Patients' perceptions of patient education on psychiatric inpatient wards: a qualitative study

'I Accelerate' model: A grounded theory on conceptual framework of patient experience with nursing care in China

AIM

To develop a conceptual framework of patient experience with nursing care.

BACKGROUND

Patient experience includes several aspects of health care delivery that patients value highly when they seek and receive care and is now increasingly used to evaluate the quality of care. Nurses are the backbone of the health care system, and patient experience with nursing care significantly influences the overall patient satisfaction and hospital performance. However, the conceptual framework of patient experience with nursing care is not clear.

METHOD

This grounded theory study employed in-depth interviews with 37 inpatients between March and May 2020.

RESULTS

An explanatory theoretical framework of the patient experience with nursing care emerged and was termed the 'I Accelerate' model; 'I Accelerate' stands for information and interpretation, appropriate attitude, close monitoring of progress, continuity of care, education, linking of the medical team, emotional support, responding to requests promptly, admission and discharge coordination, technical skills, and environment management, highlighting professional, emotional and coordinating functions of nurses.

CONCLUSIONS

This study resulted in a holistic nursing care model based on patients' views, values and preferences.

IMPLICATIONS FOR NURSING MANAGEMENT

To create a more therapeutic nurse-patient relationship and a more patient-centred health care system, hospital administrators, nursing managers and nursing practitioners should understand what patients desire and expect. Efforts should be made to explore the barriers and facilitators of using patient experience for quality improvement and to further determine how these patient-perceived attributes of nursing care can be rooted in the daily practice through organisational changes, culture shaping and staff education. There should be recognition of the potential need for psychological and emotional support, as well as of the importance of meeting communication and information needs.

Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences

A promising intervention in mental health in-patient care is behavioural activation (BA). Interventions based on BA can be used by mental health nurses and other staff members. The aim of this study was to evaluate patients' and staff members' experiences of a nursing staff-led behavioural group intervention in mental health in-patient care. The intervention was implemented at three adult acute general mental health in-patient wards in a public hospital setting in Sweden. A self-administrated questionnaire, completed by 84 patients and 34 nurses and nurse assistants, was administered, and nonparametric data analysed using descriptive statistics. Our findings revealed that both patients and nursing staff ranked nursing care and care environment as important aspects in the recovery process. Patients and staff members reported overall positive experiences of the group sessions. Patients with higher frequencies of attendance and patients satisfied with overall care had a more positive attitude towards the intervention. A more positive experience of being a group leader was reported by staff members who had been leading groups more than ten times. The most common impeding factor during implementation, reported by staff members, was a negative attitude to change. Conducive factors were having support from a psychologist and the perception that patients were showing interest. These positive experiences reported by patients and nursing staff, combined with previous research in this field, are taking us one step further in evaluating group sessions based on BA as a meaningful nursing intervention in mental health in-patient care.

Patientś experiences of patient education on psychiatric inpatient wards; a systematic review

OBJECTIVE

To synthesize the evidence on how patients with serious mental disorders perceived patient education on psychiatric wards and to learn more about the patient perceived benefits and limitations related to patient education and how well patient education meets the perceived needs of inpatients.

METHODS

Quantitative and qualitative data were categorized and synthesized. A systematic literature search was conducted. Articles were validated using validated critical appraisal tools. Data were analyzed using inductive content analysis.

RESULTS

Five articles met the inclusion criteria. The results concerned the specific population with bipolar disorder or schizophrenia. Two explanatory syntheses were aggregated: (I) Benefits and perceived barriers to receiving education and (II) Educational needs of mental health patients. Patients reported mechanical information dissemination and lack of individual and corporative discussions. Patients preferred patient education from different educational sources with respect to individual needs.

CONCLUSION

Patient education were most useful when it could be tailored to an individuaĺs specific needs and match patient preference for how to receive it. The findings did not provide evidence to support any educational methods of preference.

PRACTICE IMPLICATIONS

The findings may contribute to the development of educational interventions that are perceived more helpful for in-patients suffering from serious mental disorders.

Training physiotherapy students to educate patients: A randomised controlled trial

OBJECTIVE

To determine the effect of a training intervention on physiotherapy students' self-efficacy and skills in the area of patient education.

METHODS

Final year physiotherapy students were randomised to an intervention group or a wait-list control group. The intervention group participated in a 3.5h training intervention about patient education that included video observation, simulated patient practice and structured feedback. The control group did not receive any training. Self-efficacy was assessed at baseline (T1) and after the intervention (or no intervention for the control group) (T2). Patient education performance was assessed by a blinded rater from a video-recorded standardised clinical examination.

RESULTS

83 students were randomised to the intervention group and 81 students to the control group. There were no differences in demographic variables or self-efficacy between groups at baseline. There was significant improvement in self-efficacy for the intervention group, but no change for the control group. The intervention group performed significantly better than the control group for nine of the eleven performance items, with significantly higher scores overall.

CONCLUSION

A training intervention enhances physiotherapy student self-efficacy and performance in patient education.

PRACTICE IMPLICATION

Use of patient education training is recommended to enhance student self-efficacy and performance.

Diabetes Self-Management Education; Experience of People with Diabetes

Introduction: Diabetes self-management education (DSME) is a major factor which can affects quality of life of people with diabetes (PWD). Understanding the experience of PWD participating in DSME programs is an undeniable necessity in providing effective DSME to this population. The Aim of the study was to explore the experiences of PWD from a local DSME program in Iran. Methods: This study applied a descriptive phenomenological approach. The participants were PWD attending a well-established local DSME program in an endocrinology and diabetes center in Isfahan, Iran. Fifteen participants willing to share their experience about DSME were selected through purposive sampling from September 2011 to June 2012. Data were collected via unstructured interviews and analyzed using Colaizzi's approach. Results: The experience of participants were categorized under three main themes including content of diabetes education (useful versus repetitive, intensive and volatile), teaching methods (traditional, technology ignorant) and learning environment (friendly atmosphere, cramped and dark). Conclusion: It seems the current approach for DSME cannot meet the needs and expectations of PWD attending the program. Needs assessment, interactive teaching methods, multidisciplinary approach, technology as well as appropriate physical space need to be considered to improve DSME.

Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review

Background

Psychological interventions are recommended for people with severe mental health problems (SMI). However, barriers exist in the provision of these services and access is limited. Therefore, researchers are beginning to develop and deliver interventions online and via mobile phones. Previous research has indicated that interventions delivered in this format are acceptable for people with SMI. However, a comprehensive systematic review is needed to investigate the acceptability of online and mobile phone-delivered interventions for SMI in depth.

Objective

This systematic review aimed to 1) identify the hypothetical acceptability (acceptability prior to or without the delivery of an intervention) and actual acceptability (acceptability where an intervention was delivered) of online and mobile phone-delivered interventions for SMI, 2) investigate the impact of factors such as demographic and clinical characteristics on acceptability, and 3) identify common participant views in qualitative studies that pinpoint factors influencing acceptability.

Methods

We conducted a systematic search of the databases PubMed, Embase, PsycINFO, CINAHL, and Web of Science in April 2015, which yielded a total of 8017 search results, with 49 studies meeting the full inclusion criteria. Studies were included if they measured acceptability through participant views, module completion rates, or intervention use. Studies delivering interventions were included if the delivery method was online or via mobile phones.

Results

The hypothetical acceptability of online and mobile phone-delivered interventions for SMI was relatively low, while actual acceptability tended to be high. Hypothetical acceptability was higher for interventions delivered via text messages than by emails. The majority of studies that assessed the impact of demographic characteristics on acceptability reported no significant relationships between the two. Additionally, actual acceptability was higher when participants were provided remote online support. Common qualitative factors relating to acceptability were safety and privacy concerns, the importance of an engaging and appealing delivery format, the inclusion of peer support, computer and mobile phone literacy, technical issues, and concerns about the impact of psychological state on intervention use.

Conclusions

This systematic review provides an in-depth focus on the acceptability of online and mobile phone-delivered interventions for SMI and identified the need for further research in this area. Based on the results from this review, we recommend that researchers measure both hypothetical and actual acceptability to identify whether initial perceptions of online and mobile phone-delivered interventions change after access. In addition, more focus is needed on the potential impact of demographic and clinical characteristics on acceptability. The review also identified issues with module completion rates and intervention use as measures of acceptability. We therefore advise researchers to obtain qualitative reports of acceptability throughout each phase of intervention development and testing. Further implications and opportunities for future research are discussed.

Nursing interventions in inpatient psychiatry

The successful application of the Nursing Interventions Classification (NIC) in inpatient psychiatry depends on whether the classification adequately describes nursing care in this setting. The present study aimed to identify nursing interventions mentioned in journal articles on psychiatric inpatient nursing care and to compare these with the labels, definitions and activities described in the NIC to elucidate how well the classification covers these interventions. The MedLine, PsychInfo, Cochrane and CINAHL databases were searched for journal articles about nursing care in the adult inpatient setting. A qualitative content analysis approach was used to indentify nursing interventions in the articles. About 84% of the statements (terms and definitions) are encompassed by the interventions listed by the NIC. Very few interventions need to be added to the NIC classification or necessitate a reorganization of the taxonomy. Nevertheless, the further development of the NIC will promote its use in the daily work of psychiatric nurses and enhance the quality of nursing care in the inpatient setting.