Experience Of Inpatient Care Research Articles

Rather a Competent Practitioner than a Compassionate Healer: Patients’ Satisfaction with Interactions in Psychiatric Inpatient Care

Interactions with staff are important aspects in patients’ experiences of psychiatric inpatient care (PIC). This study aimed to evaluate patients’ satisfaction with their interactions with PIC staff and whether sociodemographic factors, depression and anxiety symptoms were associated with their perceptions of these interactions. In this cross-sectional study, we collected data from 84 patients receiving inpatient care in three psychiatric settings in Sweden. The patients’ perceptions of interactions with staff and self-reported degrees of depression and anxiety were evaluated through questionnaires. Overall, patients were satisfied with the patient–staff interaction. However, significantly higher scores were related to staffs’ practical competence than to their compassion. Older patients reported significantly more satisfaction than younger patients with their most recent meeting with staff. Tailored nursing interventions may improve staff’s compassionate capacity. Further research in larger samples is needed to improve our understanding of the factors associated with how patients perceive their interactions with staff.

Exploring the experiences of having Guillain-Barré Syndrome: A qualitative interview study.

BackgroundGuillain‐Barré syndrome (GBS) is a rare inflammatory disorder affecting the peripheral nerves. Although typically there is full neurological recovery, some people continue to experience residual physical, psychological or social problems longer term. Evidence describing the experiences of people with GBS is limited.ObjectiveWe aimed to explore the experiences of people with GBS in the UK.DesignWe used qualitative (face‐to‐face and telephone) interviews to explore experiences of people with GBS. Audio‐recorded data were transcribed verbatim and analysed using the Framework Method supported by NVivo 11.Setting and ParticipantsWe purposively recruited a sample of 16 volunteers with a prior diagnosis of GBS of varying age, sex, ethnicity, location, marital status, time since diagnosis and length of hospital stay to maximize differences in experience. Interviewees were required to have been discharged from hospital, able to give informed consent, able to speak and understand English and currently resident in the United Kingdom.ResultsThe key themes arising from the analysis were as follows: the importance of early diagnosis; the experiences of inpatient care; the importance of active support for recovery; the need for communication throughout the course of the illness; the need for greater awareness, knowledge and provision of information by health‐care staff; and path to achieving function.ConclusionThis is the first qualitative study exploring experiences of people with GBS in the UK through their whole illness journey from onset to recovery. The findings contribute to our understanding of the experiences and support needs of people recovering from GBS.

A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences.

Achieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge. We reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO. We included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles. Two researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings. We identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices. Both pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff.

To Improve the Inpatient Experience, Invest in the Human Side of Health Care.

Hospitals increasingly allocate substantial resources to improve the inpatient care experience: chief experience officers, overhauled food menus, parking discounts, and Disney customer service training for staff are just a sampling of the various investments hospitals have made in recent years to increase satisfaction and experience scores.1,2 Attention to the patient experience is important not just as a competitive business strategy but as an ethical practice; children and their parents expect to receive appropriate, respectful, and timely care; they expect to be treated in a safe and clean environment; and in the vast majority of instances, they expect to leave the hospital in better health than when they arrived. However, identification of specific modifiable mechanisms influencing formal parent and child ratings of the pediatric inpatient experience has lagged until now. In an analysis of 17 727 parent-submitted Child Hospital Consumer Assessment of Healthcare Providers and Systems surveys on care in 69 hospitals across 34 states, Feng et al3 found that of 10 items, 2 were consistently and strongly associated … Address correspondence to Heather L. Tubbs-Cooley, PhD, RN, FAAN, College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus OH 43210. E-mail: tubbscooley.1{at}osu.edu

Balancing the Inpatient-Nurse Relationship in Anorexia Care

Background: Nurses play a central role in the treatment of inpatients with anorexia, where bonding is a key factor. The inpatient-nurse relationship is based on a confident alliance characterized by important factors such as trust, confidentiality, responsiveness, genuineness, and consistency. Aim and Research Question: The aim of this study was to describe patients’ in-depth experiences of their relationship with nurses when hospitalized for anorexia. The research question was: How do women hospitalized due to anorexia nervosa experience the nurse-patient relationship? Method: A hermeneutic approach with in-depth interviews was employed. Five women with previous experience of inpatient care for anorexia were interviewed. Findings: The findings summarized how the women experienced the relationship with professional nurses in a ward characterized by a high degree of structure. The main theme Balancing feelings of emotional contradictions in the patient-nurse relationship was described by two sub-themes; Opening up for a care relationship in a rigid and structured ward atmosphere and Fluctuating in a paradox of conflicting feelings. Discussion: From the patients’ perspective, balancing the patient-nurse relationship when an inpatient involves conflicting emotional challenges. Structured interventions are perceived as effective by the patients, although they may be ambivalent about them. Therefore, a good relationship depends on the establishment of emotional and stable interaction with the nurses. Implications for Nursing Practice: Patients need interventions based on safe and competent quality care. A hermeneutic approach may improve the nurses’ ability to meet these patients in their lifeworld and establish a confident relationship. Special education related to anorexia care should be a priority in nursing.

Social media ratings of nursing homes associated with experience of care and \u201cNursing Home Compare\u201d quality measures

BackgroundSocial media platforms offer unique opportunities for patients and families to provide real-time feedback on their healthcare experiences. Consumer-generated social media ratings of hospitals tend to reflect the more subjective aspects of inpatient care experiences; however, evidence on nursing home care is extremely limited.MethodsWe collected consumer-reported 5-star ratings of Maryland nursing homes posted from July 2015 to July 2017 on 4 popular social media or online review sites (Facebook, Yelp, Google Consumer Reviews, and Caring.com). We determined if the average score of social media ratings was associated with experience-of-care ratings derived from survey of family members or other responsible parties of nursing home residents, and with “Nursing Home Compare” (NHC) 5-star ratings and individual quality measures.ResultsOne hundred ninety-six out of 206 nursing homes in Maryland were reviewed on at least one site and thus had one or more star ratings posted. The overall ratings were 3.11 on average on these sites and 3.03 on the NHC website, with a Pearson correlation of 0.41 (p < 0.001) between the 2 sets of ratings. The correlations between the social media rating and survey-based experience-of-care ratings ranged from 0.40 to 0.60, and the correlations between the social media rating and individual NHC quality measures of citations, nurse staffing, and complaints were about 0.35 (in absolute values). The social media rating also predicted well NHC and experience-of-care measures after adjusting for nursing home covariates and market competition.ConclusionsThe 5-star ratings collected from 4 social networking sites was correlated with and predictive of the NHC and survey-based experience-of-care measures for Maryland nursing homes.

The Association Between Residency Learning Climate and Inpatient Care Experience in Clinical Teaching Departments in the Netherlands.

To examine the association between residency learning climate and inpatient care experience. The authors analyzed 1,201 evaluations of the residency learning climate (using the Dutch Residency Educational Climate Test questionnaire) and 6,689 evaluations of inpatient care experience (using the Consumer Quality Index Inpatient Hospital Care questionnaire) from 86 departments across 15 specialties in 18 hospitals in the Netherlands between 2013 and 2014. The authors used linear hierarchical panel analyses to study the associations between departments' overall and subscale learning climate scores and inpatient care experience global ratings and subscale scores, controlling for respondent- and department-level characteristics and correcting for multiple testing. Overall learning climate was not associated with global department ratings (b = 0.03; 95% confidence interval -0.17 to 0.23) but was positively associated with specific inpatient care experience domains, including communication with doctors (b = 0.11; 0.02 to 0.20) and feeling of safety (b = 0.09; 0.01 to 0.17). Coaching and assessment was positively associated with communication with doctors (b = 0.22; 0.08 to 0.37) and explanation of treatment (b = 0.22; 0.08 to 0.36). Formal education was negatively associated with pain management (b = -0.16; -0.26 to -0.05), while peer collaboration was positively associated with pain management (b = 0.14; 0.03 to 0.24). Optimizing the clinical learning environment is an important step toward ensuring high-quality residency training and patient care. These findings could help clinical teaching departments address those aspects of the learning environment that directly affect patient care.

How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia

Background: The incidence of young stroke is increasing worldwide. However, young adults are inadequately supported in their recovery by a system of stroke care in which the older patient is the majority consumer.Purpose: To examine the unmet needs of younger stroke survivors in inpatient and outpatient healthcare settings and identify opportunities for improved service delivery.Materials and Methods: In-depth semi-structured interviews were undertaken with 19 participants aged 18–55 at the time of their first-ever stroke and inductively analysed using a rigorous qualitative descriptive approach.Results: Many unmet care needs were identified within three emergent themes: inadequately addressed psycho-emotional and cognitive needs after young stroke; isolation from lack of information and structured support; and failure to deliver age-relevant patient-centred care. These themes were further divided into sub-themes and the sub-themes were named in a manner to signpost the way forward for young stroke care.Conclusions: This study provides new insights into the experience of inpatient and outpatient stroke care by younger stroke survivors and outlines possible improvements for clinical practice. Future research should evaluate the effect of targeted strategies to support younger adults after stroke.Implications for rehabilitationPost-stroke rehabilitation might be improved by providing more support for the non-physical effects of stroke (e.g., psycho-emotional support, cognitive rehabilitation).Younger stroke survivors may also benefit from a long-term community care plan and longer-term rehabilitation.Patient-centered rehabilitation and education about self-management interventions appear to be important areas for further development.Future research is required to evaluate the effect of targeted strategies to support younger stroke survivors, as well as identify the needs of younger adults with post-stroke communication impairment.

Inpatient care experiences differ by preferred language within racial/ethnic groups.

ObjectiveTo describe differences in patient experiences of hospital care by preferred language within racial/ethnic groups.Data Source2014‐2015 HCAHPS survey data.Study DesignWe compared six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within applicable subsets of five racial/ethnic groups (Hispanics, Asian/Pacific Islanders, American Indian/Alaska Natives, Blacks, and Whites). We measured patient‐mix adjusted overall, between‐ and within‐hospital differences in patient experience by language, using linear regression.Data Collection MethodsSurveys from 5 480 308 patients discharged from 4517 hospitals 2014‐2015.Principal FindingsWithin each racial/ethnic group, mean reported experiences for non‐English‐preferring patients were almost always worse than their English‐preferring counterparts. Language differences were largest and most consistent for Care Coordination. Within‐hospital differences by language were often larger than between‐hospital differences and were largest for Care Coordination. Where between‐hospital differences existed, non‐English‐preferring patients usually attended hospitals whose average patient experience scores for all patients were lower than the average scores for the hospitals of their English‐preferring counterparts.ConclusionsEfforts should be made to increase access to better hospitals for language minorities and improve care coordination and other facets of patient experience in hospitals with high proportions of non‐English‐preferring patients, focusing on cultural competence and language‐appropriate services.

Voices of PostpartumWomen: Exploring CanadianWomen's Experiences of Inpatient Postpartum Care.

To explore and understand postpartum inpatient experiences in a Canadian context. Inpatients at BC Women's Hospital & Health Centre were invited to complete a questionnaire during their postpartum stay. Completed responses were obtained from 178 women, representing 44% of all postpartum inpatients during the survey period. Overall, women had positive experiences during their postpartum stay: 93% rated their experience as "excellent" or "very good"; 78% felt that nurses never seemed rushed or too busy to care for them; and 85% of women found the nurses to be very helpful with breastfeeding. Two-thirds of the women had concerns about going home that were related to infant feeding, feeling overwhelmed, and not knowing how to settle their baby. Other areas of improvement pertained to the hospital environment being less restful than desired. Certain groups needed additional support, such as primiparous women, women who had Caesarean deliveries, and women from certain ethnic groups. This exploration of women's inpatient postpartum experiences in a Canadian hospital provides valuable information for improving service delivery, including assessing hospital routines, providing information/education, and improving discharge planning. Given that postpartum experiences are not uniform across demographic groups, an alternative or augmented approach to postpartum care may be warranted for some women.

Perceptions and experiences of caregivers of severely malnourished children receiving inpatient care in Malawi: An exploratory study.

Severe acute malnutrition (SAM) affects approximately 18 million children under the age of five and is associated with more than 500 thousand deaths per year. Existing research has indicated that a high number of caregivers of children admitted for inpatient treatment of SAM experience psychological distress, depressive symptoms, and suicidality. However, no published studies in Malawi have been undertaken to qualitatively explore caregivers' perceptions and experiences regarding their children's malnutrition and inpatient treatment. To explore caregivers' perceptions and experiences surrounding childhood acute malnutrition and the experience of inpatient care in Malawi. Interviews were conducted utilising a semi-structured topic guide and were coded using thematic analysis. Caregivers (N=30) gave informed consent to participate in interviews. Caregiver understanding and perceptions of their children's illness varied. Some caregivers identified a physical cause, with a minority identifying lack of dietary protein. Other narratives were around characteristics of the infant, other circumstantial events and religious and spiritual influences. One-third of caregivers described their own health difficulties and marital and relationship stressors. Challenges such as poverty, lack of access to food, poor food variability and competing demands for caregiver time were explained. Both positive and negative experiences of family and community support and hospital-based care were reported. The themes identified contribute to a greater contextual understanding of the multifactorial and integrated approaches required to address malnutrition. This study indicates that healthcare providers need to take a multi-faceted view of malnutrition and be aware of the many factors that may influence healthcare experience and response to treatment. Acknowledging pluralistic belief systems may improve engagement with care. This demands a broader appreciation of perceptions and experiences of malnutrition, hospital-based care, sources of support and stressors within the caregiver, family and community environment as well as consideration of social determinants such as poverty and how these influences present within a clinical context.

‘In some ways it all helps but in some ways it doesn't’: The complexities of service users’ experiences of inpatient mental health care in Australia

Recovery-oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in-depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery-oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users.

Family Experiences of Pediatric Inpatient Care in Alberta, Canada: Results From the Child HCAHPS Survey.

Patient experience surveys provide feedback regarding the perceived quality of health care services. Unfortunately, many surveys have tended to be focused on an adult population, resulting in a lack of validated instruments for pediatric populations. In 2015, Alberta Health Services implemented the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey. Our objectives in the current study were to describe the use of the Child HCAHPS survey in Alberta, Canada, and to present preliminary results. Parents and/or guardians completed a modified version of the Child HCAHPS survey via telephone within 6 weeks of their child's discharge from 1 of 14 hospitals (2 stand-alone pediatric and 12 adult). For each of the survey composites and stand-alone items, the mean "top box" score is reported, reflecting the most positive response option. Overall results were reported, as were comparisons in top box scores between stand-alone pediatric and adult facilities. From October 2015 to March 2017, 3389 surveys were completed. Overall, mean top box scores ranged from 41.5% ("preventing mistakes and helping you report concerns") to 95.8% ("keeping you informed about your child's care in the emergency department"). Stand-alone pediatric hospitals tended to outperform the adult ones, particularly in global ratings of care, parental involvement in decision-making, and communication between parents and providers. With our findings, we indicate areas in which pediatric inpatient care is being delivered well, as well as targeted areas for quality improvement. Our results may be highlighted in future comparisons among others who have adopted the Child HCAHPS.

Patient experience of a psychiatric Mother Baby Unit.

BackgroundMothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy.MethodThis study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for mother-infant pairs during the course of admission and three months post-discharge.ResultsForty-five people participated in the study. High rates of satisfaction were described. Strengths of the service–as perceived by mothers–included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers’ distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant inter-ethnic differences were not apparent.ConclusionsThe experience of inpatient care can have lasting influence on recovery and wellbeing. Employing a Māori model of health broadened the holistic nature of enquiry. The approach and timing taken in seeking the views of participants’ yielded different information, all of which is of value to service evaluation and refinement. The findings suggest that keeping mothers and infants together during health service utilisation such as MBUs should be a priority for policy makers and service designers. This approach is consistent with Māori values, combining the importance of whānau relationships (kinship), wairua (spiritual connectivity), hinengaro (the mind) and tinana (physical health). These findings suggest that ‘holistic care’–in this case following a Māori holistic health model–is important in mental health settings.

The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study.

BackgroundMedical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients’ length of stay (LOS), quality and safety of care, and patient experiences with the provided care.MethodsIn a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients’ LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients’ experiences with the provided care.ResultsData on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (β 1.20, 95%CI 0.99–1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (β 0.49, 95% CI 0.22–0.76, p = .001).ConclusionsThis study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences.Trial registrationClinicalTrials.gov Identifier: NCT01835444

Improving patient experiences of mental health inpatient care: a randomised controlled trial.

Poorer patient views of mental health inpatient treatment predict both further admissions and, for those admitted involuntarily, longer admissions. As advocated in the UK Francis report, we investigated the hypothesis that improving staff training improves patients' views of ward care. Cluster randomised trial with stepped wedge design in 16 acute mental health wards randomised (using the ralloc procedure in Stata) by an independent statistician in three waves to staff training. A psychologist trained ward staff on evidence-based group interventions and then supported their introduction to each ward. The main outcome was blind self-report of perceptions of care (VOICE) before or up to 2 years after staff training between November 2008 and January 2013. In total, 1108 inpatients took part (616 admitted involuntarily under the English Mental Health Act). On average 51.6 staff training sessions were provided per ward. Involuntary patient's perceptions of, and satisfaction with, mental health wards improved after staff training (N582, standardised effect -0·35, 95% CI -0·57 to -0·12, p = 0·002; interaction p value 0·006) but no benefit to those admitted voluntarily (N469, -0.01, 95% CI -0.23 to 0.22, p = 0.955) and no strong evidence of an overall effect (N1058, standardised effect -0.18 s.d., 95% CI -0.38 to 0.01, p = 0.062). The training costs around £10 per patient per week. Resource allocation changed towards patient perceived meaningful contacts by an average of £12 (95% CI -£76 to £98, p = 0.774). Staff training improved the perceptions of the therapeutic environment in those least likely to want an inpatient admission, those formally detained. This change might enhance future engagement with all mental health services and prevent the more costly admissions.

Variation in Family Experience of Pediatric Inpatient Care As Measured by Child HCAHPS.

Making national comparisons of family experience of inpatient pediatric care has been limited by the lack of a publicly available survey. The Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services commissioned development of the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey to address this gap. Using Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, we measured performance of hospitals in a national field test. We analyzed 17 727 surveys completed from December 2012 to February 2014 by parents of children (<18 years) hospitalized at 69 hospitals in 34 states. For each of 18 survey measures, we calculated a case-mix-adjusted hospital "top-box" score (ie, percentage of respondents selecting the most positive response option). We quantified variation across hospitals by estimating hospital-level SDs for each item with a hierarchical linear probability model. We examined associations of family experience with patient, parent, and hospital characteristics. We compared aggregate performance on each measure across participating hospitals. Mean hospital top-box scores ranged from 55% ("Preventing mistakes and helping you report concerns") to 84% ("Keeping you informed about your child's care in the emergency department"). The mean for overall rating of hospital stay was 73% (SD 7%). "Quietness of hospital room" scores varied most across hospitals (SD 8%). Overall top-box scores were higher for freestanding children's hospitals (74%) and children's hospitals within a hospital (73%) than for pediatric wards within hospitals (68%, P = .007). Family experience of pediatric inpatient care shows substantial room for improvement and varies considerably across hospitals and measures.

How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians

BackgroundCarers are family members or friends who support people with a mental health problem without being paid. Carer involvement in mental health treatment has been consistently supported by research evidence and promoted by policies but its implementation rates are poor. Particularly when patients are treated in inpatient units, carers often report being left without information or being excluded from decisions about treatment. In this study we have explored, along with staff perspectives, views of patients and carers who had a recent experience of inpatient mental health care on how to improve the implementation of carer involvement in inpatient care.MethodsSixteen focus groups were held with carers, patients and clinicians in London, United Kingdom. We included staff working in inpatient units and patients and carers who had experience of inpatient care in the last five years. Data from focus groups were analysed using thematic analysis.ResultsEighty six participants in total (31 service users, 22 carers and 33 clinicians) attended the focus groups. Participants identified that generally, carer involvement should happen as soon as possible after admission, although this may be challenging in some cases. Carer involvement should include receiving information, participating in decisions about care and discharge and receiving emotional support by staff. When carers are involved, their personal knowledge of the patient’s condition should be utilised. Challenges to carer involvement may include problems with identifying carers during a mental health crisis, obtaining valid patient consent, sharing appropriate information, and contacting and engaging carers. Additionally, it was perceived that all the ward staff need to be actively engaged in order to make carer involvement happen and this cannot be left only to specifically trained clinicians.ConclusionsThese findings identify basic components that all family interventions in inpatient units should have. Further studies are needed to explore how and if purposively designed clinical interventions can improve carer involvement in inpatient treatment and, consequently, patient outcomes.

Suicidal patients\u2019 experiences regarding their safety during psychiatric in-patient care: a systematic review of qualitative studies

BackgroundIn-patient suicide prevention is a high priority in many countries, but its practice remains poorly understood. Patients in a suicidal crisis who receive psychiatric care can provide valuable insight into understanding and improving patient safety. The aim of this paper was therefore to summarize the qualitative literature regarding suicidal patients’ in-patient care experiences. The following question guided the review: How can we describe suicidal patients’ experiences regarding safety during psychiatric in-patient care?MethodsSystematic searches were conducted in the MEDLINE, Academic Search Premier, CINAHL, SOCINDEX and PsycINFO databases, identifying 20 qualitative studies on suicidal patients and their psychiatric in-patient care experiences. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, synthesized via thematic analysis and subjected to quality appraisals.ResultsPatients described safety as “feeling safe”, and three components, i.e., connection, protection and control, were vital to their experiences of safety. Fulfilling these needs was essential to patients recovering from suicidal crises, feeling safe during encounters with health care professionals and feeling safe from suicidal impulses. Unmet needs for connection, protection and control left patients feeling unsafe and increased their suicidal behaviour.ConclusionOur review addresses the importance of adopting a wider perspective of patient safety than considering safety solely in technical and physical terms. Safety for the suicidal patient is highly dependent on patients’ perceptions of their psychological safety and the fulfilment of their needs. The three patient-identified factors mentioned above – connection, protection and control – should be considered an integral part of patient safety practices and should form the basis of future efforts to understand the safety of suicidal patients during psychiatric in-patient care.

Quels patients inclure et quelles échelles utiliser dans un essai clinique ? Les études qualitatives en perspective

An inventory on the two critical dimensions that structure the Randomized Controlled Trial in Psychiatry, namely the definition of inclusion criteria for eligible patients for testing and the choice of psychometric methods of pathology assessment and its evolution during the experiment, considers the importance of increasingly numerous and precise international recommendations. Taking into account the formal constraints of industrial, questioning the cultural differences of the methodological approach of the tests, meeting the requirements of feasibility and ever increasing security, frequent cumbersome procedure often contrasts with the modest nature of the results. A better definition to include patients in randomized trials is desirable and it asks to return to the clinic studying the expectations of patients and their response to the therapeutic situation. Excessive standardization otherwise required for ensuring the objective nature of the assessment hampers the collection of original and varied clinical features of importance in the further definitions of indications. On the way to a resumption of the single case study, we can expect from qualitative methods applied to small groups of subjects, optimization principles of patient selection for the upcoming randomized trial and greater chance to address the relevant details of clinical response to the therapeutic situation. This is what has led to the discovery of psychotropic drugs and which is involved in the various modalities of the qualitative approach. For example, and beyond the exploration of clinical drug effects, the study of the experience of psychiatric inpatient care in the Healing Garden, conducted on a small group and on the basis of the narrative analysis of their experience, notes several operating thematic dimensions: a reduction in the perception of symptoms of the disease, the impression of regaining a foothold into reality, the interest of a differently perceived doctor-patient relationship, the advantage of renewed power to act and the recognition of the importance of support from others, patients recovering somehow « vitality » of touch with reality. This suggests the possibility to establish an appropriate rating scale for such a specific therapeutic situation and to provide a more accurate and efficient recruitment for a comparative objective demonstration. Moreover, this construction of meaning reinforces the therapeutic benefit of treatment in Healing Garden and offers new dimensions for research.