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

Norwegian adaptation of the Quality in Psychiatric Care - In-Patient instrument: psychometric properties and factor structure

BACKGROUND

Validated instruments measuring the quality of mental healthcare from patients' perspectives are scarce, and available instruments have been requested. One of the few instruments measuring the quality of care from a patient's perspective is the Swedish Quality in Psychiatric Care-In-Patient (QPC-IP). This cross-sectional study aimed to translate and adapt the QPC-IP instrument for a Norwegian context and assess its psychometric properties.

METHODS

The QPC-IP was translated and adapted to a Norwegian context using a translation back-translation process model. A total of 169 inpatients from specialised mental health services responded to the questionnaire. The QPC-IP comprises six dimensions: Encounter (eight items), Participation (eight items), Discharge (four items), Support (four items), Secluded Environment (three items), and Secure Environment (three items), totalling 30 items. Confirmatory factor analysis was conducted to assess the instrument's factor structure. Additionally, Cronbach's alpha was used to establish the instrument's internal consistency.

RESULTS

The results indicated that the Norwegian adaptation of the QPC-IP possesses good psychometric properties, including internal consistency, content, and construct validity, as confirmed by the confirmatory factor analysis results. The confirmatory factor analysis demonstrated an adequate fit for the six-factor structure, consistent with the original Swedish instrument.

CONCLUSIONS

The QPC-IP is a user-friendly and easily implementable tool that assesses various dimensions of the quality of inpatient mental healthcare from a patient's perspective. Moreover, the Norwegian QPC-IP holds potential for use in comparative, cross-cultural studies within mental healthcare services to monitor the quality of the provided services.

Patients' perception of the quality of psychiatric inpatient care in the Faroe Islands

PURPOSE

Evaluating the quality of psychiatric care from the patient's perspective is crucial to measure the effectiveness of the provided care. This study aimed to translate the original Swedish Quality in Psychiatric Care - Inpatient (QPC-IP) instrument into Faroese, adapting it to the specific context of psychiatric inpatient care in the Faroe Islands, conducting a detailed evaluation of its psychometric properties, and to describe patients' perception of quality of psychiatric care.

MATERIALS AND METHODS

Following a thorough translation and back-translation, the content validity of the Faroese QPC-IP was confirmed by a group of Faroese patients. Subsequently, the instrument was completed by 61 psychiatric inpatients.

RESULTS

Item total correlations revealed that most items strongly correlated with their intended dimensions, mirroring the original Swedish version. However, a noteworthy exception was found in the discharge dimension, leading to the exclusion of an item related to helping find an occupation; this task was not performed by the ward. While the internal consistency of the overall scale was excellent, specific dimensions exhibited lower consistency.

CONCLUSIONS

The translation and cultural adaptation of the Faroese QPC-IP proved satisfactory. The psychometric evaluation affirmed a shared understanding of the quality of psychiatric care in both Faroese and Swedish cultural contexts. As a result, the Faroese QPC-IP emerges as a valuable instrument for assessing the quality of psychiatric care in the Faroe Islands. Its utility extends to quality assurance initiatives and contributes to cross-cultural research examining the quality of psychiatric care from the patient's perspective.

Investigating the Associations between Patient-Reported Quality of Care and Perceived Coercion: A Norwegian Cross-Sectional Study

Patient perspectives on the quality of care received are fundamental to mental health care. This study aimed to investigate the association between patient-reported mental health care quality, perceived coercion, and various demographic, clinical, and ward-related factors. Using a cross-sectional design, data were collected from 169 patients in Norwegian mental health wards using the quality in psychiatric care-inpatient (QPC-IP) instrument and experienced coercion scale (ECS). The analysis revealed a consistent pattern in which patients with higher perceived coercion consistently rated lower quality on all QPC-IP dimensions. The significant findings of the multiple regression models further supported this association. Beyond coercion, the factors influencing quality ratings include self-reported treatment results, participation in treatment planning, and knowledge of complaint procedures. Emphasizing the pivotal role of coercion in enhancing mental health care quality, these findings contribute to a nuanced understanding of patient experiences and underscore the importance of patient participation in mental health care improvement efforts.

Quality of care in the oncological outpatient setting: Individual interviews with people receiving cancer treatment

PURPOSE

To describe how patients receiving cancer treatment perceive quality of care in the oncological outpatient settings.

METHOD

A strategic sample of 20 adult patients with cancer treated in four oncological outpatient settings in four hospitals in Sweden participated in the study. Participants were interviewed using a semi-structured interview guide with open-ended questions. The interviews were audio-recorded, and the transcripts were analysed using a phenomenographic approach.

RESULTS

Three descriptive categories emerged from the data: The patient's care is designed to meet individual needs, The patient's dignity is respected, and The patient feels safe and secure with the care. Overall, quality of care in the oncological outpatient setting is perceived as something positive and described in normative terms by the participants.

CONCLUSION

The results emphasises that in order to achieve quality of care it is important to the patients that they are able to meet with the same well-educated, professional, caring and sensible health care professionals every time.

Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff

The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.

Spanish adaptation of the quality in psychiatric care-outpatient (QPC-OP) instrument community mental health patients’ version: psychometric properties and factor structure

Background

Health systems in the field of mental health are strongly committed to community models that allow patients to be attended in their own environment. This helps them to maintain their family and social ties while trying to avoid costly hospital admissions. The patients’ perspective is a key component in the assessment of the quality of psychiatric care and can even determine their adherence to the devices where they are treated. However, there are few instruments with adequate psychometric properties for the evaluation of the quality of psychiatric care in community mental health. The Quality in Psychiatric Care – Outpatient (QPC-OP) instrument has adequate psychometric properties to assess the quality of psychiatric care from the patients’ perspective. The aim of this study was to adapt and validate the Spanish version of the QPC-OP instrument.

Methods

A translation and back-translation of the instrument was carried out. To examine its psychometric properties, the instrument was administered to 200 patients attending various community mental health services. To assess test-retest reliability, the instrument was readministered after 7-14 days (n = 98).

Results

The Confirmatory Factor Analysis revealed a structure of 8 factors identical to the original version, with an adequate model fit. The internal consistency coefficient (Cronbach’s alpha) was 0.951. The intraclass correlation coefficient was 0.764 (95% IC: 0.649 – 0.842), and higher than 0.70 in 5 of the 8 factors. Additionally, an EFA was performed and revealed that the instrument could behave in a unifactorial or four factor manner in the sample analyzed.

Conclusions

Results show that the Spanish version of the QPC-OP instrument is valid and reliable for the assessment of quality of psychiatric care in the community setting.

"Walking Together Towards Freedom." Patients' Lived Experiences of Participation in Outpatient Forensic Care

There is a general agreement regarding the significance of patient participation in care. In forensic psychiatric care, however, this appears to be troublesome because of the paradoxical nature of having responsibility; to give person-centered, recovery-oriented psychiatric care and to protect society from potentially dangerous individuals. The aim of this study was to describe patients' lived experiences of participation in outpatient forensic psychiatric care. Data were collected by means of individual interviews with five patients. The phenomenological hermeneutical analysis shed light on patient participation as having two dimensions. The outer dimension focuses on participation as "doing" and as a means of developing the understanding and skills necessary for being discharged from forensic care, while the inner dimension is related to "being" and experiences of acceptance and inclusion in communion with other people. This emphasises the importance of supporting patients' experiences of being involved in everyday life together with others, even in periods when patients' possibilities to affect decisions regarding their care are limited.

Adaptation, psychometric properties and factor structure of the Spanish Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) instrument

Quality of care is a multidimensional concept that should include the perspectives of all parties involved. There are few instruments with adequate psychometric properties for the assessment of the quality of psychiatric care in community mental health. Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) instrument has adequate psychometric properties to evaluate the quality of psychiatric care from the perspective of professionals. The aim of this study was to validate the Spanish version of the QPC-OPS instrument. The instrument was translated and back-translated, and then was administered to 260 professionals from distinct community mental health services. To assess test–retest reliability, it was re-administered after 7–14 days (n = 157). Confirmatory factor analysis revealed an 8-factor-structure identical to the original version, showing the good fit of the model. The internal consistency coefficient (Cronbach’s alpha) was 0.885. The intraclass correlation coefficient was 0.847 (95% IC 0.790–0.888), which was higher than 0.70 in all factors bar one. The NT394 General Satisfaction Scale was used for analysis of convergent validity showing a rho correlation of 0.31 (p < 0.0001). Results show that the Spanish version of the QPC-OPS instrument is valid and reliable for the assessment of the quality of psychiatric care in the community setting.

A Spanish adaptation of the Quality in Psychiatric Care-Inpatient (QPC-IP) instrument: Psychometric properties and factor structure

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.

[Motives for the use of psychosocial aftercare services]

BACKGROUND

There are hardly any studies regarding the specific motives for the use of psychosocial aftercare services. The present study aims to fill this gap by investigating the motives for the use of certain psychosocial aftercare services for people with mental health problems. In particular, the services Ability-Oriented Activity, Mobile Care and Help, Psychosocial Counseling Center and Housing are considered.

METHODS

Data from a client satisfaction surveys which had been conducted on an annual basis over a period of 5 years (2013-2017) were analyzed. Clients were surveyed regarding the importance of 5 motives for service use (getting support with problems; being able to talk to someone about problems; feeling understood; having a space of safety; feeling like they are doing something for their health) using a 5-point response scale.

RESULTS AND CONCLUSIONS

The analyses of the data show that across all services, the motive "feeling understood" is of great importance for the use of psychosocial services. Apart from this motive, it is primarily safety that motivate the use of services of ability-oriented activity and housing. In the case of Mobile Care and Assistance and the Psychosocial Counseling Center, it is predominantly instrumental aspects, such as getting support with problems. In general, it can be seen that the motivational strength, i.e. how important these reasons are for using the service, is highest for the services provided by Mobile Care and Assistance and the Psychosocial Counseling Center.

Family support and quality of community mental health care: Perspectives from families living with mental illness

AIM AND OBJECTIVES

Describe patients' and family members' perceptions of family support from nurses and other mental healthcare professionals, and quality of care in community mental healthcare service. Further, compare the perceptions of patients and family members.

BACKGROUND

While patients value family involvement, family members feel unprepared and lack the necessary skills to be supportive. Since healthcare professionals predominantly focus on patients, they may fail to understand the complex needs of families. Family perceived support and quality of community mental health care may vary across patients and family members.

DESIGN AND METHODS

Cross-sectional study with patients suffering from mental illness and family members in community mental healthcare services in Norway. Altogether 86 participants, of whom 33 patients and 33 family members had a family relationship-paired samples. Participants filled in the translated version of the Iceland Family Perceived Support Questionnaire (FPSQ-N) and Quality in Psychiatric Care-Community Out-Patient (QPC-COP) and Community Out-Patient Next of Kin (QPC-COPNK). STROBE checklist was used.

RESULTS

Family members scored family perceived support and quality of community mental health care lower than patients. Family members feel the loss of support. Patient and family members found the Patient-healthcare professionals' relationship to be of high quality, while family members gave low score to being respected and invited to take part in care by nurses and other mental healthcare professionals.

CONCLUSION

Family members' unmet need of support highlights the need for nurses and other community mental healthcare professionals to assess complex family needs and to intervene. Barriers to collaboration exist, and family members need to be respected and invited into community mental health care.

RELEVANCE TO CLINICAL PRACTICE

Contributes knowledge of how to meet the family's needs and provides a basis for further care and treatment development in similar contexts nationally and internationally.

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.

The quality in psychiatric care-Addiction outpatient instrument: Psychometric properties and patient views of the quality of care

Aim

The aim of the study was to evaluate the psychometric properties and factor structure of the Quality in Psychiatric Care—Addiction Outpatient (QPC‐AOP) instrument and to describe the experiences with the quality of care among addiction outpatients.

Design

The study has a cross‐sectional design.

Methods

A sample of 244 patients with addiction and psychiatric disorders completed the QPC‐AOP.

Results

Confirmatory factor analysis showed adequate to excellent goodness‐of‐fit indices supporting the 9‐factor structure of the QPC‐AOP. The results thus demonstrate that the concept of quality of care to a large extent is equivalent among outpatients from general psychiatry and from outpatient addiction services. Internal consistency for the full QPC‐AOP was adequate, but poor for some of the separate factors. The patients’ ratings of quality of care were generally high; the highest rating was for Encounter and the lowest for Discharge.

Dignity: The elephant in the room in psychiatric inpatient care? A systematic review and thematic synthesis

Involuntary psychiatric inpatient care presents a unique ethical challenge not least because the dignity of a person whose liberty and autonomy are restricted is inherently at risk. Understanding patients' experience of voluntary and involuntary care is an important part of ensuring that dignity is upheld as a key value. This study aimed to provide the first thematic synthesis of the existing literature on patient experience of dignity in voluntary and involuntary inpatient psychiatric care. PubMed (United States National Library of Medicine), PsycInfo (American Psychological Association), the Cochrane Library and bibliographies of relevant articles were searched for peer-reviewed, English-language studies from the start date of the databases through May 2020. Systematic searches identified 202 original papers. Consensus criteria were used to determine study inclusion through abstract and manuscript review. Eighteen articles were initially identified as suitable and nine met criteria for the final analysis. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Given the high proportion of qualitative literature, a thematic synthesis approach was adopted. Critical Appraisal Skills Program (CASP) checklists were used to assess quality of papers. Familiarization and line-by-line coding were carried out on qualitative studies and a thematic framework developed using an iterative approach. Six key themes emerged: coercion; powerlessness; care environment; relationship to staff; impact of involuntary treatment, and paradoxes. These encompassed 15 subthemes, comprising 111 individual statements. Despite dignity being at the core of this review, only five of the identified papers explicitly referenced the term. Nevertheless, core similarities in patient experiences and perspectives existed across a wide variety of primary studies from multiple sites. These themes can be taken to represent the components of dignified care and used as a framework for further research and service reform.

Saudi service users' perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry

This paper presents, as part of a larger mixed-methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi-structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users' health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self-awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay's 'Cultural Originality' as well as contemporary examples of Goffman's mortification of the self.

Factors influencing patient-perceived quality of care in psychiatric hospitals in Taiwan

Patient-perceived quality of inpatient/outpatient psychiatric care remains under-researched. A cross-sectional survey with purposive sampling comprising 567 inpatients and 549 outpatients was conducted among eight psychiatric care facilities in Taiwan to examine the factors influencing patient-perceived care quality. Inpatients and outpatients perceived moderate quality of care, where "Encounter" was reported as the highest dimension. Inpatients perceived "Secure environment" as the lowest; outpatients rated "Discharge/Referring" as the lowest. Hospital region and customer loyalty were significantly associated with patient-perceived care quality. Other significant factors were also identified: inpatient employment, perceived mental health and treatment effects, understanding diagnosis, previous treatment, and visited by appointment.

Young Adults and Their Families Living With Mental Illness: Evaluation of the Usefulness of Family-Centered Support Conversations in Community Mental Health care Settings

The aim of this study was to evaluate the usefulness of Family-Centered Support Conversations (FCSC) offered in community mental health care in Norway to young adults and their families experiencing mental illness. The FCSC is a family nursing intervention based on the Calgary Family Assessment and Intervention Models and the Illness Beliefs Model and is focused on how family members can be supportive to each other, how to identify strengths and resources of the family, and how to share and reflect on the experiences of everyday life together while living with mental illness. Interviews were conducted with young adults and their family members in Norway who had received the FCSC intervention and were analyzed using phenomenography. Two descriptive categories were identified: "Facilitating the sharing of reflections about everyday life" and "Possibility of change in everyday life." The family nursing conversations about family structure and function in the context of mental illness allowed families to find new meanings and possibilities in everyday life. Health care professionals can play an important role in facilitating a safe environment for young adults and their families to talk openly about the experience of living with and managing mental illness.

Verbesserung der Lebensqualität durch psychosoziale Nachsorge?

Ziel der Studie Die Studie untersucht, inwieweit Menschen mit psychosozialem Unterstützungsbedarf von den Leistungsangeboten Fähigkeitsorientierte Aktivität, Mobile Betreuung und Hilfe, Psychosoziale Beratungsstelle und Wohnen profitieren und wie diese Leistungsangebote sich subjektiv auf die Lebensqualität der Betroffenen auswirken.

Methodik Für die Beantwortung der Forschungsfragen wurden von den 4 Leistungsbereichen über 5 Jahre (2013–2017) 2099 Datensätze aus Klientenzufriedenheitsbefragungen statistisch ausgewertet. Die Klienten wurden dabei jeweils zum erlebten Nutzen in Bezug auf verschiedene Aspekte (z. B. Wohnsituation, Alltagsbewältigung, Zuversicht) sowie zur empfundenen Lebensqualität befragt.

Ergebnisse und Schlussfolgerungen Die Analyse der Daten zeigt eine Verbesserung und Stabilisierung von Lebensqualität nach Zugang in die jeweilige psychosoziale Nachsorge. Diese subjektiv empfundene Verbesserung von Lebensqualität im Laufe der Leistungsnutzung wurde allgemein von allen Nutzern der untersuchten Bereiche wahrgenommen. Allerdings profitieren die Nutzer, in Abhängigkeit von der Leistungsnutzung, in unterschiedlichen Aspekten und die Verbesserung der Lebensqualität ist folglich, je nach Leistungsnutzung, auf unterschiedliche Arten des Nutzens zurückzuführen.

Ethical Dilemmas of Participation of Service Users with Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed.

A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice

It is mental health consumer's human right to lead a fulfilling life as they are empowered to actively manage their recovery. This can be facilitated through care planning, yet research suggests that the care plan is not routinely created, discussed, or updated in acute mental health settings. Research on care planning and the role of the mental health nurse highlights the importance of therapeutic communication in care plan development. This paper argues that the lack of meaningful care plan discussions between consumers and mental health nurses in an acute setting is a limitation to the practice of fully accountable mental health nursing care. We explore this limitation in quality care provision by examining literature on accountability and conclude that in mental health nursing, accountability is frequently enacted through an overarching focus on the organizational need to manage risks, rather than on therapeutic engagement.

"How do we use the time?" - an observational study measuring the task time distribution of nurses in psychiatric care

Background

The nurse’s primary task in psychiatric care should be to plan for the patient’s care in cooperation with the patient and spend the time needed to build a relationship. Psychiatric care nurses however claim that they lack the necessary time to communicate with patients. To investigate the validity of such claims, this time-motion study aimed at identifying how nurses working at inpatient psychiatric wards distribute their time between a variety of tasks during a working day.

Methods

During the period of December 2015 and February 2016, a total of 129 h and 23 min of structured observations of 12 nurses were carried out at six inpatient wards at one psychiatric clinic in southern Sweden. Time, frequency of tasks and number of interruptions were recorded and analysed using descriptive statistics.

Results

Administering drugs or medications accounted for the largest part of the measured time (17.5%) followed by indirect care (16%). Relatively little time was spent on direct care, the third largest category in the study (15.3%), while an unexpectedly high proportion of time (11.3%) was spent on ward related tasks. Nurses were also interrupted in 75% of all medication administering tasks.

Conclusions

Nurses working in inpatient psychiatric care spend little time in direct contact with the patients and medication administration is interrupted very often. As a result, it is difficult to establish therapeutic relationships with patients. This is an area of concern for both patient safety and nurses’ job satisfaction.

Residents' Perceptions of Quality in Supported Housing for People with Psychiatric Disabilities

The residents' perspective of the quality of housing support for people with psychiatric disabilities living in congregate supported housing has been studied and a comparison has been made with the findings from those from a previous study in ordinary housing with outreach support. One-hundred and seventy-eight residents from 27 supported housing facilities in eight Swedish municipalities completed the Quality of Psychiatric Care-Housing (QPC-H) instrument. The highest quality ratings were found for: Secluded Environment, Encounter and Support, while Participation, Housing Specific and Secure Environment were rated at lower levels. Despite relatively high ratings, a majority of items did not attain the 80% cutoff point deemed as defining satisfactory quality of service. The residents in ordinary housing with outreach support rated higher levels for the majority of the QPC-H dimensions in comparison with those in supported housing. A conclusion is that the quality of care in supported housing facilities has a number of deficiencies that need to be addressed. Supported housing is generally rated as having a lower quality of care than in ordinary housing with outreach support. Suggestions for the content of staff training are made based on the results.

Does a new spatial design in psychiatric inpatient care influence patients' and staff's perception of their care/working environment? A study protocol of a pilot study using a single-system experimental design

Background

Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.

Methods

This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.

Discussion

The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration

ClinicalTrials.gov, NCT03140618, registered 4 May 2017

Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences

A promising intervention in mental health in-patient care is behavioural activation (BA). Interventions based on BA can be used by mental health nurses and other staff members. The aim of this study was to evaluate patients' and staff members' experiences of a nursing staff-led behavioural group intervention in mental health in-patient care. The intervention was implemented at three adult acute general mental health in-patient wards in a public hospital setting in Sweden. A self-administrated questionnaire, completed by 84 patients and 34 nurses and nurse assistants, was administered, and nonparametric data analysed using descriptive statistics. Our findings revealed that both patients and nursing staff ranked nursing care and care environment as important aspects in the recovery process. Patients and staff members reported overall positive experiences of the group sessions. Patients with higher frequencies of attendance and patients satisfied with overall care had a more positive attitude towards the intervention. A more positive experience of being a group leader was reported by staff members who had been leading groups more than ten times. The most common impeding factor during implementation, reported by staff members, was a negative attitude to change. Conducive factors were having support from a psychologist and the perception that patients were showing interest. These positive experiences reported by patients and nursing staff, combined with previous research in this field, are taking us one step further in evaluating group sessions based on BA as a meaningful nursing intervention in mental health in-patient care.

Recovery orientation in mental health inpatient settings: Inpatient experiences?

Offering mental health treatment in line with a recovery-oriented practice has become an objective in the mental health services in many countries. However, applying recovery-oriented practice in inpatient settings seems challenged by unclear and diverging definitions of the concept in and the organization of these settings. In Denmark, educational and organizational efforts have been made to organize inpatient services with a recovery-oriented approach. Hence, we aimed to explore whether and how these efforts are reflected in the inpatients' experiences of their care and treatment. Semi-structured interviews were conducted with 14 inpatients from two mental health inpatient wards using an interview guide based on factors from the Recovery Self-Assessment. Qualitative content analysis was applied in the analysis. Six themes covering the participants' experiences were identified. The participants felt accepted and protected in the ward and found comfort in being around other people but missed talking and engaging with health professionals. They described limited choice and influence on the course of their treatment, and low information levels regarding their treatment, which they considered to consist predominantly of medication. Furthermore, they described feeling continuously observed and assessed from a distance by health professionals. Like the sparse previous research among inpatients, the results highlight ambivalent experiences of health professionals' support and ward structure as well as the medical treatment hegemony. As such, the educational and organizational efforts of introducing recovery-oriented practices in the wards seemed not very well reflected in the participants' experiences of their stay.

Indonesian adaptation of the Quality in Psychiatric Care-Inpatient (QPC-IP) instrument: Psychometric properties and factor structure

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.

Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation

BACKGROUND

During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients.

METHODS

From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach's alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients' demographic and clinical variables related to the PDI score.

RESULTS

Our response rate was 93%, with excellent internal consistency (Cronbach's alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue >1, which explained >80% of total variance: 1) "loss of self-identity and anxiety for the future", 2) "concerns for social dignity and spiritual life", and 3) "loss of personal autonomy". The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients' variables, "suicide risk" and "insufficient social and economic condition" were positively and significantly correlated with the PDI total score.

CONCLUSION

The PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss.

Exploring Nursing Students' Experiences of Learning Using Phenomenography: A Literature Review

BACKGROUND

The purpose of this extensive international and national literature review was to explore how phenomenography identifies nursing students' experiences of learning within preregistration (or prelicensure) nursing education.

METHOD

Data were collected utilizing a comprehensive search of electronic databases. Full text, peer-reviewed, and scholarly articles published in English using the search terms phenomengraph*, nurs*, student, education, and learning were reviewed.

RESULTS

Two discreet themes emerged exploring students' experiences of learning within preregistration nursing education: (a) Phenomenography was a beneficial method to expose variation in students' understandings of a challenging concept or topic and (b) phenomenography was beneficial to evaluate teaching methods in attempt to improve student learning of challenging and complex concepts.

CONCLUSION

On the basis of these findings, future research utilizing phenomenography within nursing education has potential to uncover variation in students' understandings of mental health, with future consideration of implications to nursing curriculum design and development. [J Nurs Educ. 2017;56(10):591-598.].

Hospital rules and regulations: The perspectives of youth receiving psychiatric care

BACKGROUND

Rules and regulations represent an aspect of psychiatric hospitalization about which little is known.

STUDY PURPOSE

To explore the perceptions of rules from the perspective of youth receiving hospital-based psychiatric services.

DESIGN

Qualitative descriptive.

METHODS

Perceptions of rules were elicited through semi-structured interviews with a convenience sample of six youth.

RESULTS

Rules were perceived as governing virtually all aspects of everyday living in the hospital environment. Rules were used to structure daily activities, routines, and social interactions, and were embedded within clinical protocols and treatment plans. For each participant, "making sense" or "not making sense" were central themes through which rules were interpreted as being either therapeutic or oppressive. Rules that made "no sense" negatively affected youth mood, behavior, treatment adherence, and engagement in a collaborative relationship.

CONCLUSION

Working in partnership with youth in psychiatric care to establish, implement, and evaluate rules that "make sense" can promote positive health outcomes and prevent negative, unintended consequences.

The attendees' view of quality in community-based day centre services for people with psychiatric disabilities

BACKGROUND/AIMS

Community-based day centres in Sweden are well-established arenas for psychiatric rehabilitation, but little is known of the attendees' perception of the quality of the service provided. The aim of the study was thus to describe and investigate the quality of the services in community-based day centre for people with psychiatric disabilities.

METHODS

A sample of 218 attendees in 14 community-based day centre services in Sweden completed the Quality in Psychiatric Care - Daily Activities (QPC-DA).

RESULTS

The results showed that people with psychiatric disabilities perceived the quality of community-based day centre services as high. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the centre, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement.

CONCLUSION/SIGNIFICANCE

From an occupational science perspective, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the centre.

Residents' View of Quality in Ordinary Housing with Housing Support for People with Psychiatric Disabilities

The aim of the present study was to investigate the quality of housing support provided in housing services for people with psychiatric disabilities living in ordinary housing with housing support from the residents' perspective, by using the QPC-H instrument. A sample of 174 residents in ordinary housing, receiving housing support from 22 housing support services in nine Swedish municipalities, participated in this study. The results show that the quality of psychiatric care in housing services was mainly rated highly as measured with the QPC-H instrument. The dimensions Encounter and Secluded Environment were the aspects that were rated as the two with the highest quality of housing service. The dimensions Participation and Secure Environment were rated as those with the lowest quality. There were more residents who totally disagreed with the statements in the dimensions Participation and Housing Specific than in the other dimensions. The perceived lower quality in Encounter, Participation, Support and the Housing Specific dimensions was associated with a low frequency of psychiatric outpatient clinic contacts. A conclusion is that the support staff could be more observant regarding the residents' need for support and also talk more with them about what could be done to assist them. It also seems important that the support staff discuss with the residents regarding how they can help them to feel more secure in their accommodation.

Influence of staff's emotional reactions on the escalation of patient aggression in mental health care

Patient aggression is universally recognized as an important challenge in mental health care (MHC). Based upon a pragmatic exploration of the professional literature, we seek here to determine how negative emotional reactions of staff-including those conveyed in terms of fear, anger, and insult-may serve to exacerbate this serious impediment to safe and effective MHC. This is done using biological and evolutionary paradigms. Studies of patient aggression have tended to focus more on patient characteristics and behavior than on those of their caregivers. The authors suggest that patient aggression may be viewed as a response to "normal" interaction processes. The results of this investigation imply that the emotional reactions of staff may escalate the aggressive interaction by increasing the patient's perception of threat, and also, increase the probability of new incidents by creating a patient-staff relationship characterized by unsafety and mistrust. Mindfulness-based interventions are suggested as useful strategies to expand the staff's emotional awareness and increase emotional control.

Measuring quality in community based housing support - the QPC-H instrument

Purpose

The purpose of the study was to test the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care – Housing (QPC–H) and briefly describe the residents perception of quality of housing support.

Design/methodology/approach

A sample of 174 residents from 22 housing support services in nine Swedish municipalities participated in the study. Confirmatory factor analysis revealed that the QPC–H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the Quality in Psychiatric Care family of instruments

Findings

Confirmatory factor analysis revealed that the QPC–H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the Quality in Psychiatric Care family of instruments. The internal consistency of the factors was acceptable except in the case of secure and secluded environment, probably due to few numbers of items. With this exception, the QPC–H shows adequate psychometric properties.

Originality/value

The QPC–H includes important aspects of residents’ assessment of quality of housing service and offers a simple and inexpensive way to evaluate housing support services from the residents’ perspective.

The Concept of Patient Participation in Forensic Psychiatric Care: The Patient Perspective

The importance of patient participation is advocated in medical treatment and nursing care and has been linked to increased quality of care, increased patient satisfaction, and treatment adherence. Still, patients in forensic psychiatric care often report being unhappy with their experienced level of participation. The concept of patient participation is complex and has several definitions, thus it is important to investigate it from different perspectives in different contexts. The aim of this study was to describe patients' perceptions of the concept of patient participation in forensic psychiatric care. A qualitative design with a phenomenographic approach was used, and interviews with 19 participants in a Swedish setting were completed. The participants described the concept of patient participation in forensic psychiatric care as follows: influence, to have good communication and to be involved; confidence, to have mutual trust and to trust the care; and own responsibility, to participate in activities and to take the initiative. On the basis of the results of this study, improved patient participation in forensic psychiatric care may be achieved with active communication, by building up and maintaining trust for professional competence and by encouraging patients' own responsibility. It is important that knowledge about patients' views of the concept of patient participation is included in the planning and improvement of forensic care.

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014

INTRODUCTION

Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014.

METHODS

This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test.

RESULTS

The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels.

CONCLUSION

The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.

Using mixed methods to evaluate perceived quality of care in southern Tanzania

Objective

To compare perceived quality of maternal and newborn care using quantitative and qualitative methods.

Design

A continuous household survey (April 2011 to November 2013) and in-depth interviews and birth narratives.

Setting

Tandahimba district, Tanzania.

Participants

Women aged 13–49 years who had a birth in the previous 2 years were interviewed in a household survey. Recently delivered mothers and their partners participated in in-depth interviews and birth narratives.

Intervention

None.

Main Outcome Measures

Perceived quality of care.

Results

Quantitative: 1138 women were surveyed and 93% were confident in staff availability and 61% felt that required drugs and equipment would be available. Drinking water was easily accessed by only 60% of respondents using hospitals. Measures of interaction with staff were very positive, but only 51% reported being given time to ask questions. Unexpected out-of-pocket payments were higher in hospitals (49%) and health centres (53%) than in dispensaries (31%). Qualitative data echoed the lack of confidence in facility readiness, out-of-pocket payments and difficulty accessing water, but was divergent in responses about interactions with health staff. More than half described staff interactions that were disrespectful, not polite, or not helpful.

Conclusion

Both methods produced broadly aligned results on perceived readiness, but divergent results on perceptions about client–staff interactions. Benefits and limitations to both quantitative and qualitative approaches were observed. Using mixed methodologies may prove particularly valuable in capturing the user experience of maternal and newborn health services, where they appear to be little used together.

Quality of interactions influences everyday life in psychiatric inpatient care--patients' perspectives

Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients' experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories-staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content-were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff.

Systematic synthesis of barriers and facilitators to service user-led care planning

BACKGROUND

Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.

AIMS

To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.

METHOD

Systematic evidence synthesis.

RESULTS

Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.

CONCLUSIONS

Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.

Views concerning patient dignity among relatives to patients experiencing psychosis

BACKGROUND

Mental illness influences not only the suffering patient but often changes family life forever and results in experience of reduced dignity for both patients and relatives.

AIM

The aim of this study was to reveal relatives' opinions regarding what is important for taking care of patients' dignity.

PARTICIPANTS

Thirteen relatives of patients experiencing psychosis were recruited through a relatives' user organisation.

RESEARCH DESIGN

The methodological approach is Q methodology. A Q sample of 51 statements was sorted in a quasinormal distribution curve. Postinterviews were conducted with all participants.

RESULTS

Four viewpoints emerged described as 'value based', 'expectations', 'asymmetric' and 'nuanced'.

CONCLUSION

Focus on overarching values such as honesty and respect, to involve patients and relatives in care, by reducing asymmetry between patients and staff, with staff taking total responsibility for a patient's situation when needed, all represent aspects of taking care of patient dignity.

Professional development of HR practitioners – a phenomenographic study

Purpose

– The purpose of this paper is an investigation into the experiences of professional development of human resource (HR) practitioners in the North of Scotland, and the use of non-formal learning in that development.

Design/methodology/approach

– In-depth semi-structured interviews from a purposively selected sample of HR practitioners were conducted. Data from these interviews was analysed on a phenomenographic basis, to discover the qualitatively different ways in which HR practitioners describe, experience, understand and analyse their professional development and the use of non-formal learning in that development.

Findings

– What emerged from the analysis were two sets of categories of description, one for each of the phenomena. An outcome space for each of the phenomena emerged, illustrating the hierarchical relationship within each set of categories of description as well as the dimensions of variation relating to the phenomena. These outcome spaces represent the collective experience of the practitioners on the subjects of professional development and non-formal learning.

Research limitations/implications

– Sample size and the specific geographical area are acknowledged as limitations. Another factor which may be considered a limitation is that the author's position as an HR lecturer with a keen interest in the subject could lead to this being considered an “insider” study. All these factors are acknowledged. These have been mitigated against by the careful preparation undertaken during the research process which resulted from the author's awareness of these limitations.

Originality/value

– This study has given a voice to the HR practitioners in the North of Scotland with regard to their experiences and attitudes towards their professional development and the role of non-formal learning in that development. This study gives employers, other practitioners and professional bodies an opportunity to learn from the practitioners themselves as to how they can help practitioners in terms of their development.

Patient and staff views of quality in forensic psychiatric inpatient care

The study describes and compares perceived quality of care among patients and staff using the Quality in Psychiatric Care-Forensic In-Patient and the Quality in Psychiatric Care-Forensic In-Patient Staff questionnaires. The questionnaires are both based on the perception of the quality of the forensic psychiatric care given to the patients, but the wording is adjusted to fit patients or staff. The study sample consisted of 66 patients and 202 staff members from 12 forensic units in Sweden. Using multiple regression analyses to adjust for demographic variables, it was found that patients perceived the quality of support and secluded environment lower than did staff, whereas staff had lower perceptions than patients of the quality of secure environment. The combination of these questionnaires provides new possibilities for assessing the quality of forensic psychiatric care and evaluating interventions, important factors in the management and planning of forensic care.

The significance of small things for dignity in psychiatric care

Background:

This study is based on the ontological assumption about human interdependence, and also on earlier research, which has shown that patients in psychiatric hospitals and their relatives experience suffering and indignity.

Aim:

The aim of this study is to explore the experience of patients and relatives regarding respect for dignity following admission to a psychiatric unit.

Research design:

The methodological approach is a phenomenological hermeneutic method.

Participants and research context:

This study is based on qualitative interviews conducted with six patients at a psychiatric hospital and five relatives of patients who experienced psychosis.

Ethical consideration:

Permission was given by the Regional Committee for Medical Research Ethics in Western Norway, the Norwegian Data Protection Agency and all wards within the hospital in which the patients were interviewed.

Findings:

The analysis revealed one main theme: ‘The significance of small things for experiencing dignity’ and four subthemes described as follows - ‘to be conscious of small things’, ‘being conscious of what one says’, ‘being met’ and ‘to be aware of personal chemistry’.

Discussion and conclusion:

Staff members seem not to give enough attention to the importance of these small things. Staff members need to explore this phenomenon systematically and expand their own understanding of it.

A Danish adaptation of the quality in psychiatric care-forensic in-patient questionnaire: psychometric properties and factor structure

OBJECTIVE

The aims of this study were to adapt and evaluate the psychometric properties and factor structure of the Danish version of the Quality in Psychiatric Care-Forensic In-Patient (QPC-FIP) questionnaire.

METHODS

A sample of 139 inpatients from 25 wards in Denmark who received care during 5 weeks in March and April 2012 participated in the study by completing the QPC-FIP instrument.

RESULTS

Confirmatory factor analysis revealed that the factor structure of the Danish version was equivalent to that of the original Swedish QPC-FIP. The results indicate that the concept of quality of care expressed in the QPC-FIP is equivalent among forensic inpatients in nationally different healthcare systems and cultural contexts.

CONCLUSION

The Danish version of QPC-FIP is a reliable and valid measurement instrument recommended for use in evaluating quality of care in forensic inpatient care.

Patients' experiences of supportive conversation as long-term treatment in a Swedish psychiatric outpatient care context: a phenomenological study

This study aims to describe patients' experiences of supportive conversation as long-term treatment in a psychiatric outpatient context. A focus group interview was conducted with six female patients (aged 40-60 years). Five key constituents captured the essence of the general structure of supportive conversation: being treated as a responsible person, sensing intimate contact and togetherness, perceiving stability in the relationship, learning to manage daily living, and growing as a person. Supportive conversations have a positive influence on the patient's state of mind and enhance self-confidence, thereby giving the inner strength to grow as a person.

The duality of suffering and trust: abused women's experiences of general psychiatric care--an interview study

AIMS AND OBJECTIVES

To elucidate how women subjected to physical, emotional and/or sexual abuse experience the care provided at a general psychiatric clinic after the disclosure of abuse.

BACKGROUND

Violence against women is a major global public health issue, which has an impact on women's lives and mental health as well as generating frequent hospital admission.

DESIGN

Qualitative design with an inductive approach.

METHODS

Interviews with nine women who were recipients of general psychiatric care and had disclosed experiences of abuse to a member of staff were conducted. Qualitative inductive content analysis was used.

RESULTS

The overall theme emerging from the narratives, 'dependency as a reality containing a duality of suffering and trust,' links the categories together. Each subcategory is presented in relation to the categories 'being belittled,' 'being misinterpreted' and 'being cared for.' Experiences of care as caring and noncaring were found in the narratives. Caring could include situations experienced as the women being acknowledged and listened to, situations where staff approached and supported the women in a sensitive way. Experiences of noncaring were when the abuse was disregarded, and when the women were not believed in, were left with burdens of guilt and were offended. A noncaring environment focused primarily on the diagnosis, and the experienced abuse was seen as secondary.

CONCLUSIONS

Abused women are subjected to psychiatric environments where staff are divided into groups of those who believed in and supported the abused women and those who regarded experiences of abuse as a secondary issue and focused on the mental disorder.

RELEVANCE TO CLINICAL PRACTICE

This study provides knowledge of how abused women experience the care provided at a general psychiatric clinic after the disclosure of abuse.

Quality of care in psychosis and bipolar disorder from the service user perspective

According to the recovery model of mental health care, service development should incorporate the expert knowledge of service users. To date, there has been limited research into conceptualizations of mental health care quality among services users diagnosed with bipolar disorder or psychosis. To investigate service user perspectives on quality of care, we conducted six focus groups (N = 29) with inpatients and outpatients of an independent Irish mental health service. We undertook an inductive thematic analysis of the data. Participants identified proactive staff, meaningful and warm staff-patient interactions, and safety and sociability in the inpatient environment as components of good quality mental health care. Participants also discussed how the implementation of best practice guidelines does not necessarily improve quality of care from the service user perspective. This and similar qualitative research should be used to inform service development and the creation of evaluation instruments compatible with the recovery model.