Next of kin's conceptions of the quality of care in the psychiatric setting: A phenomenographic study

Abstract

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.

Experiences of the psychiatric specialist health services – The perspective of relatives of inpatients with severe depression

“…In accordance with other studies, [3,4,28,29] the relatives preferred the staff to take responsibility for inviting to collaboration. The reason for not involving relatives may be that the ill person does not want to put an extra strain on them.…”

“…This seems to be not only in the context of how they perceive the staffs' availability for the person who is depressed, but also for the relatives themselves. A closer and more inclusive collaboration with health professionals was found to be important, which corresponds with Perreault et al [5] and Schröder et al, [28] who found collaboration to be a key element and predictor of relatives' satisfaction with the mental health services. According to Rowe [36] and Weimand et al, [37] collaboration should be characterized by a more empathic communication in which mental health-care personnel encounter relatives with openness and interest.…”

“…the side effects of pharmaceuticals. [27,28] By contrast, Nordby et al [3] found that the staff acknowledged the importance of the relatives' contribution when it comes to knowledge about the ill person.…”

Next of Kin’s Experiences of Shame in End-of-Life Care

“…This can be an experience where the next of kin's needs and feelings are not acknowledged; the latter is either not seen or has been judged and found inadequate, something that is termed unhealthy shame. 25 The suffering that the next of kin then experience can reduce their dignity and manifest itself as feelings of being deeply distressed. This can be compared with the shame spiral.…”

“…The opposite is ''unhealthy shame,'' which is forced upon a person by other people, false ideals, or unattainable demands. 24 Shame in relation to caring situations has been explored by Schröder et al, 25 who found a fear of prejudice and of negative attitudes in the shame experienced by next of kin to patients in psychiatric settings in terms of their family member's psychiatric illness. Similar findings were presented by Smith and Kobayashi 26 concerning a father's diagnosis of Alzheimer disease as his behavior had led to embarrassing situations.…”