Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project

Abstract

Background Interventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness. Methods A heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke. Results Staff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation. Conclusions After implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care. Trial registration The study is part of a larger study evaluating the intervention Person-Centered Psychosis Care (PCPC). It was registered retrospectively at clinicaltrials.gov, identifier NCT03182283.

Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care

“…This kind of individualized care would then be employed to maintain security, effect adherence, and to some extent, achieve some degree of patient emancipation albeit with security prerogatives of the surrounding society setting limits to the scope of adjustments that HCPs can make. This possibility is consistent with the conclusions of Allerby et al [ 27 ], whose study revealed that staff do not perceive their patient’s psychotic symptoms or involuntary setting to be a hurdle for PCC implementation.…”

Supported decision‐making interventions in mental healthcare: A systematic review of current evidence and implementation barriers

“…32 Sufficient time was not only needed for the treatment planning session/s with service users but also for clinicians beforehand to learn a new tool and approach, as well as for collaboration with colleagues when needed. 33,36,37,45,63 Service users were acutely aware of time constraints on practitioners and it affected how some experienced the process. 59 "like, just getting the laundry done is a hassle, so for me to take someone, sort of, offline and concentrate on me One of the larger studies found that only a very small proportion of people felt that they were too unwell to complete a facilitated plan (9/285 = 3%) 64 and another similarly reported that of 128 observations, most service users were found (by clinicians) to be interested in and able to understand the shared, medical decision-making process.…”

“…42 Cultural and language differences could also be a barrier, from the clinician's perspective, that sometimes hindered the shared decision-making experience. 33,49,52 Involving different parties (including colleagues and family members) in the planning process was another barrier that has been reported as being difficult, or at least perceived as difficult. 31,36,65,69 Additional barriers to plan completion may also be experienced by (a) younger people, in one study those under median age 42 years were less likely to complete a plan compared with their older counterparts 53 ; (b) people discharged, relocating away or not receiving care from services where such planning occurred 32,80 ; (c) people who were experiencing homelessness and poverty; 42,69 and (d) although less education was shown to be associated with higher rates of plan completion, 81 illiteracy was viewed by both service users and providers as a potentially significant barrier to planning involvement and completion, and may influence whether clinicians offer such planning opportunities.…”

“…81 In addition, several studies reported that substantial effort or support was required for clinicians to change their approaches and routine practices. 57,101 One obstacle may be that many clinicians believe that they are already doing shared decision-making in treatment planning 21,30,[32][33][34]46,47,54,97 -although when they describe their practices, it suggests otherwise. 97 Clinicians also acknowledged that they had other priorities, 31,46,60 were sceptical about the associated benefits 21,61,76,97 and found shared decision-making a challenge, including 36,38,40,52,58,102 For example, in one intervention, service users who were trained in shared decision-making were perceived by clinicians to be 'more difficult'.…”

We are not even allowed to call them patients anymore: Conceptions about person‐centred care

“…PCC has been introduced in a variety of care contexts, including inpatient care, rehabilitation, outpatient care, school settings and primary care 10 in patient groups with acute psychosis, acute coronary heart disease, hypertension, rheumatism, heart failure, hip fractures, long-term pain and nursing home residents. 10,11…”