Early and Frequent Psychiatric Readmissions in a Brazilian Cohort of Hospitalized Patients Between 2001 and 2013.

OBJECTIVE: To characterize the profile of patients who were readmitted for mental and behavioral disorders, in the Brazilian Unified Health System, from 2001 to 2014, and the factors associated with early and frequent readmission. METHOD: A retrospective, non-concurrent cohort study of patients admitted with a primary diagnosis of mental or behavioral disorders, from 2001 to 2014. This study selected demographic variables and clinical variables, as well as variables related to the characteristics of the hospitals. Poisson Regression methods with a robust variance estimator were used to estimate the incidence rate ratio (IRR) for each of the outcomes. RESULTS: Early readmission occurred for 6.8% of the patients and frequent readmission for 8.3%. Characteristics such as being male, younger, with a diagnosis of a bipolar disorder, and admitted to a specialized hospital show a higher IRR for early readmission. The occurrence of early readmission was the most heavily associated characteristic with an increased rate of early readmission, and the magnitude of this increase depends on the patient's age. CONCLUSION: Early and frequent readmissions are linked to patients' demographics, clinical information and health system's organization. Early readmission should be a priority in treatment planning to prevent frequent readmissions due to its strong association.

Mental health outcomes before psychotropic medications: a retrospective case series of one state hospital records from 1945 to 1954.

BACKGROUND: Current outcomes for mental illness are widely regarded as poor. Since the introduction of psychotropic medications in the mid 1950's, previous psychosocial practices were minimized in favor of medication focused treatment. The majority of large U.S. state hospitals have closed with records destroyed or in storage, inaccessible to researchers. This creates barriers to studying and comparing outcomes before and after this shift in treatment practices. AIMS: The study aim was to examine discharge outcomes in relation to length of stay and diagnosis in one U.S. state hospital. METHODS: This case series study examined 5618 medical records of participants admitted to one state hospital from 1945 to 1954, the decade prior to adoption of psychotropic medications. RESULTS: Of the 3332 individuals who left the facility, over half (59.87%) of first episode hospitalizations were discharged within 1 year, and 16.95% were hospitalized for more than 5 years. 46.17% of all admissions were discharged from hospital with no readmission. The most common diagnoses included schizophrenia, other forms of psychosis, and alcoholism. In the decade before the introduction of psychotropic medications, participants were often admitted for a single episode and returned to their homes within several years. CONCLUSIONS: Although limited to one site, findings suggest that discharge outcomes prior to psychotropic medication as a primary treatment for mental illness may be more positive than previously understood.

Recovery-oriented mental health principles in psychiatric hospitals: How service users, family members and staff perceive the realization of practices.

AIMS: The aim of the study was to describe and compare how recovery-oriented mental health principles have been realized in Finnish psychiatric hospitals from the viewpoint of different stakeholders (service users, family members and staff). DESIGN: A multimethod research design was adopted to combine both quantitative and qualitative descriptive methods. METHODS: A total of 24 focus group interviews were conducted with service users (n = 33), family members (n = 3) and staff (n = 53) on 12 psychiatric Finnish hospital wards (October 2017). The interview topics were based on six recovery-oriented principles (WHO QualityRights Tool Kit, 2012). A quantitative deductive analysis was conducted to describe and compare the realization of the recovery-oriented principles between three stakeholder groups. A qualitative deductive content analysis was used to describe participants' perceptions of the realization of recovery-oriented principles in practice. The GRAMMS guideline was used in reporting. RESULTS: Out of six recovery-oriented principles, 'Dignity and respect' was found to have been realized to the greatest extent on the psychiatric wards. The most discrepancy between the participant groups was seen in the 'Evaluation of recovery'. Service users and family members found the realization of the practices of all principles to be poorer than the staff members did. Wide variation was also found at the ward level between perceptions among participants, and descriptions of the realization of the principles in psychiatric hospital practice. CONCLUSION: Perceptions about the realization of recovery-oriented principles in practice in Finnish psychiatric hospitals vary between different stakeholder groups. This variation is linked to differing ward environments. IMPACT: More research is needed to understand the factors associated with variation in perceptions of recovery principles. PATIENT OR PUBLIC CONTRIBUTION: Service users and family members participated in this study.

Factors associated with risk of falling among younger inpatients in a mental health setting-A systematic review.

AIM: To synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤65 years old. BACKGROUND: Hospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood. DESIGN: Systematic review. METHODS: Medline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted. RESULTS: Nine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio-demographic, fall-related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies. CONCLUSION: Factors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta-analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used. RELEVANCE TO CLINICAL PRACTICE: Fall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting. PATIENT AND PUBLIC CONTRIBUTION: Patient or public contribution was not possible because of the study design.

Thematic Analysis of Mental Health Nurses' Views of Contributing Factors Fueling Workplace Violence in Psychiatric Hospitals: Insights From Unsung Soldiers.

BACKGROUND: Workplace violence against mental health nurses is an international phenomenon that sparks concerns for nurses' safety and mental health. This phenomenon has recently arisen as a crucial concern in the Middle East as it has become pervasive and has negative implications, causing nurses to accumulate psychological and emotional distress. However, no research has yet investigated the contributing factors of this phenomenon in Jordanian psychiatric hospitals from the nurses' perspectives. AIMS: This study aimed to explore the factors contributing to workplace violence in Jordanian psychiatric hospitals from the perspective of mental health nurses. METHOD: An exploratory, qualitative design was utilized. Using audio-recorded, semi-structured, face-to-face interviews, a purposive sample of 24 mental health nurses were interviewed to collect data. Thematic analysis was used to analyze the data. RESULTS: Four overarching themes were identified: Peak Time of Violence, Unavoidable Part of the Job, Poor Organization and Lack of Policy, and Bite the Bullet. CONCLUSION: From nurses' perspectives, an in-depth understanding of factors contributing to workplace violence provides a foundation for developing preventive interventions, improving work environment safety, and promoting nurses' mental health. Prevention strategies and further studies are warranted to limit this phenomenon.

Meanings and practices about work of women discharged from a psychiatric hospital of Buenos Aires province, Argentina / Significaciones y prácticas en torno al trabajo de mujeres externadas de un hospital neuropsiquiátrico de la provincia de Buenos Aires, Argentina.

Introduction: Work is central to the social inclusion of people who have had long-term psychiatric hospitalizations. In the context of the mental health care reform in Argentina, it is important to produce local knowledge about work inclusion of people discharged from psychiatric hospitals. The objective of this study was to describe the meanings and practices of women who had long-term psychiatric hospitalizations at the José A. Estéves Hospital in the Province of Buenos Aires, Argentina, regarding their inclusion in the labor market, once they return to live in the community. Methods and Materials: Descriptive mixed-methods study. The case of the Assisted Discharge and Rehabilitation Program of José A. Estéves Hospital, which accompanied 69 women in the year 2018, was analyzed. For quantitative analysis the data of the 69 women was analyzed, and for qualitative analysis a sample of nine women were interviewed. Results: 74% of women did some work after their discharge, although at the moment of the study only 33% were working. The jobs they carried out corresponded to elementary and low-competence occupational levels, mostly in a supported work program. After the psychiatric hospitalization, jobs obtained were less qualified, more informal and less exposed to the public than those held before the hospitalization. Discussion and Conclusionss: Prolonged psychiatric hospitalization is a significant break in people's work trajectories. Despite the value of work experiences after having a psychiatric hospitalization, those experiences mainly correspond to the informal sector of the economy.

Introducción: El trabajo es central para la inclusión social de personas que tuvieron internaciones psiquiátricas prolongadas. Por ello es necesario generar conocimientos locales sobre estos procesos en personas que han sido externadas, como parte de la reforma de la atención en salud mental en Argentina. Así, el objetivo de este estudio fue describir las significaciones y las prácticas de mujeres que tuvieron internaciones psiquiátricas prolongadas en el Hospital "José A. Estéves" de la Provincia de Buenos Aires, Argentina, acerca de su inclusión en el mercado laboral, a partir de su externación. Materiales y métodos: Estudio descriptivo de  tipo mixto, tomando como caso al grupo de mujeres que eran acompañadas por el Programa de Rehabilitación y Externación Asistida del Hospital "José A. Estéves", en el año 2018. Se analizaron datos cuantitativos de todo el grupo (n=69) y se realizaron entrevistas semiestructuradas con nueve señoras. Resultados: El 74% de las mujeres realizó algún trabajo desde su externación, aunque al momento del estudio, solo el 33% lo hacía. Los trabajos que desarrollaban correspondían a niveles ocupacionales elementales o de bajo nivel de competencia, mayoritariamente en un programa asistido de trabajo. Después de la internación, los trabajos obtenidos fueron menos calificados, más informales y menos expuestos al público que los desempeñados antes de la internación. Discusión y resultados: La internación psiquiátrica prolongada constituye un corte significativo en la trayectoria laboral de las personas. Pese al valor de las experiencias laborales de quienes logran conseguir un trabajo tras la internación, tales experiencias no implican, mayoritariamente, avances sobre el mercado formal.

From psychiatric hospitals to residential facilities: Characteristics of patients who benefited from an institutional partnership.

OBJECTIVES: The population of older adults is growing fast, especially in Europe and Northern America. Old age is often associated with mental health comorbidities. Moreover, life expectancy of people suffering from psychiatric disorders has increased, but with age-related difficulties, such as loss of independence. This represents a challenge for public health policies, as this population requires specific care and living conditions. As a response, a convention was signed between living facilities for dependent elderly (EHPAD) and the GHU Paris Psychiatry and Neurosciences. The agreement included dedicated places in EHPAD for older patients with psychiatric disorders. The aim of the study was to describe the sociodemographic and clinical characteristics of those patients. METHODS: We conducted a cross-sectional study among patients who applied for an EHPAD admission. RESULTS: Between 2016 and 2019, 163 patients applied for placement in an EHPAD, and 117 were admitted (72%). Applicants were 71 years old on average. Admitted patients were older than non-admitted and lived in different Parisian sectors. Among admitted patients, nine in 10 were single, divorced or widowed, and 64.3% were childless. Almost half of them were schizophrenic or had delusional disorders (46.9%), and 65.3% were considered as moderately dependent. At the time of the study, 89 patients still lived in EHPAD. Almost half of them had anxiety and depressive disorders (48.3%), 19.1% had cognitive disorders, and 42.7% manifested agitation. CONCLUSIONS: Our study highlighted older psychiatric patients' specificities regarding their admission status into long-term living facilities.

COVID-19 outbreak in a psychiatric hospital: what makes it worse?

BACKGROUND: Psychiatric patients could be at risk of worse outcomes from COVID-19 than the general population. The primary objective of the present study was to describe the symptoms and clinical characteristics of COVID-19 patients living in long-term hospital for mental illness in Lebanon. The secondary objective was to evaluate the factors related to COVID-19 disease severity among these patients. METHODS: A retrospective observational study was conducted from September 2020 to January 2021 at the Psychiatric Hospital of the Cross. The total number of COVID-19 patients in the infected floors is 410 out of 548. The outcome variable was the severity of COVID-19 illness classified into five categories: asymptomatic, mild, moderate, severe and critically ill. RESULTS: The rate of infection in the affected floors was 74.81%. Almost half of the patients were asymptomatic (49.3%), 43.4% had hyperthermia and only 28.0% had tachycardia and 25.1% developed hypoxia. The multivariate regression analysis showed that higher temperature (ORa = 6.52), lower saturation (ORa = 0.88), higher BMI (ORa = 1.12), higher CRP (ORa = 1.01), being a female (ORa = 4.59), having diabetes (ORa = 8.11) or COPD (ORa = 10.03) were significantly associated with the increase of the COVID-19 severity. CONCLUSIONS: The current study showed that a high rate of infection from COVID-19 was detected in a psychiatric hospital with the majority having asymptomatic to mild symptoms. Female psychiatric patients, desaturation, increase inflammation and comorbidities such as diabetes and COPD were associated with the severity of COVID-19 among psychiatric patients. Future studies are needed to better understand the causal relation of the factors with severity and long term effects or sequelae of the disease.

Employees Receiving Inpatient Treatment for Common Mental Disorders in Germany: Factors Associated with Time to First and Full Return to Work.

Purpose In Germany, return to work (RTW) after inpatient treatment for common mental disorders (CMDs) is a complex process at the intersection of the mental healthcare system and the workplace. This study examined (1) the time to first and full RTW and (2) associated factors among employees receiving inpatient treatment for CMDs. Methods In this prospective cohort study, employees receiving inpatient psychiatric or medical rehabilitation treatment for CMDs were interviewed by phone during their last week before discharge. Follow-up interviews were conducted after 6, 12, and 18 months. Health-, personal, and work-related factors were used from baseline measurement. Parametric survival analysis was conducted to identify factors associated with time to first and full RTW. Results A total of N = 269 participants who stayed at a psychiatric clinic or a medical rehabilitation facility were included. Almost all participants (n = 252, 94%) from both treatment settings reported a first RTW and a full RTW. The time to first and full RTW was shortest among participants from medical rehabilitation (both median 6 days) and longer among participants from psychiatric treatment (median 17 days to first RTW and 73 days to full RTW). While only health-related and personal factors were associated with time to first RTW, leadership quality and needed individual RTW support were associated with time to full RTW. Conclusions More attention to work accommodation needs for RTW in clinical practice and coordinated actions towards RTW in collaboration with key RTW stakeholders in the workplace may support a timely RTW.Clinical Registration Number DRKS00010903, retrospectively registered.

Private psychiatric hospital care in Australia: a descriptive analysis of casemix and outcomes.

OBJECTIVE: To provide a rapid clinical update on casemix, average length of stay, and the effectiveness of Australian private psychiatric hospitals. METHODS: We conducted a descriptive analysis of the publicly available patient data from the Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service website, from 2015-2016 to 2019-2020. This was compared with corresponding reporting on public and private hospitals from the Australian Institute of Health and Welfare, and Australian Mental Health Outcomes and Classification Network. RESULTS: In 2019-2020, there were 72 private psychiatric hospitals in Australia with 3582 acute beds. There were 42,942 inpatients with 1,286,470 days of care, and a mean length of stay 19.6 days (SD 13.9) for the financial year 2019-2020. The main diagnoses were major affective and other mood disorders (49%), and alcohol and other substance abuse disorders (21%). Clinician-rated outcome measures, that is, the HoNOS, showed an improvement effect size of 1.64, while the patient-rated MHQ-14 showed an improvement effect size of 1.18. Results are similar for previous years. CONCLUSIONS: Private psychiatric hospitals provide substantial, effective psychiatric care.

Do we all speak the same language? A critical systemic functional discourse analysis of psychiatric hospital brochures.

BACKGROUND: Over the last decades, treatment of patients with mental health diseases has shifted from longer-term in-hospital diagnosis and treatment to brief crisis diagnostic and/or treatment stays in hospital wards combined with ambulatory care preventing relapse and promoting patient-centered recovery. To guarantee a shared understanding of the nature of the care provided, it is important that hospital brochures and ambulatory care information are aligned, both in the way in which they define and understand recovery and regarding how they approach the empowerment and activation of the patient. AIM AND RESEARCH QUESTIONS: The overall aim of the study was to shed light on whether (1) hospital brochures used in crisis intervention centres in Flanders reflect the tenets of recovery-oriented and empowering care, and (2) the encoded messages are reflective of patients and their needs. METHODS: A systemic functional critical discourse analytic framework was used to analyze a small corpus of hospital brochures. RESULTS: Our findings suggest that the answers to both research questions are negative. CONCLUSION: This small-scale qualitative study on the under-researched population of psychiatric patients admitted to crisis intervention wards highlights the complexities involved in imparting well-aligned psychiatric care messages to the patients, their home caregivers, the medical community and the general public.

Diagnosing the "master mechanism of the universe" in interwar and war-era America.

Drawing on personal testimonials and questions addressed to psychiatric hospital officials, this article explores how patients and their loved ones engaged with the idea of diagnosis in interwar and war-era America. I argue that diagnosis had synergies with intellectual sensibilities of American modernity, among them an enthusiasm for science and newness, a modernist sense of time that could be both forward- and backward-looking, and a knowable, interpreted self. While self-understanding and the creation of life narratives were more often considered the bailiwick of psychoanalysis in this period, understanding subjectivity and self-interpretation were not solely expressed in its conceptual vocabulary. Patient and family dialogs with diagnosis and psychiatric authorities allow for an illumination of the interaction between domestic intuitions, common sense, and folk wisdom, on the one hand, and institutional taxonomy, categorization, and scientific terminology on the other, or more broadly, between dispositions that are ostensibly antimodern and more modern ideas. I suggest that the protean and wide-ranging intellectual origins of the discipline of psychiatry, along with the inherent ambiguity of psychiatric diagnosis during the early 20th century, allowed patients to participate in their own medicalization in the most capacious way possible: by combining biology with diagnostic narrative capacities, as well as broader perceptions of morality and character. In the concluding reflection, I speculate about why it is that late 20th-century American critics and activists have tended to view diagnosis and medicalization as coercive and threatening, in contrast to earlier 20th-century patients and their intimate observers.

Patients' perspectives on the experience of absconding from a psychiatric hospital: a qualitative study.

BACKGROUND: Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients' perspectives on the experience of absconding from the psychiatry facility. METHODS: We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes. RESULTS: Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients' engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding. CONCLUSION: Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.

Psychiatric hospital reform in low- and middle-income countries: a systematic review of literature.

PURPOSE: Psychiatric hospitals or mental asylums grew across the world in the colonial era. Despite concerns over quality of care and human rights violations, these hospitals continue to provide the majority of mental health care in most low- and middle-income countries (LMICs). We sought to review the evidence of reform of mental hospitals and associated patient outcomes. METHODS: We adopted an integrative review methodology by including experimental and non-experimental research. The review protocol was registered on PROSPERO (CRD42019130399). A range of databases and systematic hand searches were conducted by two independent reviewers. Research conducted between 1980 and May 2019, that focused on any aspect of reform in mental hospitals for adults (age 18 and upwards) with severe mental illness and published in English, were considered. RESULTS: 16 studies were included in the review. 12 studies met inclusion criteria, and four additional reports emerged from the hand search. Studies covered-India, China, South Africa, Grenada, Georgia, Sri Lanka, Argentina and Brazil. Key findings emphasise the role of judicial intervention as a critical trigger of reform. Structural reform composed of optimisation of resources and renovations of colonial structures to cater to diverse patient needs. Process reforms include changes in medical management, admission processes and a move from closed to open wards. Staff engagement and capacity building have also been used as a modality of reform in mental hospital settings. CONCLUSION: There is some documentation of reform in psychiatric hospitals. However, poor methodological quality and variation in approach and outcomes measured, make it challenging to extrapolate specific findings on process or outcomes of reform. Despite being integral service providers, psychiatric hospitals still do not adopt patient centric, recovery-oriented processes. Hence, there is an urgent need to generate robust evidence on psychiatric reform and its effect on patient outcomes.

Forensic patients in state psychiatric hospitals: 1999-2016.

INTRODUCTION: In recent years mental health officials have reported a rise in the number of forensic patients present within their state psychiatric hospitals and the adverse impacts that these trends had on their hospitals. To date there have been no large-scale national studies conducted to determine if these trends are specific only to a few states or representative of a more global trend. The purpose of this study was to investigate these reported trends and their national prevalence. METHODS: The forensic directors of each state behavioral health agency (including the District of Columbia) were sent an Excel spreadsheet that had two components: a questionnaire and data tables with information collected between 1996 and 2014 from the State Profiling System maintained by the National Association of State Mental Health Program Directors Research Institute. They were asked to verify and update these data and respond to the questionnaire. RESULTS: Responses showed a 76% increase nationally in the number of forensic patients in state psychiatric hospitals between 1999 and 2014. The largest increase was for individuals who were court-committed after being found incompetent to stand trial and in need of inpatient restoration services. DISCUSSION: The data reviewed here indicate that increases in forensic referrals to state psychiatric hospitals, while not uniform across all states, are nonetheless substantial. CONCLUSION: More research is needed to determine whether this multi-state trend is merely a coincidence of differing local factors occurring in many states, or a product of larger systemic factors affecting mental health agencies and the courts.

Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis.

BACKGROUND: Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. METHODS: Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics. RESULTS: The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04-1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56-0.91) and frequent readmissions (OR 0.60, 95%CI 0.40-0.91). CONCLUSION: More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

The working alliance with people experiencing suicidal ideation: A qualitative study of nurses' perspectives.

AIMS: This study aimed to enhance the conceptual understanding of the working alliance in the context of nursing care for people experiencing suicidal ideation. DESIGN: A qualitative study based on grounded theory was conducted. METHODS: Two authors conducted individual semi-structured interviews from September 2017-January 2019. Twenty-eight nurses in 13 wards of four psychiatric hospitals participated. The Qualitative Analysis Guide of Leuven was used to support constant data comparisons and the cyclic processes of data collection and data analysis. FINDINGS: The nurses' perspectives revealed that the working alliance can be understood as an interpersonal and collaborative relational process. This relational process highlighted the core variable 'seeking connectedness and attunement with the person at risk of suicide'. The core variable underpinned three clusters: investing in the foundations of the working alliance, nourishing the clinical dimension of the working alliance and realizing an impact with the working alliance. CONCLUSION: This study highlights the importance for nurses to assess, evaluate and respond to persons' suicidal ideation in harmony with a commitment to connect with them and attune to their perspective. IMPACT: The relational process uncovered through this study offers valuable insights to support advanced nursing practice, where nurses meaningfully integrate relational elements of care with their contributions to suicide prevention and treatment.

Psychiatric nursing managers' attitudes towards containment methods in psychiatric inpatient care.

AIMS: This research was conducted to examine psychiatric nursing managers' attitudes towards containment methods. BACKGROUND: Nursing management is regarded as a key issue in the reduction of coercion and containment. However, there has been little research on managers' attitudes towards containment methods. METHODS: This descriptive, cross-sectional study utilized a survey design. Finnish inpatient psychiatric nursing managers (n = 90) completed the Attitudes to Containment Measures Questionnaire (ACMQ). The results were described with statistics, and the associations between attitudes and background variables were analysed using parametric tests. RESULTS: Psychiatric nursing managers had the most negative attitude towards net bed and mechanical restraint, and the most positive attitudes towards as necessary medication and intermittent observation. A few associations were discovered between attitudes and background variables such as gender and number of employees. CONCLUSIONS: In general, Finnish psychiatric nursing managers' attitudes towards containment methods seem to be quite negative, but more research is needed. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides fresh and unique data on the attitudes of psychiatric nursing managers towards containment methods. Managers' attitudes are important because of their ability to encourage investment in coercion reduction by nursing staff.

Satisfaction of family members with inpatient psychiatric care and its correlates: a national survey in China.

BACKGROUND: Measuring family members' satisfaction with inpatient psychiatric care may help improve the quality of healthcare in psychiatric hospitals. This survey aimed to investigate the satisfaction of family members with inpatient psychiatric care and to explore its associated factors, using a newly-developed 5-item questionnaire. METHODS: This study included 1598 family members of psychiatric inpatients in 32 tertiary public psychiatric hospitals in 29 provinces of China. Satisfaction and demographic data were collected by research staff while patient and hospital data were retrieved separately. RESULTS: We found that the overall satisfaction level was 93.84% (23.46/25). The total satisfaction score in Northeast China was the highest, followed by the East, Middle and West regions (p < 0.001). There was no significant sex difference in total family satisfaction scores. Family members with a lower educational background (elementary school or less) had significantly lower satisfaction. Family members of patients who were diagnosed with schizophrenia were significantly less satisfied with doctor-family communication. In different treatment response subgroups, the marked improvement subgroup had significantly higher total satisfaction scores and subscores. Meanwhile, lower self-payment expenses and a higher number of psychologic treatments offered per day were significantly associated with higher total satisfaction scores and all subscores. Logistic regression showed a higher educational background, more psychologic treatments offered per day, adequacy of professional staffing (higher doctor/bed, nurse/bed and psychologist/bed ratio) were all significantly associated with higher family satisfaction. CONCLUSIONS: We suggest government and hospital managers recruit more mental health professions to improve family satisfaction. If feasible, providing more psychologic treatments to inpatients may also improve families' satisfaction and involvement.

Impact of alcohol-based hand sanitizers, antibiotic consumption, and other measures on detection rates of antibiotic-resistant bacteria in rural Japanese hospitals.

There are limited data available on the relationship between multidrug-resistant bacteria and infection control activities in small to medium-sized hospitals. Therefore, we collected data on the use of alcohol-based hand sanitizers (ABHSs), personal protective equipment, antibiotics, and the levels of detectable bacteria between April 2014 and March 2015 in 11 Japanese hospitals. Average total antibiotic consumption was 100 defined daily doses per 1000 patient-days (PD), and average use of ABHSs, masks, plastic aprons, and gloves was 5 L per 1000 PD, and 1, 2, and 26 pieces per 1 PD, respectively. Average numbers of isolated (isolation rate) Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing bacteria, and multidrug-resistant Pseudomonas aeruginosa (MDRP) were 107 (8% of total bacterial tests performed), 51 (4%), and 4 (0.3%), respectively. Multivariate analyses of ABHS and tazobactam/piperacillin consumption showed a significant negative association with the MRSA isolation rate (adjusted R2 = 0.87). These findings suggest that hand hygiene is more important than antibiotic consumption in small to medium-sized hospitals.