Experiences of ward rounds among in-patients on an acute mental health ward: a qualitative exploration

Cappleman, Reed; Bamford, Zandra; Dixon, Clare; Thomas, Hayley

doi:10.1192/pb.bp.113.046409

Cited by 13 publications

(17 citation statements)

References 5 publications

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“…Another structure‐related aspect was the experience of safety of the setting. Patients expressed a strong need to feel safe in the acute care setting (Clarke et al, 2007; Kennedy & Fortune, 2014; Schmidt et al, 2018; Sebergsen et al, 2016; Wood & Pistrang, 2004), but primarily described unsafe environments that were experienced as prison‐like (Cappleman, Bamford, Dixon, & Thomas, 2015; Ezeobele, Malecha, Mock, Mackey‐Godine, & Hughes, 2014; Rose et al, 2015; Shattell et al, 2008) or, for those who were involuntarily admitted, even worse than prison (Robertson et al, 2015).…”

Section: Resultsmentioning

confidence: 99%

Experiences of acute care by persons with mental health problems: An integrative literature review

Schmidt

Umans

2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development‐oriented solutions for the improvements of these experiences. What the paper adds to existing knowledge? Acute care can be understood through patients’ experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post‐discharge well‐being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. What are the implications for practice? Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. Abstract AimThe provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure–process–outcome framework (Prospero ID: CRD42019116652). Method and resultsAn integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. DiscussionThe review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients’ satisfaction and their well‐being after discharge, were also predominantly experienced negatively. Implications for practiceUsing Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the ...

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Section: Resultsmentioning

confidence: 99%

Experiences of acute care by persons with mental health problems: An integrative literature review

Schmidt

Umans

2020

Psychiatric Ment Health Nurs

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“…This is consistent with recovery principles in inpatient care: Providing information about treatment and allowing service users to exercise choice in clinical decision‐making is important in mental health recovery (Johansson & Lundman, ). However, as has been acknowledged elsewhere, ward‐round procedures would benefit from changes that make the patient experience a priority (Cappleman, Bamford, Dixon, & Thomas, ).…”

Section: Discussionmentioning

confidence: 99%

Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives

et al. 2018

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Developing 'human' relationships at all levels of acute inpatient care continues to be an important challenge for clinical practice. Due to the distress of individuals and the constraints of the acute inpatient environment, psychologists need to be flexible and adaptable in delivering individual therapy. Making meaning and psychological formulation can give service users a sense of hope and empowerment, and can contribute to a shared understanding within the ward team of service users' difficulties.

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“…120 In addition, patients described how they were underprepared for care planning meetings and collaborative decision-making, which resulted in attendance becoming stressful and, in turn, led to an avoidance of meetings. 121,131,132 Patients' capacity for user involvement It has been argued that the average level of functioning as a result of the acuity of those occupying hospital beds is lower owing to the advent of deinstitutionalisation, thus reducing opportunities for service user involvement. 130 Other studies report similar views, in terms of both increased acuity of inpatients since the advent of deinstitutionalisation that diminish involvement in care planning, and decision-making including deficits in social skills and judgments, attention, concentration, communication difficulties and hypersensitivity towards interpersonal conflict.…”

Section: Patient Perceptionsmentioning

confidence: 99%

“…Similarly, themes of hierarchy and power as barriers to involvement appear in other studies of participation in ward rounds and decision planning. 123,132 Power differentials within the interdisciplinary team also lead to a lack of client-centred and collaborative treatment planning. 124 Outcomes of service user involvement in care planning and co-ordination Patient-centred care and involvement are often presented as overarching idealistic philosophies around which service improvements can be designed.…”

Section: Patient Perceptionsmentioning

confidence: 99%

“…Consultation with service users may have revealed patient anxiety linked to involvement in treatment conferences, as identified by others. 131,132 Outcomes (satisfaction, quality of life, hope, therapeutic relationship, perceived coercion and attitude towards and self-evaluation of recovery) were compared pre (n = 34) and post (n = 29) implementation of the changes. The results indicated no significant changes to subjective and functioning variables (e.g.…”

Section: Interventions That Redesign Service Deliverymentioning

confidence: 99%

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Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Experiences of ward rounds among in-patients on an acute mental health ward: a qualitative exploration

Cited by 13 publications

References 5 publications

Experiences of acute care by persons with mental health problems: An integrative literature review

Experiences of acute care by persons with mental health problems: An integrative literature review

Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

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