Parents' perspectives on user participation and shared decision-making in adolescents' inpatient mental healthcare

Navigating Through the Darkness: An Exploratory Study Unraveling the Experience of Hospitalization of Adolescents and Their Caregivers Amid Suicidal Presentations

Suicide prevention and treatment guidelines for pediatric patients often mirror adult strategies. Distinguishing itself from other pediatric specialties, when a child is psychiatrically hospitalized, the child is typically separated from their family, despite the impact and possible ramifications of familial separation. This exploratory study explores the perceived impact of inpatient psychiatric treatment, through patient and caregiver narratives, aiming to enhance mental health treatment approaches. Focusing on the experience of 19 adolescent and parent dyads, we conducted thematic analysis of their interviews. Participants highlighted their hospital experience across two key categories: emergency department and hospitalization experience, including personal and social impacts of their stay. Findings are explored in the context of the helpfulness-harmfulness paradox and suggest that understanding these experiences from both adolescent and caregiver perspectives can inform improvements in psychiatric treatment practices. Despite limited research on optimal practices for acute psychiatric episodes, this study underscores the importance of considering the broader familial and emotional impacts of hospitalization.

Perceptions about children and adolescents' mental health crisis intervention: a qualitative systematic review

This review aimed to identify and synthesize the perceptions of mental healthcare professionals, family members, and users about mental health crisis interventions for children and adolescents at hospitals and community mental health services. A qualitative systematic review was conducted following the Joanna Briggs Institution guidelines. The search was performed in 15 databases, with no temporal delimitation, and included studies in Portuguese, English, and Spanish. All works were assessed regarding methodological quality, credibility, and dependability according to the ConQual score and the recommendations were assessed following the Joanna Briggs Institution guidelines. In total, two independent reviewers screened and assessed the studies, extracted their data, developed categories, and conducted the thematic synthesis. A total of 13 studies met the inclusion and exclusion criteria. From these, five syntheses were developed: importance of relationships; importance of procedures during treatment; positive emotional responses to treatment; negative emotional responses to treatment; and issues with health professionals and health services. All five syntheses presented high dependability; two syntheses presented high credibility; and three presented moderate credibility. Mental healthcare professionals, family members and users had convergent perceptions about crisis intervention provided at healthcare services. Understanding their perceptions to improve care and the user experience in this vulnerable situation is crucial.

Adolescents' involvement in mental health treatment and service design: a systematic review

BACKGROUND

Adolescents' involvement in their mental healthcare is considered a fundamental human right. However, there is a lack of consensus regarding the extent and nature of user involvement and limited research on user involvement in adolescent mental healthcare has previously been identified. Given the evolving focus on this area, this study explores the experiences with, the effectiveness of, and safety issues related to adolescents' user involvement in mental healthcare.

METHOD

We conducted a systematic review, updating our original review with current research evidence relating to adolescents' involvement in mental healthcare at individual and organizational levels. Searches across six databases, screening of reference lists, and suggestions from experts within the field helped to identify 5,527 records, of which 251 full text articles were screened. Established guidelines were used for data extraction, critical appraisal, and reporting of results.

RESULTS

Collectively, the literature searches resulted in 36 eligible studies, of which 28 provided qualitative data and eight provided quantitative data. The quantitative studies identified the importance of personal help and online tools to support adolescents' involvement in their mental healthcare. A few qualitative studies suggested shared decision-making is associated with improved self-reported mental health and treatment satisfaction. No studies focused on safety issues. A thematic synthesis of qualitative studies yielded four themes at the individual level and two themes at the organizational level. The findings highlight the growing recognition of adolescents' right to be involved and their capacity to take part in decision-making, emphasizing shared decision-making, two-way communication, and trust as key components of a collaborative relationship fundamental to user involvement. Further facilitators for user involvement at both individual and organizational levels are described.

CONCLUSION

The significance of user involvement in adolescent mental healthcare is underscored by a sense of increased empowerment and services tailored to meet adolescents' needs. The evidence gathered from qualitative studies suggests involving adolescents in their treatment contributed to greater motivation for treatment, higher attendance rates, and treatment continuation. User involvement should emphasize adolescents' preferences and a collaborative relationship that incorporates shared decision-making. Further implications for future practice and research are discussed.

Shared decision-making in adolescent healthcare: a literature review of ethical considerations

PURPOSE

Adolescence is a period of growing independence and maturity, within the period of legal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare.

METHODS

We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012).

RESULTS

We included 38 articles which involved adolescents, healthcare professionals and parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studies supported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition.

CONCLUSIONS

Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation.

WHAT IS KNOWN

• Although adolescents wish to be involved in health decisions, shared decision-making in adolescents is underexplored • Adolescent shared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professional and parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.

Psychometrics assessment of ethical decision-making around end-of-life care scale for adolescents in the final stage of life

Introduction

Healthcare professionals have a critical role in ethical decision-making around end-of-life care. Properly evaluating the ethical decision-making of health care professionals in end-of-life care requires reliable, tailored, and comprehensive assessments. The current study aimed to translate and assess psychometrically a Persian version of the ethical decision making in end-of-life care scale for Iranian adolescents in the final stages of life.

Methods

The present study investigates the methodology and multicenter research. 310 healthcare professionals who treat/care for adolescents at the end of life were selected from 7 cities in Iran. The original version of the end-of-life care decision-making scale was translated into Persian using the forward-backward translation method, and its psychometric properties were evaluated using COSMIN criteria.

Results

Exploratory factor analysis revealed that the factor loadings of the items ranged from 0.68 to 0.89, all of which were statistically significant. Furthermore, three factors had eigenvalues greater than 1, accounting for 81.64% of the total variance. Confirmatory factor analysis indicated a proper goodness of fit in the hypothesized factor structure. The internal consistency reliability of the tool was assessed in terms of its homogeneity, yielding a Cronbach's alpha coefficient of 0.93.

Conclusion

The Persian version of the End-of-Life Care Decision-Making Scale demonstrates satisfactory validity and reliability among healthcare professionals working with adolescents in the final stages of life. Therefore, nursing managers can utilize this tool to measure and evaluate ethical decision-making in end-of-life care for adolescents in the final stages of life and identify the most appropriate strategies, including educational interventions, to improve ethical decision-making in end-of-life care if necessary.

Receiving a gift and feeling robbed: a phenomenological study on parents' experiences of Brief Admissions for teenagers who self-harm at risk for suicide

BACKGROUND

Brief Admission by self-referral is a preventive intervention here intended for individuals who recurrently self-harm and have a history of contact with emergency psychiatric services. Individuals with access to Brief Admission are empowered to self-admit to inpatient care for up to three days per stay and are encouraged to do so before experiencing crisis. Brief Admission was implemented relatively recently in child and adolescent psychiatric settings in Sweden. The purpose of this study was to phenomenologically explore the lived experience of parents whose teenagers, who recurrently self-harm and experience suicidal thoughts, use Brief Admissions.

METHODS

This is a qualitative study using phenomenological psychological analysis. We interviewed 17 parents who had experienced their teenagers using Brief Admissions. The interviews were recorded and transcribed verbatim and analyzed to arrive at the essential meaning structure of the phenomenon of Brief Admissions for the parent.

RESULTS

We identified two essential meaning structures of the parent's experience of their teenager's use of Brief Admissions: being gifted relief and hope or being robbed of everything you believed in. The experience of Brief Admissions as a gift was structured by the following constituents: 'a sense of safety and containment', 'liberation from a hostage situation', 'a return to wellbeing', and 'catalysts for relational shifts'. In contrast, the constituents of the experience of being robbed included 'a tug of war for control', 'an unworthy wasteland', 'abandonment and collapse of authority', and 'no sense of purpose and plan'.

CONCLUSIONS

Brief Admissions may come across as challenging, futile and painful in the life of the parent, yet they may also support a process of recovery and healthy development for the entire family. To realize the full potential of the intervention, mental health professionals providing Brief Admission must be mindful of the challenges the parent may face as their teenager starts self-admitting, tactfully and sensitively preparing the parent for a new parental role.

Experience of adolescents in mental health inpatient units: A metasynthesis of qualitative evidence

WHAT IS KNOWN ON THE SUBJECT?: Inpatient treatment is often necessary due to the vulnerability of adolescents' mental health, and hospitalization rates are increasing. There are both positive and negative experiences related to adolescent inpatient treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Inpatient ward environment and interactions with staff and peers are critical in adolescents' nursing care while undergoing inpatient treatment. Adolescents want their voice to be reflected in the treatment process, including within the discharge plan. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should establish a therapeutic milieu for adolescents to feel stable and safe so that inpatient treatment can become a positive experience. Mental health nurses should apply a person-centred approach to adolescents so that adolescents can participate in decision-making during the inpatient treatment process. ABSTRACT: Introduction Mental health inpatient treatment is necessary and increasing in adolescents due to their mental health vulnerability. Few studies have comprehensively reviewed adolescents' hospitalization experience. Aim To gain an in-depth understanding of the mental health inpatient experience from adolescents' perspectives. Method Six electronic databases, manual searches and citation searches were completed for studies published within the last 10 years. Eight articles were included, and thematic analysis was used. The Critical Appraisal Skills Program (CASP) checklist was applied to assess data quality. Results Three main themes were identified: Experiences of hospitalization, perceived outcomes and preparing for discharge. These themes included both positive and negative experiences. Discussion The environment and interactions within the ward were critical to adolescents' nursing care. Positive relationship experiences were important for adolescents to adapt well and consequently achieve beneficial inpatient treatment results. Additionally, adolescents wanted to participate in the decision-making process related to their treatment during hospitalization. Implications for Practice Mental health nurses have a responsibility to be sensitive to adolescents' mental health status during hospitalization and to understand the significance of providers' support in leading them to recovery. Nurses need to establish a more stable ward environment and form positive relationships through respect for adolescents' intentions.