Qualitative analysis of ward staff experiences during research of a novel suicide-prevention psychological therapy for psychiatric inpatients: Understanding the barriers and facilitators
Autoři:
Yvonne F. Awenat aff001; Sarah Peters aff001; Patricia A. Gooding aff001; Daniel Pratt aff001; Charlotte Huggett aff001; Kamelia Harris aff001; Christopher J. Armitage aff001; Gillian Haddock aff001
Působiště autorů:
Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
aff001; Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
aff002; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
aff003; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
aff004; Manchester University NHS Foundation Trust, Manchester, United Kingdom
aff005
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0222482
Souhrn
Background
Suicide prevention is a global priority. Psychiatric hospitalization presents an opportunity to intervene positively with, for example, psychological therapies. However, evidenced-based suicide-prevention psychological treatments are rarely available on in-patient wards. Understanding staff engagement with research investigating suicide-prevention psychological treatments is crucial for their effective, efficacious, and pragmatic implementation. A pilot randomised control trial and feasibility study of Cognitive Behavioural Suicide Prevention therapy provided the opportunity for a qualitative investigation of staff experiences and views of a psychological intervention for people with suicidal experiences on psychiatric in-patient wards.
Aims
To investigate staff acceptability of Cognitive Behavioural Suicide Prevention therapy for psychiatric inpatients based on their perceptions of their experiences during the conduct of a clinical trial.
Method
Transcribed audio-recordings of qualitative interviews and a focus group (n = 19) of purposively sampled staff from eight psychiatric wards were analysed using inductive Thematic Analysis.
Results
Facilitators and barriers were identified for: i) the conduct of the research, and, ii) the suicide-prevention intervention (Cognitive Behavioural Suicide Prevention therapy). Research-related barriers comprised communication difficulties between staff and researchers, and increased staff workload. Research-related facilitators included effective staff/researcher relationships, and alignment of the intervention with organisational goals. Suicide-prevention intervention-related barriers comprised staffs’ negative beliefs about suicide which impacted on their referral of inpatients to the clinical trial, and staff perceptions of insufficient information and unfulfilled expectations for involvement in the therapy. Facilitators included staff beliefs that the therapy was beneficial for inpatients, the service and their own clinical practice.
Conclusions
Staff beliefs that ‘suicide-talk’ could precipitate suicidal behaviour resulted in covert gatekeeping and restricted referral of only inpatients judged as stable or likely to engage in therapy, which may not be those who could most benefit. Such threats to sample representativeness have implications for future therapy research design. The findings provide novel information for researchers and practitioners regarding the conduct of psychological treatment and research in psychiatric units.
Klíčová slova:
Nurses – Patients – Behavior – Qualitative studies – Mental health and psychiatry – Inpatients – Suicide – Mental health therapies
Zdroje
1. Martelli C., Awad H., Hardy P. In-patient suicides: epidemiology and prevention. Encephale. 2010;36. Supp 2. 83–91
2. Appleby L., Shaw J., Kapur N., Windfuhr K., Ashton A., Swinson N., et al. Avoidable deaths: Five-year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). University of Manchester, UK. 2006.
3. National Confidential Inquiry into Suicide and Safety in Mental Health. Annual Report: England, Northern Ireland, Scotland, Wales. 2018. University of Manchester. UK.
4. WHO. World Health Organisation. Preventing Suicide: A global imperative. Geneva. WHO. 2014: Available at: www.who.int/mental_health/suicide-prevention/world_report_2014/en/ Accessed 24/01/19
5. Department of Health. DH. Preventing Suicide in England. A Cross-Government Outcomes Strategy to Save Lives. 2012. London, UK. Department of Health / Government
6. Department of Health. DH. The Five Year Forward View for Mental Health. 2016. Mental Health Taskforce. London, UK.
7. Large M., Chung D., Davidson M., Weiser M., Ryan C. In-patient suicide. 2017: Journal of Psychiatry Open. 3. 102–105.
8. Bowers L., Simpson A., Alexander J., Hackney D., Nijman H., Grange A., Warren J. The nature and purpose of acute psychiatric wards: The tompkins acute ward study. Journal of Mental Health. 2009:14 (6).625–635
9. Bowers L. Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing. Journal of Psychiatric and Mental Health Nursing. 2005:12 (2) 231–236. doi: 10.1111/j.1365-2850.2004.00825.x 15788042
10. James K., Stewart D., Bowers L. Self-harm and attempted suicide within inpatient psychiatric services: A review of the literature. International Journal of Mental Health Nursing. 2012: 21 (1) 301–309.
11. Hawton K., Witt K., Taylor Salisbury T., Arensman E., Gunnell D., Hazell P., Townsend E. Van Heeringen K. et al. Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis. The Lancet. 2016:3(8) 740–750. doi: 10.1016/S2215-0366(16)30070-0 27422028
12. Winter D., Bradshaw S., Bunn F., Wellsted D. A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies. Counselling and Psychotherapy Research.2013:13(3) 164–183.
13. Winter D., Bradshaw S., Bunn F., Wellsted D. A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies. Counselling and Psychotherapy Research. 2014:14(1) 64–79.
14. National Institute for Health & Care Excellence. (NICE). Self-harm: the short term physical and psychological management and secondary prevention of self-harm in primary and secondary care. NICE CG 16.2004: Available at www.nice.org.uk/guidance/CG16 accessed 10/04/19
15. National Institute for Clinical Excellence (NICE). Self-harm: Longer term management. CG133. 2011: Available at: www.nice.org.uk/guidance/CG133 accessed 04/03/19.
16. Durrant C., Clarke I., Tolland A., Wilson H. Designing a CBT service for acute inpatient settings: A pilot evaluation study. Clinical Psychology and Psychotherapy. 2007: 14. 117–125
17. Munk-Jorgensen P., Blanner Kristiansen C., Uwawke R., Larsen J., Okkels N., Christiansen B., Hjorth P. The gap between available knowledge and its use in clinical psychiatry. Acta Psychiatrica Scandinavica. 2015:132. 441–450 doi: 10.1111/acps.12512 26463889
18. Proctor E., Landsverk J., Aarons G., Chambers D., Glisson C., Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Mental Health. 2009: 36. 24–34
19. Gotham H. Diffusion of mental health and substance abuse treatments: Development, dissemination, and implementation. Clinical Psychology: Science and Practice. 2004:11(2) 160–176.
20. Haddock G., Eisner E., Boone C., Davies G., Coogan C., Barrowclough C. An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. Journal of Mental Health. 2004: 23(4) 162–165.
21. Aarons G. Measuring provider attitudes toward adoption of evidence-based practice: Organizational context and individual differences. Child and Adolescent Psychiatric Clinics of North America.2005:14. 255–271. doi: 10.1016/j.chc.2004.04.008 15694785
22. Aarons G., Sawitzky A. Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological Services. 2006:3(1) 61–72 doi: 10.1037/1541-1559.3.1.61 17183411
23. Cooksey D. A Review of UK Health Research Funding. 2006. Norwich. HMSO.
24. Medical Research Council. UK. MRC. (2008). Developing and evaluation complex interventions: New guidance. 2008: London. MRC. Available at: www.mrc.ac.uk/complexinterventionsguidance.
25. Kennedy-Martin J., Curtis S., Faries D., Robinson S., Johnson J. A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results. Trials. 2015:16.495. doi: 10.1186/s13063-015-1023-4 26530985
26. Mullen A. Mental health nurses establishing psychosocial interventions within acute inpatient settings. International Journal of Mental Health Nursing. 2009:18(2) 83–90 doi: 10.1111/j.1447-0349.2008.00578.x 19290971
27. Heneghan C., Goldacre B., Mahtani K. Why clinical trial outcomes fail to translate into benefits for patients. Trials. 2017:18.122. doi: 10.1186/s13063-017-1870-2 28288676
28. Retsas A., Barriers to using research evidence in nursing practice. Journal of Advanced Nursing. 2000:31(3) 599–606 doi: 10.1046/j.1365-2648.2000.01315.x 10718879
29. Rycroft-Malone J., Harvey G., Seers K., Kitson A., McCormack B., Titchen A. An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing. 2004:13. 913–924 doi: 10.1111/j.1365-2702.2004.01007.x 15533097
30. Awenat Y., Peters S., Shaw Nunez E., Gooding P., Pratt D., Haddock G. Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis. British Journal of Psychiatry. 2017: doi: 10.1192/bjp.bp.116.191817 28642259
31. Laker C., Callard C., Flach C., Williams P., Sayer J., Wykes T. The challenge of change in acute mental health services: measuring staff perceptions of barriers to change and their relationship to job status and satisfaction using a new measure (VOCALISE). Implementation Science. 2014:9 (23)
32. Tashakkori A., Teddlie C. Mixed Methodology. Combining Qualitative and Quantitative Approaches. 1998. London. Sage
33. Cochrane L., Olsen C., Murray S., Dupuis M., Tooman T., Hayes S. Gaps between knowing and doing: Understanding and assessing the barriers to optimal health care. Journal of Continuing Education in the Health Professions. 2007:27(2) 94–102 doi: 10.1002/chp.106 17576625
34. Dixon T., Stein E., Ngak S., Srean C., Maly P., Sokunny M., Carrico A., Page K, Maher L. Qualitative research and implementation science: Informing the acceptability and implementation of a trial of a conditional cash transfer intervention designed to reduce drug and HIV. Methodological Innovations. 2016. doi: 10.1177/2059799115622751 30956811
35. Thurmond V. The point of triangulation. Journal of Nursing Scholarship. 2001: 33(3) 253–258.
36. Haddock G., Pratt D., Gooding P., Peters S., Emsley R., Evans E., Kelly J., Huggett C., Munroe A., Harris K., Davies L., Awenat Y. Randomised controlled trial of feasibility and acceptability of suicide prevention therapy in acute psychiatric wards. British Journal of Psychiatry Open. 2019 5(1) doi: 10.1192/bjo.2018.85
37. Haddock, G., NIHR. 2014 A pilot study to investigate the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards. PB-PG-1111-26026. 2014. Final report to the National Institute for Health Research
38. Tarrier N., Kelly J., Gooding P., Pratt D., Awenat Y., Maxwell J. Cognitive Behavioural Prevention of Suicide in Psychosis: A treatment manual. 2013. London. Routledge.
39. Rapp C., Etzel-Wise D., Mary D., Coffman M., Carlson L., Asher D., Callaghan J., Holter M. Barriers to evidence-based practice implementation: Results of a qualitative study. Community Mental Health Journal. 2010:46(2) 112–118. doi: 10.1007/s10597-009-9238-z 19685185
40. Madill A., Jordan A., Shirley C. Objectivity and reliability in qualitative analysis: Realist, contextualist and radical constructionist epistemologies. British Journal of Psychology 2000. 91, 1–20. doi: 10.1348/000712600161646 10717768
41. Herbert J., Padovani F. Contextualism, psychological science, and the question of ontology. Journal of Contextual Behavioral Science. 2015: 4 225–230.
42. Braun V., Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006: 3. 77–101.
43. Braun V. & Clarke V. Chapter 4. Thematic Analysis. In American Psychological Association Handbook of Research Methods in Psychology. 2012. Vol 2. Research Designs, Cooper H. (Editor-in-Chief) American Psychological Association. doi: 10.1037/1362-004
44. Braun V. & Clarke V. Successful Qualitative Research. A practical guide for beginners. 2013. London. Sage.
45. Finlay L. Negotiating the swamp: the opportunity and challenge of reflexivity in research practice. Qualitative Research. 2 (2) 209–230.
46. Mays N., Pope C. Qualitative research in healthcare. Assessing quality in qualitative research. British Medical Journal. 2000:320. 50–52 doi: 10.1136/bmj.320.7226.50 10617534
47. Hellawell D. Inside-out: analysis of the insider-outsider concept as a heuristic device to develop reflexivity in students doing qualitative research. Teaching in Higher Education. 2006:11(4) 483–494
48. Ritchie J., Lewis J., McNaughton Nicholls C., Ormston R. Qualitative Research Practice. A guide for social science students. 2014:p22: (2nd Edition) London. Sage
49. Tong A., Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ). International Journal for Quality in Health Care. 2007:19(6) 349–357 doi: 10.1093/intqhc/mzm042 17872937
50. Lambert S., Loiselle C. Combining individual interviews and focus groups to enhance data richness. Journal of Advanced Nursing. 2008: 62(2) 228–237. doi: 10.1111/j.1365-2648.2007.04559.x 18394035
51. Marshall M. Sampling for qualitative research. Family Practice 1996. 13(6) 522–525. doi: 10.1093/fampra/13.6.522 9023528
52. Dey I. Grounding grounded theory guidelines for qualitative inquiry. 1999. San Diego, Academic Press
53. Bowers L., James K., Quirk A., Simpson A., SUGAR, Stewart D., Hodsell J. Reducing conflict and containment on acute psychiatric wards: The Safewards cluster randomised controlled trial. International Journal of Nursing Studies. 2015: 52(9) 1412–1422 doi: 10.1016/j.ijnurstu.2015.05.001 26166187
54. Armitage C., Norman P., Alganem S., Connor M. Expectations are more predictive of behaviour than behavioural intentions: evidence from two prospective studies. Annals of Behavioral Medicine. 2015:49(2) 239–246 doi: 10.1007/s12160-014-9653-4 25623893
55. Borschmann R., Patterson S., Dilkushi P., Wilson D., Weaver T. Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network. BMC Medical Research Methodology. 2014:14. 23. doi: 10.1186/1471-2288-14-23 24533721
56. Bucci S., Butcher I., Hartley S., Neil S., Mulligan J., Haddock G. Barriers and facilitators to research in mental health services: Care coordinators’ expectations and experiences of referring to a psychosis research trial. Psychology and Psychotherapy. 2014: 88(3) 335–350 doi: 10.1111/papt.12042 25257960
57. Mairs H. Lovell K., Keeley P. Clinician views of referring people with negative symptoms to outcome research. International Journal of Mental Health Nursing. 2012: 21(2) 138–144 doi: 10.1111/j.1447-0349.2011.00770.x 21951838
58. Cleary M., Hunt G., Horsfall J., Deacon M. Ethnographic research into nursing in acute adult mental health units: A review. Issues in Mental Health Nursing 2011:32(7) 424–435 doi: 10.3109/01612840.2011.563339 21736465
59. Holmes J. Acute wards: problems and solutions. Psychiatric Bulletin. 2002:26. 383–385
60. Flood C., Brennan G., Bowers L., Hamilton B., Lipong M., Oladapo P. Reflections on the process of change on acute psychiatric wards during the City Nurse project. Journal of Psychiatric and Mental Health Nursing. 2006:13 (3) 260–268 doi: 10.1111/j.1365-2850.2006.00932.x 16737492
61. Woltmann E., Whitley R., McHugo G., Brunette M., Torrey W., Coots L., Lynde D., Drake R. The role of staff turnover in the implementation of evidence based practices in mental health care. Psychiatric Services. 2008:59(7) 732–737 doi: 10.1176/appi.ps.59.7.732 18586989
62. Hurley J., & Rankin R. As mental health nursing roles expand, is education expanding mental health nurses? An emotionally intelligent view towards preparation for psychological therapies and relatedness. Nursing Inquiry.2008:15 (3) 199–205 doi: 10.1111/j.1440-1800.2008.00412.x 18786212
63. McCann E., Bowers L. Training in cognitive behavioural interventions on acute psychiatric inpatient wards. Journal of Psychiatric and Mental Health Nursing. 2005:12(2) 215–222 doi: 10.1111/j.1365-2850.2004.00822.x 15788040
64. Stavrou S., Cape J., Barker C. Decisions about referrals for psychological therapies: a matched-patient qualitative study. British Journal of General Practice. 2009:59(566) e289–e298 doi: 10.3399/bjgp09X454089 19761656
65. Awenat Y., Peters S., Gooding P., Pratt D., Shaw-Nunez E., Harris K., Haddock G. A qualitative analysis of suicidal inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths. BMC Psychiatry. 2018: doi: 10.1186/s12888-018-1921-6 30326878
66. Striman S., Brown G., Ghahramanlou-Holloway M., Fox A., Chohan M., Beck A. Participation bias among suicidal adults in a randomized controlled trial. Suicide and Life Threatening Behavior.2011:41(2) 203–209 doi: 10.1111/j.1943-278X.2010.00011.x 21470296
67. Hendricks Brown C., Curran G., Palinkas L., Aarons G., Wells K., Jones L., Collins L., Duan N., Mittman B., Wallace A., Tabac R., Ducharme L., Chambers D., Neta G., Wiley T., Landsverk J., Cheung K., Cruden G. An overview of research and evaluation designs for dissemination and implementation. Annual Review of Public Health. 2017:38. 1–22 doi: 10.1146/annurev-publhealth-031816-044215 28384085
68. Sibbald B., Roland M. Understanding controlled trials: Why are randomised controlled trials important? British Medical Journal. 1998:316. 201 doi: 10.1136/bmj.316.7126.201 9468688
69. Lovell K., Bee P., Brooks H., Cahoon P., Callaghan P., Carter L., Cree L., Davies L., Drake R., Fraser C., Gibbons C., Hinsliff-Smith K., Bower P. Embedding shared decision-making in the care of patients with severe and enduring mental health problems. The EQUIP pragmatic cluster randomised trial. PLOS One.2018: http://doi.org/10.1371/journal.pone.0201533
70. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Annual report. 2013. University of Manchester, Manchester. UK.
71. UK Index of Deprivation (2015) http://www.gov.uk/government/statistics/english-indices-of-deprivation-2015 Accessed 10/11/18
72. Dazzi T., Gribble R. Wessely S., Fear N. Does asking about suicide and related behaviours induce suicidal ideation. What is the evidence? Psychological Medicine. 2014. 44(16) 3361–3363 doi: 10.1017/S0033291714001299 24998511
73. Ajzen I. From intentions to actions: A theory of planned behaviour.p11-39, In Kuhl J. & Beckmann J., (Eds) Action Control: From Cognition to Behaviour. 1985. Berlin. Springer-Verlag
74. Armitage C. Connor M. Efficacy of the theory of planned behaviour; A meta-analytic review. British Journal of Social Psychology. 2001:40. 471–499 11795063
75. O’Connor R., Armitage C. Theory of planned behaviour and parasuicide: An exploratory study. Current Psychology. 2003:22(3) 196–205
76. Armitage C., Rahim W., Rowe R., O’Connor R. An exploratory trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm. The British Journal of Psychiatry. 2016:208(5) 470–476 doi: 10.1192/bjp.bp.114.162495 26743808
77. NHS England Research Plan. 2017. Leeds, UK. NHS England / Policy, Partnerships, & Innovation / Innovation and research Unit. Available at https://www.england.nhs.uk/wp-content/uploads/2017/04/nhse-research-plan.pdf accessed 19.06.19
78. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Making Mental Health Care Safer: Annual Report and 20 –year review (2016) University of Manchester, Manchester, UK.
79. Hawton K. Pirkis J. Suicide is a complex problem that requires a range of prevention initiatives and methods of evaluation. The British Journal of Psychiatry (Editorial) 2017: 210 381–383
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