Perceptions of care and services by the clients and families: a personal experience

Daytime night attire as a therapeutic intervention in an acute adult psychiatric in-patient unit

Aims and Method

Dressing in-patients in night attire during daytime is currently practised in many in-patient psychiatric units, despite the lack of evidence to support its benefit in reducing absconding or self-harm. Using a triangulation design, we investigated the prevalence of, attitudes towards and associations of this practice in an acute psychiatric in-patient setting in the Republic of Ireland.

Results

Case-note review revealed a high prevalence of this practice (57%) and its significant association with involuntary admission. Nursing staff believed that using night attire was effective at reducing absconding and self-harm, and that only voluntary patients should retain the right to choose their clothes. Most patients interviewed were uncomfortable in night clothes and indicated that they should be entitled to choose what to wear.

Clinical Implications

Night attire is regularly used for risk-management, despite lack of evidence supporting its efficacy and negative attitudes towards it in many patients. This practice and the reasons for its implementation deserve medical documentation.

A systematic review of factors associated with service user satisfaction with psychiatric inpatient services

BACKGROUND

Satisfaction is seen as an indicator of the quality of mental health services and has been related to outcomes and compliance with treatment. The current review seeks to examine the factors relating to satisfaction with inpatient services.

METHOD

A search was conducted of PsycInfo, Web of Science, Cinahl, Embase and Medline databases. Screening resulted in 32 papers being included in the review. Papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Review of the included papers suggested factors relating to satisfaction could be broadly classified as either service user or service/ward related. Service user related factors included findings that satisfaction was higher when service users were admitted voluntarily. Service related factors included findings that satisfaction was negatively associated with experiences of coercion and positively associated with being on an open ward.

CONCLUSION

It appears that coercion has a key role in ratings of satisfaction. Additionally, service users reported an impact of staff relationships, and the ward environment. Satisfaction is associated with a range of factors, an awareness of which will allow for the development of quality services that meet the needs of service users.

An investigation into the advocacy role of the learning disability nurse

This paper discusses the interaction between the first and second stages of a three-stage grounded theory study that investigated the advocacy role of learning disability nurses in Wales. Definitions of advocacy and their advocacy support needs obtained from people with learning disabilities in the first stage informed the design of focus groups in which nurses compared their own perceptions of advocacy with those of people with learning disabilities. The nurses also discussed barriers to advocacy, independent advocacy services and their requirements for advocacy education.

Findings revealed that all nurse participants advocated for their clients, but some definitions of advocacy by people with learning disabilities were not considered relevant to their current practice by some nurses. Nurses’ advocacy role varied with their work situation and was influenced by adherence to either the individual/medical or the social model of disability. All nurses recognised barriers to advocacy, but ability to access independent advocacy services was inconsistent, as was participants’ attitude towards and willingness to use these. Nurses’ received education in advocacy varied, but they expressed a need for ongoing support and training in advocacy related to their own work area and had specific requirements regarding how and by whom this should be provided.

Raiders of the Lost Art: A review of published evaluations of inpatient mental health care experiences emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia

Forming interpersonal therapeutic relationships with mental health Service Users remains a key aspect of the practice of Psychiatric/Mental Health nurses. Given the omnipresence of the concept within the relevant literature the reader could be forgiven for asking: why would Psychiatric/Mental Health nurses opine about something so basic, so ubiquitous and so central to the theory and practice of our discipline? While the authors could locate no substantive argument that refutes the role or value of such relationships, a sizable, growing and reasonably consistent body of work has emerged, which appears to indicate that this centrality and value is not necessarily reflected in many clinical practice settings. Accordingly, we draw on the published evaluations of mental health care emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia, compare these findings and highlight similarities or/and congruence and discuss a range of issues arising out of the findings. Alas, the findings seem to depict a mental health care inpatient experience that is often devoid of warm therapeutic relationships, respectful interactions, information or choice about treatment and any kind of formal/informal 'talk therapy'. Instead such care experiences are personified by: coercion, disinterest, inhumane practices, custodial and controlling practitioners and a gross over use of pharmacological 'treatments'.

Inpatient Therapeutic Assessment With Narcissistic Personality Disorder

Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a "hard to reach" personality.

The perceptions of the ward atmosphere in four Jordanian psychiatric hospitals from the perspective of patients' relatives

PURPOSE

To describes the perceptions of the ward atmosphere of psychiatric hospitals from the perspective of the relatives of people who were inpatients in those hospitals.

DESIGN AND METHODS

A nonexperimental descriptive survey was used. Data were collected using the Arabic version of Moos Ward Atmosphere Scale Ideal and Real forms.

FINDINGS

Data indicate that even though relatives of Jordanian mental health patients were generally positive about the ward atmosphere, they would like to see changes.

PRACTICE IMPLICATIONS

By describing their current and ideal treatment environments, participants have provided information that can guide interventions to change the ward atmosphere and thus help foster better patient treatment outcomes.

A conceptual framework for quality of care

Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services.

Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary

PURPOSE

Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients' experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity.

METHODS

From an initial list of 514 potential studies (1997-2007), 33 met our criteria of using qualitative methods and exploring patients' experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes.

RESULTS

For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians.

CONCLUSION

Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confidence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity.

Validation of a generic measure of continuity of care: when patients encounter several clinicians

PURPOSE

Patients who regularly see more than one clinician for health problems risk discontinuity and fragmented care. Our objective was to develop and validate a generic measure of management continuity from the patient perspective.

METHODS

Themes from 33 qualitative studies of patient experience with care from various clinicians were matched to existing instruments to identify potential measures and measurement gaps. Adapted and new items were tested cognitively, and the instrument was administered to 376 adult patients consulting in primary care for a variety of health conditions but seeing clinicians in a variety of settings. After initial psychometric analysis, the instrument was modified slightly and readministered after 6 months. The analysis identified reliable subscales and their association with indicators of continuity.

RESULTS

Observed factors correspond to 8 intended constructs, with good reliability. Three subscales (12 items) relate to the principal clinician and cover management and relational continuity. Four subscales (13 items) are related to multiple clinicians and address team relational continuity and problems with coordination and gaps in information transfer. Two (11 items) pertain to the patient's partnership in care. Subscales correlate well and in expected directions with indicators of discontinuity (wanting to change clinicians, suffering, and sense of being abandoned, medical errors) and degree of care organization.

CONCLUSION

The instrument reliably assesses both positive and negative dimensions of continuity of care across the entire system, and the subscales correlate with continuity effects. It supports patient-centered and relationship-based care and can be used as a whole or in part to assess coordination and continuity in primary care.

Patients' experience of groups in outpatient mental health services and its significance for daily occupations

The prevalence of mental health problems such as depression and anxiety in the Swedish population is increasing and individuals' daily occupations are seriously affected. Occupational therapy groups have long been used in mental health services. Now, with the increase in the number of outpatients and the current principle of patients' participation there is a need for further knowledge of this group of patients' perspective on the method. The aim of this study was thus to explore how outpatients in mental health services experience treatment in occupational therapy groups and what significance the treatment has for daily occupations. The focus group method was used. Four groups, with a total of 14 participants, were formed and met on one occasion. A number of factors for positive change in occupational therapy groups were found, i.e. "timing", "belonging", "involvement", "challenge", "meaningful occupation", and "balanced focus on disease". The participants' active use of the treatment and the transfer of experiences and knowledge from treatment to daily life were important for success. The abilities "to manage" and "to dare" developed in occupational therapy groups helped participants in the process of making changes in daily occupations. The findings show how a traditional method in occupational therapy in mental health services can be used to meet current needs and principles.

Creating Trust in an Acute Psychiatric Ward

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses.

Next of kin's conceptions of the quality of care in the psychiatric setting: a phenomenographic study

The next of kin play a decisive role in the care provided for patients. This and their unique experience of psychiatric care make it important to include them when defining quality of care. The aim of the present study was to describe how next of kin perceive the concept of quality of care in the case of psychiatric care. Twelve next of kin were included in a qualitative interview study and a phenomenographic approach was used for the analysis of the interviews. The next of kin described quality of care mainly from their own perspective but also to a large extent from the patient's perspective as well. Five descriptive categories resulted: dignity, security, participation, recovery, and health-promoting surroundings. Good relations and communication between staff, patients, and next of kin emerged as the central factors regarding the quality of psychiatric care. The next of kin asked for information about psychiatric illnesses and wanted to cooperate in the care. They avoid telling others about their family member's psychiatric illness because of a feeling of shame and guilt. Staff education regarding such feelings and stigmatization could be useful in furthering the understanding of the next of kin's distress and developing interventions to alleviate it. Clinical practice can be improved by guidelines and instruments developed on the basis of this study.

Patient expectation and satisfaction with nursing care in Turkey: a literature review

BACKGROUND

Patient satisfaction is used as an important indicator of care quality and is frequently included in healthcare planning and evaluation. This study presents a review of research on patient expectation and satisfaction with nursing care in Turkey.

AIM

To review the national literature on patient expectations and satisfaction with nursing care.

METHODS

The researchers reviewed 3,089 articles of which 27 were discussed in detail. Of these 3,089 articles, 1,812 were from all issues of 14 Turkish nursing journals which have been published in the last 50 years, and 1,277 articles were from 24 nursing congress and symposium books.

RESULTS

The results of this study are divided into two categories: expectations concerning 'nursing care', and 'satisfaction with nursing care'. The findings show that there exist conceptual and philosophic deficiencies in the approaches to patient satisfaction and that there is a need to use standardized instruments to study and assess patient satisfaction in the future.

CONCLUSION

Over the last 20 years, studies of patient expectation and satisfaction with nursing care have been gaining high importance, but it is also noticed that in a national and philosophical approach the studies are not based on clearly defined concepts. Moreover, it has been concluded that there is a need for valid and reliable tools in the evaluation of satisfaction.

Ward atmosphere - the Scarlet Pimpernel of psychiatric settings?

Patients and staff in a forensic psychiatric setting were requested to name three distinguishing characteristics of the ward atmosphere. The manifest content analysis of the responses revealed the following categories: interpersonal relations and pre-conditions for interpersonal relations; organization; staff; treatment; daily activities; physical environment; and feeling good and secure. The patients appeared to have a peripheral role as contributors to the ward atmosphere in the views of the respondents. The easily administered single question format provided valuable information about an intangible element of psychiatric settings - the ward atmosphere.

The health-care environment on a locked psychiatric ward: an ethnographic study

Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.

Individualized care, quality of life and satisfaction with nursing care

AIMS

This paper reports a study of the maintenance of individualized care from surgical patients' point of view and examines associations between individualized care, patient satisfaction with nursing care, and health-related quality of life. Rationale. There is preliminary evidence that individualized care is effective from patients' point of view, and is associated with improved patient outcomes, such as patient satisfaction and quality of life. However, individualized care has mainly been studied from the vantage-point of nurses' experiences.

METHODS

In this cross-sectional, descriptive, correlational study the data were collected with surgical adult patients (n = 279, response rate 93%) in surgical wards in Finland using self-administered questionnaires including the Individualized Care Scales, Patient-Satisfaction Scale, and Finnish versions of the Nottingham Health Profile and EuroQol 5D. Associations between individualized care, satisfaction with care and health-related quality of life were examined. Cronbach's alpha values and item analysis were used to evaluate the psychometric properties of the instruments, especially the Individualized Care Scales.

RESULTS

The more often patients felt they received support for individuality through specific nursing interventions, the higher the individuality of care received. Secondly, the more individualized patients regarded their care, the higher the level of reported patient satisfaction with nursing care. However, the correlation between individualized care and health-related quality of life was fairly low, albeit statistically significant.

CONCLUSION

Individualized care may produce positive outcomes, such as patient satisfaction. Further research is needed to explore individualized care in relation to health-related quality of life.

Continuity of care in mental health services: toward clarifying the construct

OBJECTIVE

To clarify "continuity of care" (COC), a construct associated with the delivery of services for persons suffering from severe and persistent mental illness (SPMI), with attention to the service recipient's perception of COC.

METHOD

The study involved a systematic appraisal of the literature on COC, supplemented by interviews with 36 SPMI patients and their families. Statements highlighting attributes of COC were extracted from both sources.

RESULTS

Comments by patients and families corresponded to descriptions of COC in the mental health literature. Attribute classifications by independent teams of judges showed good consistency. The following 4 attribute domains of the COC construct were identified: service delivery, accessibility, relationship base, and individualized care.

CONCLUSIONS

Service recipients' perceptions of COC overlapped with representations of the construct in the mental health literature. The qualitative inquiry resulted in a draft, 47-item, self-report questionnaire for use in studies of interventions designed to facilitate COC.

Development and testing of patient satisfaction measure for inpatient psychiatry care

Patient satisfaction is one of the most important indicators for service excellence. Investigations have been done with population-specific patient satisfaction tools for psychiatric patients; however, there are few published measures for evaluating inpatient care. We developed and tested a 15-item instrument to evaluate the interdisciplinary care model and therapeutic interventions. Results demonstrated reliability and validity of the tool.

Testing the individualized care model

BACKGROUND

Although there has been some research to identify the dimensions on which individualized care should be measured, the indicators that constitute individualized care remain unclear.

OBJECTIVES

To describe briefly the maintenance of individualized care and to test a hypothetical model of individualized care in a sample of surgical patients.

DESIGN AND METHODS

A correlational survey design was used. Data were collected with questionnaires from adult patients (n = 454) discharged from surgical wards in one Finnish hospital district (response rate 91%). Structural equation modelling LISREL SIMPLIS using maximum likelihood estimation was used to estimate and test the parameters of the hypothesized model derived deductively from the previous literature.

RESULTS

The goodness-of-fit statistics supported the basic solution of the Individualized Care Model, although two additional paths indicating error covariances between the sub-concepts were identified in the revised model. In this model individualized care is defined in terms of patients' views of nursing activities aimed at supporting individuality in care and in terms of perceptions of individuality in their own care.

CONCLUSIONS

The model has been found to capture attributes that characterize individualized care. It can be used as a basis for evaluation in clinical nursing practice from patients' point of view. The study highlights the importance of patients' clinical situation, personal life situation and decisional control as predictors of individualized care. The results also confirm the construct validity of the previously developed Individualized Care Scale.

Postpartum women's perceptions of the hospital environment

OBJECTIVE

To describe postpartum women's perceptions of the hospital environment and how it affects their postpartum experiences.

METHOD

Descriptive study using content analysis of interview transcripts.

SETTING

Participants were interviewed in their homes within the first 3 postpartum weeks about their postpartum experiences.

PARTICIPANTS

Thirty-one primiparous women who gave birth vaginally to full-term newborns. They were recruited from two large childbirth education programs in the Pacific Northwest.

RESULTS

The categories addressing the hospital environment were context, physical conditions, sociocultural conditions, contingencies, and consequences. Overall, these women had more negative perceptions than positive ones of the hospital environment. Women's perceptions seemed to be most influenced by the context of care. Women with mother/baby care had a greater proportion of positive perceptions than women with other care modalities.

CONCLUSION

Nurses need to modify or change the hospital environment to promote more positive experiences for new mothers.