Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations

Abstract

High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long‐term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi‐structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.

Consultations for refractory cases in mental health services: a descriptive study

“…The CCE works with independent experts and provides customized advice and support. The CCE's view is that challenging behavior is not a patient factor per se, but should always be seen in terms of interaction with the patients’ physical and social contexts [ 3 , 7 ]. The main focus is on understanding the refractory situation from multiple perspectives and searching for dysfunctional patterns in the patient–​​healthcare team–next-of-kin triad.…”