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Hickling A, Mah K, Al-Hakeem H, Scratch SE. Exploring the experiences of youth with persistent post-concussion symptoms and their families with an interprofessional team-based assessment. J Interprof Care 2022; 37:558-567. [DOI: 10.1080/13561820.2022.2137482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katie Mah
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Shannon E. Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Al Mousa Y, Callaghan P, Michail M, Caswell G. Saudi service users' perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry. Int J Ment Health Nurs 2021; 30:300-316. [PMID: 32876391 DOI: 10.1111/inm.12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/03/2023]
Abstract
This paper presents, as part of a larger mixed-methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi-structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users' health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self-awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay's 'Cultural Originality' as well as contemporary examples of Goffman's mortification of the self.
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Affiliation(s)
- Yaqoub Al Mousa
- Al Omran General Hospital, Directorate of Health Affairs in Al Hasa Governorate, Ministry of Health, Hofuf, Saudi Arabia
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, London, UK
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, Onate K, Denis JL, Pomey MP. Engaging patients to improve quality of care: a systematic review. Implement Sci 2018; 13:98. [PMID: 30045735 PMCID: PMC6060529 DOI: 10.1186/s13012-018-0784-z] [Citation(s) in RCA: 542] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. METHODS We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged. RESULTS Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign-discrete products largely derived from low-level engagement (consultative unidirectional feedback)-whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients' experiences of the engagement process (n = 12; 25%). While most experiences were positive-increased self-esteem, feeling empowered, or independent-some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. CONCLUSIONS Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients' experiences of the engagement process and whether these outcomes translate into improved quality of care. REGISTRATION N/A (data extraction completed prior to registration on PROSPERO).
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Affiliation(s)
- Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Elaina Orlando
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
- Niagara Health System, 1200 Fourth Avenue, St. Catharines, Ontario, L2S 0A9, Canada
| | - Carol Fancott
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Pooja Bhatia
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Selina Casalino
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Kanecy Onate
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Jean-Louis Denis
- Professor of Health Policy and Management, School of Public Health, Université de Montréal-CRCHUM & Canada Research Chair in Health System Design and Adaptation, 900, Saint Denis Street, Pavillion R, Montreal, Quebec, H2X 0A9, Canada
| | - Marie-Pascale Pomey
- Départment de Gestion, d'Évaluation et de Politique de Santé, École de santé Publique, Université de Montréal, Centre de recherche du CHUM, Carrefour de l'innovation et de l'évaluation en santé, 850 rue Saint-Denis, Montréal, Quebec, H2X 0A9, Canada
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Alpert JM, Morris BB, Thomson MD, Matin K, Brown RF. Implications of Patient Portal Transparency in Oncology: Qualitative Interview Study on the Experiences of Patients, Oncologists, and Medical Informaticists. JMIR Cancer 2018; 4:e5. [PMID: 29581090 PMCID: PMC5891668 DOI: 10.2196/cancer.8993] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/04/2017] [Accepted: 12/23/2017] [Indexed: 12/16/2022] Open
Abstract
Background Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledge. However, little is known about how patient portals are used in oncology. Objective The aim of this study was to understand attitudes of the portal’s adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. Methods In-depth semistructured interviews were conducted with 60 participants: 35 patients, 13 oncologists, and 12 medical informaticists. Interviews were recorded, transcribed, and thematically analyzed to identify critical incidents and general attitudes encountered by participants. Results Two primary themes were discovered: (1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists’ involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; (2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another’s culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. Conclusions The majority of patients (54%, 19/35) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure but still preferred face-to-face or telephone communication. Findings from this study indicate that portal education is needed for both patients and oncologists, especially when portals are implemented across entire health systems since highly specialized areas of medicine may have unique needs and uses. Patient portals in oncology can potentially alter the way diagnoses are delivered and how patients and oncologists communicate. Therefore, communication about the portal should be established during initial consultations so patients can decide whether they want to be informed in such a manner.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Bonny B Morris
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Khalid Matin
- Division of Hematology and Oncology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
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6
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Sjöstedt E, Dahlstrand A, Severinsson E, Lützén K. The First Nurse-Patient Encounter in a Psychiatric Setting: discovering a moral commitment in nursing. Nurs Ethics 2016; 8:313-27. [PMID: 16004086 DOI: 10.1177/096973300100800404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty.
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Affiliation(s)
- E Sjöstedt
- Karolinska Institute, Stockholm, Sweden.
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Alpert JM, Krist AH, Aycock RA, Kreps GL. Applying Multiple Methods to Comprehensively Evaluate a Patient Portal's Effectiveness to Convey Information to Patients. J Med Internet Res 2016; 18:e112. [PMID: 27188953 PMCID: PMC4887660 DOI: 10.2196/jmir.5451] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient portals have yet to achieve their full potential for enhancing health communication and improving health outcomes. Although the Patient Protection and Affordable Care Act in the United States mandates the utilization of patient portals, and usage continues to rise, their impact has not been as profound as anticipated. OBJECTIVE The objective of our case study was to evaluate how well portals convey information to patients. To demonstrate how multiple methodologies could be used to evaluate and improve the design of patient-centered portals, we conducted an in-depth evaluation of an exemplar patient-centered portal designed to promote preventive care to consumers. METHODS We used 31 critical incident patient interviews, 2 clinician focus groups, and a thematic content analysis to understand patients' and clinicians' perspectives, as well as theoretical understandings of the portal's use. RESULTS We gathered over 140 critical incidents, 71.8% (102/142) negative and 28.2% (40/142) positive. Positive incident categories were (1) instant medical information access, (2) clear health information, and (3) patient vigilance. Negative incident categories were (1) standardized content, (2) desire for direct communication, (3) website functionality, and (4) difficulty interpreting laboratory data. Thematic analysis of the portal's immediacy resulted in high scores in the attributes enhances understanding (18/23, 78%), personalization (18/24, 75%), and motivates behavior (17/24, 71%), but low levels of interactivity (7/24, 29%) and engagement (2/24, 8%). Two overarching themes emerged to guide portal refinements: (1) communication can be improved with directness and interactivity and (2) perceived personalization must be greater to engage patients. CONCLUSIONS Results suggest that simple modifications, such as increased interactivity and personalized messages, can make portals customized, robust, easily accessible, and trusted information sources.
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Affiliation(s)
- Jordan M Alpert
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States.
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Cutcliffe JR, Santos JC, Kozel B, Taylor P, Lees D. Raiders of the Lost Art: A review of published evaluations of inpatient mental health care experiences emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia. Int J Ment Health Nurs 2015; 24:375-85. [PMID: 26300551 DOI: 10.1111/inm.12159] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Forming interpersonal therapeutic relationships with mental health Service Users remains a key aspect of the practice of Psychiatric/Mental Health nurses. Given the omnipresence of the concept within the relevant literature the reader could be forgiven for asking: why would Psychiatric/Mental Health nurses opine about something so basic, so ubiquitous and so central to the theory and practice of our discipline? While the authors could locate no substantive argument that refutes the role or value of such relationships, a sizable, growing and reasonably consistent body of work has emerged, which appears to indicate that this centrality and value is not necessarily reflected in many clinical practice settings. Accordingly, we draw on the published evaluations of mental health care emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia, compare these findings and highlight similarities or/and congruence and discuss a range of issues arising out of the findings. Alas, the findings seem to depict a mental health care inpatient experience that is often devoid of warm therapeutic relationships, respectful interactions, information or choice about treatment and any kind of formal/informal 'talk therapy'. Instead such care experiences are personified by: coercion, disinterest, inhumane practices, custodial and controlling practitioners and a gross over use of pharmacological 'treatments'.
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Affiliation(s)
- John R Cutcliffe
- Centre for Nursing Research, Wright State University, Dayton, Ohio, USA.,University of Ottawa, Ottawa, Canada.,University of Coimbra, Coimbra, Portugal.,University of Malta, Malta
| | | | - Bernd Kozel
- Nursing & Social Education Research Unit, University of Bern Psychiatric Services, Bern, Switzerland.,International Graduate Academy (InGrA), 'Participation as Goal of Nursing and Therapy', Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Petrea Taylor
- Horizon HN Addictions/Mental Health, Hobart, Australia
| | - David Lees
- School of Health Sciences, University of Tasmania, Hobart, Australia
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New roles for nurses as approved mental health professionals in England and Wales. Int J Nurs Stud 2013; 50:1423-30. [DOI: 10.1016/j.ijnurstu.2013.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/18/2022]
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Cutcliffe J, Stevenson C, Lakeman R. Oxymoronic or synergistic: deconstructing the psychiatric and/or mental health nurse. Int J Ment Health Nurs 2013; 22:125-34. [PMID: 23066735 DOI: 10.1111/j.1447-0349.2012.00850.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Examination of the names used to signify a nurse who specializes in working with people with mental health problems indicates the absence of a shared nomenclature and the frequent conflation of the terms 'psychiatric' and 'mental health'. Informed by the work of Derrida (1978) and Saussure (1916-1983), the authors encourage the deconstruction of and problematization of these terms, and this shows that what nurses who work with people with so-called mental illness are called has depended on where they have worked, the vagaries of passing fashion, and public policy. Further, there are irreconcilable philosophical, theoretical, and clinical positions that prevent nurses from practicing simultaneously as 'psychiatric' and 'mental health' nurses. Related service user literature indicates that it is disingenuous to camouflage 'psychiatric' services as 'mental health' services, and as signifiers, signified, and signs, psychiatric and mental health nursing are sustained by political agendas, which do not necessarily prioritize the needs of the person with the illness. Clearly demarked and less disingenuous signs for both mental health and psychiatric care would not only be a more honest approach, but would also be in keeping with the service user literature that highlights the expectation that there are two signs (and thus two services): psychiatric and mental health services.
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Affiliation(s)
- John Cutcliffe
- Psychiatric and Mental Health Nursing, University of Maine, Orono, Maine 04469, USA.
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Ebrahimi H, Namdar H, Vahidi M. Quality of nursing care in psychiatric wards of university hospitals in northwest of iran from the perceptions of nurses. J Caring Sci 2012; 1:79-84. [PMID: 25276680 DOI: 10.5681/jcs.2012.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/28/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Nursing care is considered as an essential component of health services. Patients' health improvement depends upon the quality of nursing care. As an important principle, perceptions of nurses as well as their active participation in decision-makings has an important role in the quality of services. This study aimed to determine the percep-tion of nurses toward the quality of nursing care in psychiatric wards. METHODS In this descriptive study, we used census sampling. Seventy-six nurses employed at psychiatric wards of university hospitals in Northwest of Iran participated in this study. Quality Patient Care Scale (QUALPAC) was used to collect data. The score of each aspect and total scores were categorized as desirable, partly desirable and undesirable. The collected data were analyzed using descriptive statistics. RESULTS Findings showed that 60.5% of nurses perceived the quality of nursing care as desirable, while 65.8% and 53.9% reported the quality of physical and communicational aspects of care as desirable. Moreover, 51.3% of nurses considered the quality of care in psychosocial aspect as partly desirable. CONCLUSION Although research findings indicated the desirability of care quality from the perceptions of most nurses, designing and applying educational programs and continuous evaluation are necessary to improve nursing care quality especially in psychosocial aspects in these centers.
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Affiliation(s)
- Hossein Ebrahimi
- PhD, Assistant Professor, Departement of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Namdar
- MSc, Instructor, Departement of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Vahidi
- MSc, Postgraduate Student, Departement of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Gildberg FA, Bradley SK, Fristed P, Hounsgaard L. Reconstructing normality: characteristics of staff interactions with forensic mental health inpatients. Int J Ment Health Nurs 2012; 21:103-13. [PMID: 22321258 DOI: 10.1111/j.1447-0349.2011.00786.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic mental health nursing staff interaction with forensic mental health inpatients and to explore how staff give meaning to these interactions. The project included 32 forensic mental health staff members, with over 307 hours of participant observations, 48 informal interviews, and seven semistructured interviews. The findings show that staff interaction is typified by the use of trust and relationship-enabling care, which is characterized by the establishment and maintenance of an informal, trusting relationship through a repeated reconstruction of normality. The intention is to establish a trusting relationship to form behaviour and perceptual-corrective care, which is characterized by staff's endeavours to change, halt, or support the patient's behaviour or perception in relation to staff's perception of normality. The intention is to support and teach the patient normal behaviour by correcting their behaviour, and at the same time, maintaining control and security by staying abreast of potential conflicts.
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Affiliation(s)
- Frederik A Gildberg
- Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark.
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Entwistle V, Firnigl D, Ryan M, Francis J, Kinghorn P. Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map. J Health Serv Res Policy 2011; 17:70-8. [PMID: 21967821 PMCID: PMC3336938 DOI: 10.1258/jhsrp.2011.011029] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patients' experiences are often treated as health care quality indicators. Our aim was to identify the range of experiences of health care delivery that matter to patients and to produce a conceptual map to facilitate consideration of why they matter. METHODS Broad-based review and critical interpretive synthesis of research literature on patients' perspectives of health care delivery. We recorded experiences reported by a diverse range of patients on 'concept cards', considered why they were important, and explored various ways of organizing them, including internationally recognized health care quality frameworks. We developed a conceptual map that we refined with feedback from stakeholders. RESULTS Patients identify many health care experiences as important. Existing health care quality frameworks do not cover them all. Our conceptual map presents a rich array of experiences, including health care relationships (beyond communication) and their implications for people's valued capabilities (e.g. to feel respected, contribute to their care, experience reciprocity). It is organized to reflect our synthesis argument, which links health care delivery to what people are enabled (or not) to feel, be and do. The map highlights the broad implications of the social dynamics of health care delivery. Experiences are labelled from a patient's perspective, rendering the importance of responsiveness to individuals axiomatic. CONCLUSIONS Our conceptual map identifies and helps explain the importance of diverse experiences of health care delivery. It challenges and helps policy-makers, service providers and researchers to attend to the range of experiences that matter, and to take seriously the need for responsiveness to individuals.
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Affiliation(s)
- Vikki Entwistle
- Social Dimensions of Health Institute, University of Dundee, Dundee, UK.
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Minas H, Zamzam R, Midin M, Cohen A. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes. BMC Public Health 2011; 11:317. [PMID: 21569613 PMCID: PMC3112131 DOI: 10.1186/1471-2458-11-317] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 05/14/2011] [Indexed: 11/15/2022] Open
Abstract
Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298). Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions.
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Affiliation(s)
- Harry Minas
- Centre for International Mental Health, Melbourne School of Population Health, University of Melbourne, Parkville, Victoria 3010, Australia.
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Nolan P, Bradley E, Brimblecombe N. Disengaging from acute inpatient psychiatric care: a description of service users' experiences and views. J Psychiatr Ment Health Nurs 2011; 18:359-67. [PMID: 21418436 DOI: 10.1111/j.1365-2850.2010.01675.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The growing number of people worldwide with mental health problems is increasing and making intensive demands on existing services. Recent reorganizations of healthcare provision in the UK have focused predominantly on administrative efficiency, standardization and cost-effectiveness. Although little evidence exists that reorganizations, per se, directly result in improved health nationally, nevertheless, organizational change coupled with improved care provision can have a considerable impact on the mental health of people. It is known that service users want person-centred help with improving their confidence, autonomy and cognitive and social skills so as to be able to manage their lives within the social context in which they live. In this study, semi-structured interviews were used to explore service users' expectations and experiences of acute inpatient care and the early post-discharge period. While the social environment of the wards was seen by many as conducive to promoting safety and interpersonal relationships, others found the experience lacking in assisting them to resume their lives post discharge. If acute care is to become more than a mechanism for addressing and containing risk, better targeted interventions are required to help individuals find strategies that are transferable to the context of their 'real' lives. A number of factors that were identified by respondents in this study are identified and discussed.
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Affiliation(s)
- P Nolan
- Staffordshire University and South Staffordshire and Shropshire Mental Health NHS Trust, Stafford, UK.
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Fitzgerald MM, Kirk GD, Bristow CA. Description and evaluation of a serious game intervention to engage low secure service users with serious mental illness in the design and refurbishment of their environment. J Psychiatr Ment Health Nurs 2011; 18:316-22. [PMID: 21418431 DOI: 10.1111/j.1365-2850.2010.01668.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Service user involvement in all levels of healthcare provision is the expectation of UK government policy. Involvement should not only include participation in the planning and delivery of health care but also the exercise of choice and opinions about that care. In practice, however, service user engagement is most often tokenistic, involving post hoc consultation over plans already committed to by services. This paper explores an Occupational Therapy-led initiative to use the Serious Game format to engage low secure service users with serious mental illness in the design, layout and refurbishment of their unit. Among other things how medication was to be dispensed on the new unit was explored by this game and led to significant replanning in response to service user involvement. The game format was found to be a useful tool in facilitating communication between professionals and a traditionally marginalized and powerless client group. It enabled service users to have a voice, it provided a format for that voice to be heard and made possible service-led change in the planning process.
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Affiliation(s)
- M M Fitzgerald
- Prospect Place, Rehabilitation and High Support Services, Pennine Care NHS Foundation Trust, Ashton under Lyne, Tameside, Manchester OL6 9RW, UK.
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17
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Thibeault CA, Trudeau K, d'Entremont M, Brown T. Understanding the milieu experiences of patients on an acute inpatient psychiatric unit. Arch Psychiatr Nurs 2010; 24:216-26. [PMID: 20650367 DOI: 10.1016/j.apnu.2009.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 06/14/2009] [Accepted: 07/17/2009] [Indexed: 10/20/2022]
Abstract
The role of inpatient mental health units is changing. Increasingly, people with acute and severe mental illness are admitted for short periods of intense treatment and are discharged quickly to community-based care. Reduction in average lengths of stay for psychiatric inpatients has been accompanied by a marginalization of the concept of therapeutic milieu in the mental health discourse. This phenomenological inquiry focuses on understanding the life-world of six people with acute psychiatric illness who were hospitalized on an acute inpatient psychiatric unit. Working together, a team of four, including mental health clinicians and consumers, developed and implemented this interpretive study using the phenomenology of Heidegger and Taylor. The principle investigator conducted the interviews, and the research team engaged in a complex interpretive process, reviewing narrative accounts, exploring personal meanings and key themes, and reconstructing shared meaning as lived and shared by participants. In this report, the authors describe patient experiences of a rule-bound, controlling, and sometimes oppressive milieu while highlighting patient experiences of healing and health as lived within that same milieu. The authors describe patients' embodied, dialectical, and often paradoxical experiences of fear and affirmation, alienation and connection, and abandonment and healing. The authors share selected narrative accounts to generate new understanding of patient experiences and suggest that the inpatient psychiatric milieu remains an important but often neglected component of psychiatric treatment.
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18
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Izumi S, Baggs JG, Knafl KA. Quality nursing care for hospitalized patients with advanced illness: concept development. Res Nurs Health 2010; 33:299-315. [PMID: 20572095 PMCID: PMC3241609 DOI: 10.1002/nur.20391] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability.
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Affiliation(s)
- Shigeko Izumi
- College of Nursing, Washington State University, P.O. Box 1495, Spokane, WA 99210-1495, USA
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19
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Boyer L, Baumstarck-Barrau K, Cano N, Zendjidjian X, Belzeaux R, Limousin S, Magalon D, Samuelian JC, Lancon C, Auquier P. Assessment of psychiatric inpatient satisfaction: a systematic review of self-reported instruments. Eur Psychiatry 2009; 24:540-9. [PMID: 19699617 DOI: 10.1016/j.eurpsy.2009.05.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 05/11/2009] [Accepted: 05/29/2009] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a growing concern about satisfaction with inpatient psychiatric services. There are currently numerous satisfaction instruments available to psychiatric inpatients, but little guidance on which among them to select. AIMS To provide an overview of the psychometric properties and the content of satisfaction instruments available to psychiatric inpatients. METHODS Systematic searches of Medline database to identify inpatient satisfaction questionnaires. Assessment of the instruments according to relevant psychometric properties. RESULTS Fifteen satisfaction instruments were identified. The target population differed according to the instrument. Methods used to generate items were heterogeneous. These instruments were based on a mixed approach including patients' points of view, expert opinions, and literature reviews, causing the content of questionnaires to vary. Reliability and validity were not systematically tested. CONCLUSION The validation of a common inpatient satisfaction instrument is a major challenge. Recommendations for the future development of satisfaction instruments may include: item generation based exclusively on the patient's point of view; a validation process on a large and representative population; and an instrument combining generic (core questionnaire) and specific (additional modules) approaches.
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Affiliation(s)
- L Boyer
- Department of Public Health, La Timone Hospital, Assistance publique des Hôpitaux de Marseille, 264 rue Saint-Pierre, Marseille cedex 5, Marseille, France.
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21
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N. MARSHALL, RICHARD A. POWELL & KE MARTIN. ' Quality and quantity' : Qualitative appr oaches to mental health research. J Ment Health 2009. [DOI: 10.1080/09638239619103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Abstract
The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses.
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Affiliation(s)
| | | | - Knut W Ruyter
- National Committee for Medical Research Ethics, and University of Oslo, Oslo, Norway
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23
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Bradbury-Jones C, Tranter S. Inconsistent use of the critical incident technique in nursing research. J Adv Nurs 2008; 64:399-407. [PMID: 18764849 DOI: 10.1111/j.1365-2648.2008.04811.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion. BACKGROUND Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion. DATA SOURCES A search of the CINAHL database for the period 1956-2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers. DISCUSSION We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers' attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge. CONCLUSION While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible.
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Abstract
The CIT is a practical and efficient methodology that encourages participants to tell their story; with happenings that are memorable events in participants' lives. It is a form of story-telling, as participants share their singular experience as a story to the researcher. It is a qualitative, systematic, open-ended technique for educing descriptive data from participants as well as being an effective naturalistic tool for focusing participants' on a specific event. The CIT is a user-friendly instrument that can foster reflection and promote personal expression. The development of the CIT to generate indicators of specific happenings relative to research questions demonstrates the technique's suppleness and emphasises the capability of this methodology in nursing research. As nurses learn more about this methodology and its application to the study of nurses and nursing care, they will begin to comprehend how simple and effortless this technique is to use. The CIT can be developed to conform to any area of nursing and provide a more comprehensive awareness of what nurses do and the needs of our clients.
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Affiliation(s)
- Leighsa Sharoff
- City University of New York Hunter College - Bellevue School of Nursing New York, NY, USA,
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25
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Bee P, Playle J, Lovell K, Barnes P, Gray R, Keeley P. Service user views and expectations of UK-registered mental health nurses: A systematic review of empirical research. Int J Nurs Stud 2008; 45:442-57. [PMID: 17418194 DOI: 10.1016/j.ijnurstu.2007.02.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 02/08/2007] [Accepted: 02/18/2007] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Penny Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, UK.
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26
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Cutcliffe JR. The die has been cast? Rediscovering the essence of psychiatric nursing. ACTA ACUST UNITED AC 2008; 17:88-92. [DOI: 10.12968/bjon.2008.17.2.28134] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John R Cutcliffe
- University of Texas (Tyler), USA
- Stenberg College, Vancouver, Canada
- University of Ulster, United Kingdom
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27
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Abstract
This article describes the critical incident technique (CIT) as it informs holistic nursing. The CIT is a qualitative, systematic, open-ended technique for educing descriptive data from participants. It is an effective naturalistic tool for focusing participants on a specific event. The CIT is a user-friendly instrument that can foster reflection and promote personal expression. Holistic nursing is a personal and professional commitment to the healing process of self and others. The competency of holistic nurses revolves around their ability to incorporate the concepts and standards of the philosophy of holistic nursing into their life and practice. This article explores the use of the CIT in 2 separate studies on holistic nurses. Both studies utilized the CIT as a secondary source of data collection. All participants in both studies were members of the American Holistic Nurses Association. One study explored how experienced certified holistic nurses learned to become competent practitioners, while the other study focused on holistic nurses' experience with modalities, the perceived benefits to self and client.
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Affiliation(s)
- Leighsa Sharoff
- Hunter College - Bellevue School of Nursing, City University of New York, New York, NY 10010, USA.
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28
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Kuosmanen L, Hätönen H, Jyrkinen AR, Katajisto J, Välimäki M. Patient satisfaction with psychiatric inpatient care. J Adv Nurs 2007; 55:655-63. [PMID: 16925614 DOI: 10.1111/j.1365-2648.2006.03957.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper reports a study of psychiatric inpatient satisfaction with care in one Finnish psychiatric hospital, and explores the factors associated with satisfaction. BACKGROUND Patient satisfaction is a central indicator for healthcare quality. Previous literature has shown that psychiatric inpatients are quite satisfied with their care in general, but have reported dissatisfaction in the areas of information access and compulsory care. Changes in the structure of Finnish mental health services due to dehospitalization have increased interest in exploring psychiatric patients' treatment experiences and general satisfaction. METHOD Data were collected in inpatient settings using a self-rating patient satisfaction questionnaire. A total of 316 patients leaving the study units during a 1-year period (May 2000-April 2001) was recruited. The response rate was 61% (n = 313). FINDINGS In general, patients were quite satisfied with their care. Of seven different satisfaction areas, they were most satisfied with staff-patient relationships, and reported most dissatisfaction in the areas of information, restrictions, compulsory care and ward atmosphere/physical milieu. Younger and female patients were less satisfied with staff-patient relationships than older patients and men. manova (five factors, main effects and two-way interactions in the model) showed that male patients with occasional symptoms or symptoms persisting for less than a month were more satisfied with staff than were women. Further, when symptoms persisted for a month or up to 1 year or more, women were more satisfied with staff than men. CONCLUSION General patient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be paid to collaboration with young adults (18-24 years) and female patients with mental health problems of short duration.
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Affiliation(s)
- Lauri Kuosmanen
- Department of Nursing Science, University of Turku, Turku, Finland.
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29
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Johansson IM, Skärsäter I, Danielson E. The health-care environment on a locked psychiatric ward: an ethnographic study. Int J Ment Health Nurs 2006; 15:242-50. [PMID: 17064320 DOI: 10.1111/j.1447-0349.2006.00430.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.
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Affiliation(s)
- Inger M Johansson
- The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden. inger.x.johansson.vgregion.se
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30
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Abstract
Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the 'therapeutic' or 'helping' nurse-patient relationship. However, despite the current agenda regarding patient-centred care, the literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. I examine the work of Hursthouse on virtue ethics' action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and I conceive nursing as a practice: nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong practice-based version of virtue ethics proposed is context-dependent, particularist, and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further.
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Affiliation(s)
- Alan E Armstrong
- Department of Nursing, University of Central Lancashire, Preston, Lancashire, UK.
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31
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Halse C, Boughtwood D, Clarke S, Honey A, Kohn M, Madden S. Illuminating multiple perspectives: meanings of nasogastric feeding in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2005. [DOI: 10.1002/erv.624] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Rydon SE. The attitudes, knowledge and skills needed in mental health nurses: the perspective of users of mental health services. Int J Ment Health Nurs 2005; 14:78-87. [PMID: 15896254 DOI: 10.1111/j.1440-0979.2005.00363.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Knowledge about the practice and roles of mental health nurses in New Zealand is currently limited. In a sociopolitical climate where the views of users of mental health services are increasingly incorporated into education and the planning and delivery of services, there is a need for research that reflects the perspective of users. In this study a qualitative descriptive methodology with focus group interviews was used to explore with users of mental health services, the attitudes, knowledge and skills that they need in mental health nurses. Users of mental health services valued the therapeutic work of mental health nurses, and identified positive attitudes towards users of mental health services as essential in mental health nurses. However, they did not consistently experience a therapeutic approach in their interactions with mental health nurses.
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Affiliation(s)
- Sharon E Rydon
- School of Health Sciences, Albany Campus, Massey University, Auckland, New Zealand.
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33
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Abstract
This historical analysis draws attention to differing assumptions, which promote or limit user involvement in nursing practice. The meaning of the term 'user involvement' is analyzed with reference to varying models. A continuum is offered to illustrate the relationship between assumptions about people with mental health problems and their involvement in care. It is argued that the range of views concerning recipients of mental health services, from being dangerous and irrational to being considered equal partners with health professionals, creates an unresolved tension that has existed through the ages. The key to resolving this tension is for all parties openly to acknowledge conflicts between their views and those of others and engage in meaningful dialogue about them. In this way the lessons from history may be learned.
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Affiliation(s)
- B Rush
- University of Nottingham, School of Nursing, Nottingham, UK.
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34
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Woodring S, Polomano RC, Haagen BF, Haack MM, Nunn RR, Miller GL, Zarefoss MA, Tan TL. Development and testing of patient satisfaction measure for inpatient psychiatry care. J Nurs Care Qual 2004; 19:137-48. [PMID: 15077831 DOI: 10.1097/00001786-200404000-00011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient satisfaction is one of the most important indicators for service excellence. Investigations have been done with population-specific patient satisfaction tools for psychiatric patients; however, there are few published measures for evaluating inpatient care. We developed and tested a 15-item instrument to evaluate the interdisciplinary care model and therapeutic interventions. Results demonstrated reliability and validity of the tool.
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Affiliation(s)
- Sharon Woodring
- Department of Psychiatry, Penn State Milton S. Hershey, Medical Center Hershey, PA, USA
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35
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Abstract
OBJECTIVE In a previous study, we have suggested a revision of the Anger/Aggression and the Spontaneity subscales. The main aim of this study was to re-evaluate the psychometric properties of the other eight subscales of the Ward Atmosphere Scale. METHOD A total of 550 patients and 822 staff members on 54 psychiatric wards for psychotic patients completed the WAS and the Good Milieu Index (GMI). We calculated Cronbach's alpha, the Corrected Item Total subscale Correlation, subscale intercorrelations and the correlation between subscales and GMI. RESULTS By removing a total of 16 items, the psychometric properties improved. The revised subscales had acceptable psychometrics and gave a clearer picture of the relationship between the perceived level of patient satisfaction and the WAS subscale scores. CONCLUSION The revision suggested in this study 'modernized' several of the subscales. We suggest that this revision is implemented in the future use of the WAS.
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Affiliation(s)
- J I Røssberg
- Department of Psychiatry, Ullevål University Hospital, Oslo, Norway.
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36
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Abstract
The paper identifies shortcomings of approaches used in organizing and delivering mental health nursing. It provides a rationale for the development of a new system of mental health nursing namely the Partnership in Coping system (PinC). This system has been developed by service users, clinical mental health nurses and an academic mental health nurse. Currently, it is undergoing trials in Western Australia. The PinC focuses on the strengths of clients. It uses the positive aspects of mental health nursing namely its holistic perspective, the length and nature of the informal contacts, the 'ordinariness' of relationships with clients and the nurse's knowledge of the clients' social and physical environments. It is a versatile system that can also be used across different mental health settings (community and inpatient facilities). The paper describes the philosophy behind the system, the concept of coping, the nature of the partnership between the client and nurse and their respective roles.
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Affiliation(s)
- E Shanley
- Old Nornalup Hospital, PO Box 290, Walpole, Western Australia.
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37
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Abstract
BACKGROUND The theoretical foundations and professional ideals of psychiatric nursing contain built-in contradictions. One central ideal is that nurses should use themselves as therapeutic instruments. The expectation that nurses should have both a professional and a human function is examined in this study. PURPOSE The purpose of this study was to find out how nurses experience and interpret the contradictory demands of being both fellow human being and health professional in their work with patients. METHODS An ethnographic research design including participant observation and narrative interviews with nurses working on an acute ward of a psychiatric hospital was used. The case of one nurse is analysed and discussed. FINDINGS The study shows that when nurses themselves are 'therapeutic instruments', tensions are created. Contradictory demands produce difficult role conflicts. Nurses vary in the ways in which they interact with patients. The study shows how the nurse's own vulnerability can be a constructive element in patient care. It also shows that although the nurse is aware of this, she is also critical of her performance, feeling that it falls short of accepted professional standards. Her colleagues reinforce these standards. CONCLUSION The ideal that psychiatric nursing should be a balancing act between intimacy and distance, between human and professional ways of acting, appears to be too harmonious and narrow a one. The study suggests that there is potential for professional development if nurses are able to recognize their own vulnerability. Critical examination and discussion of conventionally accepted ideals can help develop our knowledge of the profession.
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Affiliation(s)
- Marit Helene Hem
- Section for Health Science, Faculty of Medicine, University of Oslo, Oslo, Norway.
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38
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Abstract
The aim of this report was to describe patients' experiences of psychosis in an inpatient setting. Mental illness, as a result of psychosis, has traditionally been defined from the viewpoint of clinical experts. Psychiatric nursing, as an interactive human activity, is more concerned with the development of the person than with the origins or causes of their present distress. Therefore, psychiatric nursing is based on eliciting personal experiences and assisting the person to reclaim her/his inner wisdom and power. The design of the study, in the report discussed below, was phenomenological. In 1998, nine patients were interviewed regarding their experiences of psychosis in an acute inpatient setting. The verbatim transcripts were analysed using Giorgi's phenomenological method. The participants experienced psychosis as an uncontrollable sense of self, which included feelings of change and a loss of control over one's self with emotional distress and physical pain. The participants described the vulnerability they had felt whilst having difficult and strange psychological feelings. The informants experienced both themselves and others sensitively, considered their family and friends important and meaningful, and found it difficult to manage their daily lives. Furthermore, the informants experienced the onset of illness as situational, the progress of illness as holistic and exhaustive, and the admission into treatment as difficult, but inevitable.
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Affiliation(s)
- K Koivisto
- Oulu Polytechnic Social and Health Care, Oulu, Finland
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39
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Abstract
The purpose of this study was to describe patient satisfaction with outpatient psychiatric care in two community care clinics in Finland. Data were collected using a structured questionnaire from 300 outpatients between February and March 2000. A total of 171 patients returned completed questionnaires (response rate 57%). The data analysis was based on descriptive statistics, chi-square test, the Mann-Whitney U-test and the Kruskal-Wallis test. Item homogeneity was analysed using Cronbach alpha coefficient. The results showed that patient satisfaction was highest in areas pertaining to staff and care discussions, and lowest in areas pertaining to information. Patients who considered the wait for treatment to be too long were more dissatisfied with staff, their chance of influencing their own care, and the help they received, compared with patients who considered the wait to be reasonable in length. We can conclude that although patients are quite satisfied with their outpatient treatment in general, the patient information process is not at a satisfactory level at outpatient psychiatric clinics. In the future, more emphasis should be put on developing more innovative methods to increase psychiatric patients' knowledge level regarding their own illness and treatment.
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Affiliation(s)
- U Siponen
- Mental Health Centre (A3), Turku, Finland.
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40
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Abstract
In mental health nursing, inadequate nursing practice research has resulted in a deficit of knowledge concerning the nurse-client relationship; an area seen as the heart of practice. In turn, the specialty has experienced difficulty in identifying its unique domain of practice. Findings from a hermeneutic study into adolescent mental health nursing explicated its practice knowledge. These findings include: (i) 'engaging in therapeutic relationships'; (ii) 'guiding the potential for change'; and (iii) 'facilitating positive outcomes'. A higher order finding was named 'fostering a functional self'. These findings are discussed. Findings point to the nature, purpose and processes of the nurse-client relationship, and to outcomes from that relationship. It is suggested they also represent a beginning understanding of the specialty's unique contribution to nursing; that mental health nursing fosters transformative change of self.
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Affiliation(s)
- Rene Geanellos
- University of Western Sydney, School of Nursing, Family and Community Health, Parramatta Campus, Building ER, Locked Bag 1797, Penrith South DC 1797 NSW, Australia.
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41
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Geanellos R. Exploring the therapeutic potential of friendliness and friendship in nurse-client relationships. Contemp Nurse 2002; 12:235-45. [PMID: 12219952 DOI: 10.5172/conu.12.3.235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Friendliness and friendship, within the nurse-client relationship, are explored. Friendliness is superficial and includes nurses' smiling, joking, a warm tone of voice and interest in clients, while friendship is a deeper more affective involvement between client and nurse. The therapeutic outcomes of friendliness and friendship are significant. When nurses are friendly, client feelings of disease, strangeness and alienation are replaced by feelings of comfort, belonging and involvement. Friendship between nurse and client has similar outcomes but is a deeper experience that is simultaneously rewarding and sustaining for both. The therapeutic potential of friendliness and friendship suggests: (1) focused research would assist nursings' understanding of these concepts, and (2) determine their implications to nurse education and practice.
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Affiliation(s)
- Rene Geanellos
- School of Nursing, Family & Community Health, University of Western Sydney, Parramatta, New South Wales
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Abstract
BACKGROUND In the United Kingdom (UK) and elsewhere throughout the world, the policy and legal frameworks that surround the provision of mental health care are becoming increasingly coercive. For example, emerging mental health policy in the UK includes a commitment to the introduction of compulsory treatment in the community. AIMS In this paper, our aims are: to explore the context in which this more coercive mental health policy has arisen in the UK; to challenge the assumptions and the evidence that lie behind the introduction of proposed new mental health policies; and to consider the impact that a more coercive policy is likely to have on the practice of mental health nursing. DISCUSSION In the UK, representatives of central government have declared that 'care in the community has failed'. This view has been reinforced by media representations of mental health issues. Policy documents have drawn attention to the risks posed by people with mental illnesses. Correspondingly, proposed initiatives emphasize the need to more closely 'manage' people with mental health problems, and set out a new legislative and policy framework to achieve this. We question the assumptions and evidence that underlie these planned new developments. We argue that, contrary to government assertions, there is no unequivocal evidence that 'community care' has failed. We observe, too, that people with mental health difficulties are often amongst the most vulnerable members of society. Finally, we consider the impact that a more coercive policy framework will have on the work of mental health nurses, and argue that the shift towards a more 'controlling' role is likely to run counter to what many nurses see as the 'core' of their work.
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Affiliation(s)
- Ben Hannigan
- School of Nursing and Midwifery Studies, University of Wales College of Medicine, Caerleon Education Centre, Caerleon, Newport, UK.
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Keatinge D. Versatility and flexibility: attributes of the Critical Incident Technique in nursing research. Nurs Health Sci 2002; 4:33-9. [PMID: 12087990 DOI: 10.1046/j.1442-2018.2002.00099.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article explores the value of using the Critical Incident Technique to capture qualitative data relating to nurses' experiences in three diverse clinical contexts: (i) neonatal intensive care; (ii) palliative care; and (iii) care of the demented elderly. It is suggested that this technique enables the researcher to capture the reality of contemporary nursing practise, and nurses' experiences of that practise. It is also suggested that the versatility and flexibility of the Critical Incident Technique reveals the subtleties and complexities in nurses' experiences of practising nursing in diverse contexts, thereby promoting a deeper understanding of meanings underpinning this practise.
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Affiliation(s)
- Diana Keatinge
- Hunter Area Health Service and Faculty of Nursing, University of Newcastle, Australia.
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Quirk A, Lelliott P. What do we know about life on acute psychiatric wards in the UK? A review of the research evidence. Soc Sci Med 2001; 53:1565-74. [PMID: 11762883 DOI: 10.1016/s0277-9536(00)00457-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Despite the development of community care and associated processes of de-institutionalisation, the hospital remains the hub of mental health services in the UK. However, previous quantitative and survey research indicates that quality of care in acute psychiatric (admission) wards has been compromised or is under threat, and points to a bleak experience for people who are admitted. Indicators of this include that there have been increases in admission rates, the proportion of compulsory admissions, and bed occupancy rates. There is also evidence of violence, sexual harassment and substance misuse in this setting, accompanied by rapid staff turnover, low staff morale, and an increasing proportion of 'difficult' patients (especially young men with schizophrenia). This paper reviews the evidence about life on psychiatric wards, focusing on how it is experienced by patients in acute settings. Research conducted in the UK in the 1990s, supports the impression that organisational pressures are having a negative impact on the quality of care. It shows that: nurse-patient (N-P) relationships are perceived to be an important aspect of care, but that N-P contact has declined; and patients are critical of conditions on the ward and view life there as both boring and unsafe. However, very little in-depth ethnographic research has been conducted on acute wards in the UK (and none since the 1970s) leaving us with a 'black box' view of in-patient care in this setting. Studies conducted during earlier 'care paradigms', notably those in the USA by Goffman and Strauss et al., provide useful insights into the patient's experience, but the extent to which these can be conceptually generalised to the present situation is unknown. The paper concludes by outlining questions and priorities for future investigation, focusing on the role of qualitative research.
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Affiliation(s)
- A Quirk
- Royal College of Psychiatrists' Research Unit, London, UK.
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45
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Cutcliffe JR, Black C, Hanson E, Goward P. The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part one. J Psychiatr Ment Health Nurs 2001; 8:53-9. [PMID: 11879494 DOI: 10.1046/j.1365-2850.2001.00339.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The role of the palliative care nurse emphasizes the need for holistic care, and as this role has developed it has become evident that palliative care nurses require skills which, arguably, not all registered general nurses possess; particularly, skills pertaining to the psychological, social and spiritual domains of the person. In order to identify the skills that such nurses may require, there may be merit in considering other specialities of nursing which pay particular attention to the psychological, social and spiritual domains of the person. Consequently, this two-part paper explores the areas of commonality and synchronicity between palliative care nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation, and the focus on physical care. Part one of this paper therefore focuses on the first three areas of alleged commonality, with part two focusing on the fourth commonality, the key differences and the implications of such similarity. Given these areas of similarity the authors argue there is a case for reconsidering if the RGN qualification is an essential requirement for working within palliative care or if those with other skills -- skills based on 'being with' rather than 'doing for' -- such as RMNs, should be thought of for such roles.
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Affiliation(s)
- J R Cutcliffe
- Mental Health Nursing, University of Ulster and RCN Institute, Oxford, UK
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Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med 2001; 52:417-27. [PMID: 11330776 DOI: 10.1016/s0277-9536(00)00146-5] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Much of the research on violence in the health care sector has focused on the immediate and long-term effects of patient violence on staff victims. There is a lack of studies, however, examining whether individual reactions to violent episodes, such as anger and increased fear in one's work, have any measurable effect on staff behaviour toward their patients, and ultimately on the quality of patient care. The aim of the present study was to investigate whether an association exists between staff experiences with violence and patient-rated quality of patient care. A theoretical model was presented, suggesting that violence or threats experienced by health care staff have a negative effect on the quality of health care services offered, as measured by patients. In addition, it was theorised that there would be an association between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their work environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and quality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see which combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient perspective. Violence entered consistently as an important predictor into each of the three best regression equations for 1994, 1995, and 1997, respectively. The results of this analysis suggest that the violence experienced by health care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational health issue, but may have significant implications for the quality of care provided.
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Affiliation(s)
- J E Arnetz
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.
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Abstract
This study explored the perceptions of 12 patients attending a day care unit in June/July 1996, with the purpose of finding out what was important to these people about their day care experiences. It used a phenomenological methodology derived from Paterson and Zderad's Humanistic Nursing Theory. The patients described numerous aspects of the day care service that were important to them. All 12 people interviewed considered the service satisfactory, and a number considered it to be more than anyone could or should expect. Day care was found to help them feel comfortable, to feel of value and to feel less isolated. In addition, the participants were found to be living with cancer in two different ways. All 12 knew they had cancer and might be terminally ill. Yet some seemed to "tolerate" their life with cancer, whereas others saw it as requiring "adaptation". The day care service was supporting both these styles of managing life with cancer. The interpretation of the findings suggests that the reason patients expressed such satisfaction with the service offered was because the care was humanistic. It responded to individual opinions, feelings and understandings of health and well-being, by giving people time and responding to their individual concerns. In this way, it was flexible enough to support people in managing their illness using their own preferred style.
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Affiliation(s)
- J B Hopkinson
- School of Nursing Studies, University of Manchester, Manchester, UK
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48
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Black C, Hanson E, Cutcliffe J, Goward P. Palliative care nurses and mental health nurses: sharing common ground? Int J Palliat Nurs 2001. [DOI: 10.12968/ijpn.2001.7.1.9039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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49
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Pourin C, Daucourt V, Barberger-Gateau P. Utilisation de la méthode des incidents critiques dans la construction d'un outil de mesure de la satisfaction en psychiatrie. SANTE PUBLIQUE 2001. [DOI: 10.3917/spub.012.0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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50
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Abstract
The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers' expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients' experiences in health care settings, exploring dimensions of nurse-patient interactions and identifying patients' responses to illness and health care treatment.
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Affiliation(s)
- J K Kemppainen
- VA Postdoctoral Nurse Fellow, VA Palo Alto Health Care System, Palo Alto, California, USA.
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