Patient participation in pro re nata medication in forensic psychiatric inpatient care

Patient participation is highlighted in mental health care from the viewpoint of both human rights and quality of care. The purpose of this study is to describe and explain patient participation in all pro re nata (PRN, “as-needed”) medication in forensic psychiatric inpatient care. The knowledge produced can be used to develop peoplecentered forensic psychiatric care. The study was conducted in three phases. The first phase involved an integrative review of previous knowledge conducted using electronic and manual searches. The data were analysed with the constant comparison method. The second phase was a document analysis of nursing documents over the one-year period. Statistical methods were used in the data analysis. The third phase consisted of individual interviews with patients and group interviews with registered nurses. The data were analysed with inductive content analysis. The empirical phases were carried out in a forensic psychiatric hospital in Finland in 2018–2020. Based on the studies included in integrative review (n=16), patient participation refers to the shared decision-making of patients and professionals in PRN administration. To participate, patients had to have the motivation and capability. Previous knowledge on patient participation in planning and evaluating PRN and the viewpoint of forensic psychiatric care was lacking. Based on the document analysis (67 patients), PRN was frequently used for both psychiatric and physical reasons, mostly at the patients’ request and usually administered in agreement. Patients had named several alternative methods for PRN in advance, but they were rarely documented as being used. Documented feedback, especially from the viewpoint of patients, was often missing. Interviewed patients (n=34) and registered nurses (n=19) perceived forensic psychiatric inpatient care to be a special context for patient participation in PRN. Patients had individual preferences on their PRN. Their role in collaboration with professionals in PRN was undetermined. Patients wanted to decide for themselves about PRN use, and nurses limited discussions to avoid conflicts. More research and systematic approaches are needed to promote patient participation, especially in planning and evaluating their PRN. The expertise of both patients and professionals are important in providing good quality care.Potilaan osallisuus pro re nata –lääkehoidossa oikeuspsykiatrisessa sairaalahoidossa Potilaiden osallisuutta on korostettu mielenterveyshoitotyössä sekä ihmisoikeuksien että hoidon laadun näkökulmista. Tämän tutkimuksen tarkoituksena oli kuvata ja selittää potilaan osallisuutta pro re nata (PRN, ”tarvittaessa annosteltava”) - lääkehoidossa oikeuspsykiatrisessa sairaalahoidossa. Tuotettua tietoa voidaan käyttää ihmiskeskeisen oikeuspsykiatrisen hoidon kehittämisessä. Tutkimuksessa oli kolme vaihetta. Ensimmäinen vaihe oli integratiivinen katsaus, jossa aiempi kirjallisuus haettiin elektronisesti ja manuaalisesti. Aineisto analysoitiin jatkuvan vertailun menetelmällä. Toinen vaihe oli dokumenttianalyysi potilasasiakirjoihin vuoden ajalta. Aineisto analysoitiin tilastollisilla menetelmillä. Kolmas vaihe oli yksilöhaastattelut potilaille ja ryhmähaastattelut sairaanhoitajille. Aineisto analysoitiin induktiivisella sisällönanalyysillä. Empiiriset tutkimusvaiheet toteutettiin suomalaisessa oikeuspsykiatrisessa sairaalassa vuosina 2018–2020. Kirjallisuuskatsaukseen valikoituneiden tutkimusten (n=16) perusteella potilaan osallisuus PRN-lääkehoidossa tarkoitti potilaiden ja ammattilaisten jaettua päätöksentekoa. Osallisuus edellytti potilaalta motivaatiota ja toimintakykyä. Aikaisempaa tietoa potilaan osallisuudesta PRN:ssä suunnittelun ja arvioinnin sekä oikeuspsykiatrisen hoidon näkökulmista oli vähän. Potilasasiakirjojen (n=67) analyysi osoitti, että PRN-lääkkeitä oli käytetty sekä psyykkisisiin että fyysisiin syihin usein, tavallisimmin potilaiden pyynnöstä ja yleensä yhteisymmärryksessä annostellen. Potilaat olivat suunnitelleet useita vaihtoehtoja PRN-lääkkeille, mutta näiden käyttö oli kirjaamisen perusteella vähäistä. Arviointi, etenkin potilaan näkökulmasta, puuttui usein. Haastatellut potilaat (n=34) ja sairaanhoitajat (n=19) näkivät oikeuspsykiatrisen hoidon erityisenä suhteessa potilaan osallisuuteen PRNlääkehoidossa. Potilailla oli yksilöllisiä lähtökohtia PRN-lääkehoitoonsa. Heidän roolinsa yhteistyössä ammattilaisten kanssa oli vakiintumaton. Potilaat halusivat itse päättää PRN:n käytöstä ja hoitajat rajoittivat keskusteluja konfliktien välttämiseksi. Lisätutkimus ja entistä systemaattisemmat lähestymistavat potilaan osallisuuden tukemiseksi ovat tarpeen etenkin PRN-lääkehoidon suunnittelussa ja arvioinnissa. Sekä potilaan että terveysalan ammattilaisten asiantuntijuus ovat tärkeitä laadukkaan hoidon toteuttamiseksi

Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses

Pro re nata (PRN, as-needed) medication is commonly used in forensic psychiatric inpatient care, but little is known about the participation of patients in its prescription and administration. This study describes patient participation in PRN medication treatment in forensic psychiatric inpatient care. Data were collected during interviews with 34 inpatients and 19 registered nurses in a Finnish forensic psychiatric hospital. The data underwent inductive content analysis. We found that patient participation in PRN was related to patients' individual needs and health conditions, and the use of PRN involved private decisions made in the social context of the ward. PRN was an integrated part of daily care, and it involved three stakeholders, namely patients, nurses, and physicians; however, the role of patients in this collaboration was undefined. The administration events for PRN were multiform, and depended on the level of agreement between patients and nurses on the need for PRN. In the future, more attention should be paid to how to motivate patients and provide them with equal opportunities to be involved in the planning of PRN, and to optimize shared decision making so that the expertise of both patients and nurses is utilized in the administration and evaluation of PRN

Patient participation in pro re nata medication in forensic psychiatric care: A nursing document analysis

Accessible summaryWhat is known on the subjectAs-needed medication is commonly used for psychiatric inpatients' acute psychiatric and physical symptoms. Both patients and staff can initiate such medication.Earlier studies have focused on what and how as-needed medication has been used for psychiatric reasons. Little is known about how patients participate in planning, administration and evaluation of as-needed medication and its alternatives. Nursing documentation provides an insight into these practices.What this paper adds to existing knowledgeLong-term inpatients have an active role in initiating as-needed medication. However, patients and staff may have divergent opinions on the need for medication.Alternatives to medication are mostly proposed by staff, and the feedback on as-needed medication events is usually provided from nurses' point of view.What are the implications for practicePatients' views on decision-making and evaluation should be noticed and documented more.Patient participation can be promoted by planning as-needed medication and its alternatives beforehand.Introduction Pro re nata (PRN) medication is unscheduled and used for acute physical and psychiatric symptoms. Previous studies have focused on the what and how of psychotropic PRN administration. Initiators of PRN events and occasions in which PRN was denied have rarely been studied. Thus, knowledge of patient participation in PRN is fragmented.Aim We aimed to describe and explain long-term psychiatric inpatients' participation in relation to planning and initiation of, as well as decisions and feedback on their PRN medication treatment.Methods We retrieved data from patients' (n = 67) nursing documentation in a Finnish forensic psychiatric hospital in 2018. Data were analysed using statistical methods.Results All patients were prescribed PRN, and they initiated half of the 8,626 PRN events identified, in a 1-year period. Non-pharmacological strategies were rarely (6%) documented, and most of them were initiated by staff (76%). Feedback on PRN was usually from a nurse's viewpoint (71%). Nurses' feedback was positive (80%) more often than patients' (50%).Discussion Patient participation needs to be recognized throughout the PRN process. Future research could continue to explore patient participation in planning and evaluating their PRN medication.Implications for practice Patients participate in PRN by requesting medication. Their participation can be developed by supporting patients to communicate their choice of non-pharmacological methods, take the initiative for medication when needed and disclose their viewpoint on the effects of PRN

PRN Medication Events in a Forensic Psychiatric Hospital: A Document Analysis of the Prevalence and Reasons

The aim of this study was to describe and explain the prevalence and reasons for as needed medication (pro re nata, PRN) in a forensic psychiatric hospital. We reviewed the documents of 67 long-term inpatients (87% male) over the one-year study period and identified 8626 PRN events. Virtually all of the patients received PRN for physical reasons, just over half for psychiatric reasons, and just over one-third for insomnia. The number of PRN events per patient was unevenly distributed. The prevalence of PRN events for both psychiatric reasons (26%) and insomnia (14%) were associated with the female gender, more severe psychiatric symptoms, and lower daily functioning. Half of the patients did not receive PRN for psychiatric reasons. It is likely that the use of such medication was successfully mitigated with scheduled medication and psychosocial approaches. The high number of PRN events for physical reasons (60%) was not explained by the patient characteristics and urgent research is needed on this aspect. Protracted PRN use should be recognized in clinical practice, and consider more structured solutions to develop PRN protocols and evidence-based care. Future research should examine how PRN is integrated with patients' regular treatment and non-pharmacological methods

Sensor technology to monitor health, well-being and movement among healthcare personnel at workplace: a systematic scoping review protocol

Introduction: The well-being and health of healthcare personnel is becoming increasingly important in the delivery of high-quality healthcare. The recent developments in technology have provided new opportunities for the objective detection of a wide variety of real-world properties and movement. However, technologies that are used to monitor health, well-being and movement among healthcare personnel have not been fully synthesised. The overall aim of this scoping review is to examine what type of sensor technology is available to monitor the health, well-being and movement of healthcare personnel in healthcare settings. More specifically, we want to explore what types of sensor technology applications, for what purposes and how they have been used to monitor health, well-being and movement among healthcare personnel in different workplace settings.Methods and analysis: This scoping review protocol will follow Arksey and O'Malley's methodology, complemented by the approach of the Joanna Briggs Institute to scoping reviews and guidance for conducting systematic scoping reviews. Peer-reviewed literature will be identified using a search strategy developed by a librarian, and a wide range of electronic datasets of medical, computer and information systems disciplines will be used. Eligibility of the articles will be determined using a two-stage screening process consisting of (1) a title and abstract scan, and (2) a full-text review. Extracted data will be thematically analysed and validated by an expert of sensor technology and a group of nurses as stakeholders. Descriptive statistics will be calculated when necessary.Ethics and dissemination: The results obtained from the review will inform what technology has been used, how it has been used in healthcare settings and what types of technology might still be needed for future innovations. Findings of the scoping review will be published in a peer-reviewed journal.</p

Developing a Feasible and Credible Method for Analyzing Healthcare Documents as Written Data

Healthcare provides a rich, and constantly increasing, number of written documents, which are underutilized in research data for health and nursing sciences, but previous literature has only provided limited guidance on the process of document analysis. The aim of this paper is to provide a methodological framework for analyzing health care documents as written data, based on a systematic methodological review and the research team's experience of the method. Based on the results, the methods consist of seven phases: (i) identify the purpose, (ii) determine the document selection strategy, (iii) select or design an extraction matrix, (iv) carry out pilot testing, (v) collect and analyze the data, (vi) consider the credibility, and (vii) ethics of the study. The framework that has been developed can be used to carry out document analysis studies that are both feasible and credible

Measured and perceived impacts of evidence-based leadership in nursing: a mixed-methods systematic review protocol

Introduction Despite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes. Methods and analysis We will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised. Ethics and dissemination This systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation. PROSPERO registration number CRD42021259624.</p

Optimoitu sote-ammattilaisten koulutus- ja osaamisuudistus

Hankkeen tavoitteena oli kuvata millaisia osaamistarpeita sote-uudistus synnyttää, mitä olisi tehtävä, jotta näihin uusiin tarpeisiin pystyttäisiin vastaamaan ja mitä tapahtuu, jos tarpeisiin vastaamisessa epäonnistutaan. Tutkimushankkeessa toteutettiin kansainvälinen systemoitu kirjallisuuskatsaus ja meta-analyysi, sote-asiantuntijoiden ja työntekijöiden empiirinen aineistonkeruu, kansallinen osaamishanke-kartoitus sekä verkkokysely koulutuksen asiantuntijoille. Tutkimushankkeen tulokset syventävät ja monipuolistavat sote-ammattilaisten tulevaisuuden osaamistarpeita. Ammattialakohtainen substanssiosaaminen muodostaa tulevaisuuden osaamisen ytimen. Tämän lisäksi kaikkia sote-ammattiryhmiä koskeva geneerinen osaaminen sisältää asiakastyöosaamisen, palvelunkehittämisosaamisen sekä työntekijyyden ja yhteistoiminnan muutososaamisen. Lisäksi tulee arvioida, onko tarvetta uusille tutkinnoille tai nykyisten tutkintojen uusille kelpoisuuksille, jotta sosiaali- ja terveyssektorit ylittävien asiakkuuksien tarpeisiin voitaisiin vastata. Näillä kohdistuksilla ja muutoksilla voidaan varmistaa, että tulevaisuudessa sosiaali- ja terveydenhuollon ammattien osaaminen on ammattialakohtaisesti näyttöön perustuvaa, ja ammattilaisilla on jaettua, toimintaympäristön muutostarpeisiin vastaavaa osaamista tuottaa asiakaslähtöistä ja vaikuttavaa hoitoa ja palvelua. Osaamisen kehittäminen edellyttää aiempaa systemaattisempaa osaamisen arviointia ja näyttöön perustuvien koulutusinterventioiden käyttöä. Uusien geneeristen osaamisalueiden perustaidot tulee sisällyttää sote-alan tutkintoon johtaviin koulutuksiin, mutta erityisen ajankohtaista on vastata osaamisvajeisiin täydentävällä koulutuksella. Työelämässä toteutettavat kehittämishankkeet ovat tarpeen alueelliseen ja paikalliseen osaamisen kohdistamiseen. Osaamiseen kohdistuvien hankkeiden alueellinen ja valtakunnallinen koordinointi tukisi hankkeiden kohdistamista, toteuttamista ja raportointia sekä mahdollistaisi hyvien käytänteiden jakamisen. Sosiaali- ja terveydenhuollon ammatillinen osaaminen on ja tulee olla jatkuvassa muutoksessa, ja keinoja osaamisen parantamiseksi ja ajantasaistamiseksi on kehitettävä ja arvioitava koko ajan

Physical Restraint Events in Psychiatric Hospitals in Hong Kong: A Cohort Register Study

The need to better monitor coercion practices in psychiatric hospitals has been recognised. We aim to describe how physical restraint events occur in psychiatric hospitals and identify factors associated with physical-restraint use. A cohort register study was used. We analyzed physical restraint documents among 14 wards in two psychiatric hospitals in Hong Kong (1 July and 31 Dec. 2018). In total, 1798 incidents occurred (the rate of physical restraint event 0.43). Typically, physically restrained patients were in early middle-age, of both genders, diagnosed with schizophrenia-spectrum and other psychotic disorders, and admitted voluntarily. Alternate methods for physical restraint were reported, such as an explanation of the situation to the patients, time-out or sedation. A longer period of being physically restrained was associated with being male, aged >= 40 years, having involuntary status, and neurodevelopmental-disorder diagnosis. Our findings support a call for greater action to promote the best practices in managing patient aggression and decreasing the use of physical restraint in psychiatric wards. The reasons for the use of physical restraint, especially for those patients who are admitted to a psychiatric hospital on a voluntary basis and are diagnosed with neurodevelopmental disorders, needs to be better understood and analysed

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