Delineating Quality Indicators of Inpatient Psychiatric Hospitalization

2020 ◽  
pp. 107839032097136
Author(s):  
Kathleen R. Delaney ◽  
Jeannine Loucks ◽  
Richard Ray ◽  
Ellen Blair ◽  
Marlene Nadler-Moodie ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Inpatient Care ◽  
Psychiatric Hospitalization ◽  
Psychiatric Treatment ◽  
Quality Care ◽  
Psychiatric Inpatient ◽  
Well Being ◽  
Consumer Involvement ◽  
Inpatient Psychiatric Treatment ◽  
The Impact

BACKGROUND: Assuring quality care is critical to the well-being and recovery of individuals receiving inpatient psychiatric treatment, yet a comprehensive map of quality inpatient care does not exist. AIMS: To isolate and describe quality elements of inpatient psychiatric treatment. METHOD: A survey queried psychiatric inpatient nursing leaders on what they considered to be critical elements of quality. The survey was emailed to 40 American Psychiatric Nurses Association members, and 39 individuals responded. In the survey, participants were asked to comment on the importance of six dimensions of quality as well as quality indicators used on their units. RESULTS: Data from this survey indicate how thought leaders conceptualized quality of inpatient care. A unifying philosophy of care was endorsed as a quality element as was structure that affords staff available time on the unit—engaging with patients. While staffing levels were viewed as important, the respondents commented on the nuances between staffing and quality. Participants endorsed the importance of involving individuals in their treatment planning as well as tapping into patients’ perspectives on the treatment experience. CONCLUSION: The participants’ responses compliment the quality literature and reinforce the need to develop a comprehensive map of quality elements. These elements interact in complex way, for instance, staffing, engagement, and teamwork is tied to the organizational structure and philosophy of care, which in turn facilitates consumer involvement in care. Thus, gauging the impact of quality on outcomes will demand consideration of the interaction of factors not just the linear relationship of one element to an outcome.

Addressing Burnout in Oncology: Why Cancer Care Clinicians Are At Risk, What Individuals Can Do, and How Organizations Can Respond

2016 ◽  
pp. 271-279 ◽  
Author(s):  
Fay J. Hlubocky ◽  
Anthony L. Back ◽  
Tait D. Shanafelt
Keyword(s):  
Cancer Care ◽  
Quality Care ◽  
Action Planning ◽  
Well Being ◽  
Care Patient ◽  
Shared Responsibility ◽  
Direct Care ◽  
Organizational Level ◽  
Individual Level ◽  
The Impact

Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care.

scholarly journals Caregiver involvement in psychiatric inpatient treatment – a representative survey among triads of patients, caregivers and hospital psychiatrists

2020 ◽  
Vol 29 ◽  
Author(s):  
F. Schuster ◽  
F. Holzhüter ◽  
S. Heres ◽  
J. Hamann
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
Well Being ◽  
Subjective Perception ◽  
Representative Survey ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Caregiver Involvement

Abstract Aims Studies on the frequency of caregiver involvement in representative inpatient samples are scarce. The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). Therefore, we performed face-to-face interviews consisting of open-ended questions to gain a deeper understanding of when and how caregivers are involved in care treatment and to identify which topics are mainly discussed. Methods This cross-sectional survey included inpatients from 55 acute psychiatric wards across ten psychiatric hospitals, their treating psychiatrists and, when possible, their caregivers. In total, we performed semi-structured face-to-face interviews with 247 patients, their treating psychiatrists and 94 informal caregivers. Each psychiatrist named the next two to three patients to be discharged. After a patient had given informed consent, the interview was performed by a researcher. In addition, the psychiatrist and, when possible, the primary caregiver identified by the patient, were also interviewed. Results It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases. Predictors for psychiatrist-caregiver-contact were revealed in the patient's diagnosis (schizophrenia), a lower history of inpatient stays, and the respective hospital. According to psychiatrists the most frequent subjects of discussion with caregivers involved therapeutic issues and organisational and social-psychiatric topics (e.g. work, living and social support). Patients and caregivers stated that psychiatric treatment and the diagnostic classification of the mental illness were the most frequent topics of conversation. For all three groups, the most often cited reason for missed caregiver involvement was the subjective perception that a caregiver was not in fact needed. Conclusions Whether or not caregivers were contacted and involved during an inpatient stay strongly depended on the individual hospital. The frequency of involvement of caregivers can certainly be increased by changing processes and structures in hospitals. All three parties (patients, caregivers and psychiatrists) most often stated that the caregiver was not involved in the treatment because they thought it was unnecessary. Evidence demonstrates the positive effect of caregivers' involvement on the therapeutic process but also on the well-being of the caregiver, therefore it is necessary to increase awareness of this evidence among all three interest groups.

Self-harm and overcrowding among prisoners in Geneva, Switzerland

2016 ◽  
Vol 12 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Hans Wolff ◽  
Alejandra Casillas ◽  
Thomas Perneger ◽  
Patrick Heller ◽  
Diane Golay ◽  
...  
Keyword(s):  
Psychiatric Treatment ◽  
Well Being ◽  
Small Sample ◽  
Medical Attention ◽  
Short Report ◽  
Content Type ◽  
Pertinent Data ◽  
Self Harm ◽  
The Impact ◽  
Over Time

Purpose – Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a “deprivation state.” The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm. Design/methodology/approach – This cross-sectional study took place at Geneva’s pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014). Findings – Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment. Research limitations/implications – The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio – and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential. Practical implications – The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior. Originality/value – This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

Physical health care

2019 ◽  
pp. 91-102
Author(s):  
Mark Toynbee ◽  
Valeria Frighi
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Physical Health ◽  
Inpatient Care ◽  
Psychiatric Inpatient ◽  
Health Impacts ◽  
Psychiatric Illnesses ◽  
Physical Health Care ◽  
Diabetes Mellitus Risk ◽  
The Impact

This chapter explores the impact of physical health comorbidities on morbidity and mortality in individuals with psychiatric illnesses. There is a significant and enduring disparity in the life expectancy of the general population and people with severe mental illness (SMI). The majority of this inequality is due to preventable physical illness, particularly cardiovascular disease, respiratory disorders, and diabetes mellitus. Risk factors for these disorders such as smoking, obesity, and lack of physical activity are disproportionately represented in SMI populations and some psychotropic medications also contribute. Physical ill health impacts negatively on mental health outcomes. Psychiatric inpatient admissions represent a unique opportunity to address many of these illnesses and risk factors. Physical health care is the business of all professionals involved in inpatient care.

Introduction to core principles in children’s nursing

2010 ◽  
Author(s):  
Imelda Coyne ◽  
Joan Livesley
Keyword(s):  
Clinical Skills ◽  
Quality Care ◽  
Well Being ◽  
High Quality ◽  
Quality Healthcare ◽  
High Quality Care ◽  
The Core ◽  
Nursing Services ◽  
The Impact ◽  
Health And Well Being

The aim of this chapter is to discuss the core principles in children’s nursing and the application of these principles in everyday practice for nurses working with children and families. These essential principles are fundamental in the delivery of high quality care and as such will be evident throughout this textbook. This chapter will explain these principles in the context of community and hospital care and illustrate how nurses can use this knowledge in their clinical practice. There is no doubt that clinical skills are an essential component of high quality healthcare, but they are on their own insufficient to ensure that the needs of children and their families are met. Clinical skills need to be embedded in children’s services that are child centred and clearly focused around the needs of children and their families; but how is this possible? To ensure high quality care for children in hospital and the community you need to incorporate the core principles of family centred care into your everyday nursing practice and interventions. It is essential to understand the principles of family centred care and the importance of partnership and negotiation in the delivery of clinical skills. Knowing where to begin can be difficult, but we think that you can start with the concept of attachment and loss. Understanding this in relation to children’s separation from their family and home will help you to understand the impact of hospitalization on children, particularly those younger than five years old. The adverse aspects of hospitalization have been a substantial driving force in delivering more nursing services to children at home. However, it is also important to remain aware of the ongoing impact of lifelong illness on children and their families and why it is essential to use effective communication skills, maintain safe environments, and incorporate play into your practice. Together with evidence-based clinical skills, these facets of practice will enable you to maintain and promote children’s and families’ health and well-being. Specific learning outcomes are as follows. At the end of this chapter you will: ● Understand the basic elements of attachment and loss theory.

scholarly journals The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries—An ecological study

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Stephan Listabarth ◽  
Benjamin Vyssoki ◽  
Alexander Glahn ◽  
Andrea Gmeiner ◽  
Nathalie Pruckner ◽  
...  
Keyword(s):  
Inpatient Treatment ◽  
Inpatient Care ◽  
Suicide Risk ◽  
Ecological Study ◽  
Psychiatric Hospitalization ◽  
Psychiatric Inpatient ◽  
Suicide Mortality ◽  
Time Intervals ◽  
Psychiatric Inpatient Treatment ◽  
Inpatient Suicide

Abstract Background. Suicide risk in patients is markedly elevated during psychiatric inpatient care, as well as after discharge. However, it is unclear whether, and to what extent, this increased suicide risk varies between sex. Thus, the aim of this study was to analyze sex differences for suicides during and after psychiatric hospitalization in various countries. Methods. National suicide mortality rates and inpatient-related suicide rates (three intervals: during psychiatric inpatient treatment, 1 month, and 1 year after discharge) from 12 countries for 2000–2016 were analyzed, and a logistic model was used to quantify the effect of sex. Results. Persons admitted to or discharged from psychiatric inpatient care exhibited significantly increased rates of suicide compared to those in the general population. Furthermore, increase of suicide risk was significantly higher for females than for males for all investigated time intervals (inpatient suicide odds ratio [OR] 1.85; suicide within 1 month after discharge—OR 1.94; suicide within 1 year after discharge—OR 2.04). Conclusion. Analysis confirmed the time during and after psychiatric inpatient care to be significantly associated with an elevated risk for suicide. Further, a significant sex effect was observed, with females in this population being at a proportionally higher risk for suicide during psychiatric inpatient treatment as well as the year following discharge. Our study implicates that more effective suicide preventive measures during inpatient stay, focusing on female patients, are needed.

scholarly journals Sociodemographic and Clinical Predictors of the Length of Psychiatric Inpatient Stay of Immigrants in Switzerland

2020 ◽  
Vol 11 ◽  
Author(s):  
Renée Frizi ◽  
Barbara Lay ◽  
Erich Seifritz ◽  
Wolfram Kawohl ◽  
Benedikt Habermeyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychiatric Hospital ◽  
Psychosocial Functioning ◽  
Inpatient Treatment ◽  
Psychiatric Treatment ◽  
Strong Predictor ◽  
Psychiatric Inpatient ◽  
Inpatient Stay ◽  
Clinical Predictors ◽  
The Impact

Immigrants with mental disorders have consistently been reported to spend shorter time in the psychiatric hospital compared to native patients. The aim of this study was to identify sociodemographic, clinical and migration-related predictors of a shorter length of psychiatric inpatient stay among immigrants in Switzerland. All patients of a foreign nationality admitted for inpatient treatment in the year 2016 (N = 279) were included in this study. The sample characteristics were drawn from the register of the psychiatric hospital. Within this sample, self-harm and substance use predicted a shorter inpatient treatment episode whereas disturbances of general psychosocial functioning were a predictor of a longer length of stay. As similar results were also reported for non-immigrant patients, the impact of these specific behavioral and social problems on the length of inpatient stay does not appear to be migrant-specific. Moreover, a country of origin outside Europe was a strong predictor of shorter length of stay pointing to inequalities of inpatient psychiatric treatment within the group of immigrants. Therefore, the cultural background and migrant history of immigrants in psychiatry need stronger consideration in order to eliminate disadvantages in mental health care.

Reducing the potential for suffering in older adults with advanced cancer

2010 ◽  
Vol 8 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Genevieve N. Thompson ◽  
Harvey M. Chochinov
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advanced Cancer ◽  
Health Care Professionals ◽  
Quality Care ◽  
Well Being ◽  
Life Transitions ◽  
Spiritual Well Being ◽  
The Impact ◽  
Shed Light

AbstractObjective:To deliver quality care at the end of life, understanding the impact of various changes and life transitions that occur in older age is essential. This review seeks to uncover potential sources of distress in an elder's physical, psychological, social, and spiritual well-being to shed light on the unique challenges and needs facing this age group.Methods:Papers relating to older adults (aged 65 years and older or a mean age of 65 years and older) with advanced/terminal cancer receiving palliative, hospice, or end-of-life care published after 1998 were reviewed.Results:Older adults with advanced cancer have unique needs related to changes in their physical, psychological, social, and spirituals well-being. Changes in each of these domains offer not only the risk of causing distress but also the potential for growth and development during the final stages of advanced cancer.Significance of results:Being aware of the various changes that occur with aging will help health care professionals tailor interventions to promote dignity-conserving care and greatly reduce the potential for suffering at the end of life.

Quintessenz

2016 ◽  
Vol 1 (2) ◽  
pp. 47-49
Author(s):  
Anja Maria Reichel
Keyword(s):  
Psychiatric Treatment ◽  
Quality Measure ◽  
Psychiatric Nurses ◽  
Patient Centered ◽  
Inpatient Psychiatric Treatment

Zusammenfassung. Delaney, K. R., Johnson, M. E. and Fogg, L. (2015): Development and Testing of the Combined Assessment of Psychiatric Environments: A Patient-Centered Quality Measure for Inpatient Psychiatric Treatment. Journal of the American Psychiatric Nurses Association, 21 (2), 134–147.

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