The continuum of client-centred practice in an acute psychiatric unit: A mixed method study of clients’ perceptions

Abstract

Introduction The increase of mental health problems calls attention to the need for a quality health care provision that meets the complex needs of this group. The purpose of this study was to examine mental health clients’ perceptions of the care they received in a hospital environment, focusing on how it was reflecting the main principles of client-centred practice. Method A mixed explanatory sequential design was used and data gathered with a self-report instrument and in-depth interviews. Thirty participants, discharging from a hospital ward, responded to the instrument and six others were interviewed after being discharged. Results In general, participants evaluated the care they received as being rather client centred. Staff attitudes and support and clients’ participation in decision-making and goal-setting were the two aspects that were most congruent with client-centred practice, while staff interactions with significant others and the process and outcome of service were least congruent. Exploration by interviewing revealed the complexity of client-centred practice and the influence of contextual factors. Conclusion Some aspects of client-centred mental health practice seem to be more easily achieved than others. At the contextual level, professional culture, work habits and power structure may be some of the limiting factors.

Experiences of acute care by persons with mental health problems: An integrative literature review

“…Clarke, Dusome, & Hughes, 2007; Harris et al, 2016; Harrison et al, 2015; Kennedy & Fortune, 2014; Shattell, Andes, & Thomas, 2008), and describing the setting as lacking comfort (Eales, Callaghan, & Johnson, 2006) and privacy (e.g. Eales et al, 2006; Harris et al, 2016; Kennedy & Fortune, 2014; Schmidt et al, 2018), with only limited studies reporting a somewhat satisfactory setting experience (Alexius et al, 2000; Óladóttir & Pálmadóttir, 2017). The acute care settings were also associated with negative sensory experiences, such as smells, excessively bright lighting, lack of fresh air and chaotic noises (Harris et al, 2016; Johansson et al, 2009; Kennedy & Fortune, 2014; Maloret & Scott, 2018; Rose, Evans, Laker, & Wykes, 2015; Shattell et al, 2008) which triggered feelings of discomfort and fright.…”

“…The environment was also experienced as unpredictable (Maloret & Scott, 2018) and prone to quick change from boring to chaotic and intense (Kennedy & Fortune, 2014; Shattell et al, 2008). Needs associated with access to hygienic facilities (Clarke et al, 2007; Óladóttir & Pálmadóttir, 2017; Wood & Pistrang, 2004), to amenities such as family‐friendly rooms and private visiting rooms and to entertainment alternatives were usually not met and contributed to the negative experiences of the setting (Lunsky & Gracey, 2009; Walsh & Boyle, 2009).…”

“…Some staff were partly described in positive terms (Buykx, Ritter, Loxley, & Dietze, 2012; Johansson et al, 2009; Nolan, Bradley, & Brimblecombe, 2011; Óladóttir & Pálmadóttir, 2017; Wand, White, Patching, Dixon, & Green, 2011), for example as being friendly, motivated and attentive. However, the negative experiences dominated (Ezeobele et al, 2014; Harris et al, 2016; Kennedy & Fortune, 2014; Lunsky & Gracey, 2009; Óladóttir & Pálmadóttir, 2017; Robertson et al, 2015; Shattell et al, 2008; Stenhouse, 2011; Vandyk et al, 2018; Walsh & Boyle, 2009; Wise‐Harris et al, 2017; Wood & Pistrang, 2004) with staff described as ignorant, uninterested and intimidating among others.…”

“…Routine processes of the acute care services involved mainly seclusion (Ezeobele et al, 2014; Kalagi et al, 2018), ward rounds (Cappleman et al, 2015), receiving medication voluntarily or involuntarily (Duxbury et al, 2010; Iversen et al, 2007), voluntary or involuntary admissions (Iversen et al, 2007; Johansson et al, 2009; Svindseth et al, 2007), and discharges (Óladóttir & Pálmadóttir, 2017; Vandyk et al, 2018). Other responsibilities of staff concerned maintaining ward safety.…”

“…Discharge, on the other hand, was experienced as rushed and occurred before the patients felt stable (Vandyk et al, 2018). Some patients felt well prepared to go home and were offered ongoing care as outpatients, while others felt a lack of collaboration on discharge and were not prepared to go home (Óladóttir & Pálmadóttir, 2017), suggesting that admission and discharge processes could be more tailored to individual needs (Nolan et al, 2011; Walsh & Boyle, 2009; Wise‐Harris et al, 2017).…”