The Experience of Patients in Mental Health Hospitals

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Using the PROMPT criteria for this essay I will undertake an evaluation Bunyan, M., Crowley, J., Cashen, A. and Mutti, M. ‘A look at inpatients’ experience of mental health rehabilitation wards’, Mental Health Practice, vol. 20, no. 6, pp. 17–23 and how this research may be applicable to my clinical practice.

This essay was undertaken to explore the experiences of patients on three rehabilitation wards and compare it with the experiences of patients in acute settings alongside safety and clinical effectiveness. With patient experiences at the centre of quality measures required by the Department of Health as past research into the experience of patients in mental health hospitals had focused on acute care rather than rehabilitation. This research was undertaken to look at what people with mental health disorders, carers and health professionals consider to be the most effective ways of improving care in rehabilitation wards. 

Themes from the study have been described from the workers, carers and service users ' perspectives. This essay will focus on the key principles of core values of equality and diversity, evidence-based practice and the recovery approach within this study The significance of this within the field of mental health will be discussed and the experience of service users in hospitals for mental health explored. The data collected through focus groups were led by experienced service users acting as experts which helped encourage this audience to participate.

Both reviewers described two main themes inflexible and oppressive regimes on the wards and service user's concerns about being unable to cope after leaving the recovery ward which addresses the consequential results and recommendations for strengthening treatment in recovery wards. According to The Nursing and Midwifery Council the core concepts when carrying out care have many strengths and barriers however overall it is imperative to treat people as individuals and appreciate their privacy and dignity ensuring that each person has an equal opportunity to have their needs met. People should be treated the same no matter what their race, gender, disability, age or sexual orientation is. Not to discriminate in any way or collaborate with others is quintessential to protect and promote the fitness and well-being of those receiving care, their families, carers and people in the wider community.

PROMPT offers a structured method for evaluating, I will use this to critique my chosen article. The articles layout was presented clearly at times, the font changed and some of the paragraphs were misleading to read with their layout running onto the page after a summary, albeit readable and balanced with subheadings, authors' names and professions clearly set out. It was easy to navigate without busy designs or images and the language used made it easy to follow although bland in colour. 

I found it difficult at times to stay focused on the reading as it did refer you to guidelines of how research was conducted which took me away from what I was reading at that given time. Both the reviewer and author’s identities were concealed from the reviewers throughout the review process utilised “double-blind review and checked for plagiarism” hence the authors manuscripts were prepared not to give away their identity taking into consideration confidentiality as the name of the organisations used could not be published to protect the identities of the patients and their consent gained for participation.

As a mental health student nurse, the context and relevance of this article is very relevant, albeit the information could be incomplete as it solely focused on researchers based within the UK, other worldwide studies over a larger geographical area with a larger number of participants would be preferable to deny, backup or contradict further findings. Different cultural participation would be of benefit as this article could be biased taking as findings found “cultural sensitivity among staff was also seen as important”, as the UK is a culturally diverse area therefore as health professionals, we need to be more educated, mindful and respectful. It would be better to have an equal combination of male and female participants of similar age ranges as the age range of participants was 19-62 years and 59% of participants were male with variations in diagnosis, the majority diagnosed with schizophrenia and or secondary diagnosis, such as substance abuse. 

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The article mentioned good communication with the staff and patients feeling listened to were key features and this influenced how valued the patients felt. Speaking and listening were also seen as a therapeutic and cultural sensitivity among the workers, all of which were also considered important as part of the 237 module materials. The article provides only a small insight into this topic and can neither confirm nor refute other researchers ' findings without further studies.

Objectively the study presents the knowledge from a place of interest by two writers although it may not be the intention of the authors, thus objectivity with any study can be an unachievable fact. The authors state their point of view by discussing patients ' knowledge in recovery wards using other academic articles as sources of debate, which can be unsubstantiated theories. 

Therefore, the article mentions no conflict of interest declared there is no conflict of interest that we know exists with the author, reviewer, or editor has financial or personal relationships that could be inappropriately influenced by bias, so no known or declared dual commitments, interests or loyalties. As the authors who all come from a background in mental health, some may assume that it might be possible to suggest bias as they would have an invested interest in this article to support what they are trying to say, all sponsors agreed to access the research data.

The method was clear inviting all 45 service users on the ward with only 22 participants to participate. Ethical approval was received and seven focus group meetings, three on one ward, two on each of the other wards were held over the course of a year. Facilitation determined that two service users manage the groups and the clinical psychologist, who works independently of the staff team. No prejudice or hidden motives have been clarified as the clinical psychologist researcher had worked at the service. 

Points for consideration and how accurate the results could have been if service users were perhaps sharing with others who were not involved, and did they really understand what was expected of them when they consented to participate. All focus groups whereby one author (MB) who did not contribute to the discussions and both transcripts were 'subjected to an inductive thematic study' and reviewed separately by reviewers from the perspectives of academics, service users and carers who tended to have a fair representation. Although we do not know if any of these persons were related to those participants due to confidentiality and only independently reviewed half the samples of transcripts.

The article was published in 2017 and is therefore considered up-to-date, valid and unbiased, although it may be important to note, as this field is evolving rapidly, that it may soon become outdated. The authors are experienced mental health experts and have used respected and reliable sources, although consideration could be given to the date and volume of references, a total of forty used with eighteen exceeding the ten-year guidelines, and this could be obsolete or considered to be out of date, which could complicate the results. Due to more relevant up-to-date studies available as health is constantly changing by using evidence-based practices and ongoing studies using the experience of service users in their families, audits, protocols and guidelines, research studies, and randomised control studies as examples, the age of information might matter on this occasion.

To summarise I will utilise SWOT and a quote from the Nursing and Midwifery Council (NMC) which sums up my learning of this study: “All nurses must appreciate the value of evidence in practice, be able to understand and appraise research, apply relevant theory and research findings to their work, and identify areas for further investigation”.

Using the SWOT analysis to build on the findings of this study suggests how essential the services provided efficiently meet the needs of service users, carers and professionals. The advantage it brings to patients is to give nurses a better understanding of why they may find it difficult to communicate with service users who are not being listened to, for example, and to build more successful, inflexible, authoritarian wards regimes and better patient fear education after leaving the rehabilitation ward to improve overall care, which ultimately improves satisfaction.

The study's drawbacks are only the view of twenty-two patients, and may not represent a larger majority, and proposed improvements in practice need to be further examined to decide whether it is the best evidence in practice. Of course, these are also important issues addressed and incentives for me to work in mental health, the obstacles to authoritarian regimes found by mental health sufferers in this study such as the rules and routine and fear of the unknown, as well as their individual responsibility for personal care and wellbeing will also extend to all service user engagement and save money by more effectively utilizing resources by encouraging service users to contribute to their own health and autonomy.

Health professionals must adhere to policies and procedures and are therefore bound by guidelines with staffing issues and limited funding this could challenge funding for suggested changes, staff may not have time to consult with service users leading to frustration of service users and feeling that they too are not being listened to. To me, this research reinforces the notion that nursing care needs to apply beyond the patient's immediate state to their health and wellbeing in general.

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