Patient initiatives in psychiatric care concerning shame in the discussion in co-operative team meetings

Participation of inpatients in multidisciplinary team meetings: An explorative study of mental healthcare workers' perception

AIM

To explore the perception of mental healthcare workers about participation of inpatients during multidisciplinary team meetings (MTMs) and to determine which demographic and contextual factors are associated with this perception.

METHODS

A cross-sectional multicentre study in 17 psychiatric hospitals with 701 mental healthcare workers was performed between 29 April and 19 May 2019. For measuring the perception of the mental healthcare workers, the Patient Participation during Multidisciplinary Team meetings Questionnaire was used.

RESULTS

93 % of the mental healthcare workers indicate that they are willing to allow patients to participate in a MTM. Most mental healthcare workers prefer an active role for the patient when participating in a MTM (93 %) and a collaborative role for the patient when making decisions in a MTM (75 %). Level of education, discipline, experience with patient participation in MTMs, working in a team where patient participation is applied, and recent training on patient participation, are associated with the mental healthcare worker's perception on patient participation in MTMs.

CONCLUSION

Mental healthcare workers report a great willingness to involve inpatients in MTMs. However, social workers, nurses, and pedagogues feel less competent and are less positive about the effects of patient participation in MTMs. Mental healthcare workers with recent training in patient participation and experience in patient participation in MTMs feel more competent and believe more often that the patient should fulfil a more autonomous role when participating in a MTM. These results can be used to understand and improve patient participation in MTMs in mental healthcare.

The Relationships between Health Professionals' Perceived Quality of Care, Family Involvement and Sense of Coherence in Community Mental Health Services

Mental health professionals have a responsibility to ensure the best possible quality of care. Family is strongly involved in the patient's everyday life. The aim of this study was to investigate the relationship between health care professionals' perception of the quality of care, attitudes of family involvement and their own sense of coherence. A descriptive quantitative study with fifty-six health professionals, completed "Quality in Psychiatric Care-Community Outpatient Psychiatric Staff", "Families' Importance in Nursing Care-health professionals' attitudes", "The Sense of Coherence Scale-13". The health professionals perceived quality as high and did not perceive the families as a burden.

Shame and acute psychiatric in-patient care

Aims and method

To investigate the complementarities of staff and service users' experiences of shame in psychiatric in-patient settings. Qualitative methods were used by means of focus group interviews in two compositions – staff and service users. Data were transcribed and thematically analysed.

Results

Service user group transcripts revealed four prominent themes: ‘loss of value’, ‘loss of adulthood and autonomy’, ‘loss of subjectivity’ and ‘shaming or blaming of others’. Staff group transcripts also revealed two themes one of which overlapped with service users (‘shaming or blaming of others’) and one of which was distinct (‘entrapment’).

Clinical implications

Shame processes may be elicited by caregiving and impede treatment. Staff find themselves in the predicament of provoking the problems they intend to address. Suggestions are made as to how to respond to this dilemma and practically improve aspects of the in-patient care process to reduce shame.

Patient Experiences of Loneliness: An Evolutionary Concept Analysis

Loneliness is a painful experience for patients. To clarity the concept of patient loneliness, this study undertook an evolutionary concept analysis based on a literature search in the main relevant databases. We identified 7 dimensions in adult patients' experiences of loneliness. These dimensions of loneliness have different causes and theoretical foundations, which have different implications for patient care. Patients may be lonely in their different relationships, including those with nurses and doctors. Loneliness in relation to health care professionals is a new application of the concept of loneliness that provides a useful starting point for future research.

Older patients' participation in team meetings-a phenomenological study from the nurses' perspective

Although the importance of patient participation is acknowledged in today's healthcare, many challenges remain before patient participation can become an integral part of care provision. The ward round has traditionally been the forum for crucial decisions about patient care, but often with limited possibilities for patient participation. As part of the process of improving patient participation, the round in the present study has been replaced by a team meeting (TM) to which the patient has been invited. The aim of this study is to highlight nurses' experiences of older patients' participation in TMs. The research process was guided by the principles of phenomenological reflective life world research. Data were collected in a Swedish hospital, in a ward specializing in older patients. Nine nurses, who had invited and planned for a patient to participate in TMs and/or had experienced TMs in which patients participated, were interviewed. The essential meaning of patient participation in the TM, as experienced by the nurses, is that patient participation can be supported by a safe relationship in which the patient can make his or her voice heard. Participation is challenged by the patients' vulnerability and by the subordinated role assigned to the patient. The essential meaning is further described by its constituents: "the need for a guide," "patient participation challenged by structures," and "creating space for the whole human being." In conclusion, the nurse plays a core role in guiding the patient in an unfamiliar situation. The meaning of patient participation in the TM needs to be discussed by professionals so that the patient perspective is present.

"It made me feel human"-a phenomenological study of older patients' experiences of participating in a team meeting

This study focused on older patients participating in a team meeting (TM) in a hospital ward in Sweden. A process had taken place on the ward, in which the traditional round had developed into a TM and understanding what participating in a TM means for the older patient is necessary for the development of care that facilitates older patient's participation. The aim of this study was to describe the caring, as experienced by the older patients on a ward for older persons, with a specific focus on the team meeting. A reflective lifeworld research (RLR) design was used. Fifteen patients, 12 women and three men (mean age of 82 years) were interviewed while they were hospitalized in a hospital ward for older people. In the essential meaning of the phenomenon, the TM is described as being a part of a wider context of both caring and life. The need for hospitalization is an emotional struggle to overcome vulnerability and regain everyday freedom. The way in which the professionals are able to confirm vulnerability and create a caring relationship affects both the struggle for well-being and the possibilities for maintaining dignity. The essence is further explicated through its constituents; Vulnerability limits life; Life is left in the hands of someone else; Life is a whole and Space for existence. The result raises concern about how the care needs to be adjusted to older people's needs as lived bodies. The encounter between the carer and the patient needs to be developed in order to get away from the view of the patient as object. An expanded vision may open up for existential dimensions of what brings meaning to life. One way, as described by the patients, is via the patient's life stories, through which the patients can be seen as a whole human being.

Social injury: An interpretative phenomenological analysis of the attitudes towards suicide of lay persons in Ghana

One way of furthering our understanding of suicidal behaviour is to examine people's attitudes towards it and how they conceive the act. The aim of this study was to understand how lay persons conceive the impact of suicide on others and how that influences their attitudes towards suicide; and discuss the implications for suicide prevention in Ghana. This is a qualitative study, using a semi-structured interview guide to investigate the attitudes and views of 27 lay persons from urban and rural settings in Ghana. Interpretative Phenomenological Analysis was used to analyse the data. Findings showed that the perceived breach of interrelatedness between people due to suicidal behaviour influenced the informants' view of suicide as representing a social injury. Such view of suicide influenced the negative attitudes the informants expressed towards the act. The negative attitudes towards suicide in Ghana are cast in consequential terms. Thus, suicide is an immoral act because it socially affects others negatively. The sense of community within the African ethos and The Moral Causal Ontology for Suffering are theoretical postulations that are used to offer some explanations of the findings in this study.

The use of videophones for patient and family participation in hospice interdisciplinary team meetings: a promising approach

Inclusion of patients and caregivers in decisions related to the delivery of care is inherent in the hospice philosophy. Telemedicine technologies offer a potential solution to the challenges presented by the geographic distance between team meetings and the home environment. While inclusion requires additional coordination by the hospice team, it also offers an important opportunity to improve communication between the team and the patient and family. A modified conceptual model based on two previous frameworks is outlined to support patient and family involvement in hospice team meetings. Further research is suggested to determine the structural feasibility of patient and family involvement via videophone as well as the structural and procedural changes resulting from this inclusion. Finally, clinical outcomes and family evaluation of the inclusion experience need to be thoroughly researched before final conclusions may be reached.

Stigma in mental health: clients and professionals

Stigmatising attitudes are not uncommon among mental health professionals who may be less than optimistic about outcomes for people with long-term mental health problems. These perceptions are probably related to the professionals' experiences, such as those working in the public sector dealing with clients in the most disturbed phases of mental illness. We provide an overview of stigma and some contemporary stigma conceptualisations and then explore some stigma-reducing strategies for mental health professionals. The way that mental health professionals work with patients can have an important effect on their recovery.

A study of information flow in hospice interdisciplinary team meetings

The aim of this study was to explore the information flow of hospice interdisciplinary meetings focusing on information access, exchange and documentation. The study participants were members of four hospice interdisciplinary teams in the Midwestern United States. Team members included a diverse range of professionals including physicians, nurses, social workers, bereavement counselors, and others. A total of 81 patient care discussions were videotaped and transcribed. A content analysis revealed several themes that needed to be addressed to improve the overall information flow, such as access to and recording of information, documentation of services, obtaining information from absent team members, data redundancy and updating of recorded information. On average, 5% of all utterances when discussing a patient case were focused on soliciting information from the member who had access to the patient chart. In 12.3% of all discussions, members referred to an absent member who could have provided additional information. In 8.6% of all discussions the same facts were repeated three times or more. Based on the findings we propose guidelines that can address potential informational gaps and enhance team communication in hospice.

In the mind of another shame and acute psychiatric inpatient care: an exploratory study. A report on phase one: service users

In the UK and internationally, there are concerns for the quality of health care available to people with mental health problems. A number of surveys and reports suggest that hospital admission for acute psychiatric care can be stigmatizing and non-therapeutic. This paper describes the setting up and progress to date, of an ongoing qualitative research study carried out in Wales. The study explores service users' subjective experience of shame before, during and after psychiatric hospital admission. The research study's aims are to learn about situations that might influence quality of care because of shame experienced by individuals and groups of people. The study also seeks to explore specifically ways that relationships with healthcare professionals are influenced because of shame related experiences. This paper reports on phase one of the study, service users views and reviews acknowledged benefits and difficulties experienced to date. Both phases of the study encompassed mixed membership focus groups conducted by both researchers. Although the data analysis is still in progress, provisional findings of this research study suggest that an awareness of the complexities in relation to ways shame is aroused in individuals and groups of people because of mental health problems could contribute to improving the quality of care provided to service users, before, during and after hospital treatment and care. Although not initially part of the study's intentions, the views of all focus group participants so far indicate that collaborative research is found to be empowering. Information gained to date indicates that we will gain a better understanding of situations that provoke feelings of shame in established service users and those experiencing emotional distress for the first time.

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.

Is loneliness a psychological dysfunction? A literary study of the phenomenon of loneliness

The purpose of this investigation was to explore how loneliness is described in literature and research. The study employed a hermeneutic approach rooted in the ideology of humanistic science in a caritative nursing tradition. Data sampling for the study was completed over two different periods of time (1998 and 2004). The main findings are that loneliness is understood as a complex dimension in our lives and it can be experienced at many levels. Through the survey of the theoretical material, loneliness may be understood as a structural dimension of existence and not as an illness. The deep dimension of loneliness, however, can entail suffering that is possibly so intolerable that it may turn towards becoming an illness. Loneliness is assumed as something we are, an ontological structure in our existence. Loneliness can therefore be turned into suffering as well as into health. It is perhaps in the silent reflective loneliness that we paradoxically develop a greater understanding of the benefits of togetherness. Our conclusion is therefore, that the phenomenon of loneliness is not a psychological dysfunction.

Patients' perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study

AIM

The aim was to describe how patients perceived the concept of quality of care in psychiatric care.

BACKGROUND

It is important to include patients' experiences in defining quality of care and in the development of instruments measuring quality of psychiatric care, as patients have unique information. But only a limited number of studies have directly involved patients.

DESIGN

It was a qualitative interview study with 20 adult in and outpatients from psychiatric care.

METHOD

A phenomenographic approach was used for the analysis of the interviews.

RESULTS

The results showed that quality of care was perceived as a positive concept, namely as 'good' quality of care. The normative component was striking. Five descriptive categories emerged: The patient's dignity is respected; The patient's sense of security with regard to care; The patient's participation in the care; The patient's recovery; and The patient's care environment. Two conceptions emerged that had not emerged explicitly in earlier studies of quality of care: Being helped to reduce the shame and Being looked upon as like anyone else.

CONCLUSIONS

The findings emphasize the importance of the interpersonal relationship between patients and staff. There is a need for further exploration of central aspects of quality in psychiatric care.

RELEVANCE TO CLINICAL PRACTICE

It is important that the knowledge about how patients perceived the quality of care in psychiatric care is included in the planning and evaluation of care. The guidelines should designate quality of care from the patient perspective as the goal of interventions.

Health professionals' perspectives of suicide in Taiwan

The ethnographic study on which this report is based investigated experiences among patients, their families, friends, colleagues, and health professionals following a suicide attempt. Misunderstanding and ineffective treatment are often based on different explanations of suicide held by patients, their families, and health professionals, even when they share culture and language. In this report we describe how suicide is perceived by psychiatric team members in one regional teaching hospital in northern Taiwan. Twenty-two staff members of the Department of Psychiatry participated in this study. "Making a diagnosis" characterized the psychiatric subculture around the care of suicidal patients. In addition, mental health professionals tended to differentiate the patient's condition through three main avenues: (a) psychotic symptoms versus personality problems, (b) low IQ and high educational level, and (c) high versus low lethality of method. These findings suggest that mental health professionals need to bridge the gap between their knowledge and understanding of suicide and patients' and patients' families' expectations for care and treatment.

Psychiatric care staff's and care associates' perceptions of the concept of quality of care: a qualitative study

Quality of care is a multidimensional concept and has been given different meanings in the literature. The aim in the present study was to describe how the psychiatric care staff and care associates perceived the concept of quality of care in the case of psychiatric care. Ten staff and 10 associates were interviewed. Qualitative method with a phenomenographic approach was used for the analysis. Four descriptive categories emerged: The patient's dignity is respected, The patient's participation in the care, The patient's recovery, and The patient's care environment plays an important role. Quality of care was perceived as a positive concept and as being of great importance for the patient's health and conditions of living. The results were of importance with regard to the forthcoming development of an instrument to measure the quality of psychiatric care.

The cultural context of suicide stigma in Taiwan

In the ethnographic study on which this article is based, the authors investigate experiences after a suicide attempt from the perspective of patients and their family members in Taiwan. Thirty-four patients and 49 family members or colleagues participated in interviews from the point of patients' hospitalization to their return to the community. The postsuicide stigma suffered by patients and their families was based on such cultural themes as Suicide is bu-hsiao (non-filial piety), Suicide results in an inability to transmigrate the soul, and Suicide is inherited. Patients, family members, and colleagues cope with the stigma through explaining suicide as due to "bad luck" or "a kan-huo (hot energy) problem," or by insisting that it was "not a true suicide." These findings suggest that health professionals can move closer to patients and their families and suggest appropriate health care policy through understanding the patient's and the family's explanation of suicide experiences.