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Valuing the past: The importance of an understanding of the history of psychiatry for healthcare professionals, service users and carers.

Drawing primarily on examples from the UK, this paper argues that an under-standing of the history of psychiatry can be of practical use to clinicians, service users and carers. It can provide a window on the present and an explanation of some aspects of current practice. In addition, a study of the past can provide a vision of how things might be done differently in the present and in the future. Moreover, knowledge of the past can also serve to remind us of psychiatry's potential for misuse and the dangers inherent in a view of the world in which psychiatry is simply seen as a benevolent science destined to find an answer to mental illness.

Attitude of Health Personnel↗

Psychiatric advance directives: qualitative study of informed deliberations by mental health service users.

BACKGROUND: Established legal mandates and high expectations for psychiatric advance directives are not matched by empirical evidence documenting their actual implementation. AIMS: To explore the interests, concerns and planning activities of informed mental health service users contemplating such directives. METHOD: Standard qualitative research techniques were used: field observations, interviews, focus groups, archival research and key informant interviews; 33 persons participated in the interviews and focus groups. Transcripts were coded and analysed for thematic content, and results were member-checked. RESULTS: Training set in motion labour-intensive projects: conceptualising how a psychiatric advance directive would work in one's life, mobilising resources, reviewing past experiences and assessing risks. Especially meaningful was the prospect of being treated as a responsible agent in future interactions with the mental health system. CONCLUSIONS: Advance directives are best thought of as complex planning tools for future psychiatric crisis management, rather than focal interventions to enhance compliance. Research is needed to explore the institutional response to this prospective decision-sharing initiative.

Adult↗

'You need them to know your ways': service users' views about valued dimensions of home care.

Dominant approaches to evaluating supportive home care tend to be 'top-down,' undertaken from the vantage points of funding bodies and professionals, rather than from the perspectives of service users. A longitudinal, qualitative study of women receiving home care in Ontario, Canada explored their accounts of what constitutes good and responsive care. Participants identified four dimensions of care that they particularly valued: Minimized exposure, being known, staying in charge, and being able to speak. The implications of their perspectives for home care practice, evaluation and organization are discussed.

Female↗

Information in mental health: qualitative study of mental health service users.

BACKGROUND: Despite the widespread proliferation of consumer health information provision, little is known about information needs or information-seeking behaviour in mental health. A qualitative study was therefore undertaken to explore these issues for mental health service users. DESIGN: In-depth interview study with purposive sample of 36 men and women with experience of mental health problems. RESULTS: Four main themes were identified. A general lack of information was equated with a lack of respect. People undertook their own research into their condition, and recognized the challenge to professionals. Stigma was widespread and inhibited information seeking. There was a desire for an explanation of mental health problems in physical terms. People particularly valued hearing other people's experience of mental health problems, for reasons of universality, instillation of hope, and understanding and empathy. CONCLUSIONS: The findings provide support for a more equal partnership between patients and professionals. Information providers and health practitioners should take account of the value of other people's experience as an information source.

Adult↗

Carers and confidentiality in mental health care: considering the role of the carer's assessment: a study of service users', carers' and practitioners' views.

Relatives or carers of people with mental health problems have criticised professionals for their failures to share information with them. This article reports on a multiple method study comprising a policy search, a survey of service users, carers and professionals, and stakeholder interviews and group events. The study found few policies that addressed the principles underpinning information sharing with carers. However, examples of good practice in professional involvement of carers that took account of carer rights and responsibilities emerged from the research. This suggests the relevance of the carer's assessment, a carer's right to an assessment of his or her circumstances and wishes in assisting understanding of the care context and enhancing appropriate information sharing between professionals and carers.

Caregivers↗

Legal, social, cultural and political developments in mental health care in the UK: the Liverpool black mental health service users' perspective.

Documentary evidence suggests that attitudes among local health and social services professionals towards the concept of user involvement in health and social care remain deeply polarized, a position characterized by commentators simultaneously as praise and damnation. Perhaps user involvement in health and social care will enhance, and it appears to resonate with the logic of, participatory democracy, in localities where the centralization of power has posed questions as to the nature and purpose of local governance in public services provision. The problems experienced by Britain's black and ethnic minorities within the mental health system have been the subject of exhaustive social inquiry. This essay attempts to explore the way in which legal, social, cultural, and political developments interface with mental health care practice in the UK, in order to assist those responsible for mental health services provision to deliver services that are in line with the Government's expectation of a modernized mental health service that is safe, sound, and supportive. An exploration of these developments within the European, national (UK), and local (Liverpool) contexts is undertaken. An appropriate local response to national priorities will ostensibly cut a swathe through the barriers confronted by the ethnic minority mental health service user in the cross-cultural context, an important prerequisite for the implementation of genuine user involvement.

Humans↗

Measuring outcomes in genitourinary medicine: involving service users in the measurement of outcomes.

Recently there has been increased emphasis on the user perspective in health care. At the same time the concern with effective health care is making us look more critically at the outcomes of treatment and other interventions, and the evidence available to us to make sense of effectiveness. This paper addresses the involvement of genitourinary medicine service users in outcome measurement through 3 linked questions: (1) What do we mean by outcomes? (2) What do we mean by users? and (3) What do we mean by involving?

Female Urogenital Diseases↗

The attitudes of forensic nurses to substance using service users.

There is now a body of research that has shown that the attitudes of nurses towards substance misuse in the mentally ill are generally suboptimal and this has an impact on the quality of nursing care provided. Despite this, to date there have been no published studies that have examined the attitudes of forensic nurses towards substance misusing forensic service users. Sixty-three multiethnic registered forensic psychiatric nurses based on an inpatient unit in outer London were surveyed using the Substance Abuse Attitude Survey (SAAS). This has five subscores: Treatment Intervention, Treatment Optimism, Permissiveness, Non-Moralism and Non-Stereotypes. Only Permissiveness scores were at an optimum level and equivalent to other community mental health workers. The Treatment Intervention and Treatment Optimism subscores were well below those of a multidisciplinary group of community mental health workers. Three other findings were of note. Firstly, women had higher Non-Moralism scores than men. Secondly, staff nurses had higher Non-Stereotypes scores than other grades. Finally, Black nurses had higher Treatment Optimism scores than non-Black colleagues. In conclusion, the attitudes of forensic nurses towards substance misuse in forensic clients are more suboptimal than other groups of community mental health workers. Our findings also indicate that gender, staff grading and ethnicity are associated with suboptimal scores.

Adult↗

High service users: does the clinical psychologist have a role?

OBJECTIVE: To assess the impact of psychological intervention on high users of the GP service. DESIGN: A sample of high-attenders was offered the opportunity to attend an interview with a clinical psychologist. A three-year (one year before and two years after psychological intervention) survey of patient records was carried out to determine the pattern of patient attendances. In addition, GP and patient satisfaction questionnaires were utilised to rate the psychological service. SETTING: A GP surgery situated in the coastal region of Scotland. SUBJECTS: All adult patients, who had consulted over 12 times in the 12 months prior to the beginning of the study except those who had ongoing medical problems that the GP felt were being dealt with adequately, were invited to a psychological interview. In all, 174 invitations were sent, and 101 agreed to psychological intervention. RESULTS: After three months both the GPs and patients positively rated the input of the psychologist. There were short-term benefits from the psychological intervention in terms of attendance rates, which were not in evidence in the long term. For the participating group there was a significant decrease in attendance rate three months after psychological intervention compared to the non-participating group (P < 0.001). However, at 12 and 24 months after intervention both groups reduced attendance at a similar rate. CONCLUSION: Psychologist intervention had a short, but not long term, benefit, in reducing attendance rates. However, both GPs and patients found the provision of a report from the psychologist useful.

Adult↗

Attuned practice: a service user study of specialist child and adolescent mental health, UK.

AIMS: Best practice emphasises user involvement. This exploratory study addresses the views of teenage clients and their parents on service delivery in a specialist Child and Adolescent Mental Health Service (CAMHS) serving a population of 250,000. It aims to explore some of the complexities inherent in children's services when parents are integral to modes of treatment. METHODS: Twenty-seven teenage clients from specialist CAMHS were recruited with their parents (n=30). All were white British, 11 boys and 16 girls, from a range of socioeconomic backgrounds. Focus groups were employed using a series of structured interactive technique to elicit information, preceded by home visits. Analysis of interview data followed standard approaches to qualitative data analysis. Descriptive statistics were generated from both home interview data and focus groups. RESULTS: Three themes emerged: the core values implicated in establishing a therapeutic alliance; the style of therapy and mode of practice (i.e. its inclusiveness of different family members). PRACTICE IMPLICATIONS: Core therapeutic skills are of fundamental importance. Our paper supplements a model of organisational user involvement with a model of therapeutic user involvement for use in negotiating mode of practice. CONCLUSIONS: This exploratory study was a collaboration between service users, researchers and health professionals exploring three important themes of therapy and the complexities inherent in children's services. The process of eliciting views was therapeutic in itself leading to the formation of a parent-led self-help group. The design can be replicated in other specialist CAMHS to achieve attuned practice.

Adolescent↗

New approaches to sexual health services in a rural health board area: involving service users and primary care professionals.

Research was undertaken to inform the future development of sexual health services for the population of a rural health board. Three separate surveys were carried out: (i) users of local and regional genitourinary medicine (GUM) services, (ii) users of local family planning clinics, and (iii) all local general practitioners (GPs) and practice nurses-to obtain views on current sexual health services and the optimum future configuration of services. Respondents to the GUM survey (n=137) attended GUM service for a range of sexual health reasons; confidentiality was the most important factor affecting choice of service provider and almost half (44%) would have been happy to receive the service from their GP. Family planning clinic respondents (n=298) attended clinics for a range of reasons; confidentiality was the most important factor affecting choice of service provider and less than one-third (29%) would attend their GP for a similar service. Both GUM and family planning clinic survey respondents supported the development of clinics providing a broad range of sexual health services. Almost all (97%) GP respondents in the primary care professionals survey saw patients for sexual health-related consultations; over half (54%) treated sexually transmitted infections (STIs). Significant training needs in sexual health were identified for primary care professionals. New models for the provision of sexual health services are proposed for this health board area.

Adult↗

Involving service users in dementia care planning.

The evaluation of dementia services has been hindered by the difficulties of involving patients themselves. Current research emphasises the importance of good communication when attempting to elicit the views of those with dementia. Listening to and learning from people with dementia in everyday life will help nurses understand their fears, needs and wishes.

Aged↗

Cancer care. Part 2. How cancer service users can influence research and practice.

There is increasing cooperation between NHS service providers and patients, who provide feedback on the care they receive and make suggestions for research and changes in practice. This article discusses why such links are necessary and describes the cancer research open day organised by a cancer network as one example of a forum for such exchanges of information to take place. The authors believe this example of collaborative interaction between patients and health professionals can be adapted and used by nurses working in a variety of health care settings.

Cancer Care Facilities↗

Measuring satisfaction with social care amongst older service users: issues from the literature.

Issues of quality and accountability in social care for older people are of increasing importance. A key factor in determining quality is the extent to which older people themselves are satisfied with both the assessment of their needs and the services provided. The 1997 White Paper, Modernising Social Services, stated that local authorities will need to establish authority-wide objectives and performance measures to improve the quality and efficiency of services. In measuring quality, the White Paper stipulated that social service departments would need to design and administer satisfaction surveys as one means of capturing user and carer perceptions and experiences of services. This paper attempts to highlight some of the main issues to be considered when designing and conducting such surveys with older users of community care services. Through a review of the British and North American literature on older people's satisfaction with services, current approaches to measuring satisfaction are outlined and the relationship between the characteristics and circumstances of older people and their responses to satisfaction questions is examined. The paper concludes by offering some solutions to overcoming current problems by drawing conclusions about quality from survey findings, so that older people's opinions about the services they receive can begin to be assessed in a more meaningful way.

Journal Article↗

Findings from a statewide program of respite care: a comparison of service users, stoppers, and nonusers.

This study compared respite users with stoppers and nonusers in the Health Resources and Services Administration-funded Alzheimer's disease demonstration grant in the State of Maryland. Of those accepted into the program, only 54% participated for at least 6 months. The primary reasons for stopping were the death or institutionalization of the relative, while those not using respite services felt they didn't really need them. Determinants of program use included the poorer cognitive status of the relative and less anxiety and greater burden among the caregivers. After 6 months, users reported fewer hours of informal assistance, less burden, and that the relative had fewer behavioral problems although cognitive status and activities of daily living (ADLs) had deteriorated.

Aged↗