Feeling safe with patient‐controlled admissions: A grounded theory study of the mental health patients' experiences

Abstract

Aim To develop a grounded theory of the patients' experiences with patient‐controlled admission. Background Research indicates a potential for involving patients in mental health care, but there is a need to develop and investigate new approaches in health services. Patient‐controlled admission is an option for patients with severe mental disorders to refer themselves for a brief hospital admission when needed and thus avoid the usual admission procedure. Design Classic grounded theory with generation of a theory based on the constant comparative method for data collection and analysis. Methods Field observations and interviews with 26 mental health patients. The COREQ checklist was followed. Results We found that patient‐controlled admission induced safety by providing faster access to help and thus preventing further deterioration of symptoms. Being self‐determined, achieving calmness and receiving care with support and guidance from professionals during admission contributed to the sense of safety. The familiarity with the mental health professionals in their related units supported the patients in managing their situation. On the other hand, feelings of being overlooked by the professionals and experiencing uncertainty could undermine patients' feeling of safety. Conclusions We demonstrate that safety is a focal point for patients when receiving help and support in mental health care. Patient‐controlled admission can induce a feeling of safety both at the hospital and at home. Patients' self‐determination is strengthened, and brief admissions give them an opportunity to handle what they are currently struggling with. Professionals can support patients in this, but their actions can also reduce patients’ feeling of safety. Relevance to clinical practice Patient involvement can be introduced in psychiatry, and even severely ill patients seem to be able to assess their own condition. Feasibility may, however, be associated with the attitude and behaviour of the professionals in clinical practice.

Patient-controlled admission contracts: a longitudinal study of patient evaluations

“…This indicates that the shifting of gatekeeping powers to the patient and away from professionals and bureaucratic procedures is important. This fits well with the documented importance to be in control of aversive events, that clinical populations have lower level of control than non-patients [16], and that patients report safety as the core of the PCA benefit [17]. The favorable evaluation of PCAs in our study questions whether the possible gains from professionals symptom evaluations in the gatekeeping process should be considered more important than the possible gains from giving mental health patients more safety through controlling their own admissions.…”

“…It is reasonable to think that more socializing stimulates improvement, but stable differences in patients' social style may also confound the observed relation. A recent qualitative study of patients with a PCA-contract found that they felt relating with staff were helpful, and if they felt ignored or pushed aside, they tended to withdraw from contact with staff [17]. This indicates that emphasizing and strengthening patient socializing might indeed improve outcome.…”

A new measure of feeling safe: Developing psychometric properties of the Neuroception of Psychological Safety Scale (NPSS).

“…In medical settings concern for the sense of safety experienced by patients (Ellegaard et al, 2020; Morton, 2020) and when exposed to disempowering aspects of care (Morton et al, 2020) is of interest in terms of quality of experience and speed of recovery. In one study, feeling safe during the process of hospitalization was found to increase feelings of control, calm and hope (Mollon, 2014).…”

Application and Optimization of Luenberger Observer Phase-Locked Loop and Inductance-Free Vector Control Method for Aviation Three-Phase Converter in Wearable Equipment

“…At the same time, the capacity and power generation efficiency of the aircraft power system have been continuously improved with the development of multielectric aircraft technology. The advantages of aviation variable frequency power supply without the need to continuously install converters have gradually emerged [ 1 ]. Three-phase converters, especially three-phase rectifiers, are crucial power conversion links in airborne electrical equipment.…”