Marianne Storm

Models of User Involvement in the Mental Health Context: Intentions and Implementation Challenges

Patient-centered care, shared decision-making, patient participation and the recovery model are models of care which incorporate user involvement and patients’ perspectives on their treatment and care. The aims of this paper are to examine these different care models and their association with user involvement in the mental health context and discuss some of the challenges associated with their implementation. The sources used are health policy documents and published literature and research on patient-centered care, shared decision-making, patient participation and recovery. The policy documents advocate that mental health services should be oriented towards patients’ or users’ needs, participation and involvement. These policies also emphasize recovery and integration of people with mental disorders in the community. However, these collaborative care models have generally been subject to limited empirical research about effectiveness. There are also challenges to implementation of the models in inpatient care. What evidence there is indicates tensions between patients’ and providers’ perspectives on treatment and care. There are issues related to risk and the person’s capacity for user involvement, and concerns about what role patients themselves wish to play in decision-making. Lack of competence and awareness among providers are further issues. Further work on training, evaluation and implementation is needed to ensure that inpatient mental health services are adapting user oriented care models at all levels of services.

Inpatients’ and Providers’ Experiences with User Involvement in Inpatient Care

A qualitative study of inpatients’ perspectives on what it means to be involved in their own care, and providers’ experiences with encouraging user involvement in care planning and service provision is reported. Twenty semi-structured interviews with inpatients, fourteen log reports from providers and sixteen sets of written minutes from staff meetings constitute the study data. Differences were found between inpatient and provider perspectives. Inpatients reported few opportunities to have meaningful input in the decision-making regarding their care, while providers reported difficulty engaging inpatients into discussions or care planning. Although participants described providers as nice, understanding and supportive, these qualities did not always translate into their feeling seen and heard as unique individuals. When experiencing difficulty in engaging inpatients in existing forms of treatment, providers reported being aware of few options for them to try in increasing user involvement. Such different perspectives will need to be addressed in future efforts to increase service user involvement in inpatient care.

Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality?

BackgroundPatient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality.The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide.MethodsThis multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012).ResultsGovernmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients’ and family members’ experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically.ConclusionsThe relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality.

A review of the literature on patient participation in transitions of the elderly

Patient participation is highlighted in healthcare policy documents as an important area to address in order to improve and secure healthcare quality. The literature on healthcare quality and safety furthermore reveals that transitional care carries a risk of adverse events. Elderly persons with co-morbidities are in need of treatment and healthcare from several care professionals and are transferred between different care levels. Patient-centered care, shared decision-making and user involvement are concepts of care that incorporate patient participation and the patients’ experiences with care. Even though these care concepts are highlighted in healthcare policy documents, limited knowledge exists about their use in transitions, and therefore points to a need for a review of the existing literature. The purpose of the paper is to give an overview of studies including patient participation as applied in transitional care of the elderly. The methodology used is a literature review searching electronic databases. Results show that participation from elderly in discharge planning and decision-making was low, although patients wanted to participate. Some tools were successfully implemented, but several did not stimulate patient participation. The paper has documented that improvements in quality of transitional care of elderly is called for, but has not been well explored in the research literature and a need for future research is revealed. Clinical practice should take into consideration implementing tools to support patient participation to improve the quality of transitional care of the elderly.

Quality and safety in transitional care of the elderly: the study protocol of a case study research design (phase 1)

Introduction Although international studies have documented that patients’ transitions between care providers are associated with the risk of adverse events and uncoordinated care, research directed towards the quality and safety of transitional care between primary and secondary health and care services, especially for the elderly receiving care from multiple healthcare providers due to complex health problems, is lacking. This study investigates how different aspects of transitional care can explain the quality and safety of elderly healthcare services in Norway. The overall aim of the study was to explore different aspects of transitional care of the elderly, in different contexts and how they might explain the quality and safety of care. Methods and analysis The study applies a case study design. Two cases are chosen: one city-based hospital and one rural hospital with associated nursing homes and home-based nursing services. Admission and discharge to/from hospital to/from nursing homes or home-based nursing services constitute the main focal areas of the study, including the patient, next-of-kin and the professional perspective. The qualitative methods employed include participant observation, individual interviews and document analysis. To ensure trustworthiness in the data analysis, we will apply analyst triangulation and member checks. A total impression of the data material will first be created in a systematic text condensation approach. Second, the qualitative data analysis will involve in-depth analyses of two specific themes: the risk perspective and the patient perspective in transitional care. Ethics and dissemination The study is approved by the Norwegian Regional Committees for Medical and Health Research Ethics. The study is based on informed written consent, and informants can withdraw from the study at any point in time. Interview and observation data material will be managed confidentially. Results It will be disseminated at research conferences, in peer-reviewed journals and through public presentations to people outside the academic community.

“Service user involvement in practice”: The evaluation of an intervention program for service providers and inpatients in Norwegian Community Mental Health Centers

Background: Modern mental health strategies emphasize the necessity of user participation, but only a few studies examine how user involvement can be promoted effectively. Aim: To study the possible effect of an intervention program designed to (1) increase attention to user involvement and (2) increase user involvement at the inpatient departmental level. Methods: The study has a quasi‐experimental design, involving inpatient departments in five Norwegian Community Mental Health Centers (CMHCs). Two CMHCs received the intervention, and were compared with three CMHCs that did not. The impact of the intervention was assessed with the Service User Involvement in Mental Health Scale (SUIM), a selection of items from the Consumer Participation Questionnaire (CPQ) and the Psychiatric Inpatient Experience Questionnaire (PIPEQ). One hundred and twenty‐three service providers, 51 in the intervention group and 72 in the comparison group, and 47 inpatients took part in the study. Results: Providers in the intervention group reported higher mean scores at follow‐up for the variables of organizational user involvement, patient collaboration, and carer involvement than the comparison group. The intervention program was not associated with inpatients reporting more satisfaction with care. Conclusion: An intervention program can be useful in increasing attention to service user involvement in inpatient mental health services.

Inpatient service providers’ perspectives on service user involvement in Norwegian community mental health centres

Background: For two decades, mental health services in Norway have focused on service user involvement. Despite this, there is little knowledge about how inpatient mental health services have promoted user involvement. Aim: To examine service providers’ reports of service user involvement at the individual and departmental levels in Norwegian community mental health centres (CMHCs). Methods: One hundred and eighty six (186) inpatient service providers in five CMHCs filled out a questionnaire. Results: Confirmatory factor analysis showed that service provider perceptions and awareness of service user involvement can be measured by three subscales: organizational user involvement; patient collaboration; and assisted patient involvement. Little user involvement was reported at the departmental level. Providers more often reported user involvement at the individual level. Providers in two of the CMHCs reported a somewhat higher degree of departmental-level user involvement. There were no significant differences across gender, age, leader position, profession and job tenure, though evening/night shift workers reported a lesser degree of user involvement. Conclusion: The results suggest that user involvement at the departmental level needs to be addressed in future efforts to promote user involvement in CMHCs.

Virtual Visits in Home Health Care for Older Adults

Background. This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits. Design. An integrative literature review. Method. Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience. Results. Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found. Conclusions. The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.

Quality and safety in the transitional care of the elderly (phase 2): the study protocol of a quasi-experimental intervention study for a cross-level educational programme

Introduction Transitional care and patient handover are important areas to ensure quality and safety in elderly healthcare services. Previous studies showed that healthcare professionals have little knowledge of the setting they are transferring patients to and a limited understanding of roles and functions; these constitute barriers to effective communication and shared care responsibilities across levels of care. Aim The main objective is to implement a cross-level education-based intervention programme with healthcare professionals aimed at (1) increasing professionals’ awareness and competencies about quality and safety in the transitional care of the elderly; (2) creating a discussion platform for knowledge exchange and learning across levels and units of care and (3) improving patient safety culture, in particular, in transitional care. Methods and analysis A quasi-experimental control group study design with an intervention group and a control group; this includes a pretest, post-test and 1-year follow-up test assessment of patient safety culture. Qualitative data will be collected during the intervention programme and between the measurements. The study design will be beneficial for addressing the effects of the cross-level educational intervention programme on reports of patient safety culture and for addressing the feasibility of the intervention measures. Ethics and dissemination The study has been approved by the Regional Committees for Medical and Health Research Ethics in Norway, Ref. No. 2011/1978. The study is based on informed written consent; informants can withdraw from the study at any point in time. The results will be disseminated at research conferences, in peer review journals and through public presentations outside the scientific community.

Safer@home—Simulation and training: the study protocol of a qualitative action research design

Introduction While it is predicted that telecare and other information and communication technology (ICT)-assisted services will have an increasingly important role in future healthcare services, their implementation in practice is complex. For implementation of telecare to be successful and ensure quality of care, sufficient training for staff (healthcare professionals) and service users (patients) is fundamental. Telecare training has been found to have positive effects on attitudes to, sustained use of, and outcomes associated with telecare. However, the potential contribution of training in the adoption, quality and safety of telecare services is an under-investigated research field. The overall aim of this study is to develop and evaluate simulation-based telecare training programmes to aid the use of videophone technology in elderly home care. Research-based training programmes will be designed for healthcare professionals, service users and next of kin, and the study will explore the impact of training on adoption, quality and safety of new telecare services. Methods and analysis The study has a qualitative action research design. The research will be undertaken in close collaboration with a multidisciplinary team consisting of researchers and managers and clinical representatives from healthcare services in two Norwegian municipalities, alongside experts in clinical education and simulation, as well as service user (patient) representatives. The qualitative methods used involve focus group interviews, semistructured interviews, observation and document analysis. To ensure trustworthiness in the data analysis, we will apply member checks and analyst triangulation; in addition to providing contextual and sample description to allow for evaluation of transferability of our results to other contexts and groups. Ethics and dissemination The study is approved by the Norwegian Social Science Data Services. The study is based on voluntary participation and informed written consent. Informants can withdraw at any point in time. The results will be disseminated at research conferences, peer review journals, one PhD thesis and through public presentations to people outside the scientific community.