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Cameron SLA, Laletas S, Gallo Cordoba B, McLean L. Who Cares? Service Users' Opinions and Opportunities for Family Involvement in Mental Health Care. Int J Ment Health Nurs 2024. [PMID: 38973754 DOI: 10.1111/inm.13372] [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] [Received: 02/19/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 07/09/2024]
Abstract
Involving families in mental health care can provide benefits to service users, their families and clinicians. However, family involvement is neither uniform nor routine. Understanding the complexities of this involvement is critical to improving application. This study sought to increase current knowledge about service users' opinions and opportunities for family involvement in mental health care. Data were collected from a total of 10 adult participants through 10 individual semi-structured interviews of approximately 30 min each. Findings are reported in accordance with COREQ and EQUATOR guidelines. Thematic analysis identified several consistent themes: respect for service user opinions of family involvement; opportunities for family involvement; negative and positive service user opinions of family involvement. Our findings support previous appeals for routine family involvement in care but extend this charge with the assertion that as important is a customary discussion with service users to ask their opinions about this involvement. Establishing this dialogue prior to treatment commencement has the potential to alleviate or resolve service user concerns and potentially improve and/or increase how families are engaged.
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Affiliation(s)
- Sarah L A Cameron
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Stella Laletas
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Beatriz Gallo Cordoba
- The Centre for International Research on Education Systems, Mitchell Institute, Victoria University, Melbourne, Victoria, Australia
| | - Louise McLean
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
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Magnusson E, Tuvesson H, Rask M, Hörberg U. "A Lonely Road to Walk Along" - The Experiences of Being a Next of Kin to a Woman in Need of Compulsory Psychiatric Inpatient Care. Issues Ment Health Nurs 2023; 44:1245-1253. [PMID: 37852003 DOI: 10.1080/01612840.2023.2260481] [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: 10/20/2023]
Abstract
It is seldom that it is only the patient who is affected when someone is admitted to compulsory psychiatric inpatient care, the next of kin is usually also impacted. The aim was to describe the lived experiences of being a next of kin to a woman in need of compulsory psychiatric inpatient care. Ten next of kin were interviewed and the material was analyzed with a Reflective Lifeworld Research approach. The results show loneliness and feelings that their existence has collapsed. An emotional duality is described in the realization that the care is needed but they are devastated that the woman is there. A trust exists, but it changes when the next of kin are no longer a part of the care process.
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Affiliation(s)
- Emilie Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Owusu E, Shalaby R, Elgendy H, Mao W, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Lawal MA, Agyapong VIO. Comparison of Resilience, Personal Recovery, and Quality of Life Measures Pre- and Post-Discharge from Inpatient Mental Health Units in Alberta: Analysis of Control Group Data from a Randomized Trial. Healthcare (Basel) 2023; 11:2958. [PMID: 37998451 PMCID: PMC10670919 DOI: 10.3390/healthcare11222958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
Background: The transition from hospital to community settings for most mental health service users is often hindered by challenges that affect community adjustment and continuity of care. The first few weeks and days after discharge from mental health inpatient units represent a critical phase for many service users. This paper aims to evaluate the changes in the resilience, personal recovery, and quality of life status of individuals with mental health challenges recently discharged from acute mental health care into the community. Methods: Data for this study were collected as part of a pragmatic stepped-wedge cluster-randomized, longitudinal approach in Alberta. A paired sample t-test and Chi-squared/Fisher test were deployed to assess changes from baseline to six weeks in the recovery assessment scale (RAS), brief resilience scale (BRS), and EuroQol-5d (EQ-5D), using an online questionnaire. Results: A total of 306 service users were recruited and 88 completed both baseline and six weeks, giving a response rate of 28.8%. There was no statistically significant change in the level of resilience, recovery and quality of life as measured with the brief resilience scale, recovery assessment scale and EQ-5D from baseline to six weeks (p > 0.05). Conclusions: The study showed that there was neither an improvement nor deterioration in resilience, recovery, or quality of life status of service users six weeks post-discharge from inpatient mental health care. The lack of further progress calls into question whether the support available in the community when patient's leave inpatient care is adequate to promote full recovery. The results justify investigations into the effectiveness of innovative and cost-effective programs such as peer and text-based supportive interventions for service users discharged from inpatient psychiatric care.
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Affiliation(s)
- Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mobolaji A. Lawal
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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Dehbozorgi R, Fereidooni-Moghadam M, Shahriari M, Moghimi-Sarani E. Barriers to family involvement in the care of patients with chronic mental illnesses: A qualitative study. Front Psychiatry 2022; 13:995863. [PMID: 36339878 PMCID: PMC9627781 DOI: 10.3389/fpsyt.2022.995863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Caregivers are patients' family members or intimate friends who take care of individuals suffering from chronic mental illnesses without being paid. Evidence has supported the role of family-centered collaborative care in the treatment of patients with chronic mental illnesses. It has also been emphasized by national policies. However, carrying out this type of care is accompanied by challenges in Iran. Considering the importance of family participation in taking care of these patients as well as the necessity to determine its effective factors, the present study aimed to assess the barriers to family involvement in the care of patients with chronic mental illnesses. METHOD A conventional content analysis was used to conduct this qualitative study. Thirty four health care providers, patients, and caregivers were interviewed unstructured in-depth face-to-face using purposive sampling. Until saturation of data, sampling and data analysis were conducted simultaneously. Graneheim and Lundman's method was used to record, transcribe, and analyze the interviews. RESULT The results showed that there were many barriers to the collaboration of family in the care of patients with chronic mental illnesses. Accordingly, four main categories and twelve subcategories were extracted from the data as follows: "family-related barriers", "treatment-related factors", "disease nature threatening care", and "mental disease-associated stigma in the society". CONCLUSION The findings presented the barriers to family centers' collaborative care in patients with chronic mental illnesses and the necessary components of family involvement in the care to be used by healthcare managers and policymakers. The reported barriers emphasize the need for the development of structured approaches whose implementation is easy for health care providers, does not require a lot of time and resources, and can improve patient and family outcomes.
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Affiliation(s)
- Raziye Dehbozorgi
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohsen Shahriari
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim Moghimi-Sarani
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
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Discharge interventions from inpatient child and adolescent mental health care: a scoping review. Eur Child Adolesc Psychiatry 2022; 31:857-878. [PMID: 32886222 PMCID: PMC9209379 DOI: 10.1007/s00787-020-01634-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
The post-discharge period is an extremely vulnerable period for patients, particularly for those discharged from inpatient children and adolescent mental health services (CAMHS). Poor discharge practices and discontinuity of care can put children and youth at heightened risk for readmission, among other adverse outcomes. However, there is limited understanding of the structure and effectiveness of interventions to facilitate discharges from CAMHS. As such, a scoping review was conducted to identify the literature on discharge interventions. This scoping review aimed to describe key components, designs, and outcomes of existing discharge interventions from CAMHS. Nineteen documents were included in the final review. Discharge interventions were extracted and summarized for pre-discharge, post-discharge, and bridging elements. Results of this scoping review found that intervention elements included aspects of risk assessment, individualized care, discharge preparation, community linkage, psychoeducation, and follow-up support. Reported outcomes of discharge interventions were also extracted and included positive patient and caregiver satisfaction, improved patient health outcomes, and increased cost effectiveness. Literature on discharge interventions from inpatient CAMHS, while variable in structure, consistently underscore the role of such interventions in minimizing patient and family vulnerability post-discharge. However, findings are limited by inadequate reporting and heterogeneity across studies. There is a need for further research into the design, implementation, and evaluation of interventions to support successful discharges from inpatient child and adolescent mental health care.
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Ådnanes M, Cresswell-Smith J, Melby L, Westerlund H, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Discharge planning, self-management, and community support: Strategies to avoid psychiatric rehospitalisation from a service user perspective. PATIENT EDUCATION AND COUNSELING 2020; 103:1033-1040. [PMID: 31836249 DOI: 10.1016/j.pec.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Psychiatric rehospitalisation is often seen as a negative outcome in terms of healthcare quality and cost, as well as potentially hindering the process of recovery. The purpose of our study was to explore psychiatric rehospitalisation from a service-user perspective, paying attention to how rehospitalisation can be avoided. METHOD Eight focus groups, including a total of 55 mental health service users, were conducted in six European countries (Austria, Finland, Italy, Norway, Romania, and Slovenia). The results were analysed using systematic text condensation. RESULTS All participants had been in touch with mental health services for at least one year, and had experienced more than one psychiatric hospitalisation. Participants emphasised the importance of discharge planning and psychoeducation both during and after the hospital stay, as well as the benefits of structured plans, coping strategies, self-monitoring techniques, and close contact with local community services.Social contacts and meaningful activities were also considered to be critical, as was support from peers and family members. CONCLUSION Efforts to avoid psychiatric rehospitalisation should include actions that support a functional day-to-day life, improve coping strategies, and build on cross-sectoral collaboration. PRACTICE IMPLICATIONS The study emphasises the need for psychoeducational and psychosocial interventions, starting already during the inpatient stay.
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Affiliation(s)
- M Ådnanes
- SINTEF Digital, Dept of Health Research, PO Box 4760 Torgarden, 7465 Trondheim, Norway.
| | - J Cresswell-Smith
- National Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland.
| | - L Melby
- SINTEF Digital, Dept of Health Research, Trondheim, Norway.
| | - H Westerlund
- Competence Centre for Experiential Knowledge and Service Development, Trondheim, Norway.
| | - L Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Ljubljana, Slovenia.
| | - R Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest; 2. Faculty of Psychology and Educational Sciences, Bucharest, Romania.
| | - C Straßmayr
- IMEHPS. Research - Forschungsinstitut für Sozialpsychiatrie, Vienna, Austria.
| | - V Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Effect of the Nurse-Led Sexual Health Discharge Program on the Sexual Function of Older Patients Undergoing Transurethral Resection of Prostate: A Randomized Controlled Trial. Geriatrics (Basel) 2020; 5:geriatrics5010013. [PMID: 32131446 PMCID: PMC7150998 DOI: 10.3390/geriatrics5010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Sexual dysfunction is a complication of transurethral resection of prostate (TURP). There is a lack of knowledge of the effect of discharge programs aiming at improving sexual function in older patients undergoing TURP. Objective: To investigate the effect of the nurse-led sexual health discharge program on the sexual function of older patients undergoing TURP. Methods: This randomized controlled clinical trial was conducted on 80 older patients undergoing TURP in an urban area of Iran. Samples were selected using a convenience method and were randomly assigned into intervention and control groups (n = 40 in each group). The sexual health discharge program was conducted by a nurse in three sessions of 30-45 min for the intervention group. Sexual function scores were measured using the International Index of Erectile Function (IIEF) Questionnaire, one and three months after the intervention. Results: The intervention significantly improved erectile function (p = 0.044), sexual desire (p = 0.01), satisfaction with sexual intercourse (p = 0.03), overall satisfaction with sexual function (p = 0.01), and the general score of sexual function (p = 0.038), three months after the program. In the first month after the intervention, except in sexual desire (p = 0.028), no statistically significant effect of the program was reported (p > 0.05). Conclusion: The nurse-led sexual health discharge program led to the improvement of the sexual function of older patients undergoing TURP over time. This program can be incorporated into routine discharge programs for the promotion of well-being in older patients.
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Stuart R, Akther SF, Machin K, Persaud K, Simpson A, Johnson S, Oram S. Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2020; 6:e19. [PMID: 32043435 PMCID: PMC7176830 DOI: 10.1192/bjo.2019.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. AIMS We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. METHOD We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. RESULTS The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. CONCLUSIONS Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.
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Affiliation(s)
- Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Karen Machin
- Visiting Lecturer, School of Health and Social Work, University of Hertfordshire, UK
| | - Karen Persaud
- Honorary Research Associate, NIHR Mental Health Policy Research Unit, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Alan Simpson
- Professor of Mental Health Nursing, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Director (KCL), NIHR Mental Health Policy Research Unit, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London; Director (UCL), NIHR Mental Health Policy Research Unit; and Consultant Clinical Psychiatrist, Camden and Islington NHS Foundation Trust, UK
| | - Sian Oram
- Lecturer and Head of the Section of Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; Deputy Director (KCL), NIHR Mental Health Policy Research Unit, UK
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Roson Rodriguez P, Franco JVA, Garegnani L, Arancibia M, Escobar Liquitay CM, Mohammad HA. Transitional discharge interventions for people with serious mental illness. Hippokratia 2019. [DOI: 10.1002/14651858.cd009788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pablo Roson Rodriguez
- Instituto Universitario Hospital Italiano; Research Department; Potosí 4234 Buenos Aires Argentina 1199
| | - Juan VA Franco
- Instituto Universitario Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Argentina C1199ACL
| | - Luis Garegnani
- Instituto Universitario Hospital Italiano; Research Department; Potosí 4234 Buenos Aires Argentina 1199
| | - Marcelo Arancibia
- Universidad de Valparaíso; Interdisciplinary Centre for Health Studies CIESAL; Viña del Mar Chile
| | | | - Husam Aldeen Mohammad
- Al-Mowasat Hospital, Damascus University; Department of Psychiatry; Damascus Syrian Arab Republic
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Xiao S, Tourangeau A, Widger K, Berta W. Discharge planning in mental healthcare settings: A review and concept analysis. Int J Ment Health Nurs 2019; 28:816-832. [PMID: 31039293 DOI: 10.1111/inm.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty-nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient-centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.
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Affiliation(s)
- Sarah Xiao
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ann Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
INTRODUCTION Care transition for patients being discharged from inpatient mental healthcare to outpatient settings is a growing focus for healthcare delivery systems. Many studies of this inpatient to outpatient transition use the rate of postdischarge readmissions as a patient-level outcome measure to assess the quality of transition. However, it is unclear how studies define the measure, and whether there is a shared understanding by the field regarding which definition is appropriate for which circumstances. This scoping review thus aims to examine how published studies have approached measuring unnecessary psychiatric readmissions. METHODS AND ANALYSIS The scoping review will be structured according to Levac et al's enhancement to Arksey and O'Malley's framework for conducting scoping reviews. The protocol is registered through the Open Science Framework (https://osf.io/5nxuc/). We will search literature databases for studies that (1) are about care transition processes associated with unnecessary psychiatric readmissions and (2) specify use of at least one readmission time interval (ie, time period since previous discharge from inpatient care, within which a hospitalisation can be considered a readmission). Screening and review of articles will be carried out by two reviewers, first independently then involving a third reviewer as needed for consensus. We will assess review findings through both tabular and thematic analyses, noting prevalent trends in study characteristics and emergent themes across our reviewed studies. ETHICS AND DISSEMINATION This work comes at a time of heightened interest by many mental healthcare systems in high-quality practices that structure their care processes towards effective inpatient to outpatient transitions. Findings will support the systems' careful examination of alternative potential transitional interventions, helping to ensure that their often limited quality enhancement resources are put to optimal use. We will focus on disseminating our findings to the healthcare community through strong communication infrastructures and connections with health system stakeholders that our multidisciplinary study consultants will foster throughout this study.
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Affiliation(s)
- Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Weatherly
- George Warren Brown School of Social Work, Washington University, Saint Louis, Missouri, USA
| | - Courtney Benjamin Wolk
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Enola K Proctor
- George Warren Brown School of Social Work, Washington University, Saint Louis, Missouri, USA
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Rothrock RJ, Morra RP, Deutsch BC, Neifert SN, Cho SK, Caridi JM. Effect of Psychiatric Comorbidities on In-Hospital Outcomes and Cost for Cervical Spondylotic Myelopathy. World Neurosurg 2019; 129:e718-e725. [PMID: 31181363 DOI: 10.1016/j.wneu.2019.05.258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The present study examined the differences in outcomes of cervical spinal surgery for patients with and without a major psychiatric comorbidity using the Healthcare Cost and Utilization Project National Inpatient Sample database. METHODS Data were queried from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2013 to 2014 for hospitalizations with a major psychiatric comorbidity and a diagnosis of cervical spondylotic myelopathy treated by an appropriate surgical procedure. The included psychiatric comorbidities were schizophrenia, episodic mood disorders (bipolar I and II disorders), delusional disorders, and psychoses not otherwise specified. Univariate and multivariate regression analyses were performed to determine the differences in outcomes between patients with and without a major psychiatric comorbidity. RESULTS A total of 18,335 hospitalizations met the inclusion criteria, of which 648 (3.5%) included a major psychiatric comorbidity. Multivariate regression analysis demonstrated that psychiatric comorbidity was an independent predictor of non-home discharge (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.43-2.30; P < 0.0001) and a longer hospital stay (+0.52 day; 95% CI, 0.43-0.61; P < 0.0001) but was not an independent predictor of overall complications (OR, 0.79; 95% CI, 0.58-1.07; P = 0.13) or total hospital charges ($1992; 95% CI, -$917-$4902; P = 0.18). CONCLUSIONS Psychiatric comorbidity was associated with an increased risk of non-home discharge and a longer length of stay for patients undergoing surgical intervention for cervical myelopathy. However, we did not find an associated increased risk of in-hospital mortality, complications, or total hospital charges. Psychiatric comorbidity should not be weighed against patients who require surgical treatment for cervical spondylotic myelopathy, and special attention should be given to postoperative care and discharge planning for this unique patient population.
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Affiliation(s)
- Robert J Rothrock
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Rocco P Morra
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian C Deutsch
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Clibbens N, Harrop D, Blackett S. Early discharge in acute mental health: A rapid literature review. Int J Ment Health Nurs 2018; 27:1305-1325. [PMID: 29949227 DOI: 10.1111/inm.12515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 11/28/2022]
Abstract
Long psychiatric hospital stays are unpopular with services users, harmful, and costly. Economic pressures alongside a drive for recovery-orientated care in the least restrictive contexts have led to increasing pressure to discharge people from hospital early. Hospital discharge is, however, complex, stressful, and risky for service users and families. This rapid literature review aimed to assess what is known about early discharge in acute mental health. Searches were conducted in nine bibliographic databases, reference lists, and targeted grey literature sources. Fourteen included papers focused on early discharge in mental health, a population over 18 years with a mental health condition, and reported outcomes on therapeutic care or service delivery. Quality appraisal was undertaken using The Mixed Method Appraisal Tool. The meta-summary of the literature found that early discharge was neither provided to all inpatients nor limited to the Crisis Resolution and Home Treatment (CRHT) service model internationally. Early discharge interventions required collaborative working and discharge planning. It was not associated with unplanned readmissions and had a small effect on length of stay. Most studies reported service outcomes, whereas health outcomes were underreported. Professionals and service users were positive about early discharge and service users asked for peer support. Carers preferred hospital or day hospital care suggesting their need for respite. Limitations in the scope, detail, and quality of the evidence about early discharge leave an unclear picture of the components of early discharge as an intervention, its effectiveness, cost-effectiveness, or outcomes.
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Affiliation(s)
| | - Deborah Harrop
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Sally Blackett
- South Humber NHS Foundation Trust, Rotherham, Doncaster, UK
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15
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Botha UA, Coetzee M, Koen L, Niehaus DJH. An Attempt to Stem the Tide: Exploring the Effect of a 90-Day Transitional Care Intervention on Readmissions to an Acute Male Psychiatric Unit in South Africa. Arch Psychiatr Nurs 2018; 32:384-389. [PMID: 29784219 DOI: 10.1016/j.apnu.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/28/2017] [Accepted: 12/03/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pressure on inpatient beds often results in premature discharges, which may precipitate early readmission. This has prompted an increased interest in transitional care interventions to bridge the gap between in- and outpatient care to reduce such readmissions. Our study aimed to assess the effect of a Transitional Care Service (TCS) on readmission rates in a high pressure inpatient service which utilizes a premature discharge policy to address bed pressures. METHODS Sixty male patients identified for crisis discharge were offered a TCS for the first ninety days after discharge. Patients received a structured intervention consisting of four phone calls and one home visit, focusing on maintaining adherence, appointment reminders and psychoeducation. The TCS patients were retrospectively compared to a matched control group in terms of readmission after 90days. Data was collected on adherence to medication, attendance of appointments and incidence of substance use. RESULTS There was no significant difference in readmission rates. Prevalence of substance use was very high (90%), especially methamphetamine use (48%). Adherence dropped from 45% (n=27) at one week post-discharge to 25% (n=15) at 90days. CONCLUSION Structured telephone-based transitional interventions have no effect on readmission rates in this setting. Prematurely discharged patients require more comprehensive support with focus on comorbid substance use.
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Affiliation(s)
- Ulla A Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa; Stikland Hospital, South Africa.
| | - Marise Coetzee
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa; Stikland Hospital, South Africa
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa; Stikland Hospital, South Africa
| | - Dana J H Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa; Stikland Hospital, South Africa
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16
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Shimada T, Ohori M, Inagaki Y, Shimooka Y, Sugimura N, Ishihara I, Yoshida T, Kobayashi M. A multicenter, randomized controlled trial of individualized occupational therapy for patients with schizophrenia in Japan. PLoS One 2018; 13:e0193869. [PMID: 29621261 PMCID: PMC5886394 DOI: 10.1371/journal.pone.0193869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia.
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Affiliation(s)
- Takeshi Shimada
- Department of Occupational Therapy, Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Manami Ohori
- Department of Occupational Therapy, North Alps Medical Center, Azumi Hospital, Nagano, Japan
| | - Yusuke Inagaki
- Department of Occupational Therapy, Nagano Prefectural Mental Wellness Center Komagane, Nagano, Japan
| | - Yuko Shimooka
- Department of Occupational Therapy, Social Medical Corporation Ritsuzankai, Iida Hospital, Nagano, Japan
| | - Naoya Sugimura
- Department of Occupational Therapy, Medical Corporation Akitsukai, Nanshin Hospital, Nagano, Japan
| | - Ikuyo Ishihara
- Department of Occupational Therapy, Medical Corporation Aiseikai, Matsuoka Hospital, Nagano, Japan
| | - Tomotaka Yoshida
- Department of Occupational Therapy, Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
- * E-mail:
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17
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Lin LE, Lo SC, Liu CY, Chen SC, Wu WC, Liu WI. Effectiveness of Needs-oriented Hospital Discharge Planning for Caregivers of Patients With Schizophrenia. Arch Psychiatr Nurs 2018; 32:180-187. [PMID: 29579510 DOI: 10.1016/j.apnu.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 11/26/2022]
Abstract
Hospital discharge planning for clients with schizophrenia reduces client rehospitalization rates and improves their medication adherence. The effectiveness of caregiver participation in hospital discharge planning has seldom been explored. The purpose of this study was to examine the effectiveness of caregiver participation in hospital discharge planning for clients with schizophrenia in reducing caregiver burden and improving health status. A quasi-experimental research design was adopted. The research location was in a psychiatric hospital in Northern Taiwan. The target population was caregivers of inpatients with schizophrenia. Nurses served as care coordinators and provided six-step hospital discharge planning services to caregivers. Structured questionnaires were employed to measure caregiver burden and health status. Intervention effect was tested using analysis of covariance in which outcome measure at pretest and selected demographic variables were treated as covariates. A total of 114 caregivers completed pretest and posttest evaluations, with 57 people in each group. A significant difference was found between the experimental and the control group regarding the caregiver burden and health status (P<0.001) The caregiver burden and health status of the experimental group improved more significantly compared with the control group. The caregiver-involved discharge planning process developed in this study effectively reduced the burden placed on caregivers and improved their health status. Mental health nurses can serve as the main care coordinators for assessment, planning, referral and provision of the required services. Caregiver-involved hospital discharge planning should become part of the routine care process.
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Affiliation(s)
- Li-En Lin
- Department of Nursing, Bali Psychiatric Center, No.33, Huafushan, Bali Dist., New Taipei City 249, Taiwan, ROC
| | - Su-Chen Lo
- Department of Nursing, Bali Psychiatric Center, No.33, Huafushan, Bali Dist., New Taipei City 249, Taiwan, ROC
| | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences
| | - Shing-Chia Chen
- School of Nursing, College of Medicine, National Taiwan University, Department of Nursing, National Taiwan University Hospital, No.1, Sec. 1, Ren Ai Rd., Zhongzheng Dist., Taipei City 10052, Taiwan, ROC
| | - Wen-Cheng Wu
- Tao Yuan General Hospital, Ministry of Health and Welfare; School of Law, Fu Jen Catholic University
| | - Wen-I Liu
- National Taipei University of Nursing and Health Sciences.
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18
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Digel Vandyk A, Young L, MacPhee C, Gillis K. Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons. QUALITATIVE HEALTH RESEARCH 2018; 28:587-599. [PMID: 29231128 DOI: 10.1177/1049732317746382] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants' experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.
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Affiliation(s)
| | | | - Colleen MacPhee
- 3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- 4 The Ottawa Hospital, Ottawa, Ontario, Canada
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19
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Brief Report: A Randomized Control Trial Assessing the Influence of a Telephone-based Intervention on Readmissions for Patients with Severe Mental Illness in a Developing Country. Community Ment Health J 2018; 54:197-203. [PMID: 27900649 PMCID: PMC5794800 DOI: 10.1007/s10597-016-0069-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/24/2016] [Indexed: 10/28/2022]
Abstract
Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were randomized to facilitated care or treatment as usual. All were interviewed prior to discharge and after 12 months. Facilitated care consisted of structured telephonic interviews and motivational support to patients and families. At 12 months no significant differences in either readmissions (p = 0.10) or days in hospital (p = 0.44) could be demonstrated. Substance use was high (64%), particularly methamphetamine (44%) in both groups. The intervention did not have any impact on inpatient usage in our setting. Though this study was limited by its small sample size, the results indicated that affordable post-discharge services may not be comprehensive enough to reduce readmission rates and would have to be tailored to the distinct population of dual diagnosis patients identified in this study.
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20
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Rugkåsa J, Canvin K. Mental health, coercion and family caregiving: issues from the international literature. BJPsych Int 2017; 14:56-58. [PMID: 29093945 PMCID: PMC5618899 DOI: 10.1192/s2056474000001902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article summarises current knowledge about two aspects of family care for people with mental illness: potentially pressurising or coercive aspects of family life; and family carers’ experiences of being involved in coercive service interventions. There is a paucity of studies on these topics, especially outside Europe, North America and Australasia, and further research is recommended.
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Affiliation(s)
- Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; email
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21
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Ortiz MM, Carr E, Dikareva A. An Integrative Review of the Literature on Pain Management Barriers: Implications for the Canadian Clinical Context. Can J Nurs Res 2017; 46:65-93. [PMID: 29509486 DOI: 10.1177/084456211404600305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite decades of pain research, substandard pain management continues to be distressingly prevalent across health-care settings. This integrative literature review analyzes and synthesizes barriers to effective pain management and identifies areas for future investigation in a Canadian context. Three sets of key barriers were identified through thematic analysis of 24 original research studies published in the period 2003-13: patient, professional, and organizational. These barriers rarely occurred in isolation, with many studies reporting examples in all three categories. This suggests that interventions need to reflect the multifactorial nature of pain management. Reframing pain education as a public health initiative could lead to sustainable improvement, as could the strengthening of partnerships between patients and health-care providers. There are tremendous opportunities for the advanced practice nurse to take a lead in pain management. The delivery of high-quality care that encompasses effective pain management strategies must be a priority for nursing. Research approaches, such as pragmatic mixed methods, that offer contextual understanding of how pain is managed are suggested.
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Affiliation(s)
- Mia Maris Ortiz
- BSN student in the Faculty of Nursing, University of Calgary, Alberta, Canada
| | - Eloise Carr
- Faculty of Nursing, and Associate Dean, Faculty of Graduate Studies, University of Calgary
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22
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Giacco D, Dirik A, Kaselionyte J, Priebe S. How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians. BMC Psychiatry 2017; 17:101. [PMID: 28320376 PMCID: PMC5359804 DOI: 10.1186/s12888-017-1259-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Carers are family members or friends who support people with a mental health problem without being paid. Carer involvement in mental health treatment has been consistently supported by research evidence and promoted by policies but its implementation rates are poor. Particularly when patients are treated in inpatient units, carers often report being left without information or being excluded from decisions about treatment. In this study we have explored, along with staff perspectives, views of patients and carers who had a recent experience of inpatient mental health care on how to improve the implementation of carer involvement in inpatient care. METHODS Sixteen focus groups were held with carers, patients and clinicians in London, United Kingdom. We included staff working in inpatient units and patients and carers who had experience of inpatient care in the last five years. Data from focus groups were analysed using thematic analysis. RESULTS Eighty six participants in total (31 service users, 22 carers and 33 clinicians) attended the focus groups. Participants identified that generally, carer involvement should happen as soon as possible after admission, although this may be challenging in some cases. Carer involvement should include receiving information, participating in decisions about care and discharge and receiving emotional support by staff. When carers are involved, their personal knowledge of the patient's condition should be utilised. Challenges to carer involvement may include problems with identifying carers during a mental health crisis, obtaining valid patient consent, sharing appropriate information, and contacting and engaging carers. Additionally, it was perceived that all the ward staff need to be actively engaged in order to make carer involvement happen and this cannot be left only to specifically trained clinicians. CONCLUSIONS These findings identify basic components that all family interventions in inpatient units should have. Further studies are needed to explore how and if purposively designed clinical interventions can improve carer involvement in inpatient treatment and, consequently, patient outcomes.
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Affiliation(s)
- Domenico Giacco
- Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK. .,Newham Centre for Mental Health, E13 8SP, London, UK.
| | - Aysegul Dirik
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK ,0000 0001 2227 3745grid.416554.7Newham Centre for Mental Health, E13 8SP, London, UK
| | - Justina Kaselionyte
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK ,0000 0001 2227 3745grid.416554.7Newham Centre for Mental Health, E13 8SP, London, UK
| | - Stefan Priebe
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK ,0000 0001 2227 3745grid.416554.7Newham Centre for Mental Health, E13 8SP, London, UK
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Shimada T, Nishi A, Yoshida T, Tanaka S, Kobayashi M. Development of an Individualized Occupational Therapy Programme and its Effects on the Neurocognition, Symptoms and Social Functioning of Patients with Schizophrenia. Occup Ther Int 2016; 23:425-435. [PMID: 27748565 DOI: 10.1002/oti.1445] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 01/01/2023] Open
Abstract
We described an individualized occupational therapy (IOT) programme and examined the effects of adding IOT to group OT (GOT) on improving neurocognition, symptoms and social functioning among recently hospitalized patients with schizophrenia. The Brief Assessment of Cognition in Schizophrenia-Japanese version (BACS-J), the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale were used for outcome evaluations. Fifty-one patients were voluntarily assigned to either the GOT + IOT (n = 30) or GOT alone (n = 21) groups based on their preferences. Retention in the GOT + IOT group was 100%. Three-month baseline to discharge assessments in the GOT + IOT group showed significant improvements in BACS-J verbal memory, working memory, verbal fluency, attention, executive function and composite score, and in PANSS positive subscale, general psychopathology subscale, and total score compared to the GOT alone group. Study limitations notwithstanding, the present findings provide preliminary support for the feasibility of implementing IOT and its effectiveness for improving cognitive impairment and symptoms in patients with schizophrenia. The results of this study indicate that IOT in psychiatric facilities may improve psychosocial treatment of schizophrenia. Additional study is warranted to replicate the effects of IOT as demonstrated in this Japanese study. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Takeshi Shimada
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan.,Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Ai Nishi
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Tomotaka Yoshida
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Sachie Tanaka
- Graduate School of Medicine, Shinshu University, Nagano, Japan
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24
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Al-Sughayir MA. Effect of accreditation on length of stay in psychiatric inpatients: pre-post accreditation medical record comparison. Int J Ment Health Syst 2016; 10:55. [PMID: 27606002 PMCID: PMC5013634 DOI: 10.1186/s13033-016-0090-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/29/2016] [Indexed: 12/04/2022] Open
Abstract
Background An interest in hospital accreditation is growing rapidly among many countries to enhance the quality of health care services. The literature showed a positive association between accreditation and some processes of health care. One of the main factors that influence bed availability is the length of hospital stay (LOS), which is considered as an important indicator of the quality of inpatient psychiatric hospitalization. We aimed to investigate whether hospital accreditation drives improvements for the length of stay in psychiatric inpatients. Methods The study reviewed medical records of consecutive hospital admissions for pre- and post-accreditation comparisons of LOS in two acute mental health wards at a teaching general hospital in Riyadh, Saudi Arabia. Data obtained from the 12-month-post-accreditation period (July 2011 to June 2012) were compared with those from the 12-month-pre-accreditation period (July 2009 to June 2010). The adoption of accreditation program occurred over a 12-month period in the middle of the study (July 2010 to June 2011). Compiled information included demographics, diagnosis, assessment, and LOS. All identified charts were reviewed; there were no exclusion criteria. Patients were not contacted. Results Post-accreditation, the mean (SD) length of stay was 35.3 ± 18.5 days and the range was 3–113 days. Whereas in the pre-accreditation period the mean (SD) length of stay was 41.1 ± 29.5 days and the range was 1–167 days. The difference was statistically significant (P = 0.026). Conclusion Accreditation reduces excess LOS and contributes to improving the quality of psychiatric inpatient care and access to psychiatric beds.
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Affiliation(s)
- Mohammed Abdullah Al-Sughayir
- Psychiatry Department, College of Medicine, King Saud University, PO Box 21525, Riyadh, 11485 Kingdom of Saudi Arabia
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25
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Lettner BH, Doan RJ, Miettinen AW. Housing outcomes and predictors of success: the role of hospitalization in street outreach. J Psychiatr Ment Health Nurs 2016; 23:98-107. [PMID: 26914865 DOI: 10.1111/jpm.12287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/29/2022]
Abstract
ACCESSIBLE SUMMARY What is known on the subject? Outreach services are often successful in engaging and housing street homeless individuals. People experiencing homelessness have greatly increased rates of mental illness and substance abuse. What this paper adds to existing knowledge? Given the relative lack of research involving street homeless individuals, this retrospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework. The majority of clients were successfully housed by the end of outreach team involvement. An admission to hospital was strongly associated with successful housing for those with a psychotic disorder. What are the implications for practice? Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homelessness and psychosis. Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals. Introduction Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness. METHOD A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement. RESULTS Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization (OR = 9.04, 95% CI [2.43, 33.59]). It was significantly diminished by psychosis (OR = 0.22, 95% CI [0.05, 0.95]) and prior homelessness >36 months (OR = 0.10, 95% CI [0.02, 0.50]). Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized (Fisher's exact, P < .001). DISCUSSION Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage.
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Affiliation(s)
- B H Lettner
- Department of Nursing, University of Toronto, Toronto
| | - R J Doan
- Department of Psychiatry, University of Toronto, Toronto
| | - A W Miettinen
- Department of Economics, University of Toronto, Toronto
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Im EO, Kim S, Tsai HM, Nishigaki M, Yeo SA, Chee W, Chee E, Mao JJ. Practical issues in multi-lingual research. Int J Nurs Stud 2016; 54:141-9. [PMID: 25739658 PMCID: PMC5890920 DOI: 10.1016/j.ijnurstu.2015.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND With an increasing number of ethnic minority populations, the use of multiple languages in one research study has increased in recent years. The use of multiple languages helps increase comprehensiveness of educational materials and/or survey questionnaires, and promote ethnic minorities' participation in research. However, little has been clearly known about practical issues in using multiple languages in one research study. OBJECTIVES The purpose of this paper is to explore practical issues in using multiple languages in a study among diverse sub-ethnic groups of Asian American breast cancer survivors in order to propose future directions for the use of multiple languages in research projects. METHODS Throughout the research process, research team made written records of practical issues and possible reasons for the issues as they arose. Weekly group discussions among research team members were administered, and the written records of these discussions were reviewed and analyzed using the content analysis. The unit of analysis was individual words. The words in the data (memos and written records) were classified into idea categories that emerged from the coding process. RESULTS The idea categories included issues in: (a) collaborators from various sub-ethnic groups; (b) IRB protocol submissions; (c) consistencies in translation process, (d) conceptual equivalence; (e) cultural differences; (f) existing translated versions; and (g) authorship issues. Based on the issues, we made the following suggestions for multi-lingual research: (a) networking and setting multiple communication channels with potential collaborators; (b) checking the institution's IRB policies related to the use of multiple languages; (c) setting the rules and procedures for translation process; (d) checking existing different language versions of instruments; and (e) setting the rules for authorship in advance. CONCLUSIONS The suggestions made in this study would help the researchers be prepared in advance to deal with the challenges.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, University of Pennsylvania, 418 Curi Blvd., Philadelphia, PA 19104, United States.
| | - Sangmi Kim
- School of Nursing, University of Pennsylvania, 418 Curi Blvd., Philadelphia, PA 19104, United States.
| | - Hsiu-Min Tsai
- Chang Gung University of Science and Technology, 261 We-hua 1st Road, Kwei-shan, Tao-yuan, Taiwan.
| | - Masakazu Nishigaki
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Seon Ae Yeo
- University of North Caronia, Carrington Hall, CB No. 7460, Chapel Hill, NC 27599, United States.
| | - Wonshik Chee
- School of Nursing, University of Pennsylvania, 418 Curi Blvd., Philadelphia, PA 19104, United States.
| | - Eunice Chee
- School of Engineering and Applied Science, University of Pennsylvania, 220 S 33rd St, Philadelphia, PA 19104, United States.
| | - Jun James Mao
- School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA 19104, United States.
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Keogh B, Callaghan P, Higgins A. Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study. J Psychiatr Ment Health Nurs 2015; 22:715-23. [PMID: 26303064 DOI: 10.1111/jpm.12265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 11/30/2022]
Abstract
ACCESSIBLE SUMMARY What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms. INTRODUCTION Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users. AIM The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital. METHOD This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users. RESULTS The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital. IMPLICATIONS FOR PRACTICE This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged.
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Affiliation(s)
- B Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P Callaghan
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - A Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Nakanishi M, Niimura J, Tanoue M, Yamamura M, Hirata T, Asukai N. Association between length of hospital stay and implementation of discharge planning in acute psychiatric inpatients in Japan. Int J Ment Health Syst 2015; 9:23. [PMID: 26029254 PMCID: PMC4449576 DOI: 10.1186/s13033-015-0015-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background Japan has introduced an acute psychiatric care unit to the public healthcare insurance program, but its requirement of a shorter length of stay could lead to discharges without proper discharge planning. The aim of this study was to examine the association between the implementation of discharge planning and the length of stay of acute psychiatric inpatients in Japan. Methods This retrospective cross-sectional study included 449 patients discharged from the ‘psychiatric emergency ward’ of 66 hospitals during a two-week period from March 7 to 20, 2011. The assigned nurse or nursing assistant for each patient provided information on the implementation of discharge planning in the hospital stay. Results Approximately one quarter of the 449 patients (n = 122) received no support for coordination with post-discharge community care resources. The 122 patients who had received no support for community care coordination had a significantly lower mean age at admission, a shorter length of stay, and a higher rate of either no follow-up or unidentified post-discharge outpatient service than the other 327 patients. Multilevel linear regression analysis demonstrated a significantly greater length of stay among patients who were older, those who had a primary diagnosis of schizophrenia, those who were admitted compulsorily, those who received hospital outpatient services, and those who received community care coordination support from the assigned nurse or nursing assistant. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. Conclusion Patients to whom the assigned nurse or nursing assistant provided support on community care coordination experienced a significantly greater length of hospital stay. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. The mental health policy should increase focus on discharge planning in the acute psychiatric setting to enhance a link between psychiatric inpatient care and post-discharge community care resources.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Junko Niimura
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Michika Tanoue
- Mental Health and Psychiatric Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Motoe Yamamura
- Division of Nursing Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Toyoaki Hirata
- Chiba Psychiatric Medical Centre, Chiba-shi, Chiba Japan
| | - Nozomu Asukai
- Research Project for Mental Health Promotion, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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