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PubMed2002

Patient involvement in education for enhanced quality of care.

Government policies in the UK are promoting health care practitioners working in partnership with patients and clients as an important constituent of quality in health care delivery. However, for practitioners to work in this way requires experience of such partnerships in the educational preparation. The involvement of patients and clients (i.e. service users) and their carers in the curriculum has been encouraged and supported in England since the early 1990s. From 1998, the comprehensive involvement in all phases of programme provision has been a requirement, ensuring that service users have a real 'voice' in influencing the direction of programmes. Examples of good practice are provided, demonstrating a range of approaches in the different stages of the educational process. Issues to be considered for successful implementation are included. Benefits to education and patient/client care are identified on the basis of literature and recent experience. They are strongly associated with enhanced quality of care. The article argues for a need to continue to broaden implementation for the major benefits of influencing the attitudes and approaches of students, and empowering users, with the end result of enhancing the quality of care. A strategic approach is needed to make user involvement an effective and workable reality. The need for systematic evaluation of the outcomes and for publications is highlighted. The principle of service user involvement in educational preparation is deemed to be equally relevant in other countries.

Education, Nursing↗

PubMed2005

Language, therapeutic relationships and individualized care: addressing these issues in mental health care pathways.

Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.

Communication↗

PubMed2005

Social services day care and health services day care in mental health: do they differ?

BACKGROUND: The difference between the services provided by day hospitals and day centres is far from clear. The supposition that day hospitals would provide an acute service, while day centres would offer social support for a more chronic population has been contentious and there is little evidence of how they are currently used. AIMS: We aimed to ascertain the differences between day hospitals (partial hospitalisation) and social service day centres in functions and roles, as perceived by staff, service users and referrers. METHODS: The views of service users and staff at two day hospitals and four day centres were ascertained through questionnaires and interviews, along with those of staff of eight Community Mental Health Teams, who constitute the sole pathway to the two services. RESULTS: Day hospitals were perceived by both referrers and clients to offer short-term, more intensive 'treatment' to more acutely ill people in need of mental health monitoring. Day centres were perceived to offer longer-term support, particularly social support, to people more likely to have longer-term and psychotic illnesses. CONCLUSION: There is currently a clear distinction between day centres and day hospitals, in key features of their services and client groups. It would be unwise to treat them as interchangeable.

Ambulatory Care↗

PubMed2004

The beliefs of people with chronic pain in relation to 'important' treatment components.

BACKGROUND: The beliefs of people with chronic pain (service users) about the importance of treatment components offered through both multidisciplinary and other types of chronic pain programmes are not widely examined in the literature. AIM AND METHOD: As part of a wider research study of the congruence between what service providers and service users believe to be important treatments for chronic pain, members of three chronic pain support groups located in the North-West region of England were surveyed. The survey asked service users' opinion about whether specific treatment components are important or not important for people with chronic pain. The survey also included Skevington's Beliefs About Pain Control Questionnaire (BPCQ) that measures beliefs in the internal or personal control of pain, beliefs that powerful others (doctors) control pain and beliefs that pain is controlled by chance events. RESULTS AND CONCLUSION: Findings show that no treatment components were endorsed as important by more that 67% of the participants. Endorsements clustered around treatments that focused on self-management and biomedical interventions. A statistically significant relationship emerged between certain treatment components and BPCQ scores. These findings contribute to the growing cautions regarding standardised, 'one-size-fits all' treatment programs and the mistake of assuming people with pain form a homogenous group.

Adult↗

PubMedDate not supplied

Identifying the needs of carers in mental health services.

AIM: To assess all carers in the Gloucester Assertive Community Treatment Team and identify their needs. METHOD: Carers were identified using the definition employed in the Notional Service Framework for Mental Health (DH, 1999): they were family or close friends who spent a minimum of 12 hours per week helping/supporting the service user. Paid carers were excluded. A standardised carer's assessment that had been developed as part of the care programme approach (CPA) was used to evaluate the needs of carers. RESULTS: The study highlights the type of support that carers give those who use the mental health services and reveals the impact that this caring has on them. The carers' needs are identified as: someone to talk to; help with cleaning/ironing; help with finances; support to enable them to take a break; plus respite care and accommodation for the service user. CONCLUSION: Carers play an important role in supporting people who are diagnosed with severe mental illness although further research is necessary to consider the benefits of a closer relationship between the carer, service user and mental health professionals.

Attitude to Health↗

PubMed2002

Work stress and people with Down syndrome and dementia.

This study aimed to assess how staff ratings of challenging behaviour for people with Down syndrome and dementia affected the self-reported well-being of care staff. Data were collected from 60 care staff in 5 day centres in a large city in England. The data were collected by use of a questionnaire. There was no significant difference between those who cared for individuals with Down syndrome and dementia and those caring for service users with other non-specified learning disabilities without dementia, regarding their self-reported well-being. Self-reported well-being did correlate with staff rating of challenging behaviour in both those who cared for people with Down syndrome and dementia and those who did not care for such service users, with well-being declining as perceived challenging behaviour increased. The findings indicate that challenging behaviour prevention and reduction may be of benefit to both service users and care staff well-being.

Adult↗

PubMed2002

Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy.

BACKGROUND: Previous short-term work reported fewer suicides among elderly users of a telephone helpline and emergency response service (the TeleHelp-TeleCheck Service). AIMS: To examine long-term effects of the service on suicide in an elderly population of northern Italy. METHOD: The service provided twice-weekly support and needs assessment telephone calls and a 24h emergency alarm service. Data from 1988 to 1998 allowed comparison of 18 641 service users with a comparable general population group of the Veneto region in Italy. RESULTS: Significantly fewer suicide deaths (n(OBSERVED)=6) occurred among elderly service users (standardised mortality ratio (SMR) 28.8%) than expected (n(EXPECTED)=20.86; chi(2)=10.58, d.f.=1, P<0.001) despite an assumed overrepresentation of persons at increased risk. The service performed well for elderly females (n(OBSERVED)=2, SMR=16.6%, n(EXPECTED)=12.03; chi(2)=8.36, d.f.=1, P<0.001). CONCLUSIONS: The study confirms the initial promise of the TeleHelp-TeleCheck service over a much longer time period. Further research will clarify the apparent lack of benefit for elderly males.

Aged↗

PubMed2001

Complexity of staff communication and reported level of understanding skills in adults with intellectual disability.

Staff reports of the communication acts taking place with 22 adults with intellectual disability were compared with video observations of the communication acts used by staff with 12 of these service users. The interactions were coded in terms of the form of communication used, the function of the act and the level of complexity. The results show that staff tend to underestimate their own use of verbal communication and overestimate their use of non-verbal communication. The findings also indicate a mismatch between the reported level of understanding of the service user and the level of complexity of the language used. Staff appeared unable to adapt their communication to the skills of the service user and an average of 45% of communicative acts were outside the reported understanding skills of the individual. The implications of these findings are discussed and possible explanations for staff behaviour are suggested.

Adult↗

PubMed2004

Practitioner relationships and quality of care for low-income persons with serious mental illness.

OBJECTIVE: Though central to experiences of mental health care for persons with serious mental illness, relationships with practitioners have been underemphasized in recent quality-of-care research. This qualitative study described concepts of good care in relationships with psychiatrists, therapists, and case managers from the perspectives of low-income persons with psychiatric disabilities. METHODS: In-person, semistructured interviews were conducted with 51 adult Medicaid enrollees with psychiatric disabilities and diagnoses of schizophrenia. Grounded theory techniques were used to analyze the data. RESULTS: Eight categories representing service users' priorities for care in practitioner relationships resulted from the analysis: getting "extra things," looking for common ground, feeling known, the importance of talk, feeling like "somebody," practitioner availability, practitioner flexibility, and opportunities for input into treatment. CONCLUSIONS: Quantitative and illness-centered formulations may miss much of what low-income service users with serious mental illness value in their relationships with practitioners. The opportunity to counter feelings of vulnerability and alienation with a sense of connection that is based on shared humanness may be a high priority for services for this group. Practitioner relationships that help service users feel cared about and connected to the social world address suffering in mental illness and are thus essential to the meaning of good care.

Adult↗

PubMed2005

Neuroleptic medication and sexuality: the forgotten aspect of education and care.

Discussing issues of sexuality is a challenging and difficult issue for many health care workers. When it comes to sexuality and people with mental health problems there seems to be a dual taboo. Mental health nurses are ideal members of the health care team to talk to service users about issues as sensitive as sexuality and the side effects of medication that impact on sexual health. However, in both clinical practice and the nursing literature, the side effects of medications that impact on sexual function are often ignored and unspoken about. This paper examines the impact of both conventional and atypical neuroleptic medication on sexual function and discusses the probable causes of such effects. The possible reasons why health care professionals are reluctant to discuss side effects impacting on sexual health with service users are explored and emphasis is placed on the need for mental health nurses to respond to requests from service users for more education and discussion in the area of sexuality and sexual health.

Antipsychotic Agents↗

PubMed2006

Outcomes of interprofessional education for Community Mental Health Services in England: the longitudinal evaluation of a postgraduate programme.

We report a comprehensive, longitudinal evaluation of a two-year, part-time postgraduate programme designed to enable health and social care professionals in England to work together to deliver new community mental health services, including psychosocial interventions (PSIs). The study tracked three successive cohorts of students (N = 111) through their learning. Outcomes were assessed according to the Kirkpatrick/Barr et al. framework using a mixed methodology, which employed both quantitative measures and interviews. The students evaluated the programme positively and appreciated its focus on interprofessional learning and partnership with services users, but mean levels of stress increased and almost one quarter dropped out. There was considerable evidence of professional stereotyping but little evidence of change in these during the programme. Students reported substantial increases in their knowledge and skills in multidisciplinary team working and use of PSIs (p < 0.001). Experiences in the implementation of learning varied; in general, students reported significantly greater role conflict (p = 0.01) compared to a sample of their team colleagues (N = 62), but there was strong evidence from self-report measures (p < 0.001) and work-place interviews that the students' use of PSIs had increased. Users with severe mental health problems (N = 72) randomly selected from caseloads of two cohorts of students improved over six months in terms of their social functioning (p = 0.047) and life satisfaction (p = 0.014). Having controlled statistically for differences in baseline score, those in the intervention (programme) group retained a significant advantage in terms of life skills (p < 0.001) compared to service users in two non-intervention comparison groups (N = 133). Responses on a user-defined measure indicated a high level of satisfaction with students' knowledge, skills and personal qualities. We conclude that that there is strong evidence that a well-designed programme of IPE can be effective in helping students to learn new knowledge and skills, and to implement their learning in the workplace. Further, we consider that there is some modest evidence of the benefits of such learning for service users.

Adult↗

PubMed2003

User involvement. Pick and choose.

Involving service users in the selection of a manager for learning disabilities services proved successful when implemented by a primary care trust with the use of facilitators and special training. The PCT chief executive made it clear that no-one would be appointed if the user and carer panel considered them inappropriate. The users were involved in drawing up five questions for each of the candidates. On the basis of their answers, each candidate was scored by the service users. The users, carers and managers were unanimous in their choice of candidate.

Administrative Personnel↗

PubMed2006

Day care service use is associated with lower mortality in community-dwelling frail older people.

OBJECTIVES: To clarify the association between day care service use and 21-month mortality in community-dwelling frail older people. DESIGN: Prospective cohort study (the Nagoya Longitudinal Study for Frail Elderly). SETTING: Community-based. PARTICIPANTS: One thousand six hundred seventy-three community-dwelling older people (540 men, 1,133 women). MEASUREMENTS: Data included the clients' demographic characteristics; depression as assessed using the short version of the Geriatric Depression Scale; a rating for basic activities of daily living (ADLs); comorbidity; number of prescribed medications and physician-diagnosed chronic diseases; use of home-care services, including day care, visiting nurse, and home-help services; and number of regular medical checkups. Survival analysis of 21-month mortality was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. RESULTS: Of the 1,673 participants, 726 were day care service users at baseline, and 268 (94 day care service users, 174 nonusers) died during the 21-month follow-up. Multivariate Cox regression models adjusting for potential confounders showed that day care service use was associated with reduction in mortality. Subgroup analysis demonstrated that day care service use was associated with less risk of mortality in subjects who were female; were in the youngest age group (65-74); had higher ADL scores, lower comorbidity, depression, no dementia; and used a visiting nurse service. Participants using day care service two and three times or more a week had 63% or 44% lower relative hazard ratios, respectively, than participants not using the service. CONCLUSION: Among community-dwelling frail older people, day care service use two or more times per week was associated with 44% to 63% lower 21-month mortality.

Aged↗

PubMed2000

What do people need psychiatric and mental health nurses for?

The study reported here aimed to describe, by consulting with psychiatric practitioners of different disciplines, what people in contact with mental health services need nurses for, in terms of core nursing activity. Yet, recent trends have also been towards consumer-led definitions of good practice. The views of service and ex-service users can contribute much to an exploration of the role of psychiatric and mental health nurses and these perspectives were incorporated into the study. Given the lack of existing theory, a qualitative, grounded theory methodology was selected. In order to generate data rich enough for the analysis, focus groups of psychiatric nurses, social workers, service users, psychiatrists, carers and professions allied to medicine were sampled (13 groups, n=92) on the basis of the themes emerging from the data. Using critical incident technique (Flanagan 1954), the groups were invited to give examples of effective and ineffective nursing interventions, in relation to specific patient needs. The taped material was transcribed and analysed with the help of a computer package (QSR NUD.IST). This led to the selection of a core category, 'knowing you, knowing me', which described service users' and professionals' expectations that nurses are best placed to second guess the needs of patients and present themselves accordingly. Thus, nurses were expected, moment by moment, to know whether to be the patient's friend, a friendly professional, or take a more distant professional stance. The continuum entails different levels of knowledge and power, different language forms and different approaches to structuring time. Nurses themselves are most likely to prefer a position of friendly professional, from which they can move to a more intimate or distant role. Further study is needed to explore how nurses predict patients' expectations of them using a symbolic interactionist framework.

Attitude of Health Personnel↗

PubMed2005

Nurse-led models of chemotherapy care: mixed economy or nurse-doctor substitution?

AIM: This paper reports a study exploring the perspectives of people affected by cancer (service users) and health care professionals' about current medical consultant-led services and the acceptability of a proposed nurse-led ambulatory chemotherapy service. BACKGROUND: A number of studies have evaluated a nurse-led model of cancer care delivery but little work has been undertaken in chemotherapy settings. Furthermore, many of these studies give little information on how the perspective of users was incorporated in the design and evaluation of these services. METHODS: Service users (n = 26) and health care professionals (n = 22) were recruited across the South East of England. A qualitative study was undertaken... Using a semi-structured interview schedule, participants were asked to give their perceptions of current chemotherapy services and the potential of a nurse-led service. A thematic analysis of data was undertaken. FINDINGS: This paper focuses on the theme of the current and future context of a chemotherapy service. Three sub-themes were identified: contextualizing roles, defining therapeutic outcomes, and demonstrating effectiveness. All interviewees saw this role as different but complementary to the role of medical staff. There were mixed opinions from service users and professionals on the acceptability of nurse-led chemotherapy provision. In defining potential outcomes of nurse-led care, service users described benefits in terms of service and economic outcomes. Professionals saw additional benefits in terms of patient-based outcomes. Professionals and service users expressed the need for appropriate education of nurses for this role and rigorous evaluation of any new service before widespread implementation. CONCLUSIONS: Understanding the perspective of users is imperative when re-designing cancer nursing services. Implementation of nurse-led models in chemotherapy services should be preceded by staff education and followed by systematic evaluation.

Adolescent↗

PubMed2005

Coercion or collaboration? Nurses doing research with people who have severe mental health problems.

Nurses should address the concerns of service users in research and engage in collaborative work with them. Doing this presents ethical dilemmas, not least around the issues of assessing capacity and informed consent to participation in research. The view that judgement regarding the capacity to consent is solely the responsibility of a consultant psychiatrist is challenged as inadequate. The concept of 'moral discourse' (Pike 1991) is used to understand the process by which the assessment of capacity may be carried out. This is illustrated by the application of the concept in a qualitative research study carried out to explore what makes mental health services accessible to women with children. The role of the mental health nurse entails surveillance and the development of expertise in negotiating compliance with treatment programmes. The paper outlines the measures taken to ensure that service users felt empowered, rather than coerced, to participate in this study. While Community Mental Health Team workers were engaged in 'moral discourse' in respect of participation by service users in the study, there were difficulties in engaging General Practitioners. However, there was evidence that women themselves felt empowered both to express interest in participating and to withdraw if they so wished.

Coercion↗

PubMed1988

Sexual assault history and use of health and mental health services.

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.

Adult↗

PubMed2005

Implementing family intervention following training: what can the matter be?

Family interventions (FI) have been established as an effective treatment for psychosis. Training in this intervention is now widely available in the UK. This paper reports a review of published literature that investigates whether, following this training, graduates provide this evidence-based treatment for individuals with psychosis and their caregivers. It further seeks to identify the barriers to implementation in cases where the treatment is not provided and assess benefits for service users and carers when it is. The review was conducted using the MEDline, PsycINFO, CINAHL and Embase databases. Studies that have attempted to evaluate the rates of implementation of FI by graduates of FI training programmes were identified, retrieved and reviewed. Six studies investigating the rates of implementation upon graduation were identified. The findings of these six studies were generally consistent. Rates of implementation by graduates of training programmes are usually low and a small number of graduates work with most of the families who are seen. The studies reviewed failed to assess service user and carer outcomes or consider the full range of likely impediments to the implementation of this evidence-based intervention. A key barrier to the implementation of FI is the reliance upon professionally developed and facilitated approaches. Alternative models that are service user and carer-led may provide a potential solution to the problem of implementation. Implications for future research and practice are considered.

Attitude of Health Personnel↗