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Baker J, Kendal S, Bojke C, Louch G, Halligan D, Shafiq S, Sturley C, Walker L, Brown M, Berzins K, Brierley-Jones L, O'Hara JK, Blackwell K, Wormald G, Canvin K, Vincent C. A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-182. [PMID: 38794956 DOI: 10.3310/udbq8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s) Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John Baker
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Sarah Kendal
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Daisy Halligan
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Saba Shafiq
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Lauren Walker
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Mark Brown
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Kathryn Berzins
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Jane K O'Hara
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Gemma Wormald
- Department of Health Sciences, University of York, York, UK
| | - Krysia Canvin
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Charles Vincent
- Social Spider CIC, The Mill (Community Centre), London, UK
- Thrive by Design, Leeds, UK
- University of Oxford Medical Sciences Division, Oxford, UK
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Taylor F, Galloway S, Irons K, Mess L, Pemberton L, Worton K, Chambers M. Barriers and enablers to implementation of the therapeutic engagement questionnaire in acute mental health inpatient wards in England: A qualitative study. Int J Ment Health Nurs 2022; 31:1467-1479. [PMID: 35976724 PMCID: PMC9804631 DOI: 10.1111/inm.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 01/09/2023]
Abstract
A strong association exists between the quality of nurse-service user therapeutic relationship and care outcomes on acute mental health inpatient wards. Despite evidence that service users desire improved therapeutic engagement, and registered mental health nurses recognize the benefits of therapeutic relationships, such interactions remain sub-optimal. There is a dearth of evidence on factors influencing implementation of interventions to support and encourage therapeutic engagement. This study aimed to understand the barriers and enablers to implementation of the Therapeutic Engagement Questionnaire (TEQ), across fifteen acute inpatient wards in seven English mental health organizations. Qualitative methods were used in which data were collected from ethnographic field notes and documentary review, coded, and analysed using thematic analysis. Theoretical framing supported data analysis and interpretation. Reporting adheres to the Standards for Reporting Qualitative Research. The TEQ as an evidence-based intervention co-produced with service users and nurses was valued and welcomed by many nurse directors, senior clinicians, and ward managers. However, a range of practical and perceptual factors impeded implementation. Furthermore, many existing contextual challenges for intervention implementation in acute inpatient wards were magnified by the COVID-19 pandemic. Suitable facilitation to address these barriers can help support implementation of the TEQ, with some transferability to implementation of other interventions in these settings. Our study suggests several facilitation methods, brought together in a conceptual model, including encouragement of reflective, facilitative discussion meetings among stakeholders and researchers, effort put into winning nurse 'buy-in' and identifying and supporting ward-level agents of change.
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Affiliation(s)
- Francesca Taylor
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Sarah Galloway
- South-West London and St George's Mental Health NHS Trust, London, UK
| | | | - Lorna Mess
- North-East London NHS Foundation Trust, London, UK
| | | | - Karen Worton
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, London, UK
| | - Mary Chambers
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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Ma E, Kritsimali A, Olby-Clements B, Boyd K, Demirbasa B. Innovative Staffing Solutions to Nursing Shortages in Acute Mental Health Inpatient Wards. Issues Ment Health Nurs 2022; 43:103-110. [PMID: 34569903 DOI: 10.1080/01612840.2021.1961331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this pilot project was to investigate the perceived impact of a newly introduced therapeutic staffing model at Kent and Medway NHS and Social Care Partnership Trust (KMPT). Questionnaires were distributed to patients and staff across four wards and analysed for the purposes of getting a better understanding from patients and staff on how the model was working. Results indicate that the therapeutic staffing model was well received by patients, although staff perception was more mixed. Amongst patients, themes in staffing, therapeutic input and ward environment were identified. Amongst staff themes: shift patterns, ward duties/workload, and morale were identified. The new model appears promising, although there are some issues identified. Recommendations were made in terms of improving team cohesiveness, sense of value and professional identities.
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Affiliation(s)
- Eva Ma
- Kent and Medway NHS and Social Care Partnership Trust, Priority House, Maidstone, UK
| | - Afroditi Kritsimali
- Kent and Medway NHS and Social Care Partnership Trust, Priority House, Maidstone, UK
| | - Ben Olby-Clements
- Kent and Medway NHS and Social Care Partnership Trust, Priority House, Maidstone, UK
| | - Kyle Boyd
- Kent and Medway NHS and Social Care Partnership Trust, Priority House, Maidstone, UK
| | - Belinda Demirbasa
- Kent and Medway NHS and Social Care Partnership Trust, Priority House, Maidstone, UK
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Ward-Stockham K, Kapp S, Jarden R, Gerdtz M, Daniel C. Effect of Safewards on reducing conflict and containment and the experiences of staff and consumers: A mixed-methods systematic review. Int J Ment Health Nurs 2022; 31:199-221. [PMID: 34773348 DOI: 10.1111/inm.12950] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
Safewards is an internationally adopted framework that provides interventions to reduce conflict and containment in healthcare settings. This systematic review evaluated the effect of Safewards on conflict and containment events in inpatient units and the perceptions of staff and consumers. Quantitative, qualitative, and mixed-methods studies were considered for inclusion. Following the Joanna Briggs Institute methodology, two reviewers independently screened, appraised, and extracted data. Qualitative data were synthesized using inductive-thematic analysis. Quantitative and qualitative data were integrated with a convergent-segregated approach and presented in tabular and narrative format. A search of 13 databases and grey literature yielded 14 studies of variable methodological quality. Four studies reported reduced rates of conflict and one study reported reductions that were not statistically significant. Six studies reported reductions in rates of containment, three studies found no statistical significance and one study reported statistically significant reductions at follow-up. Staff and consumers in four studies reported an improved experience of safety. Three themes were developed as follows: (i) therapeutic hold, cohesion, support and the environment, (ii) conflict, containment and the experience of safety, and (iii) the complexities of adapting and embedding change. This review found most staff and consumers reported Safewards improved therapeutic relationships, cohesion, and ward atmosphere. Staff and consumers reported improved ward atmosphere, leading to consumer-centred, recovery-oriented care. Safewards improved the experience of safety from the perspective of staff and consumers when combined with ongoing training, leadership and time for consolidation. While results are promising they should be used cautiously until more robust evidence is established.
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Affiliation(s)
| | - Suzanne Kapp
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Jarden
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Daniel
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, Melbourne, Australia
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Coffey A, Hartigan I, Timmons S, Buckley C, Lehane E, O'Loughlin C, O'Connell S, Cornally N. Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2021; 2:137. [PMID: 34895359 PMCID: PMC8665505 DOI: 10.1186/s43058-021-00241-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre-Mdn = 19.50 versus post-Mdn = 22.00, U = 497.00, p = 0.07). Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00241-7.
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Affiliation(s)
- Alice Coffey
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland. .,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Catherine Buckley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Northridge House Education and Research Centre, St Lukes Nursing Home, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Selena O'Connell
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Lee H, Doody O, Hennessy T. Mental health nurses experience of the introduction and practice of the Safewards model: a qualitative descriptive study. BMC Nurs 2021; 20:41. [PMID: 33706733 PMCID: PMC7953680 DOI: 10.1186/s12912-021-00554-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A lack of safety experienced by patients and staff in acute psychiatric units is a major concern and containment methods used to manage conflict have the potential to cause harm and upset to both staff and patients. To ensure safety for all, it is highly desirable to reduce levels of conflict and containment and the Safewards model is an evidence-based model aimed at reducing conflict and containment rates by improving nurse-patient relationships and safety. METHODS The aim of this study was to explore mental health nurses' experience of the introduction and practice of three Safewards interventions; reassurance, soft words and discharge messages. A qualitative descriptive research design utilising a purposive sample (n = 21) of registered psychiatric nurses (n = 16) and managers (n = 5) in an acute psychiatric unit in Ireland. Following a 12-week implementation of Safewards, three focus groups were conducted, two with nursing staff and one with nurse managers. Data were analysed using Braun and Clarke thematic analysis framework which supported the identification of four themes: introducing Safewards, challenges of Safewards, impact of Safewards and working towards success. RESULTS The findings indicate that the process of implementation was inadequate in the training and education of staff, and that poor support from management led to poor staff adherence and acceptance of the Safewards interventions. The reported impact of Safewards on nursing practice and patient experience were mixed. Overall, engagement and implementation under the right conditions are essential for success and while some participants perceived that the interventions already existed in practice, participants agreed Safewards enhanced their communication skills and relationships with patients. CONCLUSION The implementation of Safewards requires effective leadership and support from management, mandatory training for all staff, and the involvement of staff and patients during implementation. Future research should focus on the training and education required for successful implementation of Safewards and explore the impact of Safewards on nursing practice and patient experience.
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Affiliation(s)
- Heather Lee
- Mid-West Health Service Executive, Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
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Timmons S, O'Loughlin C, Buckley C, Cornally N, Hartigan I, Lehane E, Finn C, Coffey A. Dementia palliative care: A multi-site survey of long term care STAFF'S education needs and readiness to change. Nurse Educ Pract 2021; 52:103006. [PMID: 33690020 DOI: 10.1016/j.nepr.2021.103006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 02/05/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Many people with dementia reside in long-term care, where limited staff knowledge of dementia palliative care has been identified, along with poor awareness that a palliative approach can assist in identifying unmet care needs. Evidence-based guidance in palliative care for people with dementia is available however, implementing this guidance requires staff engagement and a tailored educational approach. This pre-implementation situational analysis informed a tailored staff education intervention to support the implementation of national guidance on dementia palliative care in long term care. Using a cross-sectional study design, underpinned by the Consolidated Framework for Implementation Research, survey data were collected on site profile, staff demographics, learning needs, and readiness-to change at three residential care sites for older people in Ireland. In total, 69 staff (predominantly nurses and healthcare attendants) completed the surveys. Medication management and management of pain were the most frequently identified learning needs. Staff were confident in their ability to implement change but de-motivation and powerlessness were substantial factors as only one-third of staff were "ready for change". Staffing levels, managing risk during change and perceived reluctance in others were common barriers. These results informed an educational intervention to address the specific care context, staff learning needs and barriers to change prior to implementation.
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Affiliation(s)
- S Timmons
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - C O'Loughlin
- University of Limerick, Limerick, V94 X5K6, Ireland
| | - C Buckley
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - N Cornally
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - I Hartigan
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - E Lehane
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - C Finn
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - A Coffey
- University of Limerick, Limerick, V94 X5K6, Ireland.
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Raphael J, Price O, Hartley S, Haddock G, Bucci S, Berry K. Overcoming barriers to implementing ward-based psychosocial interventions in acute inpatient mental health settings: A meta-synthesis. Int J Nurs Stud 2021; 115:103870. [PMID: 33486388 DOI: 10.1016/j.ijnurstu.2021.103870] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The culture of acute mental health wards is often dominated by medical models of care despite some patient dissatisfaction with care in these settings and a demand for increased access to psychosocial interventions. Research has found that psychosocial interventions can improve a number of patient and staff outcomes, however, implementation within these settings is often challenging. OBJECTIVES The aim of this review was to provide a comprehensive synthesis of the barriers and facilitators to implementing psychosocial interventions on acute wards, in order to develop a list of recommendations for embedding psychosocial interventions within the ward culture in acute settings. METHODS Databases were systematically searched using search terms related to acute mental health wards and psychosocial intervention implementation from inception to December 2019. Thirty-nine studies (forty-three papers) that explored the implementation of psychosocial interventions on adult acute mental health wards using qualitative methods met inclusion criteria. Data relating to barriers and facilitators to implementing psychosocial interventions extracted from the results sections of the papers were synthesised using the COM-B model. RESULTS AND CONCLUSIONS We conclude that to address barriers to the implementation of psychosocial interventions, services should provide clear information to patients regarding the benefits of engagement, and additional training for staff. A shift in ward culture is required and can be achieved through the recruitment of empathic implementers, together with providing staff with protected time for delivery of psychosocial interventions with clear accountability for intervention delivery through the provision of clearly defined roles.
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Affiliation(s)
- Jessica Raphael
- Greater Manchester Mental Health NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Owen Price
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Samantha Hartley
- Pennine Care NHS Foundation Trust, Oldham, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Katherine Berry
- Greater Manchester Mental Health NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
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Laker C, Cella M, Agbediro D, Callard F, Wykes T. The side effects of service changes: exploring the longitudinal impact of participation in a randomised controlled trial (DOORWAYS) on staff perceptions of barriers to change. BMC Psychiatry 2019; 19:407. [PMID: 31852502 PMCID: PMC6921549 DOI: 10.1186/s12888-019-2370-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staff and service users have expressed concerns that service improvements in British mental health wards have been slow or transient. It is possible that certain changes are positive for some (e.g. service users), but negative for others (e.g. staff), which may affect implementation success. In this study, we explore whether a programme of change to improve the therapeutic milieu on mental health wards influenced staff perceptions of barriers to change, 12 months after implementation. METHOD A cluster randomised controlled trial called DOORWAYS was conducted on eight British, inner-city acute mental health wards. Randomisation was achieved using a list randomly generated by a computer. A psychologist trained ward staff (mainly nurses) to deliver evidence-based groups and supported their initial implementation. The impact of these changes was measured over 12 months (when 4 wards were randomised), according to nurses' perceptions of barriers to change (VOCALISE), using unstructured multivariate linear regression models. This innovative analysis method allows maximum use of data in randomised controlled trials with reduced sample sizes due to substantial drop out rates. The contextual influences of occupational status (staff) and of workplace setting (ward) were also considered. RESULTS Staff who participated in the intervention had significantly worse perceptions of barriers to change at follow up. The perceptions of staff in the control group did not change over time. In both groups (N = 120), direct care staff had more negative perceptions of barriers to change, and perceptions varied according to ward. Across time, direct care staff in the intervention group became more negative than those in the control group. CONCLUSION Participation in this program of change, worsened staff perceptions of barriers to change. In addition, occupational status (being from the direct care group) had a negative effect on perceptions of barriers to change, an effect that continued across time and was worse in the intervention group. Those providing direct care should be offered extra support when changes are introduced and through the implementation process. More effort should be placed around reducing the perceived burden of innovation for staff in mental health wards. TRIAL REGISTRATION ISRCTN, ISRCTN 06545047. Registered 29/04/2010, https://www.isrctn.com/search?q=06545047.
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Affiliation(s)
- Caroline Laker
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford Campus, Bishop Hall Lane, Chelmsford, Essex, CM1 1SQ, UK.
| | - Matteo Cella
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychology, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, PO77, Room 2.11, London Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF UK
| | - Deborah Agbediro
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Felicity Callard
- 0000 0001 2161 2573grid.4464.2Birkbeck, Department of Psychosocial Studies, University of London, Malet Street, Bloomsbury, London, WC1E 7HX UK
| | - Til Wykes
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychology, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, PO77, Room 2.11, London Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF UK ,0000 0001 2324 5535grid.415717.1South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX UK
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10
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Awenat YF, Peters S, Gooding PA, Pratt D, Huggett C, Harris K, Armitage CJ, Haddock G. Qualitative analysis of ward staff experiences during research of a novel suicide-prevention psychological therapy for psychiatric inpatients: Understanding the barriers and facilitators. PLoS One 2019; 14:e0222482. [PMID: 31550251 PMCID: PMC6759174 DOI: 10.1371/journal.pone.0222482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/29/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Suicide prevention is a global priority. Psychiatric hospitalization presents an opportunity to intervene positively with, for example, psychological therapies. However, evidenced-based suicide-prevention psychological treatments are rarely available on in-patient wards. Understanding staff engagement with research investigating suicide-prevention psychological treatments is crucial for their effective, efficacious, and pragmatic implementation. A pilot randomised control trial and feasibility study of Cognitive Behavioural Suicide Prevention therapy provided the opportunity for a qualitative investigation of staff experiences and views of a psychological intervention for people with suicidal experiences on psychiatric in-patient wards. AIMS To investigate staff acceptability of Cognitive Behavioural Suicide Prevention therapy for psychiatric inpatients based on their perceptions of their experiences during the conduct of a clinical trial. METHOD Transcribed audio-recordings of qualitative interviews and a focus group (n = 19) of purposively sampled staff from eight psychiatric wards were analysed using inductive Thematic Analysis. RESULTS Facilitators and barriers were identified for: i) the conduct of the research, and, ii) the suicide-prevention intervention (Cognitive Behavioural Suicide Prevention therapy). Research-related barriers comprised communication difficulties between staff and researchers, and increased staff workload. Research-related facilitators included effective staff/researcher relationships, and alignment of the intervention with organisational goals. Suicide-prevention intervention-related barriers comprised staffs' negative beliefs about suicide which impacted on their referral of inpatients to the clinical trial, and staff perceptions of insufficient information and unfulfilled expectations for involvement in the therapy. Facilitators included staff beliefs that the therapy was beneficial for inpatients, the service and their own clinical practice. CONCLUSIONS Staff beliefs that 'suicide-talk' could precipitate suicidal behaviour resulted in covert gatekeeping and restricted referral of only inpatients judged as stable or likely to engage in therapy, which may not be those who could most benefit. Such threats to sample representativeness have implications for future therapy research design. The findings provide novel information for researchers and practitioners regarding the conduct of psychological treatment and research in psychiatric units.
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Affiliation(s)
- Yvonne F. Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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11
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Greer B, Newbery K, Cella M, Wykes T. Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives. J Med Internet Res 2019; 21:e15620. [PMID: 31538943 PMCID: PMC6754691 DOI: 10.2196/15620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/25/2023] Open
Abstract
Background Monitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown. Objective This study aimed to explore staff views, specifically potential benefits and implementation barriers, on using this technology for monitoring risk of inpatient aggression. Methods We conducted semistructured focus groups with nurses in an inpatient forensic mental health service. We used thematic analysis with two independent raters to identify themes and subthemes related to staff attitudes toward passive remote monitoring. We subsequently checked with members to ensure the validity of the themes identified by the raters. Results From January to March 2019, a total of 25 nurses took part in five focus groups. We identified five main themes, one of which concerned the potential benefits that passive remote monitoring could provide for monitoring risk of aggression. Staff suggested it could provide an early warning of impending aggression and enable support to be provided earlier. The remaining themes concerned implementation barriers, including risks to the users’ physical and mental well-being; data security concerns and potential access by third parties; the negative impact of a constant stream of real-time data on staff workload; and design characteristics and user awareness of the benefits of passive remote monitoring. Conclusions Passive remote monitoring technology could support existing methods of monitoring inpatient aggression risk, but multiple barriers to implementation exist. Empirical research is required to investigate whether these potential benefits can be realized, and to identify ways of addressing these barriers to ensure acceptability and user engagement.
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Affiliation(s)
- Ben Greer
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katie Newbery
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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12
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Laker C, Cella M, Callard F, Wykes T. Why is change a challenge in acute mental health wards? A cross-sectional investigation of the relationships between burnout, occupational status and nurses' perceptions of barriers to change. Int J Ment Health Nurs 2019; 28:190-198. [PMID: 29993168 PMCID: PMC7328713 DOI: 10.1111/inm.12517] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2018] [Indexed: 11/28/2022]
Abstract
Changes in UK psychiatric wards have been difficult to implement. Specific areas of nursing staff resistance remain unclear. Previous healthcare research suggests that burnout is common and that managers' regard changes more positively than direct care staff. We will therefore examine whether burnout and workforce characteristics influence psychiatric nurses' perceptions of barriers to change. Psychiatric nurses (N = 125) completed perceptions measures of 'barriers to change' (VOCALISE: subscales included 'powerlessness, confidence and demotivation'); and 'burnout' (Maslach Burnout Inventory: subscales included 'emotional exhaustion, personal accomplishment and depersonalization '). Staff characteristics, such as length of employment, occupational status, education, ethnicity, gender and age, were also collected. Correlations between these measures informed random-effects regression models, which were conducted to predict the barriers to change score and to explore differential effects in the subscales of VOCALISE. Perceptions of barriers to change (VOCALISE) were correlated with burnout (r = 0.39), occupational status (r = -0.18) and age (r = 0.22). Burnout (Coef. β: 10.52; P > 0.001) and occupational status (Coef. β: -4.58; P = 0.05) predicted VOCALISE. Emotional exhaustion (Coef. β: 0.18; P < 0.001) and low personal accomplishment (Coef. β: 0.21; P = 0.001) predicted powerlessness. Emotional exhaustion predicted low motivation regarding changes (Coef. β: 0.11; P = 0.005). Low confidence predicted high levels of depersonalization (Coef β: 0.23; P = 0.01). Direct care staff expressed significantly more powerlessness (Coef. β: -2.60; P = 0.02) and significantly less confidence (Coef. β: -3.07; P = 0.002) than managers. For changes to be successful in psychiatric wards, burnout will need to be addressed. Future change strategies may consider involving direct care staff to improve perceptions of barriers to change.
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Affiliation(s)
- Caroline Laker
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, London, UK.,Anglia Ruskin University, Chelmsford, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, London, UK
| | | | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, London, UK.,South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
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13
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Wykes T, Csipke E, Rose D, Craig T, McCrone P, Williams P, Koeser L, Nash S. Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Emese Csipke
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Thomas Craig
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Williams
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Leonardo Koeser
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Nash
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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14
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Sharp M, Gulati A, Barker C, Barnicot K. Developing an emotional coping skills workbook for inpatient psychiatric settings: a focus group investigation. BMC Psychiatry 2018; 18:208. [PMID: 29929511 PMCID: PMC6013871 DOI: 10.1186/s12888-018-1790-z] [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: 12/14/2017] [Accepted: 06/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Evidence suggests an unmet need for provision of psychological interventions in inpatient psychiatric settings. However, inpatient wards can present a challenging environment in which to implement interventions. The authors developed the Emotional Coping Skills workbook, a psychosocial intervention designed to overcome these challenges and provide inpatients with an opportunity for psychologically-informed therapeutic engagement. The workbook includes information and exercises to empower inpatients to understand their emotions and learn to cope with their distress. METHODS A qualitative study using thematic analysis was undertaken in two UK inpatient psychiatric hospitals to explore staff's views about whether and how the workbook could be implemented, and on barriers to its use. Thirty-five nursing and occupational therapy staff members participated in four focus groups, and a further two psychologists in semi-structured interviews. RESULTS Staff identified key barriers to successful implementation of the workbook. These were firstly, the difficulty in finding time and space for therapeutic work in the stressful ward environment. Secondly, staff identified a culture of emotional neglect whereby neither staff nor inpatients felt able to talk about emotions, and patients' physical needs and medication were prioritised. Thirdly, staff discussed how psychotic symptoms and emotional distress could limit patients' ability to engage with the workbook material. Staff suggested ways in which the feasibility of using the workbook could be enhanced. Firstly, they discussed the importance of encouraging staff to value psychological approaches and to view the workbook as a resource to help them manage their existing tasks. Secondly, they emphasised the value of staff drawing on their expertise to deliver the workbook flexibly in different formats and settings, depending on each patient's particular presentation. Thirdly, they advocated empowering staff to decide the timing of intervention delivery in the context of each inpatient's fluctuations in distress and progress towards recovery. CONCLUSIONS The study has highlighted key principles for flexible and well-integrated intervention delivery; these principles will be helpful for enhancing the feasibility of any nurse-delivered psychological intervention in inpatient settings.
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Affiliation(s)
- Molly Sharp
- Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Anu Gulati
- Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Chris Barker
- Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Kirsten Barnicot
- Centre for Psychiatry, Department of Medicine, Imperial College London, Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
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15
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Björkdahl A, Perseius KI, Samuelsson M, Lindberg MH. Sensory rooms in psychiatric inpatient care: Staff experiences. Int J Ment Health Nurs 2016; 25:472-9. [PMID: 26875931 DOI: 10.1111/inm.12205] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022]
Abstract
There is an increased interest in exploring the use of sensory rooms in psychiatric inpatient care. Sensory rooms can provide stimulation via sight, smell, hearing, touch and taste in a demand-free environment that is controlled by the patient. The rooms may reduce patients' distress and agitation, as well as rates of seclusion and restraint. Successful implementation of sensory rooms is influenced by the attitudes and approach of staff. This paper presents a study of the experiences of 126 staff members who worked with sensory rooms in a Swedish inpatient psychiatry setting. A cross-sectional descriptive survey design was used. Data were collected by a web based self-report 12-item questionnaire that included both open- and closed-ended questions. Our findings strengthen the results of previous research in this area in many ways. Content analyses revealed three main categories: hopes and concerns, focusing on patients' self-care, and the room as a sanctuary. Although staff initially described both negative and positive expectations of sensory rooms, after working with the rooms, there was a strong emphasis on more positive experiences, such as letting go of control and observing an increase in patients' self-confidence, emotional self-care and well-being. Our findings support the important principals of person-centred nursing and recovery-oriented mental health and the ability of staff to implement these principles by working with sensory rooms.
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Affiliation(s)
- Anna Björkdahl
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
| | | | - Mats Samuelsson
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Mathilde Hedlund Lindberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
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16
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Le Grande MR, Neubeck L, Murphy BM, McIvor D, Lynch D, McLean H, Jackson AC. Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association. Eur J Prev Cardiol 2016; 23:1466-75. [DOI: 10.1177/2047487316652975] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Australia
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Dawn McIvor
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- CNC Cardiology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Dianna Lynch
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Ashford Hospital, Australia
| | - Helen McLean
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Royal Perth Hospital, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- University of Hong Kong, Centre on Behavioural Health, Hong Kong
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