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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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Kaminskiy E, Zisman-Ilani Y, Morant N, Ramon S. Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views. Front Psychiatry 2021; 12:678005. [PMID: 34220584 PMCID: PMC8245843 DOI: 10.3389/fpsyt.2021.678005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.
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Affiliation(s)
- Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Shulamit Ramon
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
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Kaminskiy E, Zisman-Ilani Y, Morant N, Ramon S. Corrigendum: Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views. Front Psychiatry 2021; 12:789916. [PMID: 35368727 PMCID: PMC8964398 DOI: 10.3389/fpsyt.2021.789916] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.678005.].
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Affiliation(s)
- Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Shulamit Ramon
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
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Abstract
After a person experiences an acquired brain injury (ABI), there can be grieving for what has been lost. Little is known about the loss felt by relatives of people with ABI. This study investigates concepts of loss among individuals with ABI and their families. Forty participants, recruited from a brain injury charity client pool, took part in a semi-structured interview. Of the participants, 17 were in dyadic relationships (53% spouses, 41% parent/child and 6% sibling relationships). They also completed the Brain Injury Grief Inventory (BIGI; Coetzer, B. R., Vaughan, F. L., & Ruddle, J. A. (2003). The Brain Injury Grief Inventory. Unpublished Manuscript. North Wales Brain Injury Service, Conwy & Denbighshire NHS Trust) as a quantitative measure of loss after ABI. Five main themes emerged from the interviews: loss of person; loss of relationships; loss of activity/ability; loss of future; unclear loss. There were distinct differences qualitatively between individuals and relatives and only two dyads experienced similar loss, but there were no significant differences in loss as measured quantitatively by the BIGI. The differences between relatives' loss and individuals with ABIs' loss are discussed. This research suggests that it is important when supporting families to consider individual experiences, because even though the loss originates from the same injury, the loss as experienced may substantially differ among those affected by it.
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Affiliation(s)
- S Buckland
- Division of Psychology, Anglia Ruskin University, Cambridge, UK
| | - E Kaminskiy
- Division of Psychology, Anglia Ruskin University, Cambridge, UK
| | - P Bright
- Division of Psychology, Anglia Ruskin University, Cambridge, UK
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Kaminskiy E, Finlay M. It Does Take Two to Tango: An Applied Conversation Analysis of Interactions between a Psychiatrist and Service-Users Discussing Medication. Health Commun 2019; 34:1628-1636. [PMID: 30207485 DOI: 10.1080/10410236.2018.1517633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Decisions concerning psychiatric medication are complex and often involve a protracted process of trial and error. We examine three recorded meetings for power-sharing and power-taking discourse strategies employed by both the psychiatrist and mental health service-user, when discussing psychiatric medication. We identify examples of good practice, as well as missed opportunities to engage service-users in co-constructed dialogue, and highlight that participation and active involvement in decisions is not best seen as a fixed pattern, but is a complex interplay that changes both between and within interactions.
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Affiliation(s)
| | - Mick Finlay
- Department of Psychology, Anglia Ruskin University
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Lombardo C, Van Bortel T, Wagner AP, Kaminskiy E, Wilson C, Krishnamoorthy T, Rae S, Rouse L, Jones PB, Kar Ray M. PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare. BMJ Open Qual 2018; 7:e000332. [PMID: 30057959 PMCID: PMC6059331 DOI: 10.1136/bmjoq-2018-000332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/10/2018] [Revised: 04/16/2018] [Accepted: 05/15/2018] [Indexed: 11/04/2022] Open
Abstract
Reducing physical intervention in mental health inpatient care is a global priority. It is extremely distressing both to patients and staff. PROactive Management of Integrated Services and Environments (PROMISE) was developed within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to bring about culture change to decrease coercion in care. This study evaluates the changes in physical intervention numbers and patient experience metrics and proposes an easy-to-adopt and adapt governance framework for complex interventions. PROMISE was based on three core values of: providing a caring response to all distress; courage to challenge the status quo; and coproduction of novel solutions. It sought to transform daily front-line interactions related to risk-based restrictive practice that often leads to physical interventions. PROactive Governance of Recovery Settings and Services, a five-step governance framework (Report, Reflect, Review, Rethink and Refresh), was developed in an iterative and organic fashion to oversee the improvement journey and effectively translate information into knowledge, learning and actions. Overall physical interventions reduced from 328 to 241and210 across consecutive years (2014, 2015-2016 and 2016-2017, respectively). Indeed, the 2016-2017 total would have been further reduced to 126 were it not for the perceived substantial care needs of one patient. Prone restraints reduced from 82 to 32 (2015-2016 and 2016-2017, respectively). During 2016-2017, each ward had a continuous 3-month period of no restraints and 4 months without prone restrains. Patient experience surveys (n=4591) for 2014-2017 rated overall satisfaction with care at 87%. CPFT reported fewer physical interventions and maintained high patient experience scores when using a five-pronged governance approach. It has a summative function to define where a team or an organisation is relative to goals and is formative in setting up the next steps relating to action, learning and future planning.
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Affiliation(s)
- Chiara Lombardo
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK.,Institute for Health and Human Development, University of East London, London, UK
| | - Tine Van Bortel
- Institute for Health and Human Development, University of East London, London, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK
| | - Adam P Wagner
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Emma Kaminskiy
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Ceri Wilson
- Faculty of Health, Social Care and Education, Department of Adult and Mental Health Nursing, Anglia Ruskin University, Chelmsford, UK
| | | | - Sarah Rae
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK
| | - Lorna Rouse
- Faculty of Wellbeing, Education & Language Studies, The Open University, Milton Keynes, UK
| | - Peter Brian Jones
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Manaan Kar Ray
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK.,Addictions and Mental Health Services, Princes Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. OBJECTIVES This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. CONCLUSION A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care.
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Affiliation(s)
| | - Emma Kaminskiy
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Shulamit Ramon
- Department of Education and Social Care, Anglia Ruskin University, Cambridge, UK
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