Article

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

The Department of Social Work, Community and Mental Health, Canterbury Christ Church University, Canterbury, Kent CT1 1QU, United Kingdom.
International journal of nursing studies (Impact Factor: 2.9). 06/2011; 48(11):1349-56. 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.

Download full-text

Full-text

Available from: Daniel Bressington, Jul 31, 2014
    • "Questionnaires that are too long tend to lead to low participation rates due to the fact that the patients may get tired or bored, or that they may involve excessive work for the staff who have to distribute them and are possibly required to give advice during their administration (Reininghaus & Priebe, 2012). While in other clinical settings such participation rates may not necessarily invalidate the significance of the data and may therefore be acceptable, in the psychiatric setting for acute patients this is highly likely to exclude the less satisfied patients who are, in all probability, those whose admission was involuntary (Boyer et al., 2009;Bressington et al., 2011;Katsakou et al., 2010). By excluding this patient group, the significance of opinions indicating satisfaction regarding the caring aspects of the services risks being partial and misleading. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patient satisfaction is considered an important indicator of the quality of care in psychiatric services. Its importance has been widely studied, but the literature identifies methodological problems deriving from samples with low response rates and exclusion criteria which would seem to imply a kind of exclusion in the evaluations of less compliant patients. The aim of this study is to test a methodology to assess patient satisfaction with the quality of care received at an acute psychiatric ward in terms of its application in daily routine. In this cross sectional survey inpatients were given the Rome Opinion Questionnaire (ROQ). Our patients, involuntary patients included, with a 92.3% participation rate (47 patients out of 51), returned a mean general satisfaction score of 7.7/9. This response rate is higher than that reported in most previously published studies, which shows that a good level of both voluntary and involuntary patient participation may be achieved when an appropriate methodological approach is adopted. Not acknowledging patient satisfaction reduces the possibility of more effective caring actions. Measuring patient satisfaction, through use of short questionnaires, should become a routine in daily practice.
    No preview · Article · Jul 2015 · Archives of psychiatric nursing
  • Source
    • "Furthermore, the relatively small sample size and the specific environmental context within which the study was undertaken suggest that it is prudent to be cautious when generalizing the findings to other settings. Indeed, the recent literature on the application of recovery approaches in forensic mental health settings (Birch, 2012; Brookes, 2012; Corlett & Miles, 2010; Miles, 2012; Smith & Garcia, 2012) and a small but growing number of studies canvassing forensic service users' views about various aspects of their care (Bouman, de Ruiter, & Schene, 2008; Bressington et al., 2011; Carlin et al., 2005; McQueen &Turner, 2012; Mezey et al., 2010) are suggestive of efforts to foster a degree of self-determination and give voice to this population. A second limitation concerns the representativeness of the sample. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous literature has highlighted a number of concerns about forensic care and rehabilitation by those who use the services. The Good Lives Model (GLM) is a strength-based, humanistic approach to offender rehabilitation that has been largely overlooked by forensic mental health practitioners. This study explored the impact of a brief GLM program on forensic service users' perceptions of rehabilitation, both within and beyond therapeutic programs, using a thematically linked, multiple-case study research design. Pre-post comparisons of participants' perceptions of rehabilitation suggested three different outcomes: definite change, subtle change, and no change. Possible factors associated with participants' divergent experiences included level of exposure to the GLM, readiness to change, and practitioners' adherence to the GLM and experience with the model. The importance of attending to the wider system for successful implementation of this innovative approach is highlighted. © The Author(s) 2015.
    Full-text · Article · Feb 2015 · International Journal of Offender Therapy and Comparative Criminology
  • Source
    • "Furthermore, the relatively small sample size and the specific environmental context within which the study was undertaken suggest that it is prudent to be cautious when generalizing the findings to other settings. Indeed, the recent literature on the application of recovery approaches in forensic mental health settings (Birch, 2012; Brookes, 2012; Corlett & Miles, 2010; Miles, 2012; Smith & Garcia, 2012) and a small but growing number of studies canvassing forensic service users' views about various aspects of their care (Bouman, de Ruiter, & Schene, 2008; Bressington et al., 2011; Carlin et al., 2005; McQueen &Turner, 2012; Mezey et al., 2010) are suggestive of efforts to foster a degree of self-determination and give voice to this population. A second limitation concerns the representativeness of the sample. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this qualitative study was to explore perspectives on rehabilitation of those detained in a New Zealand forensic hospital setting. Twenty forensic service users participated in individual interviews, which were audio-taped, transcribed verbatim, and subjected to thematic analysis. The analysis identified seven themes that were broadly categorized into those that concerned the rehabilitation context (external) and those that more directly reflected the forensic service user's personal experience (internal). External themes highlighted a person-centered approach, the nature of relationships with staff, consistency of care, and awareness of the rehabilitation pathway. Internal themes related to forensic service users' self-evaluations, agency, and coping strategies. These findings are discussed within the broader context in which rehabilitation took place.
    Full-text · Article · Jul 2014 · Journal of Interpersonal Violence
Show more