The experiences of people with borderline personality disorder admitted to acute psychiatric inpatient wards: a meta-synthesis.

Background: Acute psychiatric inpatient care is recommended for people with borderline personality disorder (BPD) to manage a crisis. Qualitative research exploring service user experience is valuable for the development of evidence-based treatment guidelines. Aim: To conduct a meta-synthesis of qualitative research exploring the experiences of people with BPD on acute psychiatric inpatient wards. Methods: Literatures searches of five electronic databases. Data were analysed using a three-stage theme identification process. Results: Eight primary studies and three first-hand accounts met the inclusion criteria. Four overarching themes were found to explain the data: contact with staff and fellow inpatients; staff attitudes and knowledge; admission as a refuge; and the admission and discharge journey. Conclusions: Similar experiences of acute psychiatric inpatient care were reported by people with BPD across the studies. Opportunities to be listened to and to talk to staff and fellow inpatients, time-out from daily life and feelings of safety and control were perceived as positive elements of inpatient care. Negative experiences were attributed to: a lack of contact with staff, negative staff attitudes, staff's lack of knowledge about BPD, coercive involuntary admission and poor discharge planning.

Understanding Outcomes in a Randomized Controlled Trial of a Ward-based Intervention on Psychiatric Inpatient Wards: A Qualitative Analysis of Staff and Patient Experiences.

OBJECTIVE: Team formulation is advocated to improve quality of care in mental health care and evidence from a recent U.K.-based trial supports its use in inpatient settings. This study aimed to identify the effects of formulation on practice from the perspectives of staff and patient participating in the trial, including barriers and enhancers to implementing the intervention. METHOD: We carried out semistructured interviews with 57 staff and 20 patients. Data were analyzed using thematic analysis. RESULTS: Main outcomes were: improved staff understanding of patients, better team collaboration and increased staff awareness of their own feelings. Key contextual factors were as follows: overcoming both staff and patient anxiety, unwelcome expert versus collaborative stance, competing demands, and management support. CONCLUSION: Team formulation should be implemented to improve quality of care in inpatient settings and larger definitive trials should be carried out to assess the effect of this intervention on patient outcomes.

"Just be a light": Experiences of peers working on acute inpatient psychiatric units.

OBJECTIVE: The study aimed to clarify the potential role and impact of behavioral health peer support providers on community hospital acute inpatient psychiatric units. METHOD: Qualitative interviews were conducted to examine perspectives of peer support providers (peers) and individuals who initially received peer services (recipients) during an inpatient stay on a community hospital psychiatric unit. Interviews elicited perspectives on interactions between peers and recipients, the role of peers vis-à-vis the clinical treatment team, and involvement of peers in discharge planning and transitions to community-based care. Fourteen interviews were completed (6 peers and 8 recipients of peer services); all were recorded, transcribed, and coded using a thematic analysis approach. RESULTS: Emergent themes were grouped into 3 domains: (a) initial impressions and client engagement, (b) peer interventions to support discharge planning, and (c) shared or sharing experiences in an inpatient setting. Recipients described inpatient experiences as disempowering and humiliating and reported powerful positive initial reactions to peers who had had similar experiences but who also displayed competence and professionalism. Peers and recipients described strong emotional connections that differed from traditional attitudes and relationships with clinical staff. Peers described challenges and obstacles related to interactions with the clinical treatment team, and both peers and recipients strongly endorsed the role of peers in facilitating successful care transitions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Behavioral health peers can play important roles in acute inpatient psychiatric care, supplementing clinical treatment team activities and filling important gaps related to engagement, discharge planning, and care transitions. (PsycINFO Database Record

Training peer specialists with mental illness in motivational interviewing: A pilot study.

OBJECTIVE: The objective of this study was to evaluate the effects of providing motivational interviewing (MI) training to peer specialists in the Veterans Affairs (VA) health-care system. METHODS: Fourteen peer specialists at a local VA medical center received a 2-day workshop on MI and 2 monthly booster sessions afterward. A total of 55 therapy sessions between peer specialists and their peer service recipients were audio-recorded and independently rated on MI fidelity before the workshop and each month after the workshop for 3 months. Sessions were rated on fidelity scales assessing Fundamental MI Adherence and Competence, Advanced MI Adherence and Competence, and MI Inconsistent Adherence scales. One item was created for this study that assessed Sharing Lived Experiences. Repeated measures analysis was conducted to examine change in MI fidelity over time. RESULTS: Peer specialists had a significant decline in MI Inconsistent Adherence scale scores over time. Specifically, they showed reductions in providing unsolicited advice and emphasizing absolute abstinence. Peer specialists also showed a significant decline in the Sharing Lived Experience Adherence item score. There were no significant changes on MI Fundamental and Advance scale scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record

Nursing and health-care assistant experience of supervision in a medium secure psychiatric service for women: implications for service development.

In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.

Attitudes to coercion at two Norwegian psychiatric units.

BACKGROUND: Many countries allow for the use of restraint and seclusion in emergencies with psychiatric inpatients. Authors have suggested that the attitudes of staff are of importance to the use of restraint and seclusion. AIM: To examine the attitudes to coercion at two Norwegian psychiatric units. In contrast to the idea that attitudes to coercion vary much within and between institutions, we hypothesized that staff's attitudes would be quite similar. METHODS: We distributed a questionnaire to staff at two psychiatric units in two Norwegian counties. Eight wards were included. The questionnaire contained fictitious case histories with one patient that was violent and one patient that was self-harming, and staff were asked to describe how they would intervene in each emergency. Emergency strategies were sorted according to degree of restrictiveness, from the highly restrictive (restraint, seclusion) to the unrestrictive (talking, offering medication). Data were analysed with regression analyses. RESULTS: There was only a limited degree of variance in how staff at the different units and various groups of staff responded. Staff were more likely to favour a highly restrictive intervention when the patients were physically violent. Male staff and unskilled staff were significantly more prone to choosing a highly restrictive intervention. CONCLUSIONS: Our hypothesis was confirmed, as there was a limited degree of variance in staff's responses with respect to degree of restrictiveness. The study supported the idea that a range of different interventions are used in emergency situations.

Psychiatric staff perceptions of patient attachments: a pilot study to investigate differences in and predictors of psychiatric staff perceptions of patient attachments.

OBJECTIVES: We explored the extent to which a group of psychiatric staff differed in their ratings of patients' attachment styles and whether deviations in mean ratings were related to education, clinical experience, familiarity with patients, or staff attachment styles. METHOD: Fifteen mental healthcare workers assessed the attachment styles of nine patients with schizophrenia or schizoaffective disorder using the Psychosis Attachment Measure. Staff also reported on their own attachment styles. Similarity in ratings was investigated using two-way random interclass correlation coefficients (ICCs). An index showing how much each rater's assessments of attachment style deviated from the mean attachment style rating for each of the patients was used to investigate possible predictors of deviations from mean ratings. RESULTS: Average staff ICCs for attachment anxiety and avoidance suggested reasonable levels of convergence between staff perceptions. Deviations from mean ratings were unrelated to staff qualifications or years of experience in mental health. However, staff who had known patients for longer periods tended to rate patients more similarly, whereas staff who had higher levels of attachment anxiety and avoidance tended to deviate from colleagues' ratings. CONCLUSIONS: Attachment styles in psychosis are observable characteristics that can be rated by mental health professionals, although length of time staff have known patients, as well as their own attachment styles are likely to influence perceptions.

Staff attachment styles: a pilot study investigating the influence of adult attachment styles on staff psychological mindedness and therapeutic relationships.

The attachment styles of psychiatric staff are likely to impact on their capacity to form positive therapeutic relationships with patients with psychosis. Twenty staff completed a measure assessing levels of attachment anxiety and avoidance. Staff and patients completed a measure of patients' interpersonal problems and staff completed the Five-Minute Speech Sample, which was used to derive ratings of psychological mindedness and therapeutic relationships. Higher staff avoidance was associated with greater discrepancies in staff and patient ratings of patients' interpersonal problems and poorer staff psychological mindedness. Lower staff anxiety and avoidance were associated with positive therapeutic relationships. Findings warrant replication in larger samples, but suggest that staff attachment style may be important in the development of better quality staff and patient relationships.

Factors associated with life satisfaction of personal care workers delivering dementia care in day care centers.

This study examined the overall life satisfaction of personal care workers (PCWs) delivering dementia care in elderly day care centers in Hong Kong. A total of 142 PCWs participated in the present study. Regression analysis results showed that self-efficacy in dementia care was a robust predictor for PCWs' life satisfaction. Female gender, perceived adequacy of training, low staff to client ratio, and high emotional support from colleagues predicted a high level of self-efficacy. To promote a higher level of life satisfaction among PCWs, it is essential for organizations to enhance their sense of self-efficacy. Providing PCWs with adequate training that address areas specific to their perceived needs is of utmost importance in achieving this goal.

Burnout among employees in human service work: design and baseline findings of the PUMA study.

AIM: To present the theoretical framework, design, methods, and baseline findings of the first Danish study on determinants and consequences of burnout, and the impact of workplace interventions in human service work organizations. METHOD: A 5-year prospective intervention study comprising 2,391 employees from different organizations in the human service sector: social security offices, psychiatric prison, institutions for severely disabled, hospitals, and homecare services. Data were collected at baseline and at two follow-ups. The authors developed a new burnout tool (the Copenhagen Burnout Inventory) covering work-related, client-related, and personal burnout. The study includes potential determinants of burnout (e.g. the psychosocial work environment, social relations outside work, lifestyle factors, and personality aspects) and consequences of burnout (e.g. poor health, low job satisfaction, turnover, and absenteeism). Here, the focus is on the description of the study population at baseline, including associations of work burnout with psychosocial work environment scales and absence. RESULTS: Response rate at baseline was 80.1%. Midwives and homecare workers had high levels on both work- and client-related burnout. Prison officers had the highest level on client-related burnout. Supervisors and office assistants had low levels on both scales. Work burnout showed the highest correlations with job satisfaction (r = -0.51), quantitative demands (r = 0.48), role-conflicts (r = 0.44), and emotional demands (r = 0.42). Sickness absence was 13.9 vs 6.0 days among participants in the highest and lowest work burnout quartile, respectively. CONCLUSION: The findings indicate that study design and methods are adequate for the upcoming prospective analyses of aetiology and consequences of burnout and of the impact of workplace interventions.

Violence and threats of violence within psychiatric care--a comparison of staff and patient experience of the same incident.

This study compared staff members' and psychotic patients' experiences of one and the same violent incident. The staff exposed to the violence completed the Staff Observation Aggression Scale (SOAS). The patients who had exhibited the violent behaviour were interviewed prior to discharge from the ward. When comparing the SOAS data with the patient interviews, it was found that the staff members were able to identify less than 50% of the provocations that the patient experienced. According to the patient interviews, giving the patient medication was far more often experienced as a provocation, resulting in violence, than the staff perceived. Knowledge about how to interpret the patients' body language and other signals, and how patients perceive the staff's behaviour, must be understood for an efficient prevention of violence in psychiatric care.

[Comparison of ward atmosphere between three specialized wards for patients with alcoholism, schizophrenia, and depression and a diagnostic heterogeneous satellite ward]. / Vergleich der Stationsatmosphäre zwischen drei Spezialstationen für alkoholkranke, schizophrene und depressive Patienten und einer diagnostisch gemischten Satellitenstation.

OBJECTIVE: Does the ward atmosphere differ between three specialized wards for patients with alcoholism, schizophrenia, and depression and a diagnostic heterogeneous satellite ward? METHODS: The ward atmosphere was assessed by patients and staff with the German version of the ward atmosphere scale (WAS). RESULTS: The data of 49 co-workers and 41 patients were evaluated. The satellite ward was rated significantly better than the specialized wards by both staff and patients (p < 0.01). CONCLUSIONS: If it is not possible to prove empirically, in future, that specialized wards have treatment advantages, our study suggests for atmospheric reasons that diagnostic heterogeneous wards should be recommended as standard care.

What do we know about life on acute psychiatric wards in the UK? A review of the research evidence.

Despite the development of community care and associated processes of de-institutionalisation, the hospital remains the hub of mental health services in the UK. However, previous quantitative and survey research indicates that quality of care in acute psychiatric (admission) wards has been compromised or is under threat, and points to a bleak experience for people who are admitted. Indicators of this include that there have been increases in admission rates, the proportion of compulsory admissions, and bed occupancy rates. There is also evidence of violence, sexual harassment and substance misuse in this setting, accompanied by rapid staff turnover, low staff morale, and an increasing proportion of 'difficult' patients (especially young men with schizophrenia). This paper reviews the evidence about life on psychiatric wards, focusing on how it is experienced by patients in acute settings. Research conducted in the UK in the 1990s, supports the impression that organisational pressures are having a negative impact on the quality of care. It shows that: nurse-patient (N-P) relationships are perceived to be an important aspect of care, but that N-P contact has declined; and patients are critical of conditions on the ward and view life there as both boring and unsafe. However, very little in-depth ethnographic research has been conducted on acute wards in the UK (and none since the 1970s) leaving us with a 'black box' view of in-patient care in this setting. Studies conducted during earlier 'care paradigms', notably those in the USA by Goffman and Strauss et al., provide useful insights into the patient's experience, but the extent to which these can be conceptually generalised to the present situation is unknown. The paper concludes by outlining questions and priorities for future investigation, focusing on the role of qualitative research.

Caring for individuals with severe and persistent mental illness: the contributions and challenges of residential case aides.

The challenge of helping individuals with mental illness live more independently and purposefully within the community warrants a collaborative system of caregiving between professional and paraprofessional caregivers. Residential community support aides are a crucial component of this system of care. However, current investigation of their daily work experiences is lacking. In this study, a team of researchers, employing an interpretive phenomenological approach, analyzed data from in-depth, individual interviews with 5 residential community support aides and identified a constitutive pattern: the teacher as learner. Examination of this pattern and its associated themes will identify those clinical practices that should be preserved and those that are in need of change.

Creating a supportive environment using staff psychoeducation in a supervised residence.

The prevailing approach to rehabilitation in residential care emphasizes goal attainment. This approach often produces considerable stress for residents, most of whom have schizophrenia. Based on the view that low-demand environments, incorporating graduated expectations, may be more appropriate for this patient population, a three-component model for creating and maintaining a calm, supportive environment in a supervised residence was developed. The model utilizes staff psychoeducation, which is based on the principles of family psychoeducation, a highly effective intervention for patients with schizophrenia. The three components of the model are training in supportive interaction, a medication-monitoring program, and a behavioral approach to problem solving. Resident groups promote each of these components. The groups' goals are encouragement of positive, low-key interactions, compliance with medications, and slow, steady rehabilitation.

Further evaluation of verbal ability selection test and work performance validity with psychiatric aides.

Verbal selection test and work performance validity based on two samples of psychiatric aides were both .25, with corrected validities of .60 (n = 40) and .46 (n = 60). When combined with three previous samples (N = 273), meta-analysis yielded a mean validity of .25 (cumulative p = .00003) which provided further evidence of the validity of cognitive ability tests in selection of psychiatric aides.