including research from the UK, Australia and the USA. FINDINGS Three research traditions are identified consisting of (a) research that evaluates the effects of government policies on the organization, management and delivery of services; (b) evaluations of attempts to improve organizational and service delivery efficiency; (c) service-users and carers experiences of community mental health care coordination and planning and their involvement in research. The review found no seminal papers in terms of high citation rates, or papers that were consistently cited over time. The traditions of research in this topic area have formed reactively in response to frequent and often unpredictable policy changes, rather than proactively as a result of intrinsic academic or intellectual activity. This may explain the absence of seminal literature within the subject field. As a result, the research tradition within this specific area of mental health service delivery has a relatively short history, with no one dominant researcher or researchers, tradition or seminal studies amongst or across the three traditions identified. CONCLUSIONS The research findings reviewed suggests a gap has existed internationally over several decades between policy aspirations and service level interventions aimed at improving personalised care planning and coordination and the realities of everyday practices and experiences of service users and carers. Substantial barriers to involvement are created through poor information exchange and insufficient opportunities for care negotiation.
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Affiliation(s)
- Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Michael Coffey
- Department of Public Health Policy and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City University London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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Bordeleau L, Leblanc J. La collaboration interprofessionnelle comme modalité pour résoudre les impasses thérapeutiques en pédopsychiatrie : une revue de littérature. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1041925ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
L’intervention auprès des enfants et des adolescents en clinique de pédopsychiatrie génère un risque d’impasses thérapeutiques élevé pour les cliniciens. L’alourdissement des difficultés des jeunes qui y sont référés et l’obligation pour les professionnels qui y travaillent de collaborer avec les différents acteurs présents auprès de cette clientèle contribuent à cette situation. Les recherches démontrent toutefois qu’il existe un lien positif entre la collaboration interprofessionnelle et l’efficacité des services en santé, et ce, même si son implantation demeure difficile. D’Amour et coll. ont développé un modèle de structuration de la collaboration interprofessionnelle qui permet d’en comprendre les processus. La revue de littérature qui constitue le sujet du présent article explore comment, en extrayant les indicateurs de ce modèle, il serait possible d’aider les professionnels travaillant en clinique de pédopsychiatrie à dénouer les impasses thérapeutiques qu’ils rencontrent.
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Affiliation(s)
- Lyne Bordeleau
- M. Ps., psychologue clinicienne, Doctorante en psychologie, Université de Sherbrooke
| | - Jeannette Leblanc
- Ph. D., psychologue, Professeur associée, Département de psychologie, Université de Sherbrooke
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Jansen BDW, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C. Exploring healthcare assistants' role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study. BMC Palliat Care 2017; 16:6. [PMID: 28103847 PMCID: PMC5247820 DOI: 10.1186/s12904-017-0184-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals' use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area. METHODS A qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015. RESULTS Fourteen participants took part in the study. Participants' average length of caring experience was 15.4 years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools. CONCLUSIONS Healthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.
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Affiliation(s)
| | | | - Peter Passmore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Hilary Buchanan
- Patient and Public Involvement Representative, Carer for a person living with dementia, Belfast, UK
| | | | - Sonja J McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK.,All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Dublin, Ireland
| | | | | | - Carole Parsons
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Simpson A, Hannigan B, Coffey M, Jones A, Barlow S, Cohen R, Všetečková J, Faulkner A. Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP). HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alan Simpson
- School of Health Sciences, City University London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Michael Coffey
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sally Barlow
- School of Health Sciences, City University London, London, UK
| | - Rachel Cohen
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Jitka Všetečková
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
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Abstract
Purpose
– The aim of this paper is to confirm whether the factors that act as enablers of team effectiveness in professional context are also relevant for team effectiveness in higher education.
Design/methodology/approach
– From a review of the factors that act as enablers of team effectiveness in professional contexts, this paper explores whether they are also relevant in learning environments, in particular, in higher education. After conducting a literature analysis, a Delphi study was conducted to obtain a consensus proposal of a set of input factors that can act as enablers of team effectiveness; next this paper explored, via questionnaire, in a specific context the perceptions of lecturers and students involved in teamwork.
Findings
– A set of factors reached by consensus that seem to be enablers of team effectiveness in the specific context analyzed is presented. These factors can be the basis of future studies to generalize their validity.
Originality/value
– There are many studies that identify the factors that act as enablers of team effectiveness in professional environments. The set of input factors that emerged in this study would be a useful starting point for making higher education institutions and lecturers aware of the importance of taking these factors into account when using teamwork as an educational methodology. Fostering these factors will help higher education institutions to generate shared team mental models (TMMs); these TMMs, in turn, influence team effectiveness.
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Kanerva A, Kivinen T, Lammintakanen J. Communication elements supporting patient safety in psychiatric inpatient care. J Psychiatr Ment Health Nurs 2015; 22:298-305. [PMID: 25689543 DOI: 10.1111/jpm.12187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 11/28/2022]
Abstract
Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view. Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly. Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care. In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries. The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi-structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication culture is connected with the cultural issues of communication; and being active in information collecting is related to a nurse's personal working style, which affects communication. It is important to pay attention to all the three areas and use this knowledge in developing patient safety practices and strategies where communication aspect and culture are noted and developed. In mental health nursing, it is important to develop processes concerning communication in multidisciplinary teams and across unit boundaries.
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Affiliation(s)
- A Kanerva
- Central Finland Health Care District, Jyväskylä, Finland
| | - T Kivinen
- Central Finland Health Care District, Jyväskylä, Finland
| | - J Lammintakanen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Morrison P, Meehan T, Stomski NJ. Australian case managers' perceptions of mental health consumers use of antipsychotic medications and associated side-effects. Int J Ment Health Nurs 2015; 24:104-11. [PMID: 25628227 DOI: 10.1111/inm.12118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study explores Australian case managers' perceptions of mental health consumers' use of antipsychotic medications and the side-effects resulting from these medications. Semistructured interviews were used to elicit material from nine case managers in a community care setting in South-East Queensland, Australia. Content analysis was used to examine the transcripts, and the audio-recordings were replayed to identify important contextual cues. The analysis identified several main themes, including perceptions of the use of antipsychotic medications and associated side-effects, the provision of information about antipsychotic medication side-effects; the assessment of antipsychotic medication side-effects; and the promotion of effective management of antipsychotic medication side-effects. The participants believed that antipsychotic medication provided clear benefits to mental health consumers. Most participants believed that consumers adapted to side-effects and came to accept them. The case managers themselves often felt poorly informed about antipsychotic medication side-effects, leading them to request more succinct types of information. It was notable to find that there was a lack of systematic approach to the assessment of side-effects. This finding highlighted the need to incorporate the routine structured assessment of antipsychotic medication side-effects in providing care to mental health consumers in the community.
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Affiliation(s)
- Paul Morrison
- School of Health Professions, Murdoch University, Perth, Western Australia, Australia
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Burns ST. Mental Health Counselors’ Use of the Transtheoretical Model in Interprofessional Collaboration. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/2326716x.2014.928809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Hewitt G, Sims S, Harris R. Evidence of communication, influence and behavioural norms in interprofessional teams: a realist synthesis. J Interprof Care 2014; 29:100-5. [DOI: 10.3109/13561820.2014.941458] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
AbstractBackground: Care planning is a multidisciplinary process used to develop an individualised recovery plan for each service user. The success of this process will depend on the extent to which members of mental health teams can work with one another, with service users, and with other service providers in developing a coordinated plan that meets service user needs across multiple domains.Aims: This paper examined the teamworking challenges that Community Mental Health Teams (CMHTs) face during the care planning process and how such challenges may be managed.Method: A narrative review of published articles and policy documents relevant to teamworking and recovery-focused care planning within mental health teams.Findings: Teamworking challenges include the provision of integrated rather than fragmented care, the empowerment of the service user, and development of a distributed model of leadership, responsibility and decision making.Conclusions: CMHTs face a range of substantial but manageable challenges in attempting to implement recovery-focused care planning. Recommendations include the need to integrate recovery-orientated skills and values into professional training, the need for greater multidisciplinary training opportunities, and the need to evaluate CMHTs based on recovery-orientated criteria.
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Varpio L, Regehr G. What to do about trust? A source of contradiction in interprofessional collaboration. J Grad Med Educ 2013; 5:703-4. [PMID: 24455029 PMCID: PMC3886479 DOI: 10.4300/jgme-d-13-00317.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Butler MP, Begley M, Parahoo K, Finn S. Getting psychosocial interventions into mental health nursing practice: a survey of skill use and perceived benefits to service users. J Adv Nurs 2013; 70:866-77. [PMID: 24020885 DOI: 10.1111/jan.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Mary Pat Butler
- Department of Nursing and Midwifery; Health Sciences Building; University of Limerick; Ireland
| | - Mary Begley
- Limerick Mental Health Services, St Joseph's Hospital; HSE West; Limerick Ireland
| | - Kader Parahoo
- Institute of Nursing and Health Research; University of Ulster; Coleraine UK
| | - Sophia Finn
- HSE-North Cork Mental Health Service; Mental Health Resource Centre; Charleville, Co Cork Ireland
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Abstract
The main question examined is: How do nurses and other healthcare professionals ensure ethical interprofessional collaboration-in-practice as an everyday practice actuality? Ethical interprofessional collaboration becomes especially relevant and necessary when interprofessional practice decisions are contested. To illustrate, two healthcare scenarios are analyzed through three ethics lenses. Biomedical ethics, relational ethics, and virtue ethics provide different ways of knowing how to be ethical and to act ethically as healthcare professionals. Biomedical ethics focuses on situated, reflective, and nonabsolute principled justification, all things considered; relational ethics on intersubjective, professional, and institutional relations; and virtue ethics on prephilosophical tradition and what it means to be good and to be human embedded in social and political community. Analysis suggests that interprofessional collaboration-in-practice may be more rhetoric than actuality. Key challenges of interprofessional collaboration-in-practice and specific conditions perpetuating dissension and conflict are outlined with specific education and policy recommendations included.
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Walsh F, Cleary A, Dowling M. Maximising psychiatric nurses' contribution to interdisciplinary working. Br J Community Nurs 2012; 17:270-275. [PMID: 22875163 DOI: 10.12968/bjcn.2012.17.6.270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Internationally, the deinstitutionalization of psychiatric care has resulted in expanded roles for mental health nurses within a community interdisciplinary team setting. This presents an opportunity for mental health nurses to improve service delivery. This opportunity also results in a more empowered nursing team. This article identifies change issues within one community psychiatric nursing team and the team's contribution to an improved service delivery where service users can avail of same day assessment for crisis referrals, a reduction in waiting times for assessment and co-ordinated delivery of care with an identified key worker utilizing a recovery model philosophy.
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Stewart MW, Wilson M, Bergquist K, Thorburn J. Care coordinators: a controlled evaluation of an inpatient mental health service innovation. Int J Ment Health Nurs 2012; 21:82-91. [PMID: 22084905 DOI: 10.1111/j.1447-0349.2011.00771.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study aimed to evaluate the impact of introducing designated care coordinators into an acute mental health inpatient unit in terms of service delivery, clinical outcomes, and service user and significant other perceptions. A pre-post-controlled design was implemented with a consecutive sample of 292 service users admitted and staying more than 5 days in two wards, with care coordinators introduced in one ward. Data were obtained from clinical records, standard measures, and service user and significant other surveys. Care coordinator input was associated with significant improvements in service delivery and stronger involvement of significant others and community resources. Care-coordinated clients showed significantly better clinical outcomes, including the Health of Nations Outcome Scales behaviour subscale, less time in the intensive care subunit, less community crisis team input in the week following discharge, and lower rates of readmission in the month following discharge. Care-coordinated service users and their significant others gave higher ratings of service delivery, outcome, and satisfaction. The results indicate that designated care coordinators significantly improve care processes, outcomes, and service user experience in acute inpatient mental health settings.
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Affiliation(s)
- Malcolm W Stewart
- Department of Psychology, Counties Manukau District Health Board, Waitemata District Health Board, Auckland, New Zealand
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21
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Voices that care: licensed practical nurses and the emotional labour underpinning their collaborative interactions with registered nurses. Nurs Res Pract 2011; 2011:501790. [PMID: 22135732 PMCID: PMC3205919 DOI: 10.1155/2011/501790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 07/19/2011] [Indexed: 11/18/2022] Open
Abstract
Recognizing the emotional labour underlying interprofessional collaborations (IPCs) could be considered a crucial step towards building a cohesive nursing team. Although IPCs between registered nurses (RNs) and licensed practical nurses (LPNs) have been linked to quality nursing care, little is known about the emotions experienced by LPNs during their interactions with RNs or those factors that influence IPCs. A questionnaire administered to 309 LPNs found that (1) the professional identity of LPNs has evolved into a that of a unique social group; (2) LPNs define IPC as an interpersonal process of exploring similar or dissimilar assessments of a patient's status with RNs and, together, establishing a course of nursing actions; (3) the primary organizational factor facilitating IPCs is inclusive nursing leadership; (4) the interpersonal factor promoting IPCs is the level of trust RNs extend to LPNs; and (5) an LPN's emotional labour (i.e., internal emotional regulation) is most tangible during uncollaborative interactions with RNs.
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Onyett S. Revisiting job satisfaction and burnout in community mental health teams. J Ment Health 2011; 20:198-209. [DOI: 10.3109/09638237.2011.556170] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Traynor M, Boland M, Buus N. Professional autonomy in 21st century healthcare: Nurses’ accounts of clinical decision-making. Soc Sci Med 2010; 71:1506-12. [DOI: 10.1016/j.socscimed.2010.07.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 07/14/2010] [Accepted: 07/21/2010] [Indexed: 11/24/2022]
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Rice K, Zwarenstein M, Conn LG, Kenaszchuk C, Russell A, Reeves S. An intervention to improve interprofessional collaboration and communications: a comparative qualitative study. J Interprof Care 2010; 24:350-61. [PMID: 20540614 DOI: 10.3109/13561820903550713] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interprofessional communication and collaboration are promoted by policymakers as fundamental building blocks for improving patient safety and meeting the demands of increasingly complex care. This paper reports qualitative findings of an interprofessional intervention designed to improve communication and collaboration between different professions in general internal medicine (GIM) hospital wards in Canada. The intervention promoted self-introduction by role and profession to a collaborating colleague in relation to the shared patient, a question or communication regarding the patient, to be followed by an explicit request for feedback from the partner professional. Implementation and uptake of the intervention were evaluated using qualitative methods, including 90 hours of ethnographic observations and interviews collected in both intervention and comparison wards. Documentary data were also collected and analysed. Fieldnotes and interviews were transcribed and analysed thematically. Our findings suggested that the intervention did not produce the anticipated changes in communication and collaboration between health professionals, and allowed us to identify barriers to the implementation of effective collaboration interventions. Despite initially offering verbal support, senior physicians, nurses, and allied health professionals minimally explained the intervention to their junior colleagues and rarely role-modelled or reiterated support for it. Professional resistances as well as the fast paced, interruptive environment reduced opportunities or incentive to enhance restrictive interprofessional relationships. In a healthcare setting where face-to-face spontaneous interprofessional communication is not hostile but is rare and impersonal, the perceived benefits of improvement are insufficient to implement simple and potentially beneficial communication changes, in the face of habit, and absence of continued senior clinician and management support.
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Affiliation(s)
- Kathleen Rice
- Health Services Sciences, Sunnybrook Research Institute, Canada
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Quality of internal communication in health care and the professional-patient relationship. Health Care Manag (Frederick) 2010; 29:179-85. [PMID: 20436336 DOI: 10.1097/hcm.0b013e3181da8b08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A study was undertaken for the purpose of describing internal communication and the professional-patient relationship and to establish a descriptive model of the interaction between these 2 variables. A nationwide survey was carried out in primary care and specialist care centers in Spain. A simple random sampling method was used with 1183 health care professionals. The data collection instrument was a Likert questionnaire that recorded information on the perceived quality of internal communication (0-100 scale), professional-patient relationships (0-100 scale), and sociodemographic variables. The results were analyzed using SPSS 15.0, performing mean comparisons and a suitable linear regression model.The total average of the quality of internal communication was 53.79 points, and that of the professional-patient relationships was 74.17 points. Sex made no statistically significant difference. Age shows that the older the participant, the better his/her opinion of internal communication and professional-patient relationships. Nursing staff had the highest opinion of internal communication and professional-patient relationships. The association between internal communication and professional-patient relationship was positive (R = 0.45).It was concluded that continuous exchange of information among health care professionals, together with learning and shared decision making or a positive emotional climate, is an element that will consolidate good professional-patient relationships and ensure patient satisfaction.
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Donnison J, Thompson AR, Turpin G. A qualitative exploration of communication within the community mental health team. Int J Ment Health Nurs 2009; 18:310-7. [PMID: 19740140 DOI: 10.1111/j.1447-0349.2009.00620.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This qualitative study sought to explore conceptual models employed by community mental health team (CMHT) staff in the care of their clients and how CMHT clinicians communicated with one another, particularly in relation to complex clinical work. The qualitative method of interpretive phenomenological analysis was used, and semistructured in-depth interviews with seven UK CMHT clinicians were conducted and analyzed. Four themes were evident in the data and showed that clinicians face complex and competing demands and draw on a range of therapeutic models in their work. It was also clear that much discussion centred primarily on pragmatic issues and lacked conceptual depth. The results underline the complex and challenging nature of CMHT work and suggest that a more systematic approach to interdisciplinary training within teams could be beneficial in increasing clinicians' knowledge, skills, and their understanding of the conceptual models used across different disciplines.
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Miller KL, Reeves S, Zwarenstein M, Beales JD, Kenaszchuk C, Conn LG. Nursing emotion work and interprofessional collaboration in general internal medicine wards: a qualitative study. J Adv Nurs 2008; 64:332-43. [DOI: 10.1111/j.1365-2648.2008.04768.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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