Quality of life for long-stay patients of psychiatric hospitals: a literature study

Patients' satisfaction with hospital health care: Identifying indicators for people with severe mental disorder

BACKGROUND

Patients' perception of psychiatric healthcare is a critical indicator in measuring service quality. The aim of the study was to determine patient's level of satisfaction with the quality of health care delivered at the inpatient departments, and to identify the service quality factors that were important to patients.

METHOD

The Satisfaction with Psychiatry Care Questionnaire-22 was administered to 125 consecutive inpatients with schizophrenia or schizoaffective disorder in a stable condition. Sociodemographic and background variables, illness and symptom severity, insight, social anhedonia, self-esteem, perceived social support, and satisfaction with quality of life were collected.

RESULTS

Although the participants generally expressed satisfaction with the inpatient services, they indicated that the weakest aspects of the service were in the domains of 'personal experience', 'information' and 'activity'. Women were significantly more dissatisfied than men with 'staff', 'care', and by general satisfaction. Multiple regression analysis revealed that satisfaction with hospital health care was associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia.

CONCLUSION

Personality related factors rather than psychopathological symptoms were associated with a satisfaction with care of admitted patients with severe mental illness. These factors could be targets for interventions aimed to improve treatment and hospital services.

Implementation of evidence on the nurse-patient relationship in psychiatric wards through a mixed method design: study protocol

Background

Psychiatric nurses are aware of the importance of the therapeutic relationship in psychiatric units. Nevertheless, a review of the scientific evidence indicates that theoretical knowledge alone is insufficient to establish an adequate therapeutic alliance. Therefore, strategies are required to promote changes to enhance the establishment of the working relationship. The aims of the study are to generate changes in how nurses establish the therapeutic relationship in acute psychiatric units, based on participative action research and to evaluate the effectiveness of the implementation of evidence through this method.

Methods/Design

The study will use a mixed method design. Qualitative methodology, through participative action research, will be employed to implement scientific evidence on the therapeutic relationship. A quasi-experimental, one-group, pre-test/post-test design will also be used to quantitatively measure the effectiveness of the implementation of the evidence. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses will be selected by theoretical sampling, and patients assigned to each nurses will be selected by consecutive sampling. Qualitative data will be gathered through discussion groups and field diaries. Quantitative data will be collected through the Working Alliance Inventory and the Interpersonal Reactivity Index. Qualitative data will be analysed through the technique of content analysis and quantitative data through descriptive and inferential statistics.

Discussion

This study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement.

The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients

PURPOSE

To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital.

METHOD

Narrative literature review. Content analysis.

FINDINGS

The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting.

PRACTICE IMPLICATIONS

Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.

Clinical characteristics and outcomes on discharge of women admitted to a Medium Secure Unit over a 4-year period

There are limited data on women in Medium Secure settings. This study aimed to address this by assessing the characteristics of 45 consecutive admissions to the female ward of a Medium Secure Unit in the United Kingdom over a four-year period. Data on demographics, clinical outcomes and from HONOS-Secure/HONOS and HCR-20 assessments were prospectively collected. Psychiatric diagnoses were recorded using ICD-10 criteria. Data on quality of life from WHO-QoL-BREF surveys were analysed. There was a high proportion of ethnic minorities (57.8%), high rates of childhood and adult abuse and low socioeconomic status. 62.2% of the patients had schizophrenia, 57.8% had multiple diagnoses. The median length of stay at discharge was 465.5 days. There were statistically significant reductions in rates of self-harm and HoNOS-Secure/HoNOS and HCR-20 scores following intervention. Scores on WHO-QoL-BREF compared favourably to a large-scale sample with mental health difficulties. Many characteristics of this sample were comparable to samples from similar populations. However the particularly high proportion of ethnic minorities suggested that the profile of our patients differs from nationwide samples. Intervention by our service was associated with reduced self-harm and improvements in well-defined clinical outcomes and quality of life measures using validated scales.

Patients' perceptions of what makes a good doctor and nurse in an Israeli mental health hospital

The aim of this study was to identify inpatients' expectations of their doctors and nurses in a mental health hospital setting. Individual interviews were conducted with 72 inpatients of a large mental health hospital in northern Israel. Our study produced three major results. First, most patients, whatever their emotional status, share similar expectations of staff, of which the most conspicuous is that they be respected as whole persons and that staff not treat them merely as cases of illness. Second, they expect to be involved in making decisions about their treatment, including being informed of reports and records referring to them. Third, patients expect all hospital staff, particularly nurses, to provide them with emotional support. The findings of this study can be used to facilitate improved care of mental health inpatients by both doctors and nurses. Structured and methodical examinations of inpatients' expectations at the time they are hospitalized can help adjust not only the professional aspect of health care but also the therapeutic communication approach to patients' individual needs.

Does experienced seclusion or restraint affect psychiatric patients' subjective quality of life at discharge?

Background

In Finland major effort has been invested in reducing the use of coercion in psychiatric treatment, and the goal is to diminish the use of coercion by 40% by 2015. Improving patients’ quality of life (QoL) has gained prominence in psychiatric treatment during the past decade. Numerous studies have shown that most secluded or restrained patients (S/R patients) would prefer not to have had this experience. Experience of S/R could affect negatively patients’ QoL, but empirical data on this issue are lacking.

Aim

The study aimed to explore the effect of experienced S/R on the subjective QoL of psychiatric in-patients.

Method

This study explored subjective QoL of the S/R patients. At discharge, S/R patients completed the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF).

Results

We found that S/R patients’ (n = 36) subjective QoL was significantly better than that of non-S/R patients’ (n = 228). Most non-S/R patients were diagnosed with mood disorders (mostly depression). Most of S/R patients were diagnosed with schizophrenia, schizotypal and delusional disorders. The mean duration of S/R was 2.3 days, median was one day and mean length of the hospitalization after S/R episode was 2.5 months.

Conclusion

Our cross-sectional findings suggest that S/R does not considerably influence patients’ QoL or that the influence is short-lived. Because baseline QoL was not measured this remains uncertain. There are also many other factors, such as negative mood, which decrease the patients’ QoL ratings. These factors may either mask the influence of S/R on QoL or modify the experience of QoL to such an extent that no independent association can be found at the time of discharge.

Efficacy of continuous follow-up for preventing the involuntary readmission of psychiatric patients in Japan: a retrospective cohort study

BACKGROUND

Providing aftercare to psychiatric inpatients is important for preventing frequent readmissions; however, the lack of social resources is a problem in Japan. The prefectural Tama-Fuchu Public Health Centre has attempted to establish a new continuous follow-up system for all discharged psychiatric patients in order to reduce the frequency of readmissions.

AIMS

This study aims to evaluate the efficacy of this system.

METHODS

The subjects of the present study were 200 psychiatric inpatients from the Tokyo catchment area. The continuous follow-up system was applied to 130 subjects for one year in addition to conventional standard care (the intervention group). Seventy subjects received conventional care alone (the comparison group). The incident rate ratios (IRR) of total and involuntary readmission to hospital were compared by survival analysis.

RESULTS

During the observation period, there were 41 readmissions and 29 involuntary readmissions in 49,731 person-days. The patients subjected to continuous follow-up showed a trend towards a lower overall risk of readmission (IRR = 0.56, 95% CI: 0.29-1.10, p = .057) and a significantly reduced risk of involuntary admission (IRR = 0.48, 95% CI: 0.22-0.96, p = .047).

CONCLUSION

This study provides empirical evidence that providing continuous follow-up examinations as aftercare for discharged psychiatric patients significantly reduces the incidence of involuntary readmission.

Nurses' perceptions of nursing interventions supporting quality of life in acute psychiatric wards

PURPOSE

This study aimed to examine nurses' (N=29) perceptions of nursing interventions in supporting patients' quality of life (QoL) in acute psychiatric inpatient settings.

DESIGN AND METHOD

An explorative descriptive study design was applied. The data were generated through seven focus group interviews and analyzed with qualitative content analysis.

FINDINGS

Five main categories of nursing interventions to support patients' QoL were identified. Interventions were related to care planning, empowering interventions, social interventions, activating interventions, and security interventions.

PRACTICE IMPLICATIONS

Emphasis should be placed on nurses' opportunities to improve patients' QoL according to patients' individual needs.

Emotional intelligence of mental health nurses

AIMS

The aim of this study is to gain insight into the level of emotional intelligence of mental health nurses in the Netherlands.

BACKGROUND

The focus in research on emotional intelligence to date has been on a variety of professionals. However, little is known about emotional intelligence in mental health nurses.

METHOD

The emotional intelligence of 98 Dutch nurses caring for psychiatric patients is reported. Data were collected with the Bar-On Emotional Quotient Inventory within a cross-sectional research design.

RESULTS

The mean level of emotional intelligence of this sample of professionals is statistically significant higher than the emotional intelligence of the general population. Female nurses score significantly higher than men on the subscales Empathy, Social Responsibility, Interpersonal Relationship, Emotional Self-awareness, Self-Actualisation and Assertiveness. No correlations are found between years of experience and age on the one hand and emotional intelligence on the other hand.

CONCLUSIONS

The results of this study show that nurses in psychiatric care indeed score above average in the emotional intelligence required to cope with the amount of emotional labour involved in daily mental health practice.

RELEVANCE TO CLINICAL PRACTICE

The ascertained large range in emotional intelligence scores among the mental health nurses challenges us to investigate possible implications which higher or lower emotional intelligence levels may have on the quality of care. For instance, a possible relation between the level of emotional intelligence and the quality of the therapeutic nurse-patient relationship or the relation between the level of emotional intelligence and the manner of coping with situations characterised by a great amount of emotional labour (such as caring for patients who self-harm or are suicidal).

Determinants of length of stay for psychiatric inpatients: analysis of a national database covering the entire Korean elderly population

OBJECTIVE

In a rapidly aging society, inappropriately long geropsychiatric inpatient hospitalization is a challenging concern for mental health policy-makers and researchers. This study aimed to investigate patient and institutional factors affecting geropsychiatric inpatient length of stay (LOS), providing an overview of current geropsychiatric health care system in South Korea.

METHODS

This retrospective, population-based, cross-sectional study analysed nationwide reimbursement claim databases covering the entire elderly population of Korea between January 2005 and June 2006. Given the nested structure of the data, a multivariate multilevel regression analysis was performed.

RESULTS

The average LOS was 128 days. Males, patients with schizophrenia, and those enrolled in a National Medical Care Aid program tended to have longer hospital stays. Patient age was negatively related to LOS. Institutional variables related to longer hospitalizations included a psychiatric hospital, a higher number of beds, fewer human resource employees, a higher proportion of male, oldest old, and patients with dementia.

CONCLUSIONS

Our results suggest that policies targeting geropsychiatric patients diagnosed with schizophrenia, enrolled in National Medical Care Aid programs, and admitted to psychiatric hospitals could reduce LOS. Additionally, the impact of the patient composition of a medical institution on LOS needs to be closely investigated.