This paper describes a qualitative research study which explored the practices and views of nurses working on a new mental health intensive care unit. A review of the literature identified the main aspects of intensive care provision: (1) physical security, (2) characteristics of the patient group, (3) staff-patient ratios. (4) therapeutic environment and (5) multi-agency involvement. Twenty-one periods of participant observation helped form the questions for a semi structured in-depth tape recorded interview in which 11 out of a total of 16 trained nurses took part. The information is categorized and the discussion is informed by observation of practice. The nurses perceived the following as the main issues: that the physical environment is inadequate for security; that the patient group appears to have the common characteristic of being unwanted in other clinical settings; that the staff-patient ratio is inadequate and that their vision of the nature of a therapeutic environment is vague.
This paper describes a research project which aimed to discover the reasons clients give for failing to attend a mental health day hospital. There was concern that this service provision, for people with enduring mental illness, had a high level of non-attendance and therefore might not be meeting the needs of the people for whom it is targeted. Over a period of 6 months 36 people failed to attend, despite assessment and apparent agreement to attend. Of the 36, 14 agreed to talk about their reasons for not attending. An open interview format was used which enabled the clients to talk in depth about their experiences, which they felt led to the decision to stop attending. Content analysis of the interview data resulted in the identification of common themes. Main findings suggest a lack of partnership in decisions on choice of therapy, particularly the emphasis on groupwork, which 86% found unhelpful. Other main factors for non-attendance were a lack of an individual approach to care, not being listened to, and a lack of warmth from the staff. Recommendations for future practice are given, with particular attention to the need to develop a partnership with clients aimed at meeting individual needs.
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