Traversing the Services: A Constructivist Grounded Theory of Admission in Two Adult Acute Mental Health Inpatient Wards

Abstract

It is increasingly acknowledged that service-user satisfaction and experience are fundamental to the achievement of high quality care delivery worldwide. Research in this area identifies a need to capture the experience of care providers, to expand methodological approaches beyond the survey instrument and to develop patient-centred approaches that include effective partnerships between professionals, patients and their carers or family members. Evidence highlights the coercive potential of admission in adult acute mental health, and the increased complexity associated with enhancing patient satisfaction and experience in these environments. This study aimed to explore the experiences of staff, service-users, and carers with admission in two adult acute inpatient mental health wards. A grounded theory (GT) approach was adopted such that theory was developed inductively through data collection and analysis. A total of twenty-two participants were interviewed, this included: 9 (40%) service-users, 10 (46%) members of staff and 3 (14%) carers. The substantive theory of admission produced was organised across three major categories, namely: a person-centred beginning; building relationships along the way and barriers to the service received. These interrelated factors determine the meaningfulness of the admission and have the power to hinder or facilitate improvement to a service-user’s wellbeing and their evaluation of being admitted to an inpatient mental health ward. The process of admission in an acute inpatient mental health environment can pre-determine satisfaction and experience with services. It is essential that person-centred ideals are maintained from the outset in order to maximise the quality of care received. This includes the implementation of strategies that facilitate involvement approaches and nurturing positive relationships to improve communication, concordance, shared decision-making and participation with care delivery.