Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

Satisfaction toward Quality of Care and Associated Factors among Patients Admitted to Gambella General Hospital, Gambella Region, Southwest Ethiopia

Background. Patient satisfaction, the concept continues to become a crucial and commonly used indicator in the sector of health care delivery for determining the quality of health care services. Satisfaction is a highly desirable outcome of clinical care and may even be an element of health status itself. Therefore, a patient’s expression of satisfaction or dissatisfaction can be considered as a judgement on the quality of care in all of its aspects, whatever its strengths and weakness. Objective. The aim of the study is to determine patient satisfaction on the quality of care and associated factors among patients admitted in Gambella General Hospital, Gambella region, southwest Ethiopia, 2020. Methods. A facility-based cross-sectional study design was conducted, and a consecutive sampling technique was used to recruit 271 study subjects among patients admitted to Gambella General Hospital. All patients who stayed at least for five days and were discharged from inpatient wards were considered for this study. A semistructured questionnaire was used for data collection. Data were entered to Epi-data version 4.6 and exported to SPSS V21 for analysis. Binary logistic regression models were fitted to determine statistically significant associations between dependent and independent variables, and multivariable logistic regression with an AOR with a 95% confidence interval was fitted for candidate variables in binary logistic regression, and statistical significance was declared at $p$ value < 0.05. Result. The proportion of net patient satisfaction among the total of 271 respondents was 40.2% (95% CI: 34.36–46.04%). Being government employees (AOR = 0.06, 95% CI: 0.02–0.27), availability signs and direction indicators (AOR = 2.6, 95% CI: 1.18–5.54), provision of adequate information on the treatments (AOR = 2.5, 95% CI: 1.18–5.44), getting provider’s attention (AOR = 3.5, 95% CI: 1.65–7.24), and understanding of specific patient needs and concerns (AOR = 6.04, 95% CI: 2.8–12.88) were found to be significant predicators of patient satisfaction on the quality of care. Conclusion. Less than half of the patients were satisfied with the quality of service delivered in the wards of the hospital. Occupation, signs and directions to follow, getting adequate information about treatment, providers’ attention, and understanding of specific needs and concerns of the patients were the significant factors. Thus, we would recommend that the hospital management should closely work together with health professionals, supportive staff, patients, and other concerned stakeholders to improve admitted patients’ satisfaction with the quality of care. Policymakers advised to develop and institutionalize better interpersonal relations in the health system.

Instruments to evaluate hospitalised children parents' satisfaction with nursing care: a scoping review

AIM

To identify instruments that allow the evaluation of parent's satisfaction regarding nursing care during their child hospitalisation.

METHODS

A review was performed using Preferred Reporting Items for Scoping Reviews. The study was prospectively registered in Open Science Framework. Research was carried out on EBSCOhost, PubMed, SciELO, Web of Science and ScienceDirect platforms as well as grey literature. Additionally, the references of selected articles were also examined.

RESULTS

A sample of 65 articles allowed the identifications of 38 distinctive instruments to evaluate parents' satisfaction in different hospital settings. Most studies were applied in paediatric wards (n=28), followed by neonatal intensive care units (n=21), paediatric intensive care units (n=9) and emergency departments (n=7). Sample size ranged from 13 to 3354 and 3 studies used mixed methods, 20 were methodological studies of instruments construction or validation and 43 were quantitative studies. 21 different instruments previously existent were found. In 3 studies, adapted instruments were used and, in 14 studies, structured instruments were purposively designed for the study. Instruments had between 1 and 13 domains and total number of items ranged between 13 and 92. Most studies assessed overall satisfaction (n=53) and instrument reliability (n=49) and/or validity (n=37).

CONCLUSION

Most instruments consider nursing care as a domain of satisfaction. Only two instruments focused specifically on nursing care. In most of the studies, there was a concern to evaluate instruments psychometric properties. This review clearly shows that there is still a gap in the literature on the range of aspects that influence satisfaction and a lack of consensus on ideal conditions for instrument use and application.

Satisfaction with orthodontic treatment: cross-cultural adaptation and validation of an instrument for the Brazilian Portuguese language

Objective:

To cross-culturally adapt into the Brazilian Portuguese and evaluate the psychometric properties of an instrument for assessing the satisfaction of parents/guardians regarding their sons’/daughters’ orthodontic treatment.

Methods:

Translations of the instrument from English, pre-test and evaluation of validity and reliability of the Brazilian Portuguese version were performed. The questionnaire has 25 items distributed across 3 subscales (process, psychosocial effect and outcome). Eighty-three parents/guardians of children/adolescents who had completed orthodontic treatment participated. Descriptive statistics and floor and ceiling effects were calculated. Internal consistency, stability (interval of three weeks), convergent construct validity and discriminant construct validity were determined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed dimensionality.

Results:

Among the 83 parents/guardians, 58 (69.9%) were mothers and 25 (30.1%) were fathers of children/adolescents. In the questionnaire’s total score and the three subscales scores, an acceptable percentage (≤15%) of participants achieved the maximum score (ceiling effect). In the total questionnaire score and in the three subscales scores, no participant achieved the minimum score (floor effect). Cronbach’s α coefficient for the total score was 0.72 (internal consistency). Intra-class correlation coefficient for the total score was 0.71 (stability). The questionnaire’s total score presented large Pearson correlation coefficient (>0.50) with the three subscales too (construct validity). Female parents/guardians had significantly higher scores in the psychosocial effect (p=0.013) and in the treatment outcome (p=0.037) subscales, compared to male parents/guardians (discriminant validity). EFA and CFA confirmed dimensionality in a three-factor solution.

Conclusions:

The final obtained version is valid and reliable to be used in Brazilian populations.

Experiences of an adolescent inpatient model of care: Adolescent and caregiver perspectives

PROBLEM

Adolescent inpatient units have been studied regarding their effectiveness, yet little is known about the experiences of young people who are admitted and their caregivers. It is important to address this gap to understand adolescent inpatient models of care and therapeutic outcomes to maximize the benefit. Our aim was to explore adolescent and caregivers' experiences of an inpatient model of care (MoC) and perceived helpfulness.

METHODS

A longitudinal prospective qualitative design was utilized. Semistructured interviews were conducted with 16 adolescents and 12 caregivers at T1 (admission), T2 (discharge), and T3 (6 months postdischarge). Data were analysed first thematically and then using trajectory analysis. Themes from the three time-points are presented from the combined perspectives of adolescents and caregivers.

FINDINGS

Experiences described followed a recovery narrative consisting of three key phases which included, "waiting for help" (T1), "help arrived" (T2), and having "returned to regular life" (T3). The overarching trajectory theme was a "winding road to recovery."

CONCLUSION

Findings provide insights into the lived experiences from adolescents who have had an inpatient stay and their caregivers of an adolescent-specific inpatient MoC. These findings can help conceptualize quality adolescent models of care for young people and their families.

Satisfaction of family members with inpatient psychiatric care and its correlates: a national survey in China

BACKGROUND

Measuring family members' satisfaction with inpatient psychiatric care may help improve the quality of healthcare in psychiatric hospitals. This survey aimed to investigate the satisfaction of family members with inpatient psychiatric care and to explore its associated factors, using a newly-developed 5-item questionnaire.

METHODS

This study included 1598 family members of psychiatric inpatients in 32 tertiary public psychiatric hospitals in 29 provinces of China. Satisfaction and demographic data were collected by research staff while patient and hospital data were retrieved separately.

RESULTS

We found that the overall satisfaction level was 93.84% (23.46/25). The total satisfaction score in Northeast China was the highest, followed by the East, Middle and West regions (p < 0.001). There was no significant sex difference in total family satisfaction scores. Family members with a lower educational background (elementary school or less) had significantly lower satisfaction. Family members of patients who were diagnosed with schizophrenia were significantly less satisfied with doctor-family communication. In different treatment response subgroups, the marked improvement subgroup had significantly higher total satisfaction scores and subscores. Meanwhile, lower self-payment expenses and a higher number of psychologic treatments offered per day were significantly associated with higher total satisfaction scores and all subscores. Logistic regression showed a higher educational background, more psychologic treatments offered per day, adequacy of professional staffing (higher doctor/bed, nurse/bed and psychologist/bed ratio) were all significantly associated with higher family satisfaction.

CONCLUSIONS

We suggest government and hospital managers recruit more mental health professions to improve family satisfaction. If feasible, providing more psychologic treatments to inpatients may also improve families' satisfaction and involvement.

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review

Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non-disorder-specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.

Inpatient psychiatric treatment is not always effective in adolescent sample

OBJECTIVE

Numerous studies confirm efficacy of psychiatric treatment as well as psychiatric placebo. The aim of the current study was the assessment of improvement rate and factors associated with treatment response in naturalistic group of adolescent inpatients.

METHODS

Eighty two consecutive adolescent inpatients were recruited. Each patient at the admission and discharge was assessed with brief psychiatric rating scale (BPRS), eating attitude test (EAT-26), clinical global impression scale (CGI-S) and children global assessment scale (CGAS). Individual and family history was assessed by semi-structured interview. Patients, who improved in at least two interviewer-based scales (IMP, n = 67) were compared to the rest (N-IMP, n = 15). For statistical analysis STATISTICA package was used.

RESULTS

The main difference between groups was ICD-10 diagnosis distribution: in the IMP group more anxiety-related disorders (F4), in the N-IMP group more personality disorders (F6). Other differences include history of paediatric hospitalisations and surgery (more in the N-IMP group). Most of the analysed factors did not differ between groups.

CONCLUSIONS

The inpatient treatment seems to be most effective in severe mental states and in anxiety-related disorders and least effective in personality disorders. Due to limited inpatient treatment efficacy we believe outpatients services are crucial in adolescent psychiatry.

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

PURPOSE

There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes.

METHODS

This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models.

RESULTS

A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.

CONCLUSION

Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

The impact of caregiver treatment satisfaction upon child and parent outcomes

BACKGROUND

Parental perceptions about treatment influence their child's engagement in and ongoing utilization of mental health services, but less is known about the association between caregiver expectancies and family outcomes. The literature is particularly lacking with families of color, who are at high risk for the onset and perpetuation of disruptive behaviors.

METHODS

The purpose of this study was to examine caregiver treatment satisfaction amongst 320 youth of color aged 7 to 11 and their families who were assigned to either a Multiple Family Group intervention or services as usual condition. Caregiver stress was measured by the Parenting Stress Index Short-Form full scale and child oppositional defiant behaviors were measured using the Iowa Connors Rating Scale-Oppositional/Defiant subscale both at baseline and post-test. Satisfaction with treatment was measured using the Metropolitan Area Child Study process measures program satisfaction subscale at post-test.

RESULTS

The two main effects models that focused on satisfaction with treatment was predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time holding all covariates constant.

CONCLUSIONS

Our findings support previous research that shows parental expectancies, including treatment satisfaction, are powerful mechanisms of treatment outcomes for children with DBDs as well as parental emotional health. Further, parental expectancies may be enhanced by the involvement of families in the development of treatment approaches for children and a greater focus on caregiver emotional health for the benefit of the family as a whole.

The experience of adolescent inpatient care and the anticipated transition to the community: Young people's perspectives

This study explored adolescents' perspectives of inpatient mental health care, focussing on aspects of the inpatient environment they anticipated would help or hinder their transition back home. Semi-structured interviews were conducted with 12 adolescent inpatients; transcripts were analysed thematically. Participants experienced inpatient treatment as offering a mix of benefits (e.g., supportive relationships) and drawbacks (e.g., living in a "fake world"). They anticipated the transition home as providing opportunities for personal growth and consolidation of new coping skills, but also posing challenges concerning re-entering the "real world" after the experience of being "wrapped in cotton wool". Self-determination theory and attachment theory offer two potential frameworks for understanding these opportunities and challenges. Inpatient care has the potential to foster key mechanisms for adaptive development, creating a platform for developing positive future behaviours. Community teams should work closely with inpatient units to support the generalisation of the young person's newly acquired coping skills.

Validation of a subjective outcome evaluation tool for participants in a positive youth development program in Hong Kong

STUDY OBJECTIVES

Using confirmatory factor analyses, this study examined the factor structure and reliability of a subjective outcome evaluation tool for students with greater psychosocial needs within the context of the Project P.A.T.H.S. in Hong Kong.

DESIGN

To assess the views of program participants on the program content, implementer qualities, and program effectiveness of the Tier 2 Program of the Project P.A.T.H.S., the Subjective Outcome Evaluation Form for Participants (Form C) was used. Data were collected from 8,893 Grade 7 participants after they had completed the Tier 2 Program.

RESULTS

The findings based on confirmatory factor analyses are generally consistent with the original hypotheses, providing support for the 3-factor model and the higher-order factor model containing 3 primary factors. Support for different types of factorial invariance based on 2 randomly split subsamples was also found. High coefficient alphas were found for the total scale and the 3 subscales.

CONCLUSION

Confirmatory factor analyses support the conceptual model underlying the Form C. Reliability analyses showed that the total scale and subscales possess excellent internal consistency.