Following the Francis report: investigating patient experience of mental health in-patient care

BACKGROUND: The Francis report highlights perceptions of care that are affected by different factors including ward structures. AIMS: To assess patient and staff perceptions of psychiatric in-patient wards over time. METHOD: Patient and staff perceptions of in-patient psychiatric wards were assessed over 18 months. We also investigated whether the type of ward or service structure affected these perceptions. We included triage and routine care. The goal was to include at least 50% of eligible patients and staff. RESULTS: The most dramatic change was a significant deterioration in all experiences over the courseof the study. Systems of care or specific wards did not affect patient experience but staff were more dissatisfied in the triage system. CONCLUSIONS: This is the first report of deterioration in perceptions of the therapeutic in-patient environment that has been captured in a rigorous way. It may reflect contemporaneous experiences across the National Health Service of budget reductions and increased throughput. The ward systems we investigated did not improve patient experience and triage may have been detrimental to staff

Changing nurses' views of the therapeutic environment: randomised controlled trial

BACKGROUND: Although patients value evidence-based therapeutic activities, little is known about nurses' perceptions.AimsTo investigate whether implementing an activities training programme would positively alter staff perceptions of the ward or be detrimental through the increased workload (trial registration: ISRCTN 06545047). METHOD: We conducted a stepped wedge cluster randomised trial involving 16 wards with psychology-led nurse training as the intervention. The main outcome was a staff self-report measure of perceptions of the ward (VOTE) and secondary outcomes measuring potential deterioration were the Index of Work Satisfaction (IWS) and the Maslach Burnout Inventory (MBI). Data were analysed using mixed-effects regression models, with repeated assessments from staff over time. RESULTS: There were 1075 valid outcome measurements from 539 nursing staff. VOTE scores did not change over time (standardised effect size 0.04, 95% CI -0.09 to 0.18, P = 0.54), neither did IWS or MBI scores (IWS, standardised effect size 0.02, 95% CI -0.11 to 0.16, P = 0.74; MBI standardised effect size -0.09, 95% CI -0.24 to 0.06, P = 0.24). There was a mean increase of 1.5 activities per ward (95% CI -0.4 to 3.4, P = 0.12) and on average 6.3 more patients attended groups (95% CI -4.1 to 16.6, P = 0.23) following training. Staff feedback on training was positive. CONCLUSIONS: Our training programme did not change nurses' perceptions of the ward, job satisfaction or burnout. During the study period many service changes occurred, most having a negative impact through increased pressure on staffing, patient mix and management so it is perhaps unsurprising that we found no benefits or reduction in staff skill.Declaration of interestNone

Scottish theme towns: have new identities enhanced development?

Three small towns in southwest Scotland have recently been branded as distinct theme towns, based on books, artists and food. This is an attempt to make them more attractive to visitors and thereby improve their economy. The objective of this research is to establish whether the new identities possessed by the towns have enhanced their development. It is argued, using data reviewing the past decade, that they have all developed, albeit at different rates, in terms of the economy and culture. Moreover, it is maintained that social capital has been enhanced and is a factor whose importance has been under-appreciated by planners and observers of this type of process. The relevance of the new identity to the pre-branding identity is also seen as a factor in successful development and ideas of authenticity and heritage are brought to bear on the relationship

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Aims.Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.Methods.Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.Results.PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.Conclusions.Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics

A Transport and Microwave Study of Superconducting and Magnetic RuSr2EuCu2O8

We have performed susceptibility, thermopower, dc resistance and microwave measurements on RuSr2EuCu2O8. This compound has recently been shown to display the coexistence of both superconducting and magnetic order. We find clear evidence of changes in the dc and microwave resistance near the magnetic ordering temperature (132 K). The intergranular effects were separated from the intragranular effects by performing microwave measurements on a sintered ceramic sample as well as on a powder sample dispersed in an epoxy resin. We show that the data can be interpreted in terms of the normal-state resistivity being dominated by the CuO2 layers with exchange coupling to the Ru moments in the RuO2 layers. Furthermore, most of the normal-state semiconductor-like upturn in the microwave resistance is found to arise from intergranular transport. The data in the superconducting state can be consistently interpreted in terms of intergranular weak-links and an intragranular spontaneous vortex phase due to the ferromagnetic component of the magnetization arising from the RuO2 planes.Comment: 20 pages including 6 figures in pdf format. To be published in Phys. Rev.

Unusual Field-Dependence of the Intragrain Superconductive Transition in RuSr2EuCu2O8

A narrow intragrain phase-lock transition was observed in RuSr2EuCu2O8 under a magnetic field H up to a few Tesla. The corresponding transition temperature, T2, decreases rapidly (about 100 K/T at low fields) with H indicating that the grains of RuSr2EuCu2O8 behave like a Josephson-junction-array instead of a homogeneous bulk superconductor. Our data suggest that the bulk superconducting transition may occur on a length scale well below the grain size of 2 to 6 micrometer

Magneto-Transport Properties of Doped RuSr2_2GdCu2_2O8_8

RuSr$_2$GdCu$_2$O$_8$, in which magnetic order and superconductivity coexist with $T_{Magnetic}$$\gg$$T_c$, is a complex material which poses new and important questions to our understanding of the interplay between magnetic and superconducting (SC) order. Resistivity, Hall effect and thermopower measurements on sintered ceramic RuSr$_2$GdCu$_2$O$_8$ are presented, together with results on a broad range of substituted analogues. The Hall effect and thermopower both show anomalous decreases below $T_{Magnetic}$ which may be explained within a simple two-band model by a transition from localized to more itinerant behavior in the RuO$_2$ layer at $T_{Magnetic}$.Comment: 10 pages, 7 figures, submitted to Phys. Rev. B., correspondence to [email protected]

Magneto-transport study of intra- and intergrain transitions in the magnetic superconductors RuSr2GdCu2O8 and RuSr2(Gd1.5Ce0.5)Cu2O10

A characterization of the magnetic superconductors RuSr2GdCu2O8 [Ru-(1212)] and RuSr2(Gd1.5Ce0.5)Cu2O10 [Ru-(1222)] through resistance measurements as a function of temperature and magnetic field is presented. Two peaks in the derivative of the resistive curves are identified as intra- and intergrain superconducting transitions. Strong intragrain granularity effects are observed, and explained by considering the antiphase boundaries between structural domains of coherently rotated RuO6 octahedra as intragrain Josephson-junctions. A different field dependence of the intragrain transition temperature in these compounds was found. For Ru-(1212) it remains unchanged up to 0.1 T, decreasing for higher fields. In Ru-(1222) it smoothly diminishes with the increase in field even for a value as low as 100 Oe. These results are interpreted as a consequence of a spin-flop transition of the Ru moments. The large separation between the RuO2 layers in Ru-(1222) promotes a weak interlayer coupling, leading the magnetic transition to occur at lower fields. The suppression rate of the intragrain transition temperature is about five times higher for Ru-(1222), a result we relate to an enhancement of the 2D character of the vortex structure. A distinctive difference with conventional cuprates is the sharp increase in amplitude of the intergrain peak in both systems, as the field is raised, which is ascribed to percolation through a fraction of high quality intergrain junctions.Comment: Submitted for Physical Review

The emergence of 'citizenship' in popular discourse:The case of Scotland

The 2014 Scottish Referendum gauged public opinion on the possibility of Scotland leaving the United Kingdom, raising significant questions about the legitimacy of claims to citizenship in the event of independence. Through a mixed methods survey, this study explored the ways in which citizenship emerged in popular discourse in the lead up to the Scottish referendum. Findings point to an emphasis in public discourse on a commitment to and participation in society, instead of the more traditional citizenship markers of ancestry, birthplace or residency. Data indicates a view of citizenship encompassing status and practice, while identity was framed in terms of more static notions of birthplace and ancestry. The salience of social participation was noticeably greater in respondents’ assessment of others’ potential Scottish citizenship than their own. Specifically, the study highlights the salience of relational aspects of citizenship in popular discourse, with an emphasis on social citizenship in preference to legal citizenship. The study constitutes a significant contribution to ongoing discussions about ‘participatory citizenship’ in the field of Citizenship studies, by providing much needed empirical data on social conceptualizations of citizenship