Implementing Person-Centered Care Planning: A Randomized Controlled Trial

Addressing social determinants of health in individuals with mental disorders in clinical practice: review and recommendations

Social determinants of health have been shown to have a greater impact on overall health than traditionally considered medical risk factors, especially in people with mental disorders. It is the primary responsibility of healthcare providers to ensure that persons with psychiatric disorders are actively helped in reducing the adverse effects of SDoMH on their health and healthcare. Yet, the current clinical psychiatric practice in the U.S. does not have any standardized guidelines for evaluating or addressing these critical factors even among individuals who are receiving psychiatric and other medical treatment. Although there are several barriers to implementing such interventions, there are also practical approaches to address selected social determinants of mental health and improve the well-being of our patients. In this article, we review the literature on the assessment of relevant social factors and pragmatic psychosocial strategies at the individual, family, and community levels to help reduce their adverse impact. We offer guidelines for psychiatric clinicians and case managers to improve the health and quality of life of persons with mental disorders, using sustained inter-professional collaborative efforts.

Choice Matters: The Moderating Effect of Choice on the Relationship Between Mental Health Personal Recovery and Symptomatology

PURPOSE

Limited research examines how choice surrounding treatment impacts mental health recovery among young adults with serious mental illness (SMI) who are navigating symptom management, complex mental health systems, and developmental expectations of increased independence. This study examines whether perceived choice related to mental health treatment impacts the relationship between symptomatology and personal recovery among Black, Latino/e, and multiracial young adults with SMI.

METHODS

Surveys were conducted with 121 young adults with SMI attending a community-based personal recovery-oriented program. Data included covariates (demographics and social support), psychiatric symptomatology, personal recovery, and choice. Ordinary least squares regressions tested whether choice predicts symptomatology and personal recovery, and whether choice moderates the relationship between symptomatology and personal recovery.

RESULTS

Most participants were Black, Latino/e, or multiracial (96%) and male (67%) with an SMI diagnosis receiving services through Medicaid. Holding demographics and social support constant, a strong sense of choice was positively associated with personal recovery, (χ2 (7, N = 112) = 17.5, p = .01), but not symptomatology (χ2 (7, N = 112) = 12.5, p = .09). Furthermore, perceived choice moderated the relationship between symptomatology and personal recovery (β = -0.48, 95% CI [-0.79, -0.17], p = .012), where the association between symptomatology and personal recovery ceased to exist at lower levels of perceived choice in treatment.

DISCUSSION

This study suggests perceived choice can influence the relationship between symptomatology and personal recovery among Black, Latino/e, and multiracial young adults with SMI. Implications for clinical practice include further evidence for enhancing shared decision-making and transition-focused care for young adults of color.

What factors influencing surgical nurses' competence in implementing person-centered care in the perioperative period?: A cross-sectional study

Strengthening the capability of clinical surgical nurses to provide person-centered care (PCC) requires a thorough analysis of several related factors. This study used a descriptive cross-sectional design to investigate the factors that influence surgical nurses' perioperative competency in the performance of PCC in Anhui, China. A convenience sampling was implemented to administer a questionnaire survey to 437 nurses with more than 1 year of experience working in surgical wards. A web-based cross-sectional questionnaire evaluated the participant's general sociological information, empathy, job burnout, and nursing competence. The questionnaire were designed and published through the online platform Questionnaire Stars, and the link was distributed through the Internet and WeChat media by the nursing department of their hospital. Data were collected from June to September 2023 and processed by descriptive, correlation, and stepwise multiple regression analyses. Participants with high levels of empathy (β  = 0.502, P < .001), low levels of job burnout (β  = -0.288, P < .001), humanistic nursing training (β  = 0.167, P < .001), and personnel agency (β  = 0.083, P < .001) showed better PCC competence. The regression model analysis showed that 4 influencing factors explained 59.2% of the variance (F = 158.930, P < .001, adjusted R2 = 0.592). These findings suggest that steps should be taken to strengthen the key factors, such as improving empathy, minimizing job burnout, offering more humanities training, and enhancing personalities, to reinforce PCC competency.

The Importance of Time: Nurses' Experiences of Working With Suicide Prevention and Suicide Risk Assessment in the Care of Older People

AIM

To describe nurses' experiences of working with suicide prevention and suicide risk assessment in the care of older people.

BACKGROUND

Suicide is a problem among older people, worldwide. Risk factors for suicide are, among others, depression, illness and pain and a feeling of isolation. Nurses have valuable experience in suicide prevention and risk assessments. This study can shed light on what is needed to promote the mental health of older people, which has been partly overlooked in previous research.

METHODS/DESIGN

A descriptive qualitative study was conducted. Ten nurses working in care of older people across four different municipalities were interviewed. Conventional content analysis was used to analyse the data.

RESULTS

Despite shortcomings in guidelines, nurses describe performing suicide risk assessments and suicide prevention in a similar manner. The importance of giving the patients time is emphasised, although time is exactly what appears to be lacking.

CONCLUSION

By engaging with the experiences of nurses, important aspects that require further attention are highlighted. Nurses should inquire about suicidal ideation, even if older persons do not explicitly express such thoughts. Normal ageing needs to be comprehended and considered in assessments. In this work, time is important.

PATIENT OR PUBLIC CONTRIBUTION

The results were coproduced by means of interviews with nurses working in care of older people.

REPORTING METHOD

The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

IMPLICATIONS FOR PRACTICE

Encountering older people who may have experienced the loss of loved ones and addressing one's personal capabilities in the context of the ageing body imposes substantial challenges on nursing care, necessitating a capacity to adeptly navigate and address these complex issues.

Implementing Person-Centered Recovery Planning: New England Mental Health Technology Transfer Center Learning Collaborative Evaluation Report

Person-centered recovery planning (PCRP) has been a key aspect in mental health system transformation and delivering quality health care. Despite the mandate to deliver this practice and a growing evidence base, its implementation and understanding of implementation processes in behavioral health settings remain a challenge. New England Mental Health Technology Transfer Center (MHTTC) launched the PCRP in Behavioral Health Learning Collaborative to support agencies' implementation efforts through training and technical assistance. In an effort to explore and understand the internal implementation process changes facilitated by the learning collaborative, the authors conducted qualitative key informant interviews with the participants and the leadership of the PCRP learning collaborative. The interviews revealed the processes that are part of the PCRP implementation efforts, including staff training, changing agency policies and procedures, modifying treatment planning tools, and the structure of the electronic health records. The higher prior organizational investment and readiness for change, building staff's competencies in PCRP, leadership investment, and frontline staff buy-in act as factors that facilitate the implementation of PCRP in behavioral health settings. Our findings inform both the implementation of PCRP in behavioral health settings and future efforts of organizing multi-agency learning collaboratives to support PCRP implementation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43477-023-00078-3.

Nursing students' experiences and perceptions of barriers to the implementation of person-centred care in clinical settings: A qualitative study

AIM

This study aimed to explore the barriers to implementing person-centred care based on nursing students' experiences during clinical practice.

DESIGN

This is a descriptive, qualitative study.

METHODS

Seventeen nursing students were recruited through purposeful sampling from two universities in South Korea. The semi-structured interviews consisting of open-ended questions were conducted. The collected data were analysed using an inductive content analysis method.

RESULTS

Five main categories were identified from nursing students' experiences: busyness, educational challenges, lack of awareness, lack of relationship building and lack of a policy approach.

Impact of a brief intervention to improve engagement in a recovery program for young adults with serious mental illness

OBJECTIVE

Serious mental illnesses (SMI) commonly emerge during young adulthood. Effective treatments for this population exist; however, engagement in treatment is a persistent challenge. This study examines the impact of Just Do You (JDY), an innovative intake-focused intervention designed to improve engagement in treatment and enhance personal recovery.

METHODS

The study used a parallel group randomized trial to examine if and how JDY improved recovery among 121 young adults with SMI from low-resourced communities referred to personalized recovery-oriented services (PROS). Measures of engagement (buy-in and attendance) and personal recovery in this pilot study were assessed at baseline and 3-month follow-up.

RESULTS

Participants in JDY reported more positive engagement outcomes; that is, relative to the control group they reported higher past two week attendance (b = 0.72, p < 0.05, Cohen's d = 0.56) and higher levels of buy-in to treatment (b = 2.42, p < 0.05, Cohen's d = 0.50). JDY also impacted young adults' personal recovery (b = 0.99, p < 0.05, Cohen's d = 1.15) and did so largely by increasing their level of buy-in to the treatment program.

CONCLUSION

This study suggests that an engagement intervention for young adults that orients, prepares, and empowers them to be active and involved in the larger treatment program makes a difference by improving engagement and enhancing recovery. Data also support conceptualizing and examining engagement beyond treatment attendance; in this study what mattered most for recovery was the level of buy-in to treatment among young adults.

Influencing Factors on Person-Centered Care Competence among Nursing Students Experienced Clinical Training

Background and Objectives: Nursing students require appropriate education to improve their person-centered care competence. Therefore, research on the various factors that influence person-centered care competence is necessary. This study aimed to identify factors influencing nursing professional values, satisfaction with major, and perception of the nursing profession on person-centered care competence. Materials and Methods: This study was a descriptive survey, and participants were nursing students from three universities in Korea. Structured self-report questionnaires were used for data collection. Results: Nursing professional values (p < 0.001) were found to be an influencing factor on person-centered care competence (Adjusted R2 = 0.244). However, the perception of the nursing profession, and the satisfaction with the major were not found to be significant influencing factors on person-centered care competence. Conclusions: The findings suggest that fostering nursing professional values in nursing students and developing educational interventions for the same are essential to improve person-centered care competence.

Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics

Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ²(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R²) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.