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Zeng J, Zhang J, Li R, Guo ZH, Wu F, Wang SM, Zhang HY, Qian FH. Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures: A qualitative study. World J Clin Cases 2024; 12:5032-5041. [DOI: 10.12998/wjcc.v12.i22.5032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/11/2024] [Accepted: 06/04/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND More and more evidence-based practices are emerging, but researchers mostly focus on short-term effects, resulting in evidence-based practices not being applied in the clinic in the long term. In this study, we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.
AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.
METHODS This study was qualitative research. Nine nurses who implemented evidence-based practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects. Semi-structured interviews were conducted with them, and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.
RESULTS Three main themes and ten subthemes were identified: Process aspects (benefits to patients, benefits to nurses, lack of follow-up, complex processes); staff aspects (insufficient human resources, inadequate training and education, lack of leadership support); and organizational environment aspects (inadequate infrastructure, poor patient compliance, poor doctor cooperation).
CONCLUSION Human resources, training and education, leadership support, infrastructure, and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.
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Affiliation(s)
- Jia Zeng
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Jia Zhang
- Department of Nursing, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Rui Li
- Department of Nursing, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Zhi-Heng Guo
- Department of Emergency, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Fang Wu
- Department of Orthopedics, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Si-Meng Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Hai-Yue Zhang
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Fei-Hu Qian
- Department of Emergency, Shanghai Tongren Hospital, Shanghai 200335, China
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Lamb D, Milton A, Forsyth R, Lloyd-Evans B, Akther S, Fullarton K, O'Hanlon P, Johnson S, Morant N. Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success. Int J Ment Health Syst 2024; 18:18. [PMID: 38704589 PMCID: PMC11069280 DOI: 10.1186/s13033-024-00638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. METHODS Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. FINDINGS A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. CONCLUSION CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Alyssa Milton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Eiroa-Orosa FJ. Beyond recovery: toward rights-based mental health care - A cluster randomized wait-list controlled trial of a recovery and rights training for mental health professionals with or without first person accounts. Front Psychol 2023; 14:1152581. [PMID: 37780153 PMCID: PMC10539929 DOI: 10.3389/fpsyg.2023.1152581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Mental health models grounded in Recovery and Rights are driving the advancement of transformative care systems through multifaceted actions, which encompass Continuing Professional Development. The objective of this work is to evaluate a training activity developed through a participatory process that included people with lived experience of psychosocial distress, their relatives, and mental health professionals. Methods The training focused on alternatives to diagnosis, recovery principles, rights-based care, and peer support. The evaluation followed a cluster randomized wait-list controlled design. Four hundred eighty-eight health professionals from eight care centers were randomized to three experimental conditions: a wait list control, which underwent a one-month interval between the baseline assessment and the training activity, and two experimental groups, with or without first-person accounts, which accessed the training immediately after completing the baseline assessment. The dependent variables measured at all follow-ups were beliefs and attitudes toward mental health service users' rights. One hundred ninety-two professionals completed at least one follow-up and were included in the analyses. Results We observed different evolutions of experimental and control groups with statistically significant differences for tolerance to coercion and total beliefs and attitudes scores. No differences were observed between the groups with or who attended training activities with or without first person accounts. Upon receiving the training activity, the control group had an evolution equivalent to the experimental groups. Discussion The results of this evaluation project provide compelling evidence for the need to expand recovery and rights training activities to reach a larger audience of mental health professionals These training activities hold the potential to positively influence the beliefs and attitudes of mental health professionals, ultimately contributing toward a better future for individuals with lived experience of psychosocial distress.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, Barcelona, Spain
- Yale Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
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Renmans D, Castellano Pleguezuelo V. Methods in realist evaluation: A mapping review. EVALUATION AND PROGRAM PLANNING 2023; 97:102209. [PMID: 36571967 DOI: 10.1016/j.evalprogplan.2022.102209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/18/2022] [Indexed: 06/19/2023]
Abstract
Realist evaluation is becoming increasingly popular as an evaluation methodology. Its main objective is to uncover the mechanisms that lead to observed outcomes following an intervention and the contextual conditions that enabled this. The focus is on explaining why, for whom and in what circumstances an intervention works. It is a theory-driven approach and is explicitly method neutral, meaning that both quantitative and qualitative data collection methods can be used to unearth the underlying mechanisms that cause the intervention outcomes. In this review, we aim to map the methods used in realist evaluation studies, to draw lessons from the findings and to reflect on ways forward. We found that qualitative methods and interviews specifically are most commonly used in realist evaluations; that theory is often absent behind the methods and sampling techniques used; and that more innovative methods remain underexplored. We conclude the review by proposing four ways forward: (1) developing realist surveys, (2) exploring the relevance of innovative methods, (3) increasing the attention paid to sampling procedures and (4) strengthening the theory-driven nature of method. We believe that these four action points can strengthen the practice of realist evaluation and its outcomes.
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Affiliation(s)
- Dimitri Renmans
- Ecole de Santé Publique, Université Libre de Bruxelles, Route du Lennik 808, 1070 Brussels, Belgium; Institute of Development Policy (IOB), University of Antwerp, Lange Sint-Annastraat 7, 2000 Antwerp, Belgium.
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Nardella N, Hooper S, Lau R, Hutchinson A. Developing acute care-based mental health nurses' knowledge and skills in providing recovery-orientated care: A mixed methods study. Int J Ment Health Nurs 2021; 30:1170-1182. [PMID: 33848046 DOI: 10.1111/inm.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Recovery-oriented principles have progressively been accepted as a standard of mental health practice in many countries, including Australia. A private mental health Clinic in Melbourne, Australia, is dedicated to embedding the principles of recovery-oriented practice into care by (i) providing recovery education and training for their staff and (ii) co-designing resources with consumers to promote active consumer engagement and participation. The purpose of this study was to evaluate the impact of these initiatives on staff knowledge and provision of recovery-oriented care in acute care. Two groups of study participants were recruited: the first group completed the staff training programme introducing the concept of recovery-oriented practice, and the second group was a convenience sample of nurses recruited 12 months later working on the acute inpatient wards at the study site. Nurses completed Recovery Knowledge Inventory (RKI) and Recovery Self-Assessment (RSA-Provider) surveys and participated in a focus group discussion. The three major themes identified from the focus group discussion were as follows: (i) nurses' understanding of personal recovery-orientated practice, (ii) how to embed personal recovery-oriented care into practice, and (iii) barriers to consumer participation in recovery-oriented activities in acute care. There were significant differences between the two groups on the RKI subscale scores of 'Expectations regarding recovery' and the 'Roles of self-definition and peers in recovery' and 'Life goals' and 'Choice' factors on the RSA subscale scores. There were some gaps in the nurses' knowledge and implementation of personal recovery-oriented concepts, highlighting the need for further training and cultural change.
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Affiliation(s)
- Natalie Nardella
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Suzie Hooper
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Rosalind Lau
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Hawsawi T, Stein-Parbury J, Orr F, Roche M, Gill K. Exploring recovery-focused educational programmes for advancing mental health nursing: An integrative systematic literature review. Int J Ment Health Nurs 2021; 30 Suppl 1:1310-1341. [PMID: 34231293 DOI: 10.1111/inm.12908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 01/10/2023]
Abstract
Recovery-focused educational programmes have been implemented in mental health services in an attempt to transform care from a purely biomedical orientation to a more recovery-oriented approach. Mental health nurses have identified the need for enhancing their abilities and confidence in translating recovery knowledge into mental health nursing practice. However, recovery-focused educational programmes have not fully address nurses' learning needs. Therefore, this review synthesized the evidence of the effectiveness of recovery-focused educational programmes for mental health nurses. A systematic search of electronic databases and hand-searched references was conducted. It identified 35 programmes and 55 educational materials within 39 studies. Synthesizing the literature revealed three themes and nine subthemes. The first theme, a framework for understanding and supporting consumers' recovery, had four subthemes: consumers' involvement, multidisciplinary approach, profession-specific training, and performance indicators. The second theme, contents of educational materials, included the subthemes: knowledge development and recovery-focused care planning. The final theme, nurses' learning experiences, included the subthemes: understanding recovery, the positive effects of recovery-focused educational programmes, and implementation of recovery-oriented practices. Based on these findings, a mental health nursing recovery-focused educational programme framework is proposed. Further research should investigate the effectiveness of the framework, especially in relation to recovery-focused care planning and consumer and carer involvement in the development, delivery, participation, and evaluation of these educational programmes.
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Affiliation(s)
- Tahani Hawsawi
- Faculty of Nursing, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Jane Stein-Parbury
- School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Fiona Orr
- School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Michael Roche
- School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
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Big Data-Enabled Solutions Framework to Overcoming the Barriers to Circular Economy Initiatives in Healthcare Sector. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147513. [PMID: 34299964 PMCID: PMC8305369 DOI: 10.3390/ijerph18147513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022]
Abstract
Ever-changing conditions and emerging new challenges affect the ability of the healthcare sector to survive with the current system, and to maintain its processes effectively. In the healthcare sector, the conservation of the natural resources is being obstructed by insufficient infrastructure for managing residual waste resulting from single-use medical materials, increased energy use, and its environmental burden. In this context, circularity and sustainability concepts have become essential in healthcare to meliorate the sector’s negative impacts on the environment. The main aim of this study is to identify the barriers related to circular economy (CE) in the healthcare sector, apply big data analytics in healthcare, and provide solutions to these barriers. The contribution of this research is the detailed examination of the current healthcare literature about CE adaptation, and a proposal for a big data-enabled solutions framework to barriers to circularity, using fuzzy best-worst Method (BWM) and fuzzy VIKOR. Based on the findings, managerial, policy, and theoretical implementations are recommended to support sustainable development initiatives in the healthcare sector.
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Eiroa-Orosa FJ, García-Mieres H. A Systematic Review and Meta-analysis of Recovery Educational Interventions for Mental Health Professionals. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:724-752. [PMID: 31338638 DOI: 10.1007/s10488-019-00956-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The history of mental health care has been marked by various struggles in maintaining the dignity of service users. Some reform movements have started to use educational strategies aimed at the beliefs and attitudes of professionals, as well as changing the way that practice is carried out. This paper intends to systematically review and synthesize studies assessing awareness and training activities for mental health professionals covering aspects related to recovery, empowerment, and in general, rights-based care to achieve full citizenship of mental health services users. We reviewed 26 articles and were able to include 14 of them in meta-analytic calculations. Our results at the qualitative level show an evolution of the literature towards better quality designs and focus on aspects related to the impact and maintenance of the effects of these training activities. Meta-analytic calculations found high heterogeneity but no risk of biases and low-to moderate effect sizes with a statistically significant impact on beliefs and attitudes but not on practices. The importance of this information in improving and advancing these educational activities is addressed.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neuroscience, Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebron, 171, 08035, Barcelona, Catalonia, Spain. .,Yale Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA. .,First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, Barcelona, Spain.
| | - Helena García-Mieres
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neuroscience, Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebron, 171, 08035, Barcelona, Catalonia, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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Cowie J, Nicoll A, Dimova ED, Campbell P, Duncan EA. The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review. BMC Health Serv Res 2020; 20:588. [PMID: 32594912 PMCID: PMC7321537 DOI: 10.1186/s12913-020-05434-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Identifying factors that influence sustained implementation of hospital-based interventions is key to ensuring evidence-based best practice is maintained across the NHS. This study aimed to identify, appraise and synthesise the barriers and facilitators that influenced the delivery of sustained healthcare interventions in a hospital-based setting. METHODS A systematic review reported in accordance with PRISMA. Eight electronic databases were reviewed in addition to a hand search of Implementation Science journal and reference lists of included articles. Two reviewers were used to screen potential abstracts and full text papers against a selection criteria. Study quality was also independently assessed by two reviewers. Barriers and facilitators were extracted and mapped to a consolidated sustainability framework. RESULTS Our searching identified 154,757 records. We screened 14,626 abstracts and retrieved 431 full text papers, of which 32 studies met the selection criteria. The majority of studies employed a qualitative design (23/32) and were conducted in the UK (8/32) and the USA (8/32). Interventions or programmes were all multicomponent, with the majority aimed at improving the quality of patient care and/ or safety (22/32). Sustainability was inconsistently reported across 30 studies. Barriers and facilitators were reported in all studies. The key facilitators included a clear accountability of roles and responsibilities (23/32); ensuring the availability of strong leadership and champions advocating the use of the intervention (22/32), and provision of adequate support available at an organisational level (21/32). The most frequently reported barrier to sustainability was inadequate staff resourcing (15/32). Our review also identified the importance of inwards spread and development of the initiative over time, as well as the unpredictability of sustainability and the need for multifaceted approaches. CONCLUSIONS This review has important implications for practice and research as it increases understanding of the factors that faciliate and hinder intervention sustainability. It also highlights the need for more consistent and complete reporting of sustainability to ensure that lessons learned can be of direct benefit to future implementation of interventions. TRIAL REGISTRATION The review is registered on PROSPERO ( CRD42017081992 ).
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Affiliation(s)
- Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BX, Scotland.
| | - Avril Nicoll
- Health Services Research Unit, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Elena D Dimova
- Department of Nursing and Health, School of Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BX, Scotland
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BX, Scotland
| | - Edward A Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF, Scotland
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Raphael J, Haddock G, Edge D, Lovell K, Bucci S, Winter R, Drake R, Price O, Berry K. Conducting a consensus conference to design a psychology service model for acute mental health wards. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020. [DOI: 10.1111/bjc.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Gillian Haddock
- Greater Manchester Mental Health NHS Foundation Trust UK
- Division of Psychology and Mental Health School of Health Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Sciences The University of Manchester UK
| | - Dawn Edge
- Division of Psychology and Mental Health School of Health Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Sciences The University of Manchester UK
| | - Karina Lovell
- Greater Manchester Mental Health NHS Foundation Trust UK
- Division of Nursing, Midwifery and Social Work School of Health Sciences Faculty of Biology, Medicine and Health The University of Manchester UK
| | - Sandra Bucci
- Greater Manchester Mental Health NHS Foundation Trust UK
- Division of Psychology and Mental Health School of Health Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Sciences The University of Manchester UK
| | - Rachel Winter
- Greater Manchester Mental Health NHS Foundation Trust UK
| | - Richard Drake
- Greater Manchester Mental Health NHS Foundation Trust UK
- Division of Psychology and Mental Health School of Health Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Sciences The University of Manchester UK
| | - Owen Price
- Division of Nursing, Midwifery and Social Work School of Health Sciences Faculty of Biology, Medicine and Health The University of Manchester UK
| | - Katherine Berry
- Greater Manchester Mental Health NHS Foundation Trust UK
- Division of Psychology and Mental Health School of Health Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Sciences The University of Manchester UK
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Kalisova L, Pav M, Winkler P, Michalec J, Killaspy H. Quality of care in long-term care departments in mental health facilities across the Czech Republic. Eur J Public Health 2018; 28:885-890. [DOI: 10.1093/eurpub/cky151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lucie Kalisova
- Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Pav
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
- Health Service & Population Research Department, IoPPN, King’s College London, London, UK
| | - Jiri Michalec
- Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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Walsh FP, Meskell P, Burke E, Dowling M. Recovery-based Training in Mental Health: Effects on Staff Knowledge and Attitudes to Recovery. Issues Ment Health Nurs 2017; 38:886-895. [PMID: 28745921 DOI: 10.1080/01612840.2017.1346014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This longitudinal study describes the effects of recovery-based training on staff knowledge and attitudes to recovery. Mental health staff (n = 101) completed the study questionnaire (the Recovery Knowledge Inventory (RKI-20) and Recovery Attitudes' Questionnaire (RAQ-16)) before training and after six months. On the RKI, significant changes between pre- and post-training scores (p < 0.01) were found. On the RAQ, the scores showed significant changes in Factors 1 (p < 0.001) and 2 (p < 0.009). The results indicate a significant difference in confidence using a recovery model of care following training suggesting that recovery-based training positively affects staff knowledge and attitudes to recovery overall.
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Affiliation(s)
| | - Pauline Meskell
- b School of nursing , University College Limerick , Limerick , Ireland
| | - Emer Burke
- c School of Nursing , National University of Ireland , Galway , Ireland
| | - Maura Dowling
- d School of Nursing and Midwifery , National University of Ireland , Galway , Ireland
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The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial of a training intervention for community mental health teams in recovery-oriented practice. BMC Psychiatry 2017; 17:172. [PMID: 28482829 PMCID: PMC5423029 DOI: 10.1186/s12888-017-1321-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recovery features strongly in Australian mental health policy; however, evidence is limited for the efficacy of recovery-oriented practice at the service level. This paper describes the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care trial protocol for a recovery-oriented practice training intervention delivered to specialist mental health services staff. The primary aim is to evaluate whether adult consumers accessing services where staff have received the intervention report superior recovery outcomes compared to adult consumers accessing services where staff have not yet received the intervention. A qualitative sub-study aims to examine staff and consumer views on implementing recovery-oriented practice. A process evaluation sub-study aims to articulate important explanatory variables affecting the interventions rollout and outcomes. METHODS The mixed methods design incorporates a two-step stepped-wedge cluster randomized controlled trial (cRCT) examining cross-sectional data from three phases, and nested qualitative and process evaluation sub-studies. Participating specialist mental health care services in Melbourne, Victoria are divided into 14 clusters with half randomly allocated to receive the staff training in year one and half in year two. Research participants are consumers aged 18-75 years who attended the cluster within a previous three-month period either at baseline, 12 (step 1) or 24 months (step 2). In the two nested sub-studies, participation extends to cluster staff. The primary outcome is the Questionnaire about the Process of Recovery collected from 756 consumers (252 each at baseline, step 1, step 2). Secondary and other outcomes measuring well-being, service satisfaction and health economic impact are collected from a subset of 252 consumers (63 at baseline; 126 at step 1; 63 at step 2) via interviews. Interview-based longitudinal data are also collected 12 months apart from 88 consumers with a psychotic disorder diagnosis (44 at baseline, step 1; 44 at step 1, step 2). cRCT data will be analyzed using multilevel mixed-effects modelling to account for clustering and some repeated measures, supplemented by thematic analysis of qualitative interview data. The process evaluation will draw on qualitative, quantitative and documentary data. DISCUSSION Findings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry: ACTRN12614000957695 . Date registered: 8 September 2014.
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Killaspy H, King M, Holloway F, Craig TJ, Cook S, Mundy T, Leavey G, McCrone P, Koeser L, Omar R, Marston L, Arbuthnott M, Green N, Harrison I, Lean M, Gee M, Bhanbhro S. The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.
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Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Frank Holloway
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas J Craig
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sarah Cook
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Tim Mundy
- Centre for Leadership in Health and Social Care, Sheffield Hallam University, Sheffield, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Belfast, UK
| | - Paul McCrone
- David Goldberg Centre, King’s College London, London, UK
| | | | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Nicholas Green
- Division of Psychiatry, University College London, London, UK
| | - Isobel Harrison
- Division of Psychiatry, University College London, London, UK
| | - Melanie Lean
- Division of Psychiatry, University College London, London, UK
| | - Melanie Gee
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Sadiq Bhanbhro
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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15
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Gee M, Bhanbhro S, Cook S, Killaspy H. Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery-oriented training. J Adv Nurs 2017; 73:1775-1791. [PMID: 27943483 DOI: 10.1111/jan.13232] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to identify the factors contributing to lasting change in practice following a recovery-based training intervention for inpatient mental health rehabilitation staff. BACKGROUND Staff training may help nurses and other staff groups in inpatient mental health rehabilitative settings to increase their recovery-oriented practice. There are no published reviews on the effectiveness of such training and few long-term evaluations. This review informed a realist evaluation of a specific intervention (GetREAL). DESIGN Rapid realist review methodology was used to generate and prioritize programme theories. DATA SOURCES ASSIA, CINAHL, Cochrane Library, Medline, PsycINFO, Scopus, Web of Science and grey literature searches were performed in September 2014-March 2015 with no date restrictions. Stakeholders suggested further documents. GetREAL project documentation was consulted. REVIEW METHODS Programme theory development took place iteratively with literature identification. Stakeholders validated and prioritized emerging programme theories and the prioritized theories were refined using literature case studies. RESULTS Fifty-one relevant documents fed into 49 programme theories articulating seven mechanisms for lasting change. Prioritized mechanisms were: staff receptiveness to change; and staff feeling encouraged, motivated and supported by colleagues and management to change. Seven programme theories were prioritized and refined using data from four case studies. CONCLUSION Lasting change can be facilitated by collaborative action planning, regular collaborative meetings, appointing a change agent, explicit management endorsement and prioritization and modifying organizational structures. Conversely, a challenging organizational climate, or a prevalence of 'change fatigue', may block change. Pre-intervention exploration may help identify any potential barriers to embedding recovery in the organizational culture.
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Affiliation(s)
- Melanie Gee
- Centre for Health and Social Care Research, Sheffield Hallam University, UK
| | - Sadiq Bhanbhro
- Centre for Health and Social Care Research, Sheffield Hallam University, UK
| | - Sarah Cook
- Centre for Health and Social Care Research, Sheffield Hallam University, UK
| | - Helen Killaspy
- Rehabilitation Psychiatry, Division of Psychiatry, University College London, UK
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Enticott JC, Shawyer F, Brophy L, Russell G, Fossey E, Inder B, Mazza D, Vasi S, Weller PJ, Wilson-Evered E, Edan V, Meadows G. The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients. BMC Psychiatry 2016; 16:451. [PMID: 27998277 PMCID: PMC5168875 DOI: 10.1186/s12888-016-1153-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/01/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND General practitioners (GPs) in Australia play a central role in the delivery of mental health care. This article describes the PULSAR (Principles Unite Local Services Assisting Recovery) Primary Care protocol, a novel mixed methods evaluation of a training intervention for GPs in recovery-oriented practice. The aim of the intervention is to optimize personal recovery in patients consulting study GPs for mental health issues. METHODS The intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. The project is conducted in Victoria, Australia between 2013 and 2017. Eighteen general practices and community health centers are randomly allocated to one of two steps (nine months apart) to start an intervention comprising GP training in the delivery of recovery-oriented practice. Data collection consists of cross-sectional surveys collected from patients of participating GPs at baseline, and again at the end of Steps 1 and 2. The primary outcome is improvement in personal recovery using responses to the Questionnaire about the Process of Recovery. Secondary outcomes are improvements in patient-rated measures of personal recovery and wellbeing, and of the recovery-oriented practice they have received, using the INSPIRE questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Kessler Psychological Distress Scale. Participant data will be analyzed in the group that the cluster was assigned to at each study time point. Another per-protocol dataset will contain all data time-stamped according to the date of intervention received at each cluster site. Qualitative interviews with GPs and patients at three and nine months post-training will investigate experiences and challenges related to implementing recovery-oriented practice in primary care. DISCUSSION Recovery-oriented practice is gaining increasing prominence in mental health service delivery and the outcomes of such an approach within the primary care sector for the first time will be evaluated in this project. If findings are positive, the intervention has the potential to extend recovery-oriented practice to GPs throughout the community. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ( ACTRN12614001312639 ). Registered: 8 August 2014.
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Affiliation(s)
- Joanne C. Enticott
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC Australia ,Royal District Nursing Service Institute, 31 Alma Rd, St Kilda, VIC Australia
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC Australia
| | - Lisa Brophy
- Mind Australia, Heidelberg, VIC Australia ,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia ,Southern Academic Primary Care Research Unit, Monash University, Notting Hill, Victoria, Australia
| | - Ellie Fossey
- School of Primary Health Care, Monash University Peninsula Campus, Frankston, VIC Australia
| | - Brett Inder
- Department of Econometrics and Business Statistics, Monash University, Melbourne, VIC Australia
| | - Danielle Mazza
- School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia
| | - Shiva Vasi
- School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia ,Southern Academic Primary Care Research Unit, Monash University, Notting Hill, Victoria, Australia
| | | | | | - Vrinda Edan
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia. .,Monash Health, Melbourne, VIC, Australia.
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