Deprivation of liberty in psychiatric hospital care: the patient's perspective

Deprivation of liberty in psychiatric hospitals is common world-wide. The aim of this study was to find out whether patients had experienced deprivation of their liberty during psychiatric hospitalization and to explore their views about it. Patients (n = 51) in two acute psychiatric inpatient wards were interviewed in 2001. They were asked to describe in their own words their experiences of being deprived of their liberty. The data were analysed by inductive content analysis. The types of deprivation of liberty in psychiatric hospital care reported by these patients were: restrictions on leaving the ward and on communication, confiscation of property, and various coercive measures. The patients' experiences of being deprived of their liberty were negative, although some saw the rationale for using these interventions, considering them as part of hospital care.     

The adult patient, informed consent and the emergency care setting

How much information does a practitioner of emergency care give to an adult patient of sound mind in order for that patient to make a choice? This paper examines legal and professional perspectives and the challenges for the practitioner of emergency care in the process of information giving. Autonomy and human rights are significant themes in any health care context, and this paper argues that practitioners must discharge their duty of care, and facilitate an environment in which patients are informed despite the need for timely decisions about care and treatment.     

The treatment of 'difficult' patients in a secure unit of a specialized psychiatric hospital: the patient's perspective

The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called 'difficult' patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to another, specialist hospital may provide a solution. We investigated which aspects of specialist treatment available to 'difficult' patients are perceived as essential by the patients and what are the results of this treatment in their perception. A qualitative research design based on the Grounded Theory method was used. To generate data, 14 semi-structured interviews were held with 12 patients who were admitted to a specialist hospital in the Netherlands. Almost all respondents rated the results of the specialist treatment as positive. The therapeutic climate was perceived as extremely strict, with a strong focus on structure, cooperation and safety. This approach had a stabilizing effect on the patients, even at times when they were not motivated. Most patients developed a motivation for change, marked by a growing and more explicit determination of their future goals. We concluded that a highly structured treatment environment aimed at patient stabilization is helpful to most 'difficult' patients.     

Mainstreaming palliative care for cancer patients in the acute hospital setting.

Palliative care is now emerging as an integrated part of mainstream health care delivery. The importance of patient choice regarding place of dying means that a substantial proportion of palliative care provision occurs in community settings. In part, this is due to the inappropriateness of the acute hospital setting for the care of dying patients. However, most patients with cancer and other terminal illnesses are diagnosed and treated in acute hospitals. Acute hospitals are also the most common setting where people actually die. Therefore, there remains a need for skilled and compassionate provision for the care of dying patients in the acute hospital setting. This paper presents a case for the provision of palliative care services in teaching hospitals. It further argues that a high level of integration between cancer treatment services and palliative care services is needed to optimize the care of cancer patients.     

Primary care problems in patients attending a semi-rural accident and emergency unit: a prospective study.

OBJECTIVE: To analyse the characteristics of patients attending a coastal resort accident and emergency (A&E) unit and compare use by summer visitors with use by the indigenous winter population by previously validated assessment criteria. SETTING: Accident and emergency unit of a semi-rural coastal town district general hospital. SUBJECTS: 3643 first attenders in the summer cohort and 2876 in the winter cohort. METHODS: All patients attending the A&E unit over two 28 day periods in summer and winter 1995 were assessed prospectively in four categories by trained, experienced nurse assessors. Category 4 identified patients who fulfilled the King''s College Hospital criteria as being suitable for care from primary care practitioners. RESULTS: 43.8% of the summer patients could have been seen in the primary care setting, as could 38.7% of the winter visitors. CONCLUSIONS: The proportion of patients with primary care problems who attend semi-rural A&E units appears to be much higher than previously thought. These findings cast doubt on the validity of the King''s College Hospital criteria for classifying patients to either primary care or A&E categories.     

Headache patients in the emergency department of a Greek tertiary care hospital

The aim of this study was to record the demographic and epidemiological data on adult patients with headache who attend the emergency department (ED) and the diagnoses that made by the neurologists in the ED of a tertiary care hospital in metropolitan Thessaloniki (Greece). In an open prospective study, demographic and epidemiological data were collected on all patients who reported headache (as chief complaint or not) and presented to the ED of Papageorgiou Hospital between August 2007 and July 2008. Headache patients accounted for 1.3% of all ED patients and for 15.5% of patients primarily referred to the ED neurologist. Tension type headache was the most frequent diagnosis, followed by secondary headaches and migraine. The large number of patients without final ED diagnosis and ward admission for further evaluation sheds a light on the immense workload of Greek ED physicians. Furthermore, we found evidence for the misuse of Emergency Medical Services by chronic headache patients. These findings indicate shortcomings in the pre-hospital (primary care) management of headache patients in the Greek National Health System to an extent unreported so far.     

Advance care directives: counseling the patient and family in the primary care setting.

NPs are in an excellent position to provide primary care patients with the appropriate counseling for the development of required advanced care directives before the onset of serious illness and hospitalization. Discussion of how and whom to counsel assists the NP in undertaking this important responsibility encountered by primary care providers.     

Violence and aggression in the emergency department: A critical care perspective.

Aggression and violence are common in the Emergency setting, with nurses out-ranking police and prison officers in exposure to workplace violence. This paper examines the current literature to identify the incidence of violence within the ED, precipitators of violence and aggression and the government policy directive of 'zero tolerance'. Methods of managing violence and aggression are explored, including environmental management, de-escalation, pharmacological and physical restraint and seclusion and these are linked to course content recommended for staff training.     

Nursing sabbatical in the acute care hospital setting: a cost-benefit analysis

Practice-based acute care nurses experience a high incidence of burnout and dissatisfaction impacting retention and innovation and ultimately burdening the financial infrastructure of a hospital. Business, industry, and academia have successfully implemented professional sabbaticals to retain and revitalize valuable employees; however, the use is infrequent among acute care hospitals. This article expands upon the synthesis of evidence supporting nursing sabbaticals and suggests this option as a fiscally sound approach for nurses practicing in the acute care hospital setting. A cost-benefit analysis and human capital management strategies supporting nursing sabbaticals are identified.