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Quality of Care in the Psychiatric Setting: Perspectives of the Patient, Next of Kin and Care staff
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe quality of care from different perspectives in the psychiatric setting, to develop an instrument for measuring quality of care from the in-patient perspective and to use this instrument empirically. A qualitative descriptive design involving a phenomenographic analysis was used in Studies I, III and IV, and a descriptive and comparative design with statistical analysis in Study II.

In Study I, 20 patients were interviewed. The results showed that quality of care was perceived as a positive, normative concept namely as good quality of care. Five descriptive categories emerged: the patient’s Dignity is respected; the patient’s sense of Security with regard to care; the patient’s Participation in care; the patient’s Recovery; and the patient’s care Environment. In addition, two conceptions that had not explicitly emerged in previous studies on quality of care were identified: Being helped to reduce the shame and Being looked upon as like anyone else.

In Study II a definition of quality of care from a patient perspective was formulated on the basis of the results in Study I. A two-part instrument the Quality in Psychiatric Care (QPC) was developed for measuring the patients’ expectations regarding quality of care (QPC-1) and their subsequent experience of it (QPC-2). One hundred and sixteen patients answered both parts of the instrument. Overall, the quality of care was rated high in both parts. However, experienced quality of care was significantly lower than the patient’s expectations in all the dimensions of the instrument: Total dimension, Dignity, Security, Participation, Recovery and Environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health also experienced this, but had in addition significantly higher levels of Participation. This new instrument exhibited too high Cronbach’s alpha values (QPC-1 0.87–0.98, QPC-2 0.85–0.98), which means the instrument needs to be further tested in order to improve its psychometric properties.

Twelve next of kin were interviewed in Study III. The next of kin described quality of care mainly from their own perspective, but also to a large extent from the patient’s perspective as well. They described it in both positive and negative terms. Five descriptive categories resulted: Dignity, Security, Participation, Recovery and Health-promoting surroundings. Good relations and communication between staff, patients and next of kin emerged as the central factors regarding the quality of care. The next of kin asked for information about mental illnesses and wanted to co-operate and participate in the patient’s care. They avoided telling others about their family member’s psychiatric illness because of a feeling of shame and guilt.

In Study IV, 20 care staff and care associates were interviewed. They described quality of care both from the patient’s perspective and from a professional perspective. They perceived the concept as a positive one and as being of great importance for the patient’s health and life situation. Four descriptive categories resulted: the patient’s Dignity is respected; the patient’s Participation in the care; the patient’s Recovery; and the patient’s care Environment plays an important role.

The main contribution of this thesis with regard to the concept of quality of care in the psychiatric setting is its emphasis on the significance of the different perspectives described above, as such knowledge is vital when planning and implementing and evaluating quality of psychiatric care. In addition, the descriptive categories that emerged in this thesis clearly highlight the importance of interpersonal relationships in the care situation. The new instrument (QPC) needs psychometric testing before it routinely can be used as a self-rating instrument for the purpose of improving psychiatric inpatient care and help guide the proper allocation of care resources.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2006.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 969
Series
Keyword [en]
Care associates, Care staff, Instrument development, Next of kin, Patient, Phenomenography, Psychiatric care, Quality of care.
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-8044ISBN: 91-85643-46-7 (print)OAI: oai:DiVA.org:liu-8044DiVA: diva2:22929
Public defence
2006-12-01, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2007-01-15 Created: 2007-01-15 Last updated: 2009-06-04
List of papers
1. Patients’ perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study
Open this publication in new window or tab >>Patients’ perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study
2006 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 15, no 1, 93-102 p.Article in journal (Refereed) Published
Abstract [en]

Aim. The aim was to describe how patients perceived the concept of quality of care in psychiatric care.

Background. It is important to include patients' experiences in defining quality of care and in the development of instruments measuring quality of psychiatric care, as patients have unique information. But only a limited number of studies have directly involved patients.

Design. It was a qualitative interview study with 20 adult in and outpatients from psychiatric care.

Method. A phenomenographic approach was used for the analysis of the interviews.

Results. The results showed that quality of care was perceived as a positive concept, namely as 'good' quality of care. The normative component was striking. Five descriptive categories emerged: The patient's dignity is respected; The patient's sense of security with regard to care; The patient's participation in the care; The patient's recovery; and The patient's care environment. Two conceptions emerged that had not emerged explicitly in earlier studies of quality of care: Being helped to reduce the shame and Being looked upon as like anyone else.

Conclusions. The findings emphasize the importance of the interpersonal relationship between patients and staff. There is a need for further exploration of central aspects of quality in psychiatric care.

Relevance to clinical practice. It is important that the knowledge about how patients perceived the quality of care in psychiatric care is included in the planning and evaluation of care. The guidelines should designate quality of care from the patient perspective as the goal of interventions.

Keyword
patients' perspective, psychiatric care, phenomenography, qualitative method, quality of care
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-14215 (URN)10.1111/j.1365-2702.2005.01241.x (DOI)
Available from: 2007-01-15 Created: 2007-01-15 Last updated: 2009-06-04
2. Quality in Psychiatric Care: an instrument evaluating patients’ expectations and experiences
Open this publication in new window or tab >>Quality in Psychiatric Care: an instrument evaluating patients’ expectations and experiences
2007 (English)In: International journal of health care quality assurance, ISSN 1366-0756, Vol. 20, no 2, 141-160 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – The principal aim of this paper is to develop an instrument to measure quality of care in the psychiatric setting from an in-patient perspective and to describe quality of care by means of this instrument. A further aim is to investigate the influence of background variables and expectations on the experience of care.

Design/methodology/approach – The instrument “Quality in psychiatric care” consists of two parts: one for measuring the patient's expectations regarding quality of care, the other for measuring his or her experiences regarding it. The instrument was derived from an earlier interview study of patients' perceptions of the quality of psychiatric care. A sample of 116 patients from eight in-patient wards in Sweden participated in the present study.

Findings – Results indicate a generally high quality of care. Experienced quality of care was significantly lower, however, than expectations in all the dimensions of the instrument: total dimension, dignity, security, participation, recovery and environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health experienced this too, but also significantly higher participation.

Research limitations/implications – This new instrument needs to be further tested before the psychometric properties can be established.

Originality/value – The value of the research is that instruments for measuring the quality of in-patient psychiatric care from the patient's perspective and with a theoretical foundation are less common.

Keyword
Customer satisfaction, Expectation, Patient care, Psychiatry, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14216 (URN)10.1108/09526860710731834 (DOI)
Available from: 2007-01-15 Created: 2007-01-15
3. Next of kin’s conceptions of the quality of care in the psychiatric setting: a phenomenographic study
Open this publication in new window or tab >>Next of kin’s conceptions of the quality of care in the psychiatric setting: a phenomenographic study
2007 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, Vol. 16, no 5, 307-317 p.Article in journal (Refereed) Published
Abstract [en]

The next of kin play a decisive role in the care provided for patients. This and their unique experience of psychiatric care make it important to include them when defining quality of care. The aim of the present study was to describe how next of kin perceive the concept of quality of care in the case of psychiatric care. Twelve next of kin were included in a qualitative interview study and a phenomenographic approach was used for the analysis of the interviews. The next of kin described quality of care mainly from their own perspective but also to a large extent from the patient's perspective as well. Five descriptive categories resulted: dignity, security, participation, recovery, and health-promoting surroundings. Good relations and communication between staff, patients, and next of kin emerged as the central factors regarding the quality of psychiatric care. The next of kin asked for information about psychiatric illnesses and wanted to cooperate in the care. They avoid telling others about their family member's psychiatric illness because of a feeling of shame and guilt. Staff education regarding such feelings and stigmatization could be useful in furthering the understanding of the next of kin's distress and developing interventions to alleviate it. Clinical practice can be improved by guidelines and instruments developed on the basis of this study.

Keyword
next of kin's perspective, phenomenography, psychiatric care, qualitative method, quality of care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14217 (URN)10.1111/j.1447-0349.2007.00481.x (DOI)
Available from: 2007-01-15 Created: 2007-01-15
4. Psychiatric care staff ’s and care associates’ perceptions of the concept of quality of care: a qualitative study
Open this publication in new window or tab >>Psychiatric care staff ’s and care associates’ perceptions of the concept of quality of care: a qualitative study
2004 (English)In: Scandinavian Journal of Caring Science, ISSN 0283-9318, Vol. 18, no 2, 204-212 p.Article in journal (Refereed) Published
Abstract [en]

Quality of care is a multidimensional concept and has been given different meanings in the literature. The aim in the present study was to describe how the psychiatric care staff and care associates perceived the concept of quality of care in the case of psychiatric care. Ten staff and 10 associates were interviewed. Qualitative method with a phenomenographic approach was used for the analysis. Four descriptive categories emerged: The patient's dignity is respected, The patient's participation in the care, The patient's recovery, and The patient's care environment plays an important role. Quality of care was perceived as a positive concept and as being of great importance for the patient's health and conditions of living. The results were of importance with regard to the forthcoming development of an instrument to measure the quality of psychiatric care.

Keyword
quality of care, patient satisfaction, psychiatric care, staff, qualitative method, phenomenography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14218 (URN)10.1111/j.1471-6712.2004.00271.x (DOI)
Available from: 2007-01-15 Created: 2007-01-15 Last updated: 2009-06-04

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