Levels of service user satisfaction in secure settings - A survey of the association between perceived social climate, perceived therapeutic relationship and satisfaction with forensic services

Article (PDF Available)inInternational journal of nursing studies 48(11):1349-56 · June 2011with197 Reads
DOI: 10.1016/j.ijnurstu.2011.05.011 · Source: PubMed
Abstract
The interests of users should lead service developments. However, it has been claimed that forensic mental health services have largely ignored examining users' views on the nature and quality of the service offered to them. Perceived social climate and perceived therapeutic relationship are viewed as important indicators of treatment outcome; however previous findings about how these variables may be associated with satisfaction with forensic services are equivocal. This study aims to assess the levels of service user satisfaction in forensic in-patient settings in one mental health trust and explore how the perceived therapeutic relationship of the service users with their key-workers and the perceived social climate of the wards are associated with service user satisfaction. A cross-sectional survey design was chosen and an independent researcher facilitated the completion of three standardised assessments measuring service user satisfaction, therapeutic relationships and the social climate of the ward. Forty-four service users detained in secure settings completed the standardised assessments. The study was conducted in four medium secure and three low secure units in one NHS mental health trust. The data was analysed to examine the level of satisfaction with services and how both the therapeutic relationship and the ward environment were related to levels of satisfaction. The majority of service users who responded were generally satisfied with services; "rehabilitation" and "perceived safety" were viewed most positively. Service users' perceptions about the social climate of the ward were found to have a significant relationship with service users' satisfaction with forensic services. However, the variables with the strongest association with satisfaction with forensic services are service users' perceptions about the nature of therapeutic relations with staff. This study indicates that service users' satisfaction with forensic services is strongly associated with their experiences of the therapeutic relationship with their key-workers and the social climate of the ward. The findings emphasize the importance of forming and maintaining effective therapeutic relations and reinforce the need to maintain a therapeutic environment free of aggressive tension and threats of violence. The results also highlight the potential for service users to be dissatisfied with their financial situation following admission.
This article appeared in a journal published by Elsevier. The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
websites are prohibited.
In most cases authors are permitted to post their version of the
article (e.g. in Word or Tex form) to their personal website or
institutional repository. Authors requiring further information
regarding Elsevier’s archiving and manuscript policies are
encouraged to visit:
http://www.elsevier.com/copyright
Author's personal copy
Levels
of
service
user
satisfaction
in
secure
settings
A
survey
of
the
association
between
perceived
social
climate,
perceived
therapeutic
relationship
and
satisfaction
with
forensic
services
Daniel
Bressington
a,
*
,
Bill
Stewart
b
,
Dominic
Beer
b
,
Douglas
MacInnes
c
a
The
Department
of
Social
Work,
Community
and
Mental
Health,
Canterbury
Christ
Church
University,
North
Holmes
Road,
Canterbury,
Kent
CT1
1QU,
United
Kingdom
b
Oxleas
NHS
Foundation
Trust,
The
Bracton
Centre,
Bracton
Lane,
Dartford,
Kent
DA2
7AF,
United
Kingdom
c
Centre
for
Health
and
Social
Care
Research,
Canterbury
Christ
Church
University,
North
Holmes
Road,
Canterbury,
Kent
CT1
1QU,
United
Kingdom
International
Journal
of
Nursing
Studies
48
(2011)
1349–1356
A
R
T
I
C
L
E
I
N
F
O
Article
history:
Received
25
November
2010
Received
in
revised
form
20
May
2011
Accepted
26
May
2011
Keywords:
Forensic
Mental
health
Satisfaction
Therapeutic
relationship
Ward
climate
A
B
S
T
R
A
C
T
Background:
The
interests
of
users
should
lead
service
developments.
However,
it
has
been
claimed
that
forensic
mental
health
services
have
largely
ignored
examining
users’
views
on
the
nature
and
quality
of
the
service
offered
to
them.
Perceived
social
climate
and
perceived
therapeutic
relationship
are
viewed
as
important
indicators
of
treatment
outcome;
however
previous
findings
about
how
these
variables
may
be
associated
with
satisfaction
with
forensic
services
are
equivocal.
Objectives:
This
study
aims
to
assess
the
levels
of
service
user
satisfaction
in
forensic
in-
patient
settings
in
one
mental
health
trust
and
explore
how
the
perceived
therapeutic
relationship
of
the
service
users
with
their
key-workers
and
the
perceived
social
climate
of
the
wards
are
associated
with
service
user
satisfaction.
Design:
A
cross-sectional
survey
design
was
chosen
and
an
independent
researcher
facilitated
the
completion
of
three
standardised
assessments
measuring
service
user
satisfaction,
therapeutic
relationships
and
the
social
climate
of
the
ward.
Method:
Forty-four
service
users
detained
in
secure
settings
completed
the
standardised
assessments.
The
study
was
conducted
in
four
medium
secure
and
three
low
secure
units
in
one
NHS
mental
health
trust.
The
data
was
analysed
to
examine
the
level
of
satisfaction
with
services
and
how
both
the
therapeutic
relationship
and
the
ward
environment
were
related
to
levels
of
satisfaction.
Results:
The
majority
of
service
users
who
responded
were
generally
satisfied
with
services;
‘‘rehabilitation’’
and
‘‘perceived
safety’’
were
viewed
most
positively.
Service
users’
perceptions
about
the
social
climate
of
the
ward
were
found
to
have
a
significant
relationship
with
service
users’
satisfaction
with
forensic
services.
However,
the
variables
with
the
strongest
association
with
satisfaction
with
forensic
services
are
service
users’
perceptions
about
the
nature
of
therapeutic
relations
with
staff.
Conclusions:
This
study
indicates
that
service
users’
satisfaction
with
forensic
services
is
strongly
associated
with
their
experiences
of
the
therapeutic
relationship
with
their
key-
workers
and
the
social
climate
of
the
ward.
The
findings
emphasize
the
importance
of
forming
and
maintaining
effective
therapeutic
relations
and
reinforce
the
need
to
maintain
a
therapeutic
environment
free
of
aggressive
tension
and
threats
of
violence.
The
results
also
highlight
the
potential
for
service
users
to
be
dissatisfied
with
their
financial
situation
following
admission.
ß
2011
Elsevier
Ltd.
All
rights
reserved.
*
Corresponding
author.
Tel.:
+44
1227782611.
E-mail
address:
daniel.bressington@canterbury.ac.uk
(D.
Bressington).
Contents
lists
available
at
ScienceDirect
International
Journal
of
Nursing
Studies
journal
homepage:
www.elsevier.com/ijns
0020-7489/$
see
front
matter
ß
2011
Elsevier
Ltd.
All
rights
reserved.
doi:10.1016/j.ijnurstu.2011.05.011
Author's personal copy
What
is
already
known
about
the
topic?
Service
users’
views
about
satisfaction
with
forensic
services
have
been
largely
ignored
in
international
forensic
mental
health
settings.
Previous
studies
identify
lower
levels
of
satisfaction
with
forensic
services
than
in
general
psychiatric
settings
and
generally
fail
to
use
satisfaction
measures
specifically
designed
for
forensic
environments.
Previous
findings
about
predictors
of
satisfaction
with
forensic
services
are
equivocal.
What
this
study
adds
This
study
uses
a
measure
specific
to
forensic
mental
health
environments
and
details
the
levels
of
service
user
satisfaction
with
forensic
mental
health
services
on
a
range
of
satisfaction
domains
and
the
total
satisfaction
score.
Service
users’
views
about
the
quality
of
therapeutic
relationships
and
feelings
of
safety
on
inpatient
units
are
associated
with
satisfaction
with
forensic
services.
The
results
highlight
the
potential
for
service
users
to
be
dissatisfied
with
finances
early
in
treatment.
1.
Background
The
UK
Department
of
Health
(2002)
guidance
states
that
the
interests
of
users
should
lead
service
develop-
ments
and
treatment
guided
by
their
aspirations
and
experiences.
However,
it
has
been
claimed
that
forensic
mental
health
services
have
largely
ignored
examining
users’
views
on
the
nature
and
quality
of
the
service
offered
to
them
(Morrison
et
al.,
1996).
NIMHE
(2004)
in
their
review
of
forensic
mental
health
services
noted
a
lack
of
a
service
user
perspective
and
involvement
in
service
development
and
recommended
that
future
work
should
seek
to
build
mechanisms
and
services
that
involve
service
users
and
respond
to
their
views.
Measuring
service
user
satisfaction
can
be
viewed
as
a
way
of
identifying
the
service
user’s
perpsective.
Service
user
satisfaction
with
mental
health
services
has
been
viewed
as
important
for
a
number
of
reasons
(Avis
et
al.,
1995;
Ruggeri
and
Dall’Agnola,
2000;
Stallard,
1996):
treatment
will
not
be
successful
unless
there
is
some
service
user
satisfaction
with
the
service;
service
user
satisfaction
is
an
important
measure
of
treatment
outcome
and
a
useful
way
of
assessing
services;
and
assessing
service
user
satisfaction
over
time
can
result
in
services
being
adapted
to
make
them
more
acceptable
to
service
users
and
to
help
develop
better
use
of
services.
Service
users’
perceptions
about
the
social
climate
of
inpatient
uni ts
have
previously
been
shown
to
influence
clinical
outcomes
(Moos,
1974)
and
to
be
a
strong
predictor
of
satisfaction
with
mental
health
services
(Middleboe
et
al.,
2001).
A
recent
study
(Long
et
al.,
2010)
explorin g
womens’
views
of
social
climate
in
secure
mental
health
services
identified
a
positive
association
between
treatment
outcomes
and
favourable
views
about
social
climate.
Gaining
the
views
of
service
users
about
the
ward
climate
is
essential;
ward
staff
may
have
a
tendency
to
over-estimate
the
positive
aspects
of
a
clinical
environment
(Howells
et
al.,
2009;
Schalast
et
al.,
2008)
and
therefore
overlook
aspects
of
care
provision
that
may
require
improvement.
The
relationship
between
service
users’
perceptions
about
the
social
climate
of
the
ward
and
satisfaction
with
various
aspects
of
forensic
services
has
yet
to
be
investigated.
Therapeutic
relationships
have
been
viewed
as
impor-
tant
factors
in
a
range
of
clinical
outcomes
in
forensic
settings.
A
positive
therapeutic
relationship
has
previously
been
shown
to
predict
favourable
short
and
long-term
patient
outcomes,
including
level
of
disturbance
(Hamrin
et
al.,
2009;
Meehan
et
al.,
2006)
and
may
have
an
influence
on
levels
of
adherence
with
pharmacological
treatment
(Gray
et
al.,
2008;
Kikkert
et
al.,
2006;
Shelton
et
al.,
2010).
The
importance
of
the
therapeutic
relationship
in
influencing
satisfaction
with
forensic
services
is
also
highlighted
in
a
literature
review
by
Coffey
(2006)
who
concluded
that
dissatisfaction
is
often
related
to
service
user’s
concerns
about
these
relationships.
There
have
been
few
attempts
to
examine
service
user
satisfaction
in
a
forensic
environment
which
Coffey
(2006)
views
as
due
to
the
fact
that
none
of
the
reported
measures
used
to
examine
satisfaction
in
forensic
settings
could
be
viewed
as
valid.
Recently
a
specific
assessment
scale
has
been
developed
by
MacInnes
et
al.
(2010)
measuring
service
user
satisfaction
with
forensic
mental
health
services;
the
Forensic
Satisfaction
Scale
(FSS),
which
appears
to
have
good
validity
and
reliability.
This
scale
is
used
in
this
study
(in
conjunction
with
two
other
standardised
measures)
to
examine
levels
of
service
user
satisfaction
in
medium
and
low
secure
forensic
inpatient
settings
and
how
this
may
be
related
to
perceived
therapeutic
relationships
and
the
perceived
social
climate
of
the
clinical
setting.
2.
Aims
and
objectives
To
assess
the
levels
of
service
user
satisfaction
in
forensic
in-patient
settings
in
one
mental
health
trust.
To
examine
the
perceived
therapeutic
relationship
of
the
service
users
with
their
keyworkers.
To
examine
the
perceived
social
climate
of
the
wards.
To
examine
the
association
between
the
perceived
therapeutic
relationship
and
social
climate
of
the
ward
with
service
user
satisfaction
with
services.
3.
Design
A
cross-sectional
survey
design
was
chosen
allowing
the
views
of
all
service
users
to
be
assessed.
A
standardised
approach
was
used
in
the
study
to
ensure
only
questions
of
interest
to
the
project
were
asked,
recorded,
codified,
and
analysed
(De
Vaus,
2000).
4.
Recruitment
of
participants
Every
service
user
receiving
in-patient
care
in
the
forensic
directorate
of
the
mental
health
trust
was
invited
D.
Bressington
et
al.
/
International
Journal
of
Nursing
Studies
48
(2011)
1349–1356
1350
Author's personal copy
to
take
part,
with
the
only
exclusion
criterion
being
any
service
user
who
the
clinical
team
viewed
as
not
being
able
to
complete
the
assessments.
All
the
service
users
were
approached
and
informed
about
the
project
through
the
use
of
posters
on
the
ward,
by
verbal
information
given
at
the
ward
meeting
and
through
their
key-worker.
Each
service
user
was
also
given
written
information
about
the
study
and
had
the
opportunity
to
discuss
any
concerns
or
objections
prior
to
being
asked
to
give
informed
consent.
A
researcher
independent
of
the
treating
team
obtained
informed
consent
and
assisted
service
users
to
complete
the
assessments
in
the
clinical
area.
The
participants
were
given
£20
for
each
completed
set
of
assessments
as
reimbursement
for
their
time
and
expertise.
5.
Ethical
considerations
Ethical
approval
was
granted
by
the
University’s
Research
Ethics
Committee.
The
assessments
were
anon-
ymised
to
ensure
that
individual
service
users
were
not
able
to
be
identified
from
the
data.
In
order
to
minimise
the
risk
of
participants
feeling
coerced
to
take
part;
the
information
sheet
and
consent
form
clearly
stated
that
participation
was
entirely
voluntary,
would
have
no
direct
impact
upon
treatment
being
received
and
that
partici-
pants
had
the
right
to
withdraw
from
the
project
at
any
time.
6.
Data
collection
Demographic
Information
was
requested
regarding
age,
gender,
ethnicity
and
length
of
inpatient
stay.
In
addition
to
the
demographics,
three
assessment
measures
were
completed.
Table
1
details
each
measure
and
the
asso-
ciated
subscales.
6.1.
Satisfaction
This
was
measured
using
the
Forensic
Satisfaction
Scale
(FSS)
(MacInnes
et
al.,
2010).
It
is
a
60-item
measure
which
asks
respondents
to
rate
their
satisfaction
with
a
range
of
services
on
a
five
point
Likert
scale.
The
scale
records
levels
of
satisfaction
on
seven
domains
(staff
interaction,
rehabilitation,
communication,
milieu,
finance,
safety,
and
overall
care)
as
well
as
giving
a
total
score.
MacInnes
et
al.
(2010)
reported
that
the
internal
reliability
of
the
scale
was
0.9
and
also
good
concurrent
validly
with
the
Verona
Service
Satisfaction
Scale
(Ruggeri
and
Dall’Agnola,
2000).
Mean
scores
are
calculated
with
higher
scores
indicating
greater
levels
of
satisfaction.
It
is
viewed
that
increased
scores
from
the
midpoint
score
of
three
are
indicative
of
increasing
levels
of
satisfaction
while
scores
nearer
to
one
from
the
mid-point
score
indicate
decreasing
levels
of
satisfaction.
Table
one
gives
an
overview
of
the
areas
covered
by
the
domains.
6.2.
Therapeutic
relationship
The
perceived
value
of
the
therapeutic
relationship
was
assessed
using
the
revised
Helping
Alliances
Scale
(HAS)
(Priebe
and
Gruyters,
1993).
This
three-item
scale
explores:
feeling
respected
and
regarded,
beliefs
about
receiving
the
right
treatment
and
feeling
understood
by
clinical
staff.
The
questions
are
answered
via
a
100
mm
long
visual
analogue
scale
with
the
extreme
points
being
0
mm
=
not
at
all
and
100
mm
=
entirely.
Each
10
mm
point
is
marked
so
it
has
the
appearance
of
an
11-point
scale.
The
HAS
has
good
reliability
and
predictive
validity.
It
was
reported
that,
in
recent
times,
the
HAS
has
been
the
most
frequently
used
scale
to
measure
the
quality
of
the
therapeutic
relationship
in
research
evaluating
care
of
people
with
severe
mental
illness
(McCabe
et
al.,
2007).
The
three
statements
requiring
self-rating
were:
‘‘Does
your
case
manager/key
worker/therapist/doctor
under-
stand
you
and
is
he/she
engaged
in
your
treatment/care?’’,
‘‘Do
you
believe
you
are
receiving
the
right
treatment/care
for
you?’’
and
‘‘Do
you
feel
respected
and
well
regarded?’’
6.3.
Social
climate
of
ward
The
therapeutic
milieu
of
the
ward
environment
was
measured
by
a
15-item
five
point
Likert
scale
for
assessing
the
social
climate
of
forensic
psychiatric
wards
(EssenCES)
(Schalast
et
al.,
2008).
The
measure
has
three
domains
(therapeutic
hold,
patients’
cohesion/mutual
support,
and
experienced
safety)
each
measured
by
five
items.
‘‘Ther-
apeutic
hold’’
examines
the
nature
of
therapeutic
relation-
ships
with
staff
(including
staff
openness,
willingness
to
talk
and
interest
in
patient’s
concerns).
The
‘‘Patients’
cohesion
and
mutual
support’’
domain
measures
service
users’
perceptions
about
characteristics
of
a
therapeutic
community
and
the
‘‘Experienced
safety’’
domain
reflects
the
aggressive
tension
and
threats
of
violence
perceived
by
service
users.
Examples
of
statements
to
be
rated
relating
to
‘‘Therapeutic
hold’’
are:
‘‘Staff
take
a
personal
interest
in
the
progress
of
patients’’,
‘‘Staff
members
take
a
lot
of
time
to
deal
with
patients’’
and
‘‘Staff
know
patients
and
their
personal
histories
very
well’’.
The
internal
reliability
for
the
Table
1
The
three
measures
used
and
their
sub-scales.
Forensic
Satisfaction
Scale
(FSS)
Helping
Alliance
Scale
(HAS)
Essen
Climate
Evaluation
Schema
(EssenCES)
Staff
interaction
Understanding
Patient’s
cohesion
Communication
Treatment
Experienced
safety
Finances
Respected
Therapeutic
hold
Milieu
Rehabilitation
Safety
Overall
satisfaction
D.
Bressington
et
al.
/
International
Journal
of
Nursing
Studies
48
(2011)
1349–1356
1351
Author's personal copy
scale
ranges
from
0.73
to
0.87
(Schalast
et
al.,
2008)
and
there
is
concurrent
validity
with
a
number
of
other
scales
including;
the
Good
Milieu
Index
(Rossberg
and
Friis,
2003)
and
the
Ward
Atmosphere
Scale
(Moos,
1974).
These
measures
were
handed
to
the
participants
to
undertake
in
a
random
order.
The
completed
assessments
were
put
into
an
unmarked
envelope
and
sealed
thus
rendering
the
data
anonymised.
7.
Data
analysis
For
the
FSS,
the
descriptive
scores
of
the
forensic
domains,
as
well
as
total
score
were
examined.
Descriptive
analysis
was
undertaken
for
the
HAS
and
EssenCES
domain
scores
to
assess
the
perceived
therapeutic
relationship
and
ward
climate.
Pearson
correlations
were
conducted
to
explore
the
correlations
between
the
individual
domains
on
the
EssenCES
and
HAS
with
the
FSS
domains
and
the
total
FSS
score.
8.
Results
Of
the
110
service
users
receiving
inpatient
treatment
45
consented
to
participate
in
the
study
(a
response
rate
of
40.9%).
Service
users
who
refused
to
take
part
were
not
required
to
give
a
reason
for
refusal.
One
service
user
defaced
the
assessment
paperwork,
so
the
remaining
44
sets
of
data
were
analysed.
8.1.
Demographic
characteristics
The
age
group
with
greatest
representation
in
this
sample
was
26–35
years
(n
=
18;
40.9%).
25%
(n
=
11)
of
participants
were
aged
36–45,
with
the
remainder
being
aged
18–25
(n
=
9;
20.5%)
or
over
46
(n
=
6;
13.6%).
79.5%
(n
=
35)
of
participants
were
male.
In
terms
of
ethnicity,
34.1%
(n
=
15)
of
participants
described
their
ethnic
origin
as
White
British/Irish,
an
equal
number
described
themselves
as
Black
British
(n
=
6;
13.6%)
and
Black
African
(n
=
6;
13.6%),
with
the
remainder
stating
White
other
(n
=
2;
4.5%),
Indian
(n
=
1;
2.3%)
and
other
(n
=
9;
20.5%).
The
predominant
length
of
in-patient
stay
was
over
2
years
(n
=
17;
38.6%).
27.3%
(n
=
12)
of
service
users
had
been
in-patients
for
6
months
or
fewer
and
13.6%
(n
=
6)
of
the
sample
for
1–2
years.
11.4%
(n
=
5)
of
participants’
duration
of
stay
was
6–12
months.
The
demographics
and
characteristics
of
non-respon-
dents
were
not
recorded;
however,
a
Royal
College
of
Psychiatrists
benchmarking
survey
(Bartlett
et
al.,
2006)
details
the
following
characteristics
of
inpatients
in
London’s
forensic
secure
units;
they
comprised
male
86%,
44%
Black
(Afro-Caribbean),
39%
White
(any),
7%
Asian,
with
an
average
length
of
stay
of
26
months.
Although
a
direct
comparison
with
our
data
is
problematic
due
to
differing
categorisation
it
can
be
seen
that
(with
the
exception
of
women
being
overrepresented)
the
charac-
teristics
of
participants
in
our
sample
are
broadly
reflective
of
the
overall
forensic
patient
population
in
London.
Analysis
with
ANOVA
revealed
that
service
users
who
had
been
an
inpatient
for
less
than
6
months
were
most
likely
to
be
dissatisfied
with
their
financial
situation
as
measured
by
the
FSS
Finance
domain
(F:
2.915,
df:
43,
Sig:
0.047).
No
other
demographic
characteristics
were
found
to
be
significantly
associated
with
satisfaction.
8.2.
FSS
results
The
scores
for
the
7
FSS
domains
and
the
total
FSS
score
are
shown
in
Table
2.
The
total
score
and
majority
of
domain
scores
are
above
the
mean
(3)
though
the
communication
subscale
score
indicates
some
level
of
dissatisfaction
in
this
area.
Interestingly,
the
majority
of
respondents
(n
=
24,
55%)
scored
>3
on
the
total
score
indicating
some
level
of
satisfaction
with
services.
However,
a
substantial
minority
(n
=
20,
45%)
scored
three
or
less
suggesting
some
unhappiness
with
the
services
provided.
A
one-sample
test
for
FSS
revealed
the
subscale
scores
for
‘‘Rehabilita-
tion’’
and
‘‘Safety’’
are
significantly
above
the
mean;
indicating
that
the
service
users
in
this
sample
have
Table
2
Mean
scores
and
one
sample
t-tests
for
FSS,
EssenCES
and
HAS.
Mean
scores
from
previous
larger
studies
are
included
for
comparison
purposes
(df
for
all
tests
=
43).
Measure/domain
Mean
(SD)
One
sample
t-test
(p
value)
Mean
(SD)
from
previous
studies
FSS:
Communication
2.95
(0.79)
0.41
(0.69)
3.27
(0.74)
a
FSS:
Finances
3.13
(0.74)
1.19
(0.24)
3.04
(0.73)
a
FSS:
Milieu
3.10
(0.51)
1.33
(0.19)
3.11
(0.61)
a
FSS:
Rehabilitation
3.45
(0.64)
4.67
(0.00)
*
3.28
(0.65)
a
FSS:
Safety
3.45
(0.79)
3.81
(0.00)
*
3.26
(0.85)
a
FSS:
Staff
interaction
3.14
(0.76)
1.19
(0.24)
3.18
(0.64)
a
FSS:
Overall
satisfaction
3.16
(1.38)
0.76
(0.45)
3.51
(1.12)
a
FSS:
Total
score
3.09
(0.52)
1.16
(0.25)
3.23
(0.63)
a
HAS:
Understanding
60.50
(34.77)
1.99
(0.05)
73.50
(27.4)
b
HAS:
Treatment
59.30
(36.62)
1.69
(0.10)
73.80
(24.7)
b
HAS:
Respected
54.80
(33.86)
0.93
(0.36)
69.80
(29.1)
b
EssenCES:
Patient’s
cohesion
9.72
(4.60)
0.40
(0.69)
9.32
(4.84)
c
EssenCES:
Experienced
safety
11.20
(4.76)
1.67
(0.10)
8.89
(4.20)
c
EssenCES:
Therapeutic
hold
11.12
(4.36)
1.71
(0.10)
9.81
(3.97)
c
a
MacInnes
et
al.
(2010).
b
Priebe
and
Gruyters
(1993).
c
Howells
et
al.
(2009).
*
p
=
<0.01.
D.
Bressington
et
al.
/
International
Journal
of
Nursing
Studies
48
(2011)
1349–1356
1352
Author's personal copy
strongly
positive
views
about
treatments
aimed
at
facilitating
recovery
and
also
felt
safe
on
the
units.
8.3.
HAS
results
The
three
HAS
domain
mean
scores
are
shown
in
Table
2.
Scores
for
all
the
HAS
domains
are
above
the
mean
indicating
that
overall
service
users
view
all
three
domains
positively.
A
one-sample
t-test
analysis
revealed
that
the
HAS
understanding
domain
score
is
relatively
high
but
just
below
statistical
significance
(p
=
0.052).
8.4.
EssenCES
results
Table
2
shows
the
mean
scores
for
the
EssenCES
domains.
The
mean
scores
for
EssenCES
domains
are
close
to
the
mean
with
two
domains
(experienced
safety
and
ther-
apeutic
hold)
generally
viewed
positively
while
the
third
(patient
cohesion)
suggests
some
negative
perception
of
this
domain.
The
one-sample
t-test
revealed
that
none
of
the
domain
scores
are
significantly
different
from
the
mean.
Once
more,
no
significant
differences
were
found
between
different
demographic
variables.
8.5.
Relationship
between
FSS
and
HAS
Table
3
illustrates
the
relationships
observed
between
the
HAS
domains
and
the
FSS
scores.
Pearson
correlations
were
used
to
examine
the
association
between
the
HAS
scores
and
FSS
scores.
As
per
Cohen’s
(1988)
recommenda-
tions;
correlations
over
0.7
are
considered
to
be
strong
associations,
correlations
between
0.5
and
0.69
are
deemed
to
be
medium
and
correlations
below
0.5
are
weak.
The
Pearson
correlations
are
also
noted.
Items
marked
with
*
are
viewed
as
statistically
significant
(p
=
<0.05),
items
marked
with
**
are
significant
at
p
=
<0.01
and
those
marked
***
are
p
=
<0.0001.
The
HAS
understanding
domain
has
medium
correla-
tions
with
FSS
rehabilitation
(r
=
0.570,
p
=
0.000),
FSS
staff
interaction
(r
=
0.50,
p
=
0.001)
and
FSS
total
score
(r
=
0.599,
p
=
0.000).
It
has
a
weak
correlation
with
a
number
of
other
areas
of
the
FSS.
These
findings
suggest
that
service
users’
perceptions
about
feeling
understood
by
clinicians
are
important
in
terms
of
their
satisfaction
with:
staff
interaction,
treatment
aimed
at
facilitating
recovery
and
the
total
FSS
score.
The
HAS
treatment
subscale
has
a
strong
correlation
with
FSS
rehabilitation
(r
=
0.712,
p
=
0.000)
and
the
total
FSS
score
(r
=
0.719,
p
=
0.000).
This