Humanised care in acute psychiatric hospitalisation units: Definition, values and strategic initiatives from the perspective of persons with mental health problems, primary carers and professionals.

INTRODUCTION: Humanised care refers to the holistic approach to the person, considering their bio-psycho-social and behavioural dimensions. It becomes more complex when the person has mental health problems that may affect his or her will, cognition and relationship to the world. The literature on the humanisation of mental health is scarce and only offers the view of professionals. AIM: To analyse the concept, values and strategic initiatives of humanised care in acute psychiatric units from the perspective of persons with mental health problems, carers and professionals. METHOD: Qualitative grounded-theory approach. Data were collected through focus groups and in-depth interviews among persons with mental health problems, carers and professionals. RESULTS: Thirteen focus groups and three in-depth staff interviews were performed, with a total of 61 participants. Humanised care is defined as quality care of an individualised, ethical and safe nature, empowering persons/carers to involve them in their health process, helping them resist the stigma of mental illness through a therapeutic relationship, bond and communication. Formal training, teamwork and effective communication are required. Six values and strategic initiatives were identified. DISCUSSION: Each value and strategic initiatives acquires full meaning when connected with the rest. Without this interconnection, humanised care would be impossible.

Satisfacción con los cuidados de Enfermería proporcionados en una unidad de hospitalización de agudos de salud mental / Satisfaction with Nursing care provided at a hospitalization unit for acute Mental Health patients

Objetivo: analizar la satisfacción del paciente sobre los cuidados recibidos por el personal de Enfermería durante su ingreso en una unidad de hospitalización de agudos de salud mental.Métodos: estudio trasversal analítico realizado en 2021 en la unidad de hospitalización de agudos de Psiquiatría de un hospital del Vallés Occidental en Cataluña (España). La población de estudio fueron las personas con un ingreso superior a una semana que cumplimentaron la escala de Evaluación del Cuidado CAT-V (rango 27-135), en su versión validada al español. Además, se recogieron las variables clínicas de los participantes: a) tipo de ingreso: voluntario/involuntario, b) diagnóstico del ingreso, c) utilización de contención mecánica, d) consumo de tóxicos. Se realizó análisis univariado y comparativo de las variables recogidas.Resultados: se incluyeron 100 pacientes, con una media de edad de 42,5 años (19-72). El 55% (p= 55) fue mujer. La satisfacción obtuvo una puntuación mediana (P25-P75) de 114 (103-125), situándose en el cuarto cuartil de satisfacción. Los valores de satisfacción se mantuvieron en el cuarto cuartil, sin mostrar diferencias estadísticamente significativas en ninguno de los factores considerados, excepto en los valores relacionados con el uso de contención mecánica, que mostró diferencias estadísticas (p= 0,023), con peor percepción de satisfacción del cuidado para aquellos en los que se usaron, mediana (P25-P75) 96,5 (87-114), frente a los que no, 116 (108-125). Aunque no se observaron diferencias significativas para el resto de variables estudiadas se destaca que aumenta la satisfacción en los ingresos voluntarios y en las personas de mayor edad.Conclusiones: los pacientes presentaron alta satisfacción del cuidado recibido por el personal de Enfermería durante su ingreso en una unidad de hospitalización de agudos de salud mental. La prevalencia del uso de contenciones mecánicas tiene un impacto negativo sobre la satisfacción del cuidado recibido. (AU)

Objective: to analyse patient satisfaction regarding care received from the Nursing staff during their admission at a hospitalization unit for acute mental health patients.Methods: an analytical cross-sectional study conducted in 2021 at the hospitalization unit for acute Psychiatry patients at a Vallés Occidental hospital in Catalonia (Spain). The study population were those persons hospitalized for over a week who completed the Caring Assessment Tool CAT-V (range 27-135), in its version translated into Spanish. Besides, the clinical variables of participants were collected: a) type of admission: voluntary / involuntary, b) diagnosis at admission, c) use of mechanical restraint, d) use of toxic substances. There was univariate and comparative analysis of the variables collected.Results: the study included 100 patients, with 42.5 years as mean age (19-72); of these, 55% (p= 55) was female. Satisfaction obtained a median score (P25-P75) of 114 (103-125), and was placed in the fourth quartile. Satisfaction values stayed in the fourth quartile, without showing any statistically significant differences in any of the factors considered, except for those values associated with the use of mechanical restraint, which showed statistical differences (p= 0,023), with a worse perception of satisfaction with care in those for whom it was used, median (P25-P75) 96.5 (87-114), vs. those for whom it was not, 116 (108-125). Even though no significant differences were observed for the rest of variables studied, an increase in satisfaction stood out among voluntary admissions and older persons.Conclusions: patients presented high satisfaction with care received from Nursing staff during their admission at a hospitalization unit for acute mental health patients. The prevalence of the use of mechanical restraints had a negative impact on satisfaction with care received. (AU)

Humanization of care in acute psychiatric hospitalization units: A scoping review.

WHAT IS KNOWN ON THE SUBJECT?: Humanizing the world of health is a complex process that includes all the dimensions of the person. When a person has from a mental illness, the humanization of care becomes more important, as the disorder itself prevents the person to participate in their health process, even when showing self-harm or aggressive behaviours. These situations jointly with other factors related with professionals (insufficient ratio, inadequate treatment or lack of training) may cause the patient admitted to the acute psychiatric hospitalization unit to require the use of restrictive measures (involuntary admissions, mechanical restraints or forced administration of medication). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We identify the relevance of the perception the patient and family have regarding the care received, as well as the relevance of factors related to the professionals, among which the attitude, the staff ratio, the nursing time of direct dedication, and the therapeutic environment and safety of the patient and the professionals. All patients must be treated with dignity, respect, regardless of the aggressive manifestations caused by their pathology. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A greater understanding of the care offered to admitted people affected by a mental disorder, their families and professionals who care for them in acute mental health units, giving greater importance to "caring" and not exclusively to "curing." ABSTRACT: INTRODUCTION: Humanization in Mental Health refers to give the same relevance to the clinical needs and to the social, emotional and psychological needs. AIM: To identify the published knowledge on current care models related to the humanization of care in acute psychiatric units. METHOD: Scoping review based on the methodological model of Arksey and O'Malley, and PRISMA methodology. Database searches (Pubmed, Cinahl, Virtual Library, Cuiden, Academic Google and PsycInfo) with the terms: "Humanization," "Hospitals Psychiatric," "Emergency Psychiatric," "Psychiatric Service" and "Psychiatric intensive care units." RESULTS: Twenty-two articles met the inclusion criteria. Four thematic units were identified: aspects related to (i) patient perceptions; (ii) Government policies and hospitality organizational culture; (iii) external factors such as the environment, family or associations; and (iv) safety and security. DISCUSSION: Only one of the articles mentions the concept analysed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. IMPLICATIONS FOR PRACTICE: The present study can help to improve the care offered in acute mental health units.

Hand contamination during routine care in medical wards: the role of hand hygiene compliance.

The hands of healthcare workers (HCWs) are the most common vehicle for the transmission of micro-organisms from patient to patient and within the healthcare environment. The aim of this study was to evaluate the impact of a multimodal campaign on the type and amount of resident and transient flora and the presence of potential risk factors for hand contamination during routine care. A before-after (PRE and POST periods) interventional study was carried out in medical wards of a tertiary care hospital. Eighty-nine samples were analysed. Samples were cultured immediately before patient contact using a glove-juice method. Data collected included socio-demographic and risk factors for hand contamination. Flora was measured as log10 c.f.u. ml(-1) and evaluated by comparing median values in the PRE and POST periods. Transient flora was isolated from the hands of 67.4 and 46.1 % of HCWs in the PRE and POST periods, respectively (P<0.001). Enterobacteriaceae, Pseudomonas spp. and meticillin-sensitive Staphylococcus aureus were the predominant contaminants. Resident flora was isolated from 92.1 % of HCWs in the PRE period and from 70.8 % in the POST period (P<0.001). The meticillin-resistant coagulase-negative staphylococci log10 c.f.u. count ml(-1) decreased from 1.96 ± 1.2 to 0.89 ± 1.2 (mean ± s d; P<0.001), and the global flora count decreased from 2.77 ± 1.1 to 1.56 ± 1.4 (P<0.001). In the POST period, the wearing of fewer rings (P<0.001), shorter fingernail length (P = 0.008), a shorter time since recent hand hygiene (HH) (P = 0.007) and an increased use of alcohol-based hand rub instead of soap (P<0.001) were documented. The HH multimodal strategy reduced the number of risk factors and the level of HCW hand contamination.

Foodborne nosocomial outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: epidemiology and control.

BACKGROUND: We describe a foodborne nosocomial outbreak due to extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae. METHODS: An outbreak of ESBL K. pneumoniae was detected in March 2008. Initial control measures included contact isolation and a protocol for routine detection and reinforcement in hand hygiene practices. ESBL producers were screened for the bla(TEM), bla(SHV), and bla(CTX-M) genes. Pulsed-field gel electrophoresis analysis was performed using XbaI as a restriction endonuclease. RESULTS: One hundred fifty-six colonized and/or infected patients were identified, 35 (22.4%) of whom had infection. The outbreak affected all hospital wards. Fecal carriage was up to 38% of patients in some wards. Of note, investigation revealed a very short delay between admission and colonization. None of the health care workers or environmental surfaces in the wards was found to be colonized. This prompted an epidemiological investigation of a possible foodborne transmission. We found that up to 35% of the hospital kitchen-screened surfaces or foodstuff were colonized and that 6 (14%) of 44 food handlers were found to be fecal carriers. Phenotypic and genotypic analysis of all clinical, environmental, and fecal carrier isolates showed the dissemination of a single strain of SHV-1 and CTX-M-15-producing K. pneumoniae. At that time, structural and functional reforms in the kitchen were performed. These were followed by a progressive reduction in colonization and infection rates among inpatients until complete control was obtained in December 2008. No restrictions in the use of antibiotics were needed. CONCLUSIONS: To our knowledge, this is the first reported hospital outbreak that provides evidence that food can be a transmission vector for ESBL K. pneumoniae.