Experiences Of Psychiatric Care Research Articles

Conducting Women’s Groups in the Inpatient Unit: Empowering a High-Risk Population by Preventing Unplanned Pregnancies

AbstractIntroductionWomen with mental illness are 5x more likely to experience an unplanned pregnancy due to lower rates of effective contraception use; they also experience higher rates of adverse pregnancy outcomes. Education about women’s reproductive health and family planning are not routinely offered in inpatient mental health and addiction treatment settings.MethodsWeekly women’s groups on the inpatient psychiatry unit were led by psychiatry residents who were trained and provided a script. Groups focused on structured contraception education followed by an open-discussion format.Data collected included the percentage of women with history of contraception use, child protective service involvement, unplanned pregnancies, abortions, and percentage of women who found the group helpful. Special care was taken to discuss contraception as a tool for empowering women to make their own decisions about their contraceptive needs.ResultsThirteen sessions were conducted, and attendance among women on the inpatient unit was 42%. Out of the 32 patients who participated, 100% found the group beneficial and responded they would share information they learned with women outside the group. 26.4% self-identified as using contraception, 50% had unplanned pregnancy, 23.6% have had an abortion, and 26.4% have had child protective services involvement.Dissemination of contraceptive information in these women’s groups effectively led women to consider options that were available to them and seek contraceptive methods that were appropriate to their situation. Women reported they gained a better understanding of the medical, emotional, and financial implications of unplanned pregnancies. The groups were conducted in an open-discussion format that allowed women to participate in shared experiences; in many cases, the discussions were therapeutic. Feedback from patients and unit staff was positive. Many patients requested further groups to discuss issues women face, such as domestic violence and experiences as a mother.ConclusionsConducting women’s groups on the inpatient unit is critical in view of the poor access to healthcare that vulnerable women who seek inpatient psychiatric care experience. The groups on the inpatient unit are unique because it is often the only time these women have an opportunity for crucial, gender-specific preventative healthcare. These groups should further lead to appropriate referral and follow-up with primary care or women’s clinic providers.Ongoing efforts will be put forth to increase group attendance, to incorporate participation from unit staff, and to build this group into a resident curriculum for group therapy.FundingNo Funding

Erlebensbezogene Qualitätsmerkmale für die psychiatrische Behandlung: Vorstellung eines vorläufigen multivariaten Konstrukts

In the context of psychiatric care, user-generated measurement instruments may contribute to quality development and assurance. An explorative construct of experience-related quality components was developed in participative-collaborative cooperation that grasps the users’ experiences of psychiatric care. After developing the components using a grounded theory methodology, they were quantified, and their interrelations were investigated using a multidimensional scaling method to explore their internal cohesion. The construct makes it possible to separate structural from interpersonal requirements of the quality components. It further indicated which components are more feasible for the home treatment setting, and which ones for an institutional setting. The components and the construct may be perceived as first steps towards the development of user-generated quality indicators; however, further validation steps are necessary.

Nurses' Experiences of Psychiatric Care in Acute Care Units with an Open Door Policy.

Social distancing and the recent lock down due to COVID-19 has increased the feeling of disconnection, isolation, and suffering in vulnerable individuals and has brought forward questions regarding open acute care psychiatric units that cannot be answered by the literature. In Greece, there is no available research on how open ward environments are perceived and experienced by mental health professionals. The aim of the present study was to illuminate nurses' experiences of working in a public psychiatric hospital which traditionally operates with open doors. Eleven nursing care providers were interviewed, and thematic analysis was employed to explore their experiences of working in locked psychiatric acute care units. Participants described nursing care in units with an open door policy as "acceptance," "availability of staff," "real respect for the person," "ensuring patients' rights," "listening to the person," and "negotiation and not imposition." Trust in therapeutic relationships was perceived as greatly dependent on the trust being given to patients indirectly by the open door policy. Being trusted enhanced patients' self-determination and self-confidence leading to their empowerment. Containment of an acute mental health crisis took place through medication and meaningful discussions with patients and significant others rather than locking the door of the unit. Overall, meaningful care led to professional emancipation, but compassion fatigue narratives emphasized the need for continuous education, support and clinical supervision as necessary support for mental health nurses in a system of mental health provision often reduced to the point of crisis.

Association of School Engagement, Academic Difficulties and School Avoidance with Psychological Difficulties Among Adolescents Admitted to a Psychiatric Inpatient Unit

Mental illness is a pressing public health concern, particularly when the onset is during childhood or adolescence. Many youth admitted to hospital-based psychiatric care experience school-related difficulties. The purpose of this report was to explore the associations of academic difficulties, school avoidance and school engagement to total psychological difficulties and emotional problems. Youth completed surveys that included standardized measures of school-related factors and the Strengths and Difficulties Questionnaire while in hospital. Psychiatrists provided the primary diagnosis and diagnosis most responsible for the current admission. In total, 161 patients participated in this study (mean age 15 years, SD 1.4; 75% female). All three school-related variables were significantly associated with emotional problems; however, only school avoidance and academic difficulties were associated with total difficulties. School-related concerns were significantly associated with the severity of mental health symptoms. Patients may benefit from attention to school-related difficulties before discharge from psychiatric care that continues beyond school reintegration.

Patients' experiences of psychiatric care in emergency departments: A secondary analysis

The number of psychiatric emergencies presenting to EDs in the United States continues to rise. Evidence suggests that psychiatric ED care encounters can have less than optimal outcomes, and result in stress for providers.The primary aim of this study is to describe the perceptions of ED visits by persons experiencing emotional distress, identifying themes among these that may guide nursing interventions that minimize stress and optimize outcomes in the treatment of psychiatric emergency. This secondary analysis used a qualitative, phenomenological method to analyze a de-identified data set originally collected in a study of experiences of psychiatric emergency in a community based crisis management setting.Findings consist of three major themes: “Emergency rooms are cold and clinical”, “They talk to you like you're a crazy person”, and “You get put away against your will”. An overarching theme through all three is the influence of RN communication, both positive and negative, on patient perceptions of their ED encounters.While nurse–patient communication is basic to all areas of practice, it may be a low priority in the urgent and chaotic context of the ED. However, our findings suggest that increased attention to timely, empathic and validating communication and openness to the patient's reality may decrease severity of symptoms, optimize outcomes, and decrease provider stress.

The multifaceted vigilance - nurses' experiences of caring encounters with patients suffering from substance use disorder.

Nursing care is guided by a value base focusing on promoting dignity and health by means of the caring relationship. However, previous research has revealed that negative attitudes towards 'addicted' patients, as well as these patients' behaviour, can give rise to negative emotions such as frustration and disappointment among nurses. This can contribute to a judgmental and controlling attitude towards patients. To preserve order, nursing interventions focusing on creating structure and stability could be applied in a way that challenges caring values. This study aimed to describe how nurses' working in inpatient psychiatric care experience caring encounters with patients suffering from substance use disorder (SUD). This qualitative study is part of a clinical application project focusing on value-based care of patients suffering from SUD. Data were obtained during four reflective group dialogues with six nurses in a psychiatric hospital. The transcribed dialogues were subjected to latent qualitative content analysis. The analysis facilitated the organisation of the findings into a coherent pattern. A common thread of meaning was conceptualised as a theme labelled 'the multifaceted vigilance', describing how nurses strived to deliver good care, while at the same time being vigilant towards patients' behaviour as well as their own reactions to it. Within that theme, four categories described experiences related to different challenges nurses face in caring encounters. We suggest that this perhaps unavoidable aspect of caring encounters can be an asset. Thus, if acknowledged and subject to reflection, being vigilant could be understood as a strength enabling nurses to safeguard caring values, and to use their authority to promote patients' health and alleviate suffering.

Swedish Young Adults’ Experiences of Psychiatric Care during Transition to Adulthood

The number of young adults with mental illness and the need of psychiatric care has increased during the last decades. The aim of the study was to explore young adults’ experiences of psychiatric care during transition to adulthood. Individual interviews were conducted with 11 young adults and analysed according to Grounded Theory. The analyses results showed that support was a prerequisite for transition to adulthood and striving to reach recovery. By being encountered as a person and with a supportive environment, young adults can be motivated to continue care and be encouraged to express feelings.

A Self-Destructive Care: Self-Reports of People Who Experienced Coercive Measures and their Suggestions for Alternatives

Coercive measures are commonly used as a method of intervention, despite insufficient evidence for their effectiveness and benefits. The aim of this study was to describe how people who self-harm perceive alternatives to coercive measures in relation to actual experiences of psychiatric care. A total of 19 self-reports have been analysed with qualitative content analysis, resulting in three categories: a wish for understanding instead of neglect; a wish for mutual relation instead of distrust; a wish for professionalism instead of a counterproductive care. In conclusion, if the caregivers can understand and collaborate with the patient, there is seldom any need for coercive measures.

Inpatient Psychiatric Care Experience and Its Relationship to Posthospitalization Treatment Participation

This study used factor analysis of a Veterans Health Administration (VHA) survey to identify factors that measure satisfaction with inpatient treatment and to examine the factors' utility in evaluating treatment participation following discharge. The Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP) was mailed to 34,237 veterans who were discharged from inpatient to outpatient care in the VHA during fiscal year 2009 and was completed by 7,408 patients. A factor analysis of survey responses identified underlying I-SHEP factors and evaluated relationships between the factors, patient characteristics, and attendance at VHA mental health appointments within seven and 30 days of discharge. The factor analysis identified three domains of satisfaction: respect and caring by nurses-overall hospital impression; involvement and information about care; and respect and caring by doctors. These factors demonstrated good internal consistency (Cronbach's α=.93, .90, and .94, respectively) and accounted for a moderate amount of variance in patient responses (r2=.167). Only the care involvement and information factor was associated with participation in follow-up care: increased satisfaction (one standard deviation change in scale score) was associated with improved odds of a mental health visit within seven and 30 days of discharge (odds ratio=1.14 and 1.17, respectively, p<.01). After discharge, persons may not generalize satisfaction about the respect and caring shown by inpatient treatment teams toward their decision to attend outpatient care. Providing patients with information about treatment and involving them in care decisions during inpatient care may help facilitate the transition to outpatient settings.

Credibility clusters, preferences, and helpfulness beliefs for specific forms of psychotherapy

There is some evidence that the perceived credibility of specific forms of psychotherapy, beliefs about helpful and not-so-helpful interventions, and differential treatment preferences may influence both therapeutic alliance and outcome, at least in the short term. The present study explored whether distinct clusters exist, based on credibility ratings, and how these may be related to treatment preferences and beliefs about the helpfulness of specific interventions. Written descriptions of psychodynamic, cognitive, and cognitive-behavioural psychotherapy were rated by a random community sample with the 'normal' level of psychiatric treatment (n= 121), psychiatric outpatients with limited previous experience of psychiatric care (n= 118), and a group of psychiatric 'veterans' with long experience of psychiatric care (n= 48). Participants completed a questionnaire focusing on beliefs about the helpfulness of specific therapy components, rated the credibility of each form of psychotherapy, and ranked the alternatives in terms of preferences. Using cluster analysis, six distinct groups of participants were delineated. Some approached psychotherapy in an undifferentiated manner, tending to either embrace all or reject all of the methods examined. Others had differentiated ideas about the credibility of specific therapeutic approaches. These clusters were strongly associated with differential treatment preferences. They were also associated with helpfulness beliefs, type of psychological problems, previous experiences with psychotherapy, and gender. Analysis of the interactions among these factors revealed that the distribution across clusters was almost entirely accounted for by the helpfulness beliefs. For clinicians, it may be important to investigate the differential appeal of specific components of psychotherapy as well as entire therapy packages in individual cases prior to commencing therapy. For researchers, it may be important to consider whether outcome studies would become more informative by taking patients' beliefs and preferences into account.

A need for “good eyes”: Experiences told by patients diagnosed with psychosis

This study highlights experiences of psychiatric care described by patients diagnosed with psychosis. The aim was to investigate how patients, based on earlier experiences, described their wishes and needs regarding the psychiatric care system. Data comprised material from four focus groups; analysis used an inductive thematic approach. Relationships with staff emerged as a recurring theme. During periods of psychosis, patients needed staff to act as “parental figures,” providing care, safety, and help in dealing with overwhelming stimulation from the outside word. In the ensuing struggle to devise a livable life, the need for relationships recurred. In this phase, staff needed to give their time, provide support through information, and mirror the patient's capacity and hope. The patient's trials were described as threatened by a lack of continuity and non-listening professionals. It was important for staff to listen and understand, and to see and respect the patients’ viewpoints.

Association of Perceived Quality of Life and Oral Health Among Psychiatric Outpatients

The relationship between oral health and various aspects of quality of life has gone uninvestigated in psychiatric populations. The aim of this study was to investigate the correlation between the Oral Health Impact Profile-14 and subjective quality of life, perceptions about general health, and self-related variables. A structured interview constructed from validated instruments was administered to 113 consumers attending outpatient psychiatric care. A lower perceived oral health-related quality of life had a correlation with decreased ratings of subjective quality of life, general health disabilities, and chance and internal locus of control. Correlations between subjective and general health-related quality of life and oral health-related quality of life had not been detected in this group before. In order to improve mental health consumers' total perceived quality of life, oral health problems should be regularly addressed in the course of psychiatric care.

Foreign‐born and Swedish‐born families' perceptions of psychosis care

The aim of the study was to describe how foreign-born and Swedish born families living in Sweden perceive psychosis care. Eleven foreign-born and 15 Swedish-born family members were interviewed and the data were analyzed using a phenomenographic approach. The findings showed three main descriptive categories: taking responsibility, access to care, and attitudes to psychosis. The degree of responsibility in the family decreased if there was easy access to care and support from health-care staff. Knowledge of psychosis was considered to be important in order to counteract prejudiced attitudes in the family and the community. Foreign-born families did not want to be treated differently from Swedes and stressed the importance of finding ways to communicate despite communication barriers. Foreign-born families also were affected by their experiences of psychiatric care and different beliefs about psychosis in their home country. The results indicate how important it is that health-care staff members treat families on equal terms. It is necessary to take the time to identify how to communicate in a good manner and to identify families' previous experiences of and beliefs about psychosis care in order to help families face prejudice in society and to see beyond the psychosis.

Former patients' experience of psychiatric care: A qualitative investigation

In this study, 10 former patients' experiences of hospitalization are described using a qualitative approach. The informant group consisted of three men and seven women with different diagnoses and each with his or her individual experience of life as an inpatient. The aim of this study was to extend our understanding of former psychiatric inpatients' experience their time of admission to a psychiatric inpatients unit. Data were collected and analysed using a content analysis approach. From the former patients' descriptions, the following five themes emerged: being seen as a disease, striving for a sense of control in an alienating and frightening context, succumbing to repressive care, meeting an omniscient master, and care as a light in the darkness. In conclusion, the experience of psychiatric inpatient care could be interpreted and understood from former patients' narratives as a struggle for dignity in the face of discrimination and rejection.

Next of kin's conceptions of the quality of care in the psychiatric setting: A phenomenographic study

The next of kin play a decisive role in the care provided for patients. This and their unique experience of psychiatric care make it important to include them when defining quality of care. The aim of the present study was to describe how next of kin perceive the concept of quality of care in the case of psychiatric care. Twelve next of kin were included in a qualitative interview study and a phenomenographic approach was used for the analysis of the interviews. The next of kin described quality of care mainly from their own perspective but also to a large extent from the patient's perspective as well. Five descriptive categories resulted: dignity, security, participation, recovery, and health-promoting surroundings. Good relations and communication between staff, patients, and next of kin emerged as the central factors regarding the quality of psychiatric care. The next of kin asked for information about psychiatric illnesses and wanted to cooperate in the care. They avoid telling others about their family member's psychiatric illness because of a feeling of shame and guilt. Staff education regarding such feelings and stigmatization could be useful in furthering the understanding of the next of kin's distress and developing interventions to alleviate it. Clinical practice can be improved by guidelines and instruments developed on the basis of this study.

How do experiences of psychiatric care affect the perceived credibility of different forms of psychotherapy?

The study examined the influence of experience with psychiatric treatment on the perceived credibility of psychodynamic (PDT), cognitive (CT) and cognitive-behavioural psychotherapy (CBT). Written descriptions of the three forms of psychotherapy were rated by three groups of subjects with different levels of experience of psychiatric treatment, a random community sample with the normal level of psychiatric treatment (N=121), psychiatric out-patients with limited previous experience of psychiatric care (N=118), and a group of psychiatric veterans with long experience of psychiatric care (N=48). Besides a significant main effect of psychotherapy form on credibility, the interaction between psychotherapy form and level of previous experience of psychiatric care was highly significant. When respondents ranked the three forms of psychotherapy, there was an overrepresentation of preferences for CBT (and 'don't know' responses) among the general public, whereas the two patient samples were less indecisive and more often preferred PDT and, in particular, CT. Different forms of psychotherapy appear to have their own market segments, the size of which varies depending on previous experiences of psychological distress and psychiatric treatment.

'Please see and advise': a qualitative study of patients' experiences of psychiatric outpatient care.

Patient evaluations have become a sensitive indicator of service delivery and the quality of care. In this study they point to a lack of clarity surrounding the role of outpatient psychiatry in relation to primary care, raising questions about the effective integration of services for patients whose needs straddle the boundaries of primary and specialist care. Interviews with a consecutive series of 100 new referrals to two outpatient clinics compared their expectations of treatment with their subsequent experiences of psychiatric care. Patients' perception of progress was compared with clinical assessments. Follow-up interviews explored the reasons why patients tended to lapse from care. The majority of patients (74%) hoped for more effective responses to often long-standing problems which had previously been treated with limited success. In approximately one-third of cases this expectation was met; the remainder reported psychiatric intervention was less than helpful (20%), or were unable to say whether it had helped or not. Most of these patients perceived little difference between psychiatric supervision and treatment offered by their GP. Seemingly impersonal consultations and failure to engage with underlying problems contributed to the high drop-out rate. The findings indicate a relatively poor fit between the role of the outpatient service and the circumstances that commonly lead to psychiatric referral. The implications are considered in relation to alternative options for managing psychosocial problems within primary care.

First episodes of psychosis in Afro-Caribbean and White people. An 18-year follow-up population-based study.

There have been few prospective studies of the long-term outcome of psychosis in people of Afro-Caribbean origin in the UK. We followed-up a population-based, consecutive series of 34 Afro-Caribbean and 54 White people with psychosis who had been extensively investigated during their first admission in 1973/74. Diagnoses were made by direct interview using the Present State Examination at both first admission and follow-up. Ninety-seven percent of the original sample were traced. A slightly greater proportion of the Afro-Caribbean people were assigned to the S+ Catego class (schizophrenia), both on first assessment and at follow-up. No difference was found between the two groups in the consistency of diagnosis over the 18 years or in the proportion of patients considered psychotic but Afro-Caribbean people tended to have fewer negative symptoms at follow-up. There were striking differences between the two groups in their experience of psychiatric care; Afro-Caribbean people were more likely to have been readmitted, to have experienced longer hospitalisations, and to have undergone more involuntary admissions than their White counterparts. Afro-Caribbean people who met clinical and research criteria for schizophrenia had a less satisfactory experience of, and response to, psychiatric care over 18 years than their White counterparts.

Influence of patient and hospital factors on consumer satisfaction with inpatient mental health treatment.

This study examines patient- and facility-related determinants of satisfaction with inpatient mental health services. A random sample of veterans discharged from Department of Veterans Affairs inpatient units with primary diagnoses of a psychiatric or substance use disorder (N = 13,574) were mailed a 73-item questionnaire that addressed aspects of their recent hospital experience. Multiple regression analysis was used to evaluate the relationship between patient and hospital characteristics and both the likelihood of responding to the survey and aspects of satisfaction measured by 14 subscales. A total of 4,968 veterans, or 37 percent, mailed back responses to the questionnaire. Respondents were older than nonrespondents and were more likely to be white and married and to have nonpsychotic disorders other than substance use disorders. The strongest and most consistent predictors of satisfaction were older age and better self-reported health. Longer length of stay was also associated with greater satisfaction on a majority of subscales. Findings among female and minority veterans were mixed across measures. Large facilities and facilities that specialize in mental health treatment had lower levels of satisfaction than others. Patient characteristics accounted for more of the variance in satisfaction than did facility characteristics. Older and healthier patients reported greater satisfaction with mental health care services. Accurate comparison of patient satisfaction between facilities requires that adjustments be made for differences in patient characteristics. Large facilities may need to make special efforts to personalize their services.

Suicide in psychiatric care as seen by the survivors

Members of suicide survivor organizations are likely to have unique experiences of the psychiatric care of suicidal persons. The present study represents an attempt to provide a feedback of such experiences to the caregivers, through a collaborative research project with the Swedish organization for suicide survivors, the SPES. A questionnaire was mailed to the then 110 members of SPES, containing 25 general questions concerning their membership in the organization and their possible willingness to participate in a research project. Fifty-six per cent of the members returned the questionnaire. One year later a second questionnaire was mailed to the members, who had now increased to 150, with questions focusing on possible experiences of psychiatric care of their dead relatives. Sixty per cent answered, and two-thirds reported such experiences. Among those willing to be interviewed, we contacted 20 subjects who were judged, on the basis of their responses and comments to the questionnaires, to be represent...