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Mellerup M, Sjöström K, Örmon K. Recovery at an Adult Psychiatric Day Hospital-A Qualitative Interview Study Describing Patients' Experiences. Issues Ment Health Nurs 2024; 45:624-629. [PMID: 38652832 DOI: 10.1080/01612840.2024.2330565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Psychiatric Day Hospitals offer time-limited active treatment programmes that are therapeutically intensive, coordinated, and with structured clinical services within a stable environment. No previous studies have described patients' experiences of recovery-oriented care at a Psychiatric Day Hospital in a Swedish or Nordic healthcare context. The aim of the study was to explore patients' experiences of a Psychiatric Day Hospital with focus on patient recovery. A qualitative method was used; 12 in-depth interviews were performed with patients all analysed with content analysis. The theme that emerged was "A safe haven." To do something routinely and meaningful during the days, feelings of security, and to gain increased knowledge about mental ill health were concepts which felt important and contributed to recovery. Feelings of belonging and prevention of loneliness were also highlighted.
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Affiliation(s)
- Marie Mellerup
- Office for Psychiatry, Habilitation and Technical Aids, Department of Adult Psychiatry Malmö/Trelleborg, Region Skåne, Sweden
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Sjöström
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- The Västra Götaland Region Competence Centre on Intimate Partner Violence, Gothenburg, Sweden
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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2
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Johanna B, Noora G, Kaisa M, Heikki E, Mari L. Nurses' and Patients' Perceptions about Psychiatric Intensive Care-An Integrative Literature Review. Issues Ment Health Nurs 2022; 43:983-995. [PMID: 35980786 DOI: 10.1080/01612840.2022.2101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This integrative literature review describes nurses's and patients' perceptions of care in psychiatric intensive care units (PICU). The database search was conducted in April 2020. PRISMA checklist and Mixed Method Appraisal Tool guided the identification and evaluation of the studies (n = 21). Data was analyzed with qualitative content analysis. Nurses perceived PICU as a challenging work environment where their primary task was to ensure the unit's safety. Patients views on their treatment varied from positive to negative. Patients wished to have more privacy and supportive interaction. Findings can be used as a basis in developing care practices and staff's further education in PICUs.
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Affiliation(s)
- Berg Johanna
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland
| | | | - Mishina Kaisa
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku; INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Ellilä Heikki
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland
| | - Lahti Mari
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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3
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O'Connor S, Gasteiger N, Stanmore E, Wong DC, Lee JJ. Artificial intelligence for falls management in older adult care: A scoping review of nurses' role. J Nurs Manag 2022; 30:3787-3801. [PMID: 36197748 PMCID: PMC10092211 DOI: 10.1111/jonm.13853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2022]
Abstract
AIM This study aims to synthesize evidence on nurses' involvement in artificial intelligence research for managing falls in older adults. BACKGROUND Artificial intelligence techniques are used to analyse health datasets to aid clinical decision making, patient care and service delivery but nurses' involvement in this area of research for managing falls in older adults remains unknown. EVALUATION A scoping review was conducted. CINAHL, the Cochrane Library, Embase, MEDLI and PubMed were searched. Results were screened against inclusion criteria. Relevant data were extracted, and studies summarized using a descriptive approach. KEY ISSUES The evidence shows many artificial intelligence techniques, particularly machine learning, are used to identify falls risk factors and build predictive models that could help prevent falls in older adults, with nurses leading and participating in this research. CONCLUSION Further rigorous experimental research is needed to determine the effectiveness of algorithms in predicting aspects of falls in older adults and how to implement artificial intelligence tools in gerontological nursing practice. IMPLICATIONS FOR NURSING MANAGEMENT Nurses should pursue interdisciplinary collaborations and educational opportunities in artificial intelligence, so they can actively contribute to research on falls management. Nurses should facilitate the collection of digital falls datasets to support this emerging research agenda and the care of older adults.
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Affiliation(s)
- Siobhan O'Connor
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Norina Gasteiger
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK.,Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Emma Stanmore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - David C Wong
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Jung Jae Lee
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
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4
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El-Alti L, Sandman L, Munthe C. Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care. PLoS One 2022; 17:e0275205. [PMID: 36174093 PMCID: PMC9521939 DOI: 10.1371/journal.pone.0275205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
The ethical discourse surrounding patients’ agential capacities, vis-à-vis their active participation in shared decision-making (SDM) in forensic psychiatric (FP) contexts, is an unexplored area of inquiry. The aim of this paper is to explore caregivers’ perceptions of patient agential capacities and institutional pathways and barriers to person centered care (PCC) in the context of FP. Following an exploratory qualitative design, we conducted eight semi-structured interviews with hands-on caregivers at an in-patient FP facility in Sweden. A deductive framework method of analysis was employed, and four themes emerged: “Fundamental Variability in Patient Capacity”, “Patient Participation: Narration or Compliance?”, “Antagonism Rooted in Power Struggles”, and “System Structure Thwarts Patient Release”. While the results generally paint a bleak picture for the possibility of a person-centered FP care, we describe a constrained version of PCC with high-level SDM dynamics which promotes a certain degree of patient empowerment while allowing care strategies, within set restrictions, to promote patient adherence and treatment progress.
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Affiliation(s)
- Leila El-Alti
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, United Kingdom
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Lars Sandman
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Gothenburg, Sweden
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5
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Moyo N, Jones M, Kushemererwa D, Arefadib N, Jones A, Pantha S, Gray R. Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11001. [PMID: 36078717 PMCID: PMC9517907 DOI: 10.3390/ijerph191711001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Service users' views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.
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Affiliation(s)
- Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Diana Kushemererwa
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Noushin Arefadib
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Adrian Jones
- Faculty of Life Sciences, Wrexham Glyndwr University, Wrexham LL11 2AW, UK
| | - Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
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Markham S. The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales. Front Psychiatry 2021; 12:789089. [PMID: 34819890 PMCID: PMC8606637 DOI: 10.3389/fpsyt.2021.789089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders.
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Affiliation(s)
- Sarah Markham
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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7
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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8
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Jones E, Wright KM, McKeown M. An integrative review exploring the experiences of service users carrying a diagnosis of personality disorder and student mental health nurses and the time they share together. NURSE EDUCATION TODAY 2021; 98:104659. [PMID: 33199063 DOI: 10.1016/j.nedt.2020.104659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/10/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This integrative review provides a collective understanding of the experiences of student mental health nurses and service users carrying a diagnosis of personality disorder and the time they share together. DESIGN Published studies about the time service users and students share together were systematically selected in order to integrate their findings in a thematic analysis. DATA SOURCES Various databases were searched from 1984 until 2020. Specific search terms were used. REVIEW METHODS 37 studies were included in the integrative review. The studies were from peer reviewed nursing, student, psychology and health related journals. A quality appraisal was completed using Walsh and Downe (2006) framework. FINDINGS Four themes emerged from a thematic analysis of the integrative review. These were; With 'Impact of time' as an overarching theme. CONCLUSION A positive environment which considers time and focuses on seeing the person, as an individual can lead to the development of therapeutic relationships; a core element of the Nursing and Midwifery Council standards for nursing registration in the UK (Nursing and Midwifery Council, 2018). Students attempting to build such relationships need to be mindful of service users' and their own attachment experiences and the impact these can have on experiences of transference and countertransference, particularly for service users carrying a personality disorder diagnosis. It is important for students to be aware of the supportive impact of positive environments and how doing 'everyday stuff' can make a person feel human despite residing in potentially dehumanizing places.
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Affiliation(s)
- Emma Jones
- School of Nursing, University of Central Lancashire, United Kingdom.
| | - Karen M Wright
- School of Nursing, University of Central Lancashire, United Kingdom.
| | - Mick McKeown
- School of Nursing, University of Central Lancashire, United Kingdom.
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9
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Paradis-Gagné E, Guimond V. Implementation of the Mental Health Nurse Practitioner Role in Forensic Settings: A Case Report. JOURNAL OF FORENSIC NURSING 2020; 16:179-182. [PMID: 32379248 DOI: 10.1097/jfn.0000000000000283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This is a case report about the implementation of the mental health nurse practitioner role in forensic psychiatric settings. We will present its implementation and issues encountered during this process, such as a lack of understanding of the role in staff teams, scope of practice limitations, tension stemming from the conflict between treatment and punishment approaches, and the risk of medicalization of nursing. This case report, based on the authors' experiences, represents an early contribution to research on advanced nursing practice in forensic psychiatry, an area that has yet to receive much attention in the literature.
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10
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Hammarström L, Häggström M, Devik SA, Hellzen O. Controlling emotions-nurses' lived experiences caring for patients in forensic psychiatry. Int J Qual Stud Health Well-being 2019; 14:1682911. [PMID: 31645227 PMCID: PMC6818121 DOI: 10.1080/17482631.2019.1682911] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose: Nurses working in forensic psychiatry often encounter offenders who have a severe mental illness, which may cause ethical challenges and influence nurses' daily work. This study was conducted to illuminate the meaning of nurses' lived experiences of encounters with patients with mental illnesses in forensic inpatient care. Methods: This qualitative study employed narrative interviews with 13 nurses. Interviews were audiotaped and transcribed verbatim and analysed following a phenomenological-hermeneutic approach. Results: Four key themes were revealed: "Being frustrated" (subthemes included "Fighting resignation" and "Being disappointed"), "Protecting oneself" (subthemes included "To shy away," "Being on your guard," and "Being disclosed"), "Being open-minded" (subthemes included "Being confirmed," "Developing trust," and "Developing compassion"), and "Striving for control" (subthemes included "Sensing mutual vulnerability" and "Regulating oneself"). Further, working in forensic psychiatry challenged nurses' identity as healthcare professionals because of being in a stressful context. Conclusions: Dealing with aggressive patients with severe mental illnesses threatens nurses' professional identity. Nurses must attempt to empathize with patients' experiences and respond accordingly. Utilizing strategies rooted in compassion such as self-reflection, emotional regulation, and distancing themselves when necessary may enable nurses to more effectively respond to patients' needs.
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Affiliation(s)
| | - Marie Häggström
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden
| | | | - Ove Hellzen
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden
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11
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Barr L, Wynaden D, Heslop K. Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices. Int J Ment Health Nurs 2019; 28:888-898. [PMID: 30916443 DOI: 10.1111/inm.12588] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 11/28/2022]
Abstract
Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty-two nurses were recruited from one Australian forensic mental health service. Data were collected using semi-structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high-risk patient cohort.
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Affiliation(s)
- Lesley Barr
- State Forensic Mental Health Service, Western Australia, (NMHS-MH), Perth, Western Australia, Australia
| | - Dianne Wynaden
- Curtin University (Nursing & Midwifery), Perth, Western Australia, Australia
| | - Karen Heslop
- Curtin University (Nursing & Midwifery), Perth, Western Australia, Australia
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12
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Development of a Questionnaire to Assess Nursing Competencies for the Care of People with Psychiatric Disabilities in a Hospital Environment. Psychiatr Q 2018; 89:699-706. [PMID: 29457189 DOI: 10.1007/s11126-018-9567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The recovery of people with psychiatric disabilities requires high-quality nursing care. However, the existing research on the nursing competencies needed for caring for people with psychiatric disabilities have been based on a narrow competency framework. By adopting a broader competency framework, this study aimed to find the competencies needed for the nursing care of people with psychiatric disabilities in a hospital environment. Accordingly, a questionnaire will be developed to measure these competences. First, a literature review and interviews with psychiatrists, psychiatric nurses, and people with psychiatric disabilities were conducted to develop the pool of competency items. Second, a pilot study was conducted to review the initial pool of items. Finally, a survey of 581 psychiatric nurses was used to conduct a series of principal component analyses to explore the structure of the questionnaire. The 17-item questionnaire included 5 factors, which accounted for 68.60% of the total variance: sense of responsibility, vocational identification, agreeableness, cooperation capacity, and carefulness; the Cronbach's alpha coefficients were 0.85, 0.85, 0.74, 0.80, and 0.77, respectively. Most of the competencies belonged to attitudes, values, and traits, which were overlooked in previous studies. The questionnaire has satisfactory internal reliability and structural validity, and could contribute some to the selection of the psychiatric workforce.
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Fung YL, Chan ZCY, Chien WT. We are different: the voices of psychiatric advanced practice nurses on the performance of their roles. Contemp Nurse 2016; 52:13-29. [PMID: 27241032 DOI: 10.1080/10376178.2016.1194724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many studies have affirmed that psychiatric advanced practice nurses (APNs) perform multifaceted roles. However, only a limited amount of research has been conducted on their perceptions of the performance of their roles. AIM To explore the lived experiences of psychiatric APNs concerning the performance of their roles. DESIGN Data were collected from individual semi-structured interviews and analysed using the interpretative phenomenological analysis method. METHODS The study was conducted in a hospital cluster in Hong Kong. Thirteen psychiatric APNs were purposively recruited. RESULTS Three themes were discerned, namely, 'We are different', 'Who am I?', and 'I am who I am'. CONCLUSIONS The findings can help psychiatric APNs and nurse administrators to better understand the needs of the role-bearers (APNs) and to develop strategies to support the development of advanced psychiatric nursing practices in Hong Kong and worldwide.
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Affiliation(s)
- Yuen-Ling Fung
- a Department of Child and Adolescent Psychiatry , Castle Peak Hospital , 15 Tsing Chung Koon Road, Tuen Mun , New Territories , Hong Kong
| | - Zenobia C Y Chan
- b School of Nursing , The Hong Kong Polytechnic University , Hung Hom, Kowloon , Hong Kong
| | - Wai-Tong Chien
- b School of Nursing , The Hong Kong Polytechnic University , Hung Hom, Kowloon , Hong Kong
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14
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Vincze M, Fredriksson L, Wiklund Gustin L. To do good might hurt bad: exploring nurses' understanding and approach to suffering in forensic psychiatric settings. Int J Ment Health Nurs 2015; 24:149-57. [PMID: 25639292 DOI: 10.1111/inm.12116] [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: 11/28/2022]
Abstract
Patients in forensic psychiatric settings not only have to deal with their mental illness, but also memories of criminal activities and being involuntarily hospitalized. The aim of the present study was to explore how nurses working in forensic psychiatric services understand and approach patients' experiences of suffering. Data were generated by semistructured interviews with psychiatric nurses from two different forensic psychiatric units in Sweden. Data were analysed by means of a hermeneutic approach inspired by Ricoeur's hermeneutics. The findings are reflected in four main themes: (i) ignoring suffering; (ii) explaining suffering as a natural and inevitable part of daily life in the forensic context; (iii) ascribing meaning to suffering; and, (iv) being present in suffering. To engage in alleviating suffering is a struggle that demands courage and the strength to reflect on its character and consequences. To encounter suffering means that nurses are not only confronted with patients' suffering, but also their own reactions to those patients. If suffering is not recognized or encountered, there is a risk that actions may have a negative impact on patients.
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15
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O'Shea LE, Dickens GL. Predictive validity of the START for unauthorised leave and substance abuse in a secure mental health setting: a pseudo-prospective cohort study. Int J Nurs Stud 2015; 52:970-9. [PMID: 25769477 DOI: 10.1016/j.ijnurstu.2015.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Risk assessment and management is central to the nursing role in forensic mental health settings. The Short Term Assessment of Risk and Treatability (START) aims to support assessment through identification of risk and protective factors. It has demonstrated predictive validity for aggression; it also aims to aid risk assessment for unauthorised leave and substance abuse where its performance is relatively untested. OBJECTIVES To test the predictive validity of the START for unauthorised leave and substance abuse. DESIGN A naturalistic, pseudo-prospective cohort study. SETTINGS Four centres of a large UK provider of secure inpatient mental health services. PARTICIPANTS Inpatients resident between May 2011 and October 2013 who remained in the service for 3-months following assessment with the START by their clinical team. Exclusion criteria were missing assessment data in excess of prorating guidelines. Of 900 eligible patients 73 were excluded leaving a final sample size of n=827 (response rate 91.9%). Mean age was 38.5 years (SD=16.7); most participants (72.2%) were male; common diagnoses were schizophrenia-type disorders, personality disorders, organic disorders, developmental disorders and intellectual disability. METHODS Routinely conducted START assessments were gathered. Subsequent incidents of substance abuse and unauthorised leave were coded independently. Positive and negative predictive values of low and elevated risk were calculated. Receiver Operating Characteristic analysis was conducted to ascertain the predictive accuracy of the assessments based on their sensitivity and specificity. RESULTS Patient-based rates of unauthorised leave (2.4%) and substance abuse (1.6%) were low. The positive and negative predictive values for unauthorised leave were 5.9% and 98.4%; and for substance abuse 8.1% and 99.0%. The START specific risk estimate for unauthorised leave predicted its associated outcome (Area under the curve=.659, p<.05, 95% CI .531, .786); the substance abuse risk estimate predicted its outcome with a large effect size (Area under the curve=.723, p<.01, 95% CI .568, .879). CONCLUSIONS The study provides limited support for the START by demonstrating the predictive validity of its specific risk estimates for substance abuse and unauthorised leave. High negative predictive values suggest the tool may be of most utility in screening out low risk individuals from unnecessary restrictive interventions; very low positive predictive values suggest caution before implementing restrictive interventions in those rated at elevated risk. Researchers should investigate how multidisciplinary teams formulate risk assessments for these outcomes since they outperform the quantitative element of this tool.
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Affiliation(s)
- Laura E O'Shea
- St Andrew's Academic Department, St Andrew's Hospital, Billing Road, Northampton NN1 5DG, United Kingdom; King's College London Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Geoffrey L Dickens
- St Andrew's Academic Department, St Andrew's Hospital, Billing Road, Northampton NN1 5DG, United Kingdom; School of Social and Health Sciences, Abertay University, Dundee DD1 1HG, United Kingdom.
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16
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Cowman S. Commentary on Forensic and non-forensic psychiatric nursing skills and competencies for psychopathic and personality disordered patients. Bowen, M and Mason T (2012) Journal of Clinical Nursing
doi: 10·1111/j.1365-2702·2011·03970.x. J Clin Nurs 2014; 23:1170-1. [DOI: 10.1111/jocn.12220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Seamus Cowman
- Faculty of Nursing and Midwifery; Royal College of Surgeons in Ireland; Dublin Ireland
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