Exploring person-centered care in acute psychosis care settings. Findings from the Person-Centered Psychosis Care project.

Abstract

Many persons with psychotic disorders are in need of inpatient care at some point in time. The inpatient setting is suggested to need reform to better deliver recovery-oriented care and align with legislation emphasizing patient participation and autonomy. Person-centered care holds potential to contribute to needed change but has not been sufficiently explored in acute psychosis care settings. The aim of this thesis was to explore outcomes and experiences of the Person-Centered Psychosis Care project (PCPC), an educational intervention for inpatient staff. PCPC aimed at creating a sustainable increase of person-centeredness at psychosis care wards. Patient reported outcomes (empowerment and consumer satisfaction, Paper I) and administrative data (care consumption, Paper II) were compared in pre- and post-intervention samples. Focus groups were used to capture staff experiences of PCPC (Paper III). Post-intervention care experiences of patients and next-of-kin were explored in interviews (Paper IV). The findings show that PCPC could not be associated with improved empowerment but with improved satisfaction with care. Length of hospital stay, and length of involuntary stay were longer after the intervention. Staff experiences reflect both a theoretical understanding of person-centered care and a translation into practice, with positive changes such as improved work environment. However, organizational and practical features obstructed implementation. Service user and next-of-kin data reflected mixed experiences of inpatient care, suggesting that person-centeredness does not yet permeate the care process, even though some positive experiences of a more person-centered care emerged. Taken together, findings from the four studies suggest that PCPC was successful in enhancing person-centered thinking and actions in staff, but not all were committed to the project and organizational or practical features obstructed implementation. The findings in Study I, II and IV might be explained by such insufficient implementation. Results must be regarded as tentative due to study limitations.