Psychiatric Staff Members Research Articles

Psychometric properties of the Turkish version of Staff Attitude to Coercion Scale

BackgroundThe aim of this study was to provide the Turkish version of the Staff Attitude to Coercion Scale (SACS) and to determine its psychometric properties.MethodsThis is a descriptive and correlation design. The sample of this study consisted of 100 psychiatric staff members. The validity and reliability of the scale were assessed through translation procedures, content validity analysis, and confirmatory factor analysis (CFA). Reliability was further evaluated using Cronbach’s alpha and item-total score correlations.ResultsThe content validity index was found to be 0.93. The scale has a three-factor structure and the Cronbach’s alpha values of the subscales are 0.70 for offence, 0.87 for safety and 0.74 for treatment, respectively. The Cronbach alpha reliability coefficient of the total scale was found to be 0.86.ConclusionThe Turkish version of the SACS showed good reliability and validity, and confirmatory factor analysis revealed the same factor structure with three factors as in the original SACS.

Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities - Wyoming, 2020.

In the United States, approximately 180,000 patients receive mental health services each day at approximately 4,000 inpatient and residential psychiatric facilities (1). SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly within congregate residential settings (2-4), including psychiatric facilities. On April 13, 2020, two patients were transferred to Wyoming's state psychiatric hospital from a private psychiatric hospital that had confirmed COVID-19 cases among its residents and staff members (5). Although both patients were asymptomatic at the time of transfer and one had a negative test result for SARS-CoV-2 at the originating facility, they were both isolated and received testing upon arrival at the state facility. On April 16, 2020, the test results indicated that both patients had SARS-CoV-2 infection. In response, the state hospital implemented expanded COVID-19 infection prevention and control (IPC) procedures (e.g., enhanced screening, testing, and management of new patient admissions) and adapted some standard IPC measures to facilitate implementation within the psychiatric patient population (e.g., use of modified face coverings). To assess the likely effectiveness of these procedures and determine SARS-CoV-2 infection prevalence among patients and health care personnel (HCP) (6) at the state hospital, a point prevalence survey was conducted. On May 1, 2020, 18 days after the patients' arrival, 46 (61%) of 76 patients and 171 (61%) of 282 HCP had nasopharyngeal swabs collected and tested for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction. All patients and HCP who received testing had negative test results, suggesting that the hospital's expanded IPC strategies might have been effective in preventing the introduction and spread of SARS-CoV-2 infection within the facility. In congregate residential settings, prompt identification of COVID-19 cases and application of strong IPC procedures are critical to ensuring the protection of other patients and staff members. Although standard guidance exists for other congregate facilities (7) and for HCP in general (8), modifications and nonstandard solutions might be needed to account for the specific needs of psychiatric facilities, their patients, and staff members.

Diagnosing ADHD in Danish primary school children: a case study of the institutional categorization of emotional and behavioural difficulties

ABSTRACTThis study of institutional categorization reports an investigation of the practices, procedures and assumptions of psychiatric staff members when diagnosing ADHD. The main data upon which the study is based consist of transcribed audio recordings of meetings in the psychiatric clinic. Here children referred from primary schools on the suspicion of ADHD are attended to. The tools and procedures for gathering information are shown to produce decontextualized and individualizing representations of children’s conduct. The evaluation against a number of norms is found to be central. Finally, the discussions at the central team conferences are shown to reveal the use of hypothesis testing structured around a number of dichotomies, where isolated aspects of the child’s life are considered against each other as the source of the difficulties. Together, these practices have cumulative and profound consequences for how children’s problems come to be understood as caused by a neurological condition.

How do Psychiatric Staffs Approach Religiosity/Spirituality in Clinical Practice? Differing Perceptions among Psychiatric Staff Members and Clinical Chaplains

The present study examined the perception of contemporary German psychiatric staff (i.e., psychiatrists, psychotherapists and nurses) regarding their approach towards religious/spiritual issues in their clinical practice, and how clinical chaplains perceive attitudes and behaviors towards religiosity/spirituality of other psychiatric staff members. To answer these questions, two separate studies were conducted to include psychiatric staff and clinical chaplains. Curlin et al.’s questionnaire on Religion and Spirituality in Medicine: Physicians’ Perspectives was the main instrument used for both studies. According to the self-assessment of psychiatric staff members, most contemporary German psychiatric staff members are prepared and open to dealing with religiosity/spirituality in therapeutic settings. To some extent, clinical chaplains agreed with this finding, but their overall perception significantly differs from the staff’s own self-rating. Our results suggest that it may be helpful for psychiatric staff members and clinical chaplains to exchange their views on patients regarding religious/spiritual issues in therapeutic settings, and to reflect on how to apply such findings to clinical practice.

The approach to develop the effective training of new employees for the psychiatric staff members

The approach to develop the effective training of new employees for the psychiatric staff members

Person-environment interaction in a new secure forensic state psychiatric hospital.

This study examined the person-environment interaction effects of environmental design on ward climate, safety, job satisfaction, and treatment outcomes within a new high security forensic psychiatric facility. Participants included male and female adult psychiatric inpatients and staff members at different security stages. Data were collected once before and twice after the experimental group moved into the new building. The control group remained in the same facilities. Contrary to expectations, the new building had limited effects on the measured variables.

People Living in Community with a Severe Mental Illness: Utilization and Satisfaction with Care and Support

The object of this paper was to investigate the experiences of patients with severe mental illness (SMI) living in a community, including their utilization of care and treatment services. Psychiatric care and social services staff members were asked to make an inventory of those they served in two districts of Malmö, Sweden. Participants had to be over 18years of age and unable to manage their daily lives without help from others. Almost all of the 80 participants (95%) were under psychiatric care. A majority (86%) was receiving dental treatment, and 61% were supported by social services. Fifty-four percent of the participants received somatic care on an ongoing basis. Although the majority reported the care given as sufficient, one-third of this SMI population considered the care and support they received to be insufficient. Satisfying those who are dissatisfied with the care they are being given would be a significant challenge for service providers, since the unsatisfied are shown to have more difficult lives.

Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care

BackgroundPsychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients’ opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.MethodsAll staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.ResultsThe majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient’s right to self-determination and information, 2) respecting the patient’s integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.ConclusionsPaternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients’ right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.

Psychiatric nursing staff members' reflections on participating in group-based clinical supervision: A semistructured interview study

This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very limited impact on their clinical practice. Neither management nor the staff effectively prioritized clinical supervision, which added to a downward spiral where low levels of participation undermined the potential benefits of clinical supervision. The respondents embraced and used alternative forums for getting emotional support among peers, but maintained that formalized supervision was the only forum for reflection that could solve the most difficult situations.

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Variations in Smoking After Admission To Psychiatric Inpatient Units and Impact of a Partial Smoking Ban On Smoking and On Smoking-Related Perceptions

Smoke-related problems are particularly frequent in psychiatry, with additional concerns about iatrogenic effects on smoking in inpatient settings. To study the impact of a partial smoking ban on psychiatric patients and staff members. Using a pre- and post-intervention design, comparison of smoke-related characteristics and perceptions permitted changes after the introduction of smoking restrictions in 2002 to be studied. Ninety-one inpatients and 110 staff members participated in 2001 before intervention, and 134 inpatients and 85 staff members participated in 2005. After reinforcement of smoking restrictions, no significant changes in smoking prevalence or severity were observed, but there was a change in attitude for patients, more of whom were considering stopping. Daily cigarette consumption after admission changed significantly between 2001 and 2005. A marked decrease after three days in hospital as compared to the week before entry was observed in 2005 (p = 0.005), whereas in 2001 the trend was towards increase (p = 0.06). Furthermore, although the perception of quantity of smoke decreased (p = 0.0005) for both patients and staff, discomfort related to smoke remained unchanged. The introduction of a partial smoking ban had favourable effects on patients' cigarette consumption and attitudes, but more efforts need to be pursued.

Suicide in a Mental Health Setting: Caring for Staff, Clients, and Family Members

This is a reflection article presenting insights gained by a spiritual and religious caregiver through her experience of supporting and comforting individuals as they struggled with the societal, emotional, and spiritual issues resulting from a death by suicide, through her education in crisis management, and through her review of the relevant literature. The article outlines the needs of psychiatric patients, hospital staff, and family members when a suicide has occurred. The author's point of view is that open non-judgmental dialogue is essential for healing the intense grief often associated with suicide.

Do we agree about when patients are psychotic?

To investigate into the use of the term 'psychotic' as defined by ICD-10 or by the concept of impaired reality testing, among psychiatric staff members. Questionnaire investigation using 11 short case vignettes. Responses were received from 266 psychiatric staff members: psychiatrists, nursing staff and psychologists. When using ICD-10, patients were identified as psychotic with a sensitivity ranging from 90% to 55%. Specificity ranged from 60% to 75%. According to the concept of impaired reality testing, all three groups showed a sensitivity of about 60%, whereas specificity ranged from 65% to 50%. The combined use of the terms correlated significantly with responses regarding indication for legal detention for psychiatrists and nursing staff. In identifying a patient as 'psychotic' a broad concept of impaired reality testing was widely used particularly in cases with legal issues. Psychotic symptoms, however, were identified with high sensitivity and specificity.

The Relationship Between Staff Members' Working Conditions and Patients' Perceptions of the Treatment Environment

The psychosocial climate of inpatient units has proved to be related to both patient satisfaction and outcome. The aims of the study were twofold: to study the relationship between patient and staff satisfaction, and to study the relationship between the patients' perception of the treatment environment and the perceived working conditions of the staff. A total of 129 different patients completed the Ward Atmosphere Scale (WAS) and a General Satisfaction Index (GSI) at 11 time points between 1981 and 2000. Staff members completed the Working Environment Scale-10 (WES-10) and the GSI. Z-scores were calculated to describe the fluctuations in the WAS, WES-10 and the GSI subscale scores. The study revealed a strong correlation between patient satisfaction and staff satisfaction. Staff satisfaction correlated significantly with the WAS subscales of Practical orientation and Staff control. Furthermore, the study revealed a significant correlation between patient satisfaction and staff members' perception on the WES-10 subscale of Self-realization. This exploratory study revealed that the working conditions of staff are related to both patient satisfaction and the patients' perceptions of the treatment environment. A satisfactory working environment for psychiatric staff members seems important for the quality of care perceived by patients.

Multiprofessionelle systemisch-familientherapeutische Teamweiterbildung in der Akutpsychiatrie

How does the interdisciplinary cooperation of psychiatric staff members change after a multiprofessional family systems training programme? Semi-structured interviews were conducted with 49 staff members. Quantitative questionnaires were used to assess burnout (Maslach Burnout Inventory, MBI) and team climate (Team-Klima-Inventar, TKI). The multiprofessional training intensifies interdisciplinary cooperation. It results in an increased appreciation of the nurses involved and in a redistribution of therapeutic tasks between nurses, psychologists and physicians. Staff burnout decreased during the research period, while task orientation and participative security within teams increased. The multiprofessional family systems training appears suitable to improve quality of patient care and interdisciplinary cooperation and to reduce staff burnout.

Sources of psychiatric staff members' feelings towards patients and treatment outcome

This study had two purposes. The first was to assess to what extent psychiatric staff members' feelings towards patients in small psychiatric units could be attributed to (a) the individual staff member's habitual feeling style, (b) stable and consistent feelings towards individual patients (the patient's evocative style) and (c) the interaction between these two factors. The second purpose was to analyse the associations between the proportions of these factors and the average outcome for the patients in the units. The study was based on a previously presented model for analysing sources of staff counter-transference. The model specifies contributions from the different sources by using two-way ANOVAs. In the present study, data from 21 psychiatric treatment units for patients with psychosis and personality disorder were used. The results indicated that the staff members' individual habitual feeling style and the interaction between this habitual feeling style and the patient's evocative style contributed most to the variance in staff feelings. Patients' individual evocative patterns contributed less. Positive treatment outcome was mainly negatively associated with contributions to the staff counter-transference from these sources, implying that fixed patterns in personal feeling style or fixed reaction styles to individual patients had a negative influence on outcome.

Burnout and psychiatric staff's feelings towards patients

The concept of burnout describes a number of destructive aspects in work relationships. In this study, the relations between psychiatric staff members' feelings towards their patients and burnout were analyzed. Staff feelings were measured with a feeling checklist, and burnout with BM (Burnout Measure) and MBI (Maslach's Burnout Inventory). The staff at 28 treatment units rated their feelings towards the patients as a group. The results indicated that high burnout was associated with negative feelings and low levels of burnout with positive feelings towards patients. The correlation patterns for the different measures of burnout were somewhat different. BM had the strongest correlations with unhelpful and rejecting feelings towards patients, whereas Personal accomplishment, one dimension of MBI, was most strongly correlated with accepting and close feelings. The results were interpreted as opening for the question whether negative staff feelings towards patients most profitably can be seen as an aspect of burnout or whether these two phenomena should be distinguished clinically and theoretically.

Team leadership and patient outcomes in US psychiatric treatment settings

Previous studies suggest that psychiatric patients mirror the behaviors of the staff members who treat them, but there is little empirical evidence about how staff dynamics affect patients over time. The goals of this study were to examine associations between: (1) team leader discipline and mutual respect among treatment team members; and (2) mutual respect among team members and improvements in patient quality of life. Two models were tested on data from psychiatric treatment teams within the US Veterans Administration. The first examined associations between the discipline of each team's emergent leader and the level of mutual respect among that team's members. The second model tested associations between mutual respect among staff and changes over time in patients’ quality of life. The subjects for model 1 were psychiatric staff members ( n = 785 ) whose responses were aggregated for team-level analyses ( n = 78 ). Mutual respect was highest in social worker-led teams and lowest in physician-led teams. The subjects for model 2 were 1638 seriously mentally ill patients in 44 of the units examined in the first model. When mutual respect among staff was greater, patients improved more over time in their satisfaction with the quality of their housing, relations with families, social life, and finances. Together, these analyses imply that mutual respect may improve patient outcomes and that leadership by some disciplines may facilitate such dynamics. In general, leaders may consider learning from other disciplines’ strengths to improve their impact.

Psychiatric staff members' emotional reactions toward patients. A psychometric evaluation of an extended version of the Feeling Word Checklist (FWC-58)

The study evaluated the psychometric properties of an extended version of the Feeling Word Checklist (FWC-58), which measure the therapists' emotional reactions toward patients. Doctors, psychologists, nurses and aides from 23 wards in seven widely different psychiatric departments completed a total of 3012 forms. The original Feeling Word Checklist (Whyte CR, Constantopoulos C, Bevans HG. Br J Med Psychol 1982;55:187-201) was expanded with 28 feeling words covering more feelings of being invaded, idealized, devalued and of being secure. The rating scale was changed from a two-point (yes/no) scale to a five-point scale ranging from not at all (=0) to very much (=4). The factor analysis revealed ten factors with an eigenvalue equal or greater than 1.0. The two first factors were clearly the strongest but a two-factor solution did not satisfactorily reflect the data. The scree test indicated four to seven factors. We chose a seven-factor solution, as this seemed clinically most meaningful. Based on the factors we developed seven indices which were named: Important, Rejected, Confident, Bored, On guard, Overwhelmed and Inadequate. The subscales had satisfactory internal consistency and described meaningful emotional profiles of the different psychiatric wards and the individual patients. The seven subscales seem well worth to use in further research and in a clinical context.

The roles of knowledge and supervision in work with suicidal patients

Despite caregivers' impact on suicidal patients' compliance with treatment and suicide prevention, little is known about mental-health professionals' perceptions of work with suicidal patients. The roles of psychiatric staff's training and supervision in the care of suicidal patients were investigated by means of a postal questionnaire sent to a random sample of 1543 psychiatric staff members. The response rates were 71% for psychiatrists and 57% for nurses and assistant nurses. The responses of 53 psychiatrists, 164 nurses and 333 assistant nurses working with suicidal patients on a regular basis were compared and analysed using the Kruskal-Wallis test. Thirty-five per cent of the assistant nurses, 43% of the nurses and 74% of the psychiatrists who worked with suicidal patients on a regular basis perceived that they were sufficiently trained for this work, while 75% of the assistant nurses, 72% of the nurses and 34% of the psychiatrists received supervision in their work with suicidal patients. In spite of receiving supervision, nursing staff who perceived that they lacked training reported uncertainties in their work with suicidal patients to a larger extent than those who perceived that their training was sufficient. Uncertainties were significantly more prevalent among nursing staff than among psychiatrists. Basic and specific training in suicidology is needed and cannot be replaced solely by supervision, since psychiatric staff often have to deal with suicidal patients in emergency situations and must be able to rely on their own skills.