What makes community psychiatric nurses label non-psychotic chronic patients as ‘difficult’: patient, professional, treatment and social variables

Koekkoek, Bauke; Meijel, B.K.G. van; Tiemens, Bea; Schene, Aart H.; Hutschemaekers, G.J.M.

doi:10.1007/s00127-010-0264-5

Cited by 21 publications

(24 citation statements)

References 41 publications

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“…This ignores the role of the healthcare provider, therapeutic process or environment in disengagement [62]. Such a label may have ramifications for on-going participation in rehabilitation [63] by influencing clinician attitudes and behaviors toward the individual [64] and potentially influencing decisions about on-going rehabilitation [5]. Viewing engagement as a process and asking, 'how can we facilitate engagement?'…”

Section: Discussionmentioning

confidence: 99%

A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

188

177

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A conceptual review of engagement in healthcare and rehabilitationPurpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement.Method: EBSCO and SCOPUS databases and reference lists were searched for papers that sought to understand or describe the concept of engagement in healthcare or reported the development of a measure of engagement in healthcare. We drew on a Pragmatic Utility approach to concept analysis.Results: Thirty-one articles met the criteria and were included in the review. Engagement appeared to be conceptualized in two inter-connected ways: as a gradual process of connection between the healthcare provider and patient; and as an internal state which may be accompanied by observable behaviors indicating engagement. Conclusion:Our review suggests engagement to be multi-dimensional, comprising both a coconstructed process and a patient state. While engagement is commonly considered a patient behavior, the review findings suggest clinicians play a pivotal role in patient engagement. This review challenges some understandings of engagement and how we work with patients, and highlights conceptual limitations of some measures. Introduction'Patient engagement' is a term increasingly used in rehabilitation and the broader healthcare context [1]. Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge. Levels of engagement have also been associated with lower levels of depression and with higher levels of affect, adherence and attendance [2,4]. In addition, within clinical rehabilitation practice, the 'engaged patient' is perhaps identified as being the 'desirable patient', one who is easy for providers to work with [5]. On the face of it, these findings suggest that patient engagement is both positive and desirable.While the term 'engagement' is increasingly used in clinical practice and research, there has been relatively little critical exploration of what 'engagement' means and the underpinning concept/s the term may represent. Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].It could be argued that it does not matt...

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Section: Discussionmentioning

confidence: 99%

A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

188

177

View full text Add to dashboard Cite

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“…Complicated care situations may arise over time, and result in patients being labelled as “bad” or “difficult” – often because they do not improve as easily or rapidly as hoped for by professionals, in combination with behaviours that frustrate professionals (Koekkoek et al ., ). These situations are neither rare nor harmless: in previous studies 6–37% of patients were labelled as difficult (Hahn et al ., ; Jackson and Kroenke, ; Lin et al ., ), with a near‐peak of 28% in a study of people with long‐term common mental disorders (Koekkoek et al ., ). Therefore, it is important to explore associations between clinical, treatment and social variables and the emergence of chronicity in general, treatment drop‐out, and the emergence of complex care situations in particular.…”

Section: Objectivesmentioning

confidence: 99%

“…Also they may use care in high frequencies, including an array of intensive services like crisis intervention or inpatient care (Chaput and Lebel, 2007;Ledoux and Minner, 2006;Pasic et al, 2005). Last, some patients with SMI may become involved in complex care situations in which they feel stuck, and in which professionals perceive them as "difficult" (Bachrach et al, 1987;Fok et al, 2014;Koekkoek et al, 2011b). However, it is unclear which patients with common mental disorders become long-term SMI-patients.…”

Section: Introductionmentioning

confidence: 99%

The MATCH cohort study in the Netherlands: rationale, objectives, methods and baseline characteristics of patients with (long‐term) common mental disorders

Koekkoek

Manders

Tendolkar

et al. 2016

Int J Methods Psych Res

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Research in the last decades shows that common mental disorders may be long-term and severely disabling, resulting in severe mental illness (SMI). The percentage of Dutch SMI-patients with common mental disorders receiving mental health services is estimated at 65-70%. However, it is unclear which patients in fact become SMI-patients. We need to know more about the possible course of common mental disorders, understand the origins of chronicity in more detail, and have more insight in related care processes and care use of patients with common mental disorders. The MATCH cohort study is a four-year multicentre naturalistic cohort study, with yearly assessments in primary, secondary, and tertiary services in three large Dutch mental health services. Socio-demographics, mental disorders, course and severity of psychopathology, physiological health indicators, neurocognitive functioning, past and present life events, health care use and contact with mental health services, social functioning and quality of life, and recovery and well-being are assessed. Baseline findings of 283 participating individuals and their key clinicians are described. The sample appears to appropriately represent the distribution of individuals across diagnostic categories in services, and level of care (outpatient, day treatment, inpatient) in the Netherlands and other developed nations. Copyright © 2016 John Wiley & Sons, Ltd.

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“…Indeed, it is not always clear which patient behaviours must be considered as originating in the psychiatric disorder itself, and which may be the consequence of an ineffective contact with mental health clinicians or services [16]. In previous work, for instance, we found no association between any specific non-psychotic psychiatric disorder and clinicians' 'difficult'-judgment [17]. However, clinicians' perceptions of the patient (e.g.…”

Section: Introductionmentioning

confidence: 87%

Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study

Koekkoek

Meijel

Schene

et al. 2010

BMC Health Serv Res

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BackgroundHealth clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians.MethodsThe principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews), quantitative (survey), and mixed methods (Delphi-procedure) research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups.ResultsA structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out.ConclusionsIntervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care.

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What makes community psychiatric nurses label non-psychotic chronic patients as ‘difficult’: patient, professional, treatment and social variables

Cited by 21 publications

References 41 publications

A conceptual review of engagement in healthcare and rehabilitation

A conceptual review of engagement in healthcare and rehabilitation

The MATCH cohort study in the Netherlands: rationale, objectives, methods and baseline characteristics of patients with (long‐term) common mental disorders

Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study

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