Factors influencing patient-perceived quality of care in psychiatric hospitals in Taiwan.

Patient-perceived quality of inpatient/outpatient psychiatric care remains under-researched. A cross-sectional survey with purposive sampling comprising 567 inpatients and 549 outpatients was conducted among eight psychiatric care facilities in Taiwan to examine the factors influencing patient-perceived care quality. Inpatients and outpatients perceived moderate quality of care, where "Encounter" was reported as the highest dimension. Inpatients perceived "Secure environment" as the lowest; outpatients rated "Discharge/Referring" as the lowest. Hospital region and customer loyalty were significantly associated with patient-perceived care quality. Other significant factors were also identified: inpatient employment, perceived mental health and treatment effects, understanding diagnosis, previous treatment, and visited by appointment.

[The Utilization of Lean Management in Nursing Handover at a Psychiatric Acute Ward].

BACKGROUND & PROBLEMS: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. PURPOSE: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. RESOLUTION: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. RESULTS: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. CONCLUSIONS: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.

[Comparison of Clinical Diagnostic Effectiveness Between Psychiatric Inpatient and Wilson-Sims Fall Risk Assessment Tools].

BACKGROUND: The incidence of falls is very high among psychiatric inpatients. However, the lack of an effective, validated psychiatric inpatient fall risk assessment tool inhibits the ability of medical staffs to make correct judgments. PURPOSE: The purposes of this study were to compare the sensitivity, specificity, and accuracy of the psychiatric inpatient fall risk assessment tool (PIFRAT) and the Wilson-Sims fall risk assessment tool (WSFRAT) and to predict the fall risk factors in PIFRAT and WSFRAT for psychiatric inpatients. METHODS: Study data were collected from 2016/10/01 to 2017/03/10. Fall assessment data were collected from new patients during their 1st through 7th days after admission to a psychiatry unit in northern Taiwan. Data were analyzed using descriptive analysis, logistic regression analysis, reliability and validity testing, tool effective testing, and receiver operating characteristic (ROC) curve analysis. RESULTS: Both of the fall risk assessment tools exhibited low sensitivity (WSFRAT 57.1%, PIFRAT 50%), the specificity of WSFRAT (79.6%) was higher than that of PIFRAT (70.4%), and the accuracy of WSFRAT (76.9%) was higher than that of PIFRAT (67.9%). The ROC curve analysis revealed that the AUC of PIFRAT was .602 (95% CI [0.48, 0.73]). According to the Youden index, the best cutoff level is 7.5 points, in which the specificity is 88.8% and the sensitivity is 39.3%. To increase the sensitivity to 96.4%, the cutoff level must be set to 1.5 points. Moreover, the AUC of WSFRAT was .625 and the highest sensitivity was 82.1% when the cutoff point was set to 3.5 points. Further, multivariate logistic regression analysis revealed that fall risk was significantly higher among patients who had previously fallen than among those had not. Male gender (OR = 2.57, 95% CI [1.11, 5.94]), physical activity difficulties (OR = 3.43; 95% CI [1.40, 8.41]), and weakness (OR = 3.03; 95% CI [1.08, 8.49]) were each significantly associated with fall risk. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study identified four critical risk factors for falls. In the future, clinical healthcare professionals should be more aware of these factors and develop related fall-prevention interventions. The findings may serve as references for the future development of psychiatric fall assessment tools.

Responsiveness of the Personal and Social Performance scale in patients with schizophrenia.

The responsiveness (ability to detect change) of the Personal and Social Performance scale (PSP) is largely unknown, limiting its use as an outcome measure. The purpose of this study was to examine both internal and external responsiveness of the PSP in patients with schizophrenia in the acute phase. Eighty patients were administered the PSP and the Clinical Global Impression-Severity scale (CGI-S) at admission and at discharge. We used the standardized effect size, the standardized response mean, and paired t-test for examining internal responsiveness. We examined the correlations between the changes in scores of the PSP and those of the CGI-S using Pearson's r for validating the external responsiveness. The results showed that the standardized effect sizes and standardized response means of the PSP were 0.74-1.74 and 0.68-1.72, respectively. The paired t-tests showed statistically significant difference (p<0.001). Moderate to good correlations (r=0.35-0.74) were found among the changes of the PSP with those of the CGI-S. The PSP showed substantial internal responsiveness and sufficient external responsiveness in patients with schizophrenia receiving treatment in the acute phase. The PSP appears useful as an outcome measure for detecting changes of social functioning over time.

How mental health nurses improve their critical thinking through problem-based learning.

Critical thinking has been regarded as one of the most important elements for nurses to improve quality of patient care. The aim of this study was to use problem-based learning (PBL) as a method in a continuing education program to evaluate nurses' critical thinking skills. A quasiexperimental study design was carried out. The "Critical Thinking Disposition Inventory" in Chinese was used for data collection. The results indicated significant improvement after PBL continuous education, notably in the dimensions of systematic analysis and curiosity. Content analysis extracted four themes: (a) changes in linear thinking required, (b) logical and systematic thinking required performance improved, (3) integration of prior knowledge and clinical application, and (4) brainstorming learning strategy. The study supports PBL as a continuing education strategy for mental health nurses, and that systematic analysis and curiosity effectively facilitate the development of critical thinking.

Protective and risk factors for inpatient suicides: a nested case-control study.

This study aimed at estimating the protective effect of suicide precautions and clinical risk factors for inpatient suicides. A standardized precaution system was implemented in a large psychiatric center on January 1, 1996. A consecutive series of 33,121 admissions from 1998 to 2008 constituted the post-implementation cohort and 13,515 admissions from 1985 to 1995 constituted the pre-implementation cohort as comparison group. Inpatient suicides were identified via record linkage with national mortality database. For each of 41 inpatient suicides, four controls were randomly selected based on a nested case-control study. A standardized chart review process was employed to collate clinical information for each study subject. Risk and protective factors for inpatient suicides was estimated by conditional logistic regression. The findings showed that, among subjects with shorter lengths of stay, those admitted in post-implementation era had a significantly lower adjusted risk ratio (0.157, p=0.048) for inpatient suicides. Three depression-related symptoms elevated the risk for inpatient suicides: depressed mood (adjusted risk ratio=2.11, P=0.002), loss of energy (adjusted risk ratio=1.99, P=0.018), and psychomotor retardation (adjusted risk ratio=1.67, P=0.066; with marginal statistical significance). Suicide precautions have protective effect against inpatient suicides. A better assessment and prevention efforts is needed, particularly for those with depression-related symptoms.