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Moell A, Rozental A, Buchmayer S, Kaltiala R, Långström N. Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff. BMC Psychiatry 2024; 24:102. [PMID: 38317134 PMCID: PMC10845720 DOI: 10.1186/s12888-024-05553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. METHODS During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context. RESULTS The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy. CONCLUSIONS The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.
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Affiliation(s)
- Astrid Moell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Susanne Buchmayer
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, and Tampere University Hospital, Department of Adolescent Psychiatry, Tampere University, Tampere, Finland
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Graziane J, Dalke KB, Mikoluk C, Laux T, Pradhan S, Zhu J, Zug D, Noel J, Bowen JL, Kunkel EJS. Promoting Health Equity Through Voter Support Activities for the Inpatient Psychiatric Population. Community Ment Health J 2023; 59:498-506. [PMID: 36315332 DOI: 10.1007/s10597-022-01033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
Individuals with mental illness often face barriers to voting. One of the primary barriers is not being registered to vote. This paper describes voter support activities (VSAs) provided to hospitalized adults on the acute inpatient psychiatric units at Pennsylvania Psychiatric Institute. During the six weeks preceding the 2020 general election, adult inpatients were offered six VSAs and an optional survey examining previous voting behaviors and barriers encountered to voting. VSAs included checking voter registration status and polling location, completing a paper or electronic voter registration application, and requesting a mail-in ballot. Of 189 patients approached, 119 individuals participated in the survey and 60 individuals utilized at least one VSA. This project demonstrates that VSAs are a welcome and feasible resource for psychiatrically hospitalized adults. Psychiatric providers can serve an important role in promoting access to voting-related activities for their patients.
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Sanchez-Balcells S, Lluch-Canut MT, Domínguez Del Campo M, Moreno-Poyato AR, Tomás-Jiménez M, Lundqvist LO, Schröder A, Puig-Llobet M, Roldan-Merino JF. A Spanish adaptation of the Quality in Psychiatric Care-Inpatient (QPC-IP) instrument: Psychometric properties and factor structure. BMC Nurs 2021; 20:191. [PMID: 34625079 PMCID: PMC8501705 DOI: 10.1186/s12912-021-00710-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background and aim Western countries share an interest in evaluating and improving quality of care in the healthcare field. The aim was to develop and examine the psychometric properties and factor structure of the Spanish version of the Quality in Psychiatric Care–Inpatient (QPC-IP) instrument. Methods A psychometric study was conducted, translating the QPC-IPS instrument into Spanish, revision of the instrument by a panel of experts, and assessing its psychometric properties. 150 psychiatric inpatients completed the QPC-IP. Test-retest reliability was assessed by re-administering the questionnaire to 75 of these patients. Results After conducting pilot testing and a cognitive interview with 30 inpatients, it was determined that the QPC-IPS was adequate and could be self-administered. A Cronbach’s alpha of 0.94 was obtained for the full instrument and values of 0.52–0.89 for the various dimensions of the questionnaire. Test re test reliability: The Intraclass Correlation Coefficient for the full questionnaire was 0.69, while for the individual dimensions values between 0.62 and 0.74 were obtained, indicating acceptable temporal stability. Convergent validity was analysed using 10-point numerical satisfaction scale, giving a positive correlation (0.49). Confirmatory factor analysis revealed six factors consistent with the original scale. The Spanish version yielded adequate results in terms of validity and reliability. Conclusion Our findings provide evidence of the convergent validity, reliability, temporal stability and construct validity of the Spanish QPC-IP for measuring patient quality in psychiatric care in Spanish hospitals. Hospital administrators can use this tool to assess and identify areas for improvement to enhance quality in psychiatric care.
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Affiliation(s)
- Sara Sanchez-Balcells
- Community mental health nurse and case manager of the continuity of care program, Parc Sanitari Sant Joan de Déu, Sant Boi del Llobregat, Spain
| | - Maria-Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - A R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - M Tomás-Jiménez
- Parc Sanitari Sant Joan de Déu, Sant Boi del Llobregat, Spain
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Agneta Schröder
- Department of Health Science, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway.,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J F Roldan-Merino
- Department of Mental Health, Campus Docent Sant Joan de Déu-Fundació Privada, University of Barcelona, Barcelona, Spain
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Rylander M, Prandi-Abrams M, Klahr A, Houlton D, Sixta B, Wolf C, Piatz C, Thurstone CC. Improving Patient Flow and Access to Care at an Academically Affiliated Urban Safety-Net Hospital. Psychiatr Serv 2021; 72:978-981. [PMID: 33926195 DOI: 10.1176/appi.ps.202000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Access to inpatient psychiatric beds remains a significant barrier to care for patients having a mental health crisis. A quality improvement initiative described here was designed to increase access to care by increasing efficiency of health care delivery on an adult and adolescent inpatient psychiatric unit. Design and implementation centered on collaborative relationships among hospital administration, physician leadership, frontline physicians, and members of the multidisciplinary treatment team. Initial 5 months of data indicated significant improvements in care access as measured by number of encounters on both units. Reductions in length of stay were made possible by optimizing internal work flows and standardizing goals of hospitalization.
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Affiliation(s)
- Melanie Rylander
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Mara Prandi-Abrams
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Amanda Klahr
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Dana Houlton
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Brooke Sixta
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Chelsea Wolf
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Christopher Piatz
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - C Christian Thurstone
- Department of Behavioral Health (Rylander, Klahr, Houlton, Sixta, Wolf, Piatz, Thurstone) and Department of Care Management and Patient Flow (Prandi-Abrams, Klahr), Denver Health Medical Center, Denver. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
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Shields MC, Ritter G, Busch AB. Electronic Health Information Exchange At Discharge From Inpatient Psychiatric Care In Acute Care Hospitals. Health Aff (Millwood) 2020; 39:958-967. [PMID: 32479237 DOI: 10.1377/hlthaff.2019.00985] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To address the complex health care needs of patients with mental illness-who commonly have co-occurring medical conditions and substance use disorders-it is critically important for providers to use electronic health records (EHRs) for health information exchange (HIE) when patients are transferred from inpatient psychiatric units in acute care hospitals. Efficient and timely HIE is necessary to ensure that patients receive adequate and informed follow-up care. This study examined the percentage of inpatient psychiatric units that reported using EHRs for HIE at transfers of care and hospital characteristics associated with that use. We linked national data from the Inpatient Psychiatric Facility Quality Reporting Program of the Centers for Medicare and Medicaid Services, the American Hospital Association Annual Survey, and state mental health privacy laws. In 2016 the use of electronic HIE upon transfer from psychiatric units lagged behind the corresponding overall use rates from acute care hospitals (56.3 percent versus 88 percent), with wide variation across states. Hospital size and accountable care organization participation were associated with electronic HIE, but a state's having mental health privacy laws more stringent than the Health Insurance Portability and Accountability Act did not. Given these results, policy efforts to incentivize the use of electronic HIE in psychiatric settings should be strengthened.
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Affiliation(s)
- Morgan C Shields
- Morgan C. Shields is a PhD candidate and NIAAA fellow at the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts, and a research assistant in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts
| | - Grant Ritter
- Grant Ritter is an associate research professor at the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University
| | - Alisa B Busch
- Alisa B. Busch is an associate professor of psychiatry and health care policy at McLean Hospital and the Department of Health Care Policy, Harvard Medical School. She is also the chief medical information officer at McLean Hospital
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Khan S, Kashif M, Wilson L, McCauley M, Roche E. Patients prefer a continuity model of inpatient psychiatric consultant care: a patient survey in the Louth Mental Health Service. Ir J Psychol Med 2020; 37:39-42. [PMID: 32223789 DOI: 10.1017/ipm.2017.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objective of the paper was to survey patients' preference in relation to a continuity, or split, model of inpatient consultant care in the Louth Mental Health Service. METHODS A written survey was administered to all patients attending the Louth Mental Health Service over a 2-week period. Participants were asked for their preferred model of care and clinical information was obtained from their clinical notes. RESULTS In total, 149 patients completed the survey questionnaire and 103 respondents (69%) indicated a preference for a continuity model of inpatient consultant psychiatric care. There was a trend for those who reported a past experience of inpatient hospitalisation to indicate a preference for the continuity model (76% v. 61%, respectively, χ2 3.67, p=0.056). CONCLUSIONS Patients indicate a preference for a continuity model of inpatient psychiatric care and this is important to consider in service planning. More research is needed to evaluate if any model of consultant care is associated with better patient outcomes.
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Goldman ML, Mangurian C, Corbeil T, Wall MM, Tang F, Haselden M, Essock SM, Frimpong E, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M, Smith TE. Medical comorbid diagnoses among adult psychiatric inpatients. Gen Hosp Psychiatry 2020; 66:16-23. [PMID: 32593912 PMCID: PMC8684817 DOI: 10.1016/j.genhosppsych.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. METHODS Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. RESULTS 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. CONCLUSIONS A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.
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Affiliation(s)
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital
| | | | - Melanie M. Wall
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei Tang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Morgan Haselden
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Matthew Schneider
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Lisa B. Dixon
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Mark Olfson
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. Smith
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
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Lundqvist LO, Suryani, Hermiati D, Sutini T, Schröder A. A psychometric evaluation of the Indonesian version of the Quality in Psychiatric Care-Inpatient Staff (QPC-IPS) instrument. Asian J Psychiatr 2019; 46:29-33. [PMID: 31590006 DOI: 10.1016/j.ajp.2019.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 11/24/2022]
Abstract
AIM The aim of the present study was to evaluate the psychometric properties and factor structure of the Indonesian version of the Quality of Psychiatric Care - Inpatient Staff (QPC-IPS) instrument. METHODS A sample of 192 permanently employed members of staff at two general psychiatric wards in Indonesia completed the QPC-IPS, which consists of 30 items covering six dimensions of quality. RESULTS Confirmatory factor analysis revealed that the factor structure of the Indonesian version was equivalent to that proposed from the original Swedish QPC-IPS. Internal consistency for the full QPC-IPS was adequate, but poor for some of the factors. The results thus demonstrate that the concept of quality of care expressed in the QPC-IPS is to a large extent equivalent among staff in fundamentally different health care systems and cultural contexts. CONCLUSION The Indonesian QPC-IPS is a useful instrument for evaluating staff perception of psychiatric inpatient care in Indonesia, and thus contributes to health care improvement in the field of psychiatry. The QPC-IPS can be used together with the Quality of Psychiatric Care- In-Patient (QPC-IP) instrument, which is completed by the inpatients themselves, to improve the quality of psychiatric inpatient care and national as well as international benchmarking.
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Abstract
Objectives To develop knowledge of routes by which patients are admitted to Pantang hospital via the courts or police and to explore the factors that prevent discharge, rehabilitation or transfer to prison of these patients. Setting Pantang Psychiatric Hospital, Accra, Ghana, West Africa Design A cross-sectional exploratory qualitative study. Participants Adult patients with a psychiatric diagnosis who had been admitted to hospital following involvement with the criminal justice system and their families; and stakeholders (participants who had experience working with mentally disordered offenders). Methods A descriptive and ethnographic survey of patients plus interviews with key stakeholders in mental health and criminal justice. Data were analysed using hybrid thematic analysis. Results Patients arrived at Pantang Psychiatric Hospital following referral by the arresting police authorities, through court referral, or directly from prisons. All participants reported lack of understanding of the mental health and criminal justice systems, and interface between the two. Most patients and family members reported they feared the stigma of mental illness and patients' criminal charges would interrupt the patients' successful reintegration into the community. Conclusion This study revealed that forensic mental health patients in the Pantang Hospital entered through one of three ways; direct entry through the community-based policing system; on order through the court system; and referrals directly from the prison system. Inadequate staffing and other resources resulted in delays in completing the necessary psychiatric assessments. Funding The study was funded locally and by a grant received from the Faculty of Forensic Psychiatry, Royal College of Psychiatrists in the UK.
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Affiliation(s)
- Tracey A Bone
- Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Mark Roberts
- Faculty of Research and Knowledge Exchange, University of Winchester, SO22 4NR, United Kingdom
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Nienaber A, Heinz A, Rapp MA, Bermpohl F, Schulz M, Behrens J, Löhr M. [Influence of staffing levels on conflicts in inpatient psychiatric care]. Nervenarzt 2018; 89:821-7. [PMID: 29666880 DOI: 10.1007/s00115-018-0521-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Acute psychiatric wards are an important element in the mental healthcare of people at risk for acute harm to others or self-harm. Unfortunately, aggression, violence (conflict) and the use of coercion (containment) are still part of psychiatric care. The decisive factor for the correct handling of these situations is the quantity as well as the quality of the employees. Therefore, the present study dealt with the care situation on acute psychiatric wards. The hypothesis is that both the number of beds on the acute psychiatric ward and the number of caregivers have an impact on the occurrence of conflict and containment. For this purpose, data were collected in 6 clinics on a total of 12 acute psychiatric wards. The Patient Staff Conflict Checklist - Shift Report (PCC-SR) was used as the data entry tool. A total of 2026 shifts (early, late and night shifts) were recorded and evaluated. The staffing of the wards with nursing personnel varied considerably. The results show that both the size of the ward and also the number of caregivers on acute psychiatric wards have a significant impact on the occurrence of conflicts. The results also show that the incidence of conflicting behavior of patients differs both in terms of the wards of the hospitals involved and in the type of service considered. In addition, it can be seen that the extent of closure of an acute ward (i. e. the closed ward or entrance door) and the size of a ward (i. e. the number of beds) have a negative impact on the incidence of inpatient acute psychiatric contexts. The occurrence of conflict behavior can lead to alien or self-endangerment and to a variety of de-escalating and containment measures. This requires appropriate human resources.
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Lundqvist LO, Anna N, Rafiyah I, Schröder A. Indonesian adaptation of the Quality in Psychiatric Care-Inpatient (QPC-IP) instrument: Psychometric properties and factor structure. Asian J Psychiatr 2018; 34:1-5. [PMID: 29550549 DOI: 10.1016/j.ajp.2018.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 12/05/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to adapt and evaluate the psychometric properties and factor structure of the Indonesian version of the Quality in Psychiatric Care - Inpatient (QPC-IP) instrument. METHODS The QPC-IP is based on a definition of quality of care from the patient's perspective; it consists of 30 items covering six factors. A sample of 150 inpatients at general psychiatric wards in Indonesia completed the QPC-IP questionnaire. RESULTS Confirmatory factor analysis revealed that the factor structure of the Indonesian version was equivalent to that of the original Swedish QPC-IP, with the exception of the secluded environment factor. The results thus demonstrate that the concept of quality of care expressed in the QPC-IP is to a large extent equivalent among inpatients in fundamentally different health care systems and cultural contexts. Internal consistency for the full QPC-IP was adequate, but poor for the separate factors. CONCLUSION The Indonesian QPC-IP is a useful instrument for evaluating psychiatric inpatient care, and thus contributes to health care improvement in the field of psychiatry.
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Affiliation(s)
- Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Nur Anna
- Faculty of Nursing, Padjajaran University, Padjajaran, Indonesia
| | - Imas Rafiyah
- Faculty of Nursing, Padjajaran University, Padjajaran, Indonesia
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Health Science, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway
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Bryson SA, Gauvin E, Jamieson A, Rathgeber M, Faulkner-Gibson L, Bell S, Davidson J, Russel J, Burke S. What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. Int J Ment Health Syst 2017; 11:36. [PMID: 28503194 PMCID: PMC5425975 DOI: 10.1186/s13033-017-0137-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate trauma sequelae. Common practices, such as seclusion and restraint, put young people at risk of retraumatization, development of comorbid psychopathology, injury, and even death. In response, psychiatric and residential facilities have embraced trauma-informed care (TIC), an organizational change strategy which aligns service delivery with treatment principles and discrete interventions designed to reduce rates of retraumatization through responsive and non-coercive staff-client interactions. After more than two decades, a number of TIC frameworks and approaches have shown favorable results. Largely unexamined, however, are the features that lead to successful implementation of TIC, especially in child and adolescent inpatient psychiatric and residential settings. METHODS Using methods proposed by Pawson et al. (J Health Serv Res Policy 10:21-34, 2005), we conducted a modified five-stage realist systematic review of peer-reviewed TIC literature. We rigorously searched ten electronic databases for peer reviewed publications appearing between 2000 and 2015 linking terms "trauma-informed" and "child*" or "youth," plus "inpatient" or "residential" plus "psych*" or "mental." After screening 693 unique abstracts, we selected 13 articles which described TIC interventions in youth psychiatric or residential settings. We designed a theoretically-based evaluative framework using the active implementation cycles of the National Implementation Research Network (NIRN) to discern which foci were associated with effective TIC implementation. Excluded were statewide mental health initiatives and TIC implementations in outpatient mental health, child welfare, and education settings. Interventions examined included: Attachment, Self-Regulation, and Competency Framework; Six Core Strategies; Collaborative Problem Solving; Sanctuary Model; Risking Connection; and the Fairy Tale Model. RESULTS Five factors were instrumental in implementing trauma informed care across a spectrum of initiatives: senior leadership commitment, sufficient staff support, amplifying the voices of patients and families, aligning policy and programming with trauma informed principles, and using data to help motivate change. CONCLUSIONS Reduction or elimination of coercive measures may be achieved by explicitly targeting specific coercive measures or by implementing broader therapeutic models. Additional research is needed to evaluate the efficacy of both approaches.
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Affiliation(s)
- Stephanie A. Bryson
- Portland State University, School of Social Work, 1800 SW 6th, Building ASRC 620G, Portland, OR 97207-0751 USA
| | - Emma Gauvin
- University of British Columbia, School of Social Work, 2080 West Mall, Vancouver, BC V6T 1Z2 Canada
| | - Ally Jamieson
- University of British Columbia, School of Social Work, 2080 West Mall, Vancouver, BC V6T 1Z2 Canada
| | - Melanie Rathgeber
- Mental Health, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Lorelei Faulkner-Gibson
- Children’s & Women’s Hospitals and Health Centre, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Sarah Bell
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Jana Davidson
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Jennifer Russel
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Sharlynne Burke
- Child & Adolescent Mental Health & Concurrent Disorders Programs, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Fletcher TM, Markley LA, Nelson D, Crane SS, Fitzgibbon JJ. Pregnant Adolescents Admitted to an Inpatient Child and Adolescent Psychiatric Unit: An Eight-Year Review. J Pediatr Adolesc Gynecol 2015; 28:477-80. [PMID: 26233293 DOI: 10.1016/j.jpag.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/03/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess patient outcomes and describe demographic data of pregnant adolescents admitted to an inpatient child and adolescent psychiatric unit, as well as to determine if it is safe to continue to admit pregnant adolescents to such a unit. DESIGN, SETTING, AND PARTICIPANTS A descriptive retrospective chart review conducted at a free-standing pediatric hospital in northeast Ohio of all pregnant adolescents aged 13 to 17 years admitted to the inpatient child and adolescent psychiatric unit from July 2005 to April 2013. MAIN OUTCOME MEASURES Data collection included details on demographic, pregnancy status, and psychiatric diagnoses. RESULTS Eighteen pregnant adolescents were admitted to the psychiatric unit during the time frame. Sixteen of those were in the first trimester of pregnancy. Pregnancy was found to be a contributing factor to the adolescent's suicidal ideation and admission in 11 of the cases. Admission to an inpatient psychiatric facility did not lead to adverse effects in pregnancy. CONCLUSION Pregnant adolescents did not have negative pregnancy outcomes related to admission to an inpatient psychiatric unit. Results of this study suggest that it is safe to continue to admit uncomplicated pregnant adolescents in their first trimester to an inpatient child and adolescent psychiatric unit for an acute stay.
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Affiliation(s)
- Teresa M Fletcher
- Department of Adolescent Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio.
| | - Laura A Markley
- Department of Psychiatry, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - Dana Nelson
- Department of Maternal Fetal Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - Stephen S Crane
- Department of Maternal Fetal Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - James J Fitzgibbon
- Department of Adolescent Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
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Abstract
Time to psychiatric rehospitalization was predicted for a sample of 1473 Medicaid-insured youth in Illinois in 2005 and 2006. A multi-level model statistical strategy was employed to account for the fact that youth days to rehospitalization were nested within hospital and to test the hypothesis that hospitals would vary significantly in return rates, controlling for individual-level (e.g., symptom, demographic) variables. Hospitals did not vary significantly in days to rehospitalization. At the individual-level, level of externalizing behavior and residential treatment placement predicted a faster return to the hospital. These results support the perspective that hospital outcomes are best operationalized using variables tied more directly to the inpatient episode (e.g., LOS, reductions in acuity).
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