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Brekke E, Clausen H, Brodahl M, Landheim AS. Patients' experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry 2023; 23:764. [PMID: 37853402 PMCID: PMC10585822 DOI: 10.1186/s12888-023-05264-z] [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: 06/01/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? METHOD Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. RESULTS Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. CONCLUSION Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway.
| | - Hanne Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
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Lappalainen M, Härkänen M, Laukkanen E, Kuosmanen L. Effectiveness of Providing Information on Antipsychotic Medication to Patients with Psychotic Disorders: An Integrative Review. Issues Ment Health Nurs 2023; 44:373-386. [PMID: 37126802 DOI: 10.1080/01612840.2023.2195507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The aim of this integrative literature review is to describe the information provided to patients with psychotic disorders regarding their medication and to consider the effectiveness of providing such information. Searches of four databases identified 16 articles that met inclusion criteria. Results indicated that patients had relatively poor knowledge about their medications overall. Knowledge about side effects was found to improve significantly following education, with better knowledge leading to positive patient outcomes including increased adherence. Findings offer a comprehensive description of antipsychotic medication information provided to patients and an indication of the positive impact of information provision.
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Affiliation(s)
- Margit Lappalainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Emilia Laukkanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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3
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Villena-Jimena A, Morales-Asencio JM, Quemada C, Hurtado MM. "It's That They Treated Me Like an Object": A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4614. [PMID: 36901624 PMCID: PMC10002244 DOI: 10.3390/ijerph20054614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.
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Affiliation(s)
- Amelia Villena-Jimena
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Casta Quemada
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - María M. Hurtado
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
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4
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Maples NJ, Velligan DI, Jones EC, Espinosa EM, Morgan RO, Valerio-Shewmaker MA. Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry. Community Ment Health J 2022; 58:578-588. [PMID: 34176054 PMCID: PMC8860777 DOI: 10.1007/s10597-021-00856-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.
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Affiliation(s)
- Natalie J Maples
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA.
- Department of Psychiatry and Behavioral Sciences, MS7797, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Dawn I Velligan
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Eric C Jones
- Department of Epidemiology, Human Genetics and Environmental Sciences, UT School of Public Health, El Paso, TX, USA
| | | | - Robert O Morgan
- Department of Management, Policy, and Community Health, UT School of Public Health, Houston, TX, USA
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Haugom EW, Stensrud B, Beston G, Ruud T, Landheim AS. Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study. BMC Psychiatry 2022; 22:192. [PMID: 35300633 PMCID: PMC8932170 DOI: 10.1186/s12888-022-03849-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is a process where the patient and the health professional collaborate to make decisions based on both the patient's preferences and the best available evidence. Patients with psychotic disorders are less involved in making decisions than they would like. More knowledge of these patients' experiences of SDM may improve implementation. The study aim was to describe and explore experiences of SDM among patients with psychotic disorders in mental health care. METHODS Individual interviews were conducted with ten persons with a psychotic disorder. They were service users of two community mental health centres. The transcribed material was analysed using qualitative content analysis. RESULTS Four-fifths of the participants in this study found that they received insufficient information about their health situation and treatment options. All participants experienced that only one kind of treatment was often presented, which was usually medication. Although the study found that different degrees of involvement were practised, two thirds of the participants had little impact on choices to be made. This was despite the fact that they wanted to participate and felt capable of participating, even during periods of more severe illness. The participants described how important it was that SDM in psychosis was based on a trusting relationship, but stated that it took time to establish such a relationship. CONCLUSIONS This study with ten participants indicates that patients with psychotic disorders experienced that they were not allowed to participate as much as they wanted to and believed they were capable of. Some patients were involved, but to a lesser degree than in SDM. More and better tailored information communicated within a trusting relationship is needed to provide psychotic patients with a better basis for active involvement in decisions about their health care.
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Affiliation(s)
- Espen W. Haugom
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway ,grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Stensrud
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway
| | - Gro Beston
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway
| | - Torleif Ruud
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne S. Landheim
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway ,grid.477237.2Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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6
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Ismail MA, Midin M. Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study. Front Psychiatry 2021; 12:680800. [PMID: 34381387 PMCID: PMC8350437 DOI: 10.3389/fpsyt.2021.680800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia. Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses. Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = -0.33, 95% CI = -0.67 to -0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39-30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72-0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10-7.82). Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.
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Affiliation(s)
| | - Marhani Midin
- Psychiatry Department, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
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Golder S, O'Connor K, Hennessy S, Gross R, Gonzalez-Hernandez G. Assessment of Beliefs and Attitudes About Statins Posted on Twitter: A Qualitative Study. JAMA Netw Open 2020; 3:e208953. [PMID: 32584408 PMCID: PMC7317605 DOI: 10.1001/jamanetworkopen.2020.8953] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Statins are prescribed to help lower cholesterol levels but have poor adherence rates. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. OBJECTIVE To identify health-related discussion in Twitter posts mentioning a statin and analyze the content within these posts. DESIGN, SETTING, AND PARTICIPANTS This qualitative study included 11 852 posts related to 1 of 8 statins (7 licensed for use in the United States and 5 licensed in the United Kingdom) collected from May 10, 2013, to August 28, 2018. Twitter posts were identified as health related or not, and if health related, whether they were posted by a statin user, someone who knows a statin user, a health care professional, or undetermined. The health-related tweets were classified by the type of information posted, such as a belief about the medication, an adverse event, a question, or a reference to the cost of the medication. Data were analyzed from January 22 to November 19, 2019. MAIN OUTCOMES AND MEASURES The number of posts by each user type identified and the categories identified by analyzing the content. RESULTS Of the 11 852 Twitter posts about statins, 5201 (43.9%) were health related. The most frequent posts provided resource information, such as a link to a journal article (1824 of 5201 [35.1%]). The second most frequent type of health-related posts included personal beliefs or attitudes toward statins (1097 of 5201 [21.1%]). Personal experiences of adverse events (353 of 5201 [6.8%]), discussions about dosage (320 of 5201 [6.2%]), and questions about statins (191 of 5201 [3.7%]) followed. Posts indicated polarized beliefs and attitudes to statins from saving lives to causing death. Some beliefs, such as the direct confirmation that the use of statins mitigates the effects of an unhealthy diet, have not been extensively highlighted as common practice in the literature. CONCLUSION AND RELEVANCE This qualitative content analysis of Twitter posts about statins provides insights into beliefs about statins. Patient perspectives gathered from social media may help to inform research and improve public health messages and communication between health care professionals and patients.
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Affiliation(s)
- Su Golder
- Department of Health Sciences, University of York, York, United Kingdom
| | - Karen O'Connor
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sean Hennessy
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Graciela Gonzalez-Hernandez
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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8
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McMillan SS, Wilson B, Stapleton H, Wheeler AJ. Young people's experiences with mental health medication: A narrative review of the qualitative literature. J Ment Health 2020; 31:281-295. [PMID: 32031034 DOI: 10.1080/09638237.2020.1714000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: With the growing prevalence of mental illness in young people, healthcare professionals require an understanding of the social and psychological implications of medication use in this population.Aim: To characterize the qualitative literature regarding the perceptions and experiences of young people taking medication for mental illness.Methods: A narrative review of qualitative studies involving young people (13-24 years) taking any medication as treatment for a mental illness. The Medication Experience Model guided analysis of quotes related to medication use.Results: Of the 27 included studies, the majority involved participants with depression and utilized interviews. Young people reported a wide range of mental health medication experiences, both negative and positive, which could influence medication acceptance. Lack of autonomy and the influence of family members were challenges faced by this population.Conclusions: Young people reported that medications had affected them in various ways across multiple dimensions. Lack of involvement in decision-making and a loss of autonomy were of particular relevance to young people, issues which should also be of interest to healthcare professionals.
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Affiliation(s)
- Sara S McMillan
- School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Bethany Wilson
- School of Pharmacy and Pharmacology, Griffith University, Southport, Queensland, Australia
| | - Helen Stapleton
- School of Human Services and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Amanda J Wheeler
- School of Human Services and Social Work, Quality Use of Medicines Network, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Allison R, Flemming K. Mental health patients' experiences of softer coercion and its effects on their interactions with practitioners: A qualitative evidence synthesis. J Adv Nurs 2019; 75:2274-2284. [PMID: 31012149 DOI: 10.1111/jan.14035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/16/2018] [Accepted: 12/21/2018] [Indexed: 01/26/2023]
Abstract
AIMS To synthesize qualitative evidence of mental health patients' treatment-related experiences of softer coercion and its effect on their interactions with practitioners. BACKGROUND Coercion is controversial but global in mental health care. It ranges from softer to harder forms, but less attention is given in the literature to softer coercion. DESIGN Qualitative thematic synthesis examining patients' experiences of softer coercion. DATA SOURCES Electronic databases searched from inception to September 2015 and further updated January 2018. REVIEW METHODS Thematic synthesis of 11 UK/Irish articles, quality appraised using the Critical Appraisal Skills Programme tool. RESULTS Three analytic themes were developed: Losing a sense of self, Less than therapeutic relationship, and Journey through treatment. CONCLUSION Softer coercion is experienced across mental health care in a context of broader coercion.
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Affiliation(s)
- Rob Allison
- Department of Health Sciences, University of York, York, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
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10
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Bjornestad J, Lavik KO, Davidson L, Hjeltnes A, Moltu C, Veseth M. Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies. J Ment Health 2019; 29:513-523. [DOI: 10.1080/09638237.2019.1581352] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kristina O. Lavik
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | | | - Aslak Hjeltnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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11
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Hipp K, Kuosmanen L, Repo-Tiihonen E, Leinonen M, Louheranta O, Kangasniemi M. Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review. Int J Ment Health Nurs 2018; 27:536-554. [PMID: 29271033 DOI: 10.1111/inm.12427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 12/11/2022]
Abstract
Pro re nata (PRN) medication is widely used and studied in psychiatric care, but our knowledge about patient participation in its administration is fragmented. The aim of this integrative review was to describe and synthesize previous knowledge of patient participation in PRN in psychiatric inpatient settings. We conducted both electronic and manual searches, using the CINAHL, Scopus, PsycINFO, and PubMed databases, and eight scientific journals. Searches were limited to the English language, to the years 2006-2016, and to selected papers using inclusion, exclusion, and quality criteria. We identified 16 relevant papers, and these showed that patient participation included patient-related starting points, including the patients' willingness to participate and their knowledge of the medication. The patients' participation in PRN practices was demonstrated by the opportunity to request PRN and to refuse any PRN that was offered. Patient participation was shown to be linked to certain situations where PRN was recommended. The role that the professionals played in patient participation included interacting with patients, providing counselling and alternatives for PRN. Our results also revealed that coercion was used administering PRN. The existing literature exposed challenges that need to be addressed if patient participation in the use of PRN medication is to be effectively achieved in psychiatric inpatient settings. Equal partnerships between patients, nurses, and physicians are an essential part of this process, and further research into PRN medication is urgently needed, particularly studies that focus on patients' experiences.
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Affiliation(s)
- Kirsi Hipp
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland.,City of Vantaa, Social and Healthcare Department, Vantaa, Finland
| | - Eila Repo-Tiihonen
- Niuvanniemi Hospital, Kuopio, Finland.,Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,Psychiatry, University of Helsinki, Helsinki, Finland
| | | | | | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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12
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Pedley R, McWilliams C, Lovell K, Brooks H, Rushton K, Drake RJ, Rumbold B, Bell V, Bee P. Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing. BJPsych Open 2018; 4:5-14. [PMID: 29388908 PMCID: PMC6020265 DOI: 10.1192/bjo.2017.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/26/2017] [Accepted: 11/09/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication. Aims To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions. METHOD Systematic thematic synthesis. RESULTS Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes. CONCLUSIONS Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement. Declaration of interest None.
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Affiliation(s)
- Rebecca Pedley
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Room 6.306 Jean McFarlane Building,
Oxford Road, Manchester, M13
9PL
| | - Caitlin McWilliams
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Karina Lovell
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Helen Brooks
- Department of Psychological Sciences,
Institute of Psychology, Health and Society,
University of Liverpool, Liverpool,
L69 3BX
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Richard J. Drake
- Division of Psychology and Mental Health,
School of Health Sciences, Faculty of
Biology, Medicine and Health, The University
of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Barnaby Rumbold
- Millbrook Independent Hospital,
Wythenshawe, Manchester, M23
2RX
| | - Vicky Bell
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Penny Bee
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
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13
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Krska J, Katusiime B, Corlett SA. Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire. Patient Prefer Adherence 2017; 11:671-679. [PMID: 28405159 PMCID: PMC5378470 DOI: 10.2147/ppa.s126647] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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 Medicine-related burden is an increasingly recognized concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviors, including nonadherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire (LMQ) was developed for this purpose. OBJECTIVE This study validated the LMQ in a sample of adults using regular prescription medicines in the UK. METHODS Questionnaires were distributed in community pharmacies and public places in southeast England or online through UK health websites and social media. A total of 1,177 were returned: 507 (43.1%) from pharmacy distribution and 670 (56.9%) online. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and between those who did or did not require assistance with medicine use. Internal consistency was assessed by Cronbach's alpha. Free-text comments were analyzed thematically to substantiate underlying dimensions. RESULTS A 42-item, eight-factor structure comprising intercorrelated dimensions (patient-doctor relationships and communication about medicines, patient-pharmacist communication about medicines, interferences with daily life, practical difficulties, effectiveness, acceptance of medicine use, autonomy/control over medicines and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales had acceptable internal consistency (α>0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of the respondents, supported the domains identified. CONCLUSION The resultant LMQ-2 is a valid and reliable multidimensional measure of prescription medicine use experiences, which covers more diverse domains than existing questionnaires. However, further validation work is necessary.
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Affiliation(s)
- Janet Krska
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham Maritime, UK
- Correspondence: Janet Krska, Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Kent, ME4 4TB, UK, Tel +44 1634 202 950, Email
| | - Barbra Katusiime
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham Maritime, UK
| | - Sarah A Corlett
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham Maritime, UK
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14
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Jansen TL, Hanssen I. Patient participation: causing moral stress in psychiatric nursing? Scand J Caring Sci 2016; 31:388-394. [PMID: 27440011 DOI: 10.1111/scs.12358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 03/31/2016] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to explore psychiatric nurses' experiences and perspectives regarding patient participation. Patient participation is an ambiguous, complex and poorly defined concept with practical/clinical, organisational, legal and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance when moral caring acts are thwarted by constraints. METHODS An explorative quantitative pilot study was conducted at a psychiatric subacute unit through three focus group interviews with a total of nine participants. A thematic analytic approach was chosen. Preliminary empirical findings were discussed with participants before the final data analysis. Ethical research guidelines were followed. RESULTS Patient participation is a difficult ideal to realise because of vagueness of aim and content. What was regarded as patient participation differed. Some interviewees held that patients may have a say within the framework of restraints while others saw patient participation as superficial. The interviewees describe themselves as patient's spokespersons and contributing to patients participating in their treatment as a great responsibility. They felt squeezed between their ethical values and the 'system'. They found themselves in a negotiator role trying to collaborate with both the doctors and the patients. Privatisation of a political ideal makes nurses vulnerable to burn out and moral distress. CONCLUSION Nurses have a particular ethical responsibility towards vulnerable patients, and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Unclear concepts make for unclear division of responsibility. Patient participation is often a neglected value in current psychiatric treatment philosophy. When healthcare workers' ethical sensibilities are compromised, this may result in moral stress.
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Affiliation(s)
- Trine-Lise Jansen
- Lovisenberg diakonale høgskole [Lovisenberg Deaconal University College], Oslo, Norway
| | - Ingrid Hanssen
- Lovisenberg diakonale høgskole [Lovisenberg Deaconal University College], Oslo, Norway
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15
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Mohammed MA, Moles RJ, Chen TF. Medication-related burden and patients' lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open 2016; 6:e010035. [PMID: 26839015 PMCID: PMC4746464 DOI: 10.1136/bmjopen-2015-010035] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore medication-related burden (MRB) and patients' lived experience with medicines (PLEM) without regard to particular medication therapies or medical conditions. DESIGN Systematic review and metasynthesis of qualitative studies. DATA SOURCES MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsycINFO, Global health, CINAHL and Web of Science were searched from January 2000 to August 2014 using medication burden and patients' lived experience terms. SYNTHESIS METHODS Synthesis was undertaken following metaethnography methods and a comparative thematic analysis technique. RESULTS 34 articles from 12 countries with a total of 1144 participants were included. 3 major inter-related themes emerged central to PLEM: MRB, medication related beliefs and medication taking practice. The negative impact of MRB, due to its interference on patients' daily lives and effects on well-being, its influence on patients' beliefs and behaviours, and a potential risk for drug-related problems (DRPs) was evident. This resulted in non-adherence and poorer outcomes (unachieved therapeutic goals and damage to patients' health). Patients who experienced MRB interference in their life over time begin to juggle their medicines. Others continue their medicines despite experiencing MRB resulting in compromised physical, social or psychological well-being. CONCLUSIONS There is a shared commonality of PLEM among the studies. MRB plays a central role in influencing patients' health and well-being, beliefs and behaviour towards medicines. Given the complexity of MRB and its impact evident from this review, there is a need for healthcare practitioners to have insight into PLEM in therapeutic care plans. Understanding PLEM is an opportunity for practitioners to identify particular MRBs that patients encounter, and provide individualised care through selection of therapeutic care plans that suit a patient's life. This may assist in helping to achieve patients' medication-related needs, and improve medication therapy and health outcomes.
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Affiliation(s)
- Mohammed A Mohammed
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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16
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Lorem GF, Hem MH, Molewijk B. Good coercion: patients' moral evaluation of coercion in mental health care. Int J Ment Health Nurs 2015; 24:231-40. [PMID: 25394674 DOI: 10.1111/inm.12106] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of coercion in mental health care is not self-evident and requires moral justification. A joint understanding is difficult to achieve, because patients and health professionals often evaluate coercion differently. The present study aims to discuss patients' 'moral' evaluation of coercion. We believe that such a focus can form the basis for a better and more differentiated understanding of how we evaluate coercion. This is a qualitative study based on participant observation and interviews with patients. In order to focus specifically on the moral evaluation of coercion, we looked within patients' narratives to examine whether we could differentiate between how they experienced coercion and how they morally evaluated its use, and how they envision/describe good coercion. We found that patients differentiated implicitly between experiences and moral evaluation. The findings have been ordered into three types of reactions: agreeing and accepting, fighting or resisting, and resignation. Further reflection upon patients' positive and negative moral evaluations of coercion resulted in the formulation of different concrete elements at three levels: threshold elements, process elements, and empathic elements. These elements helped us to understand what these patients considered 'good coercion'. The implications are that good clinical practice cannot be separated from the formal, moral evaluation of coercion. A differentiated moral understanding of coercion can form the basis for better and more sensitive communication about coercion among all those involved. A more respectful dialogue on the moral evaluation of coercion might also raise awareness during both the decision-making process and the actual practising of coercion.
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Affiliation(s)
- Geir F Lorem
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit H Hem
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bert Molewijk
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Medical Humanities, Institute for Health and Care Search, Free University Medical Centre, Amsterdam, the Netherlands
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17
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Stensrud B, Høyer G, Granerud A, Landheim AS. "Life on hold": a qualitative study of patient experiences with outpatient commitment in two norwegian counties. Issues Ment Health Nurs 2015; 36:209-16. [PMID: 25898132 PMCID: PMC4776696 DOI: 10.3109/01612840.2014.955933] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients' experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients' daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.
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Affiliation(s)
- Bjørn Stensrud
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway, and Innlandet Hospital Trust, Brumunddal, Norway
| | - Georg Høyer
- Norwegian Research Network on Coercion in Mental Health Care, and Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Arild Granerud
- Faculty of Public Health, Hedmark University College, Elverum, Norway
| | - Anne Signe Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway, SERAF—Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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18
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Kalhovde AM, Elstad I, Talseth AG. "Sometimes I walk and walk, hoping to get some peace." Dealing with hearing voices and sounds nobody else hears. Int J Qual Stud Health Well-being 2014; 9:23069. [PMID: 24674764 PMCID: PMC3968296 DOI: 10.3402/qhw.v9.23069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/14/2022] Open
Abstract
Our objective in this article is to add to the understanding of how people with mental illness experience dealing with hearing troublesome voices and sounds in everyday life. Fourteen people contributed through in-depth interviews and we analysed these using a hermeneutic phenomenological approach. We found that the participants (a) tried to block out the voices and sounds, (b) navigated the health care services, and (c) struggled to come to terms with limitations. Our overall understanding of how the participants dealt with hearing voices is that they sought to be independent and lead ordinary lives despite being troubled by voices. The participants fought desperately to find relief and avoid being overcome by the voices and sounds in intense phases. In less intense phases, they developed ways of getting along with daily life in spite of these experiences. We reflect on the implications of these findings and emphasize the need for care providers to attempt to understand and engage in collaborative explorations with service users in search of the most helpful ways of dealing with hearing troublesome voices and sounds in everyday life.
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Affiliation(s)
- Anne Martha Kalhovde
- Department of General Psychiatry, University Hospital of North Norway, Åsgårdveien, Tromsø, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, University in Tromsø, The Artic University of Norway, Tromsø, Norway; Jaeren District Psychiatric Center, Bryne, Norway;
| | - Ingunn Elstad
- Department of Health and Care Sciences, Faculty of Health Sciences, University in Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Anne-Grethe Talseth
- Department of Health and Care Sciences, Faculty of Health Sciences, University in Tromsø, The Artic University of Norway, Tromsø, Norway
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