School of Health Sciences, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, M25 3BL, UK.
Division of Nursing, Midwifery & Social Work, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
Int J Nurs Stud. 2021 Jun;118:103920. doi: 10.1016/j.ijnurstu.2021.103920. Epub 2021 Mar 3.
With austerity measures and cuts to community mental health services, more women are accessing UK inpatient mental health services. Inpatient services have been found to lead to further retraumatisation for women, exacerbating mental health conditions. However, recent reviews of service user experiences of inpatient services have neglected the unique perspectives of women and have omitted important dynamics in attitudes and experience between staff and women service users.
The aim of this systematic review was to synthesise women service users' experiences of inpatient mental health services and staff experiences of providing care to women within inpatient mental health services, to appraise the methodological quality of research in this area and provide recommendations for clinical practice and future research.
A systematic search of the literature was undertaken in the databases: AMED, CINAHL plus, Embase and PsychINFO. The Critical Appraisal Skills Programme checklist for qualitative research was used to evaluate data quality. Thematic synthesis was conducted on papers meeting the inclusion criteria.
Eighteen studies were identified and encapsulated the views of 168 staff and 187 service users, with one paper including both staff and service user samples. Three themes derived from the data: Safe haven, Broken system and Therapeutic milieu. Safe haven related to aspects of care such as relational security which made women feel safer in hospital. Broken system pertained to experiences of being fearful of inpatient environments, inadequate acknowledgement of abuse histories, women feeling coerced into compliance with medication and systemic pressures of services being under-resourced. The therapeutic milieu of inpatient services was an important mediator of women experiencing the environment as a 'safe haven' or 'broken system'. Staff and women service users reflected on: the impact on social roles, interaction of peers, physical environment and the importance of meaningful activity, which were deemed to be important contributors to the therapeutic milieu.
The review made recommendations to improve future research by encouraging studies to include more detail on reflexivity (including the relationship between researcher and participant) and provide more information on the methodological approach to data analysis. Clinical recommendations include: ensuring staff access clinical supervision, for staff to receive training in exploring and supporting women disclosing experiences of abuse, for staff to facilitate choice within inpatient settings and support women in maintaining relationships, particularly parenting roles.
PROSPERO database (CRD42020156222).
随着紧缩措施和社区心理健康服务的削减，越来越多的女性开始使用英国住院心理健康服务。住院服务被发现会导致女性进一步受到创伤，使心理健康状况恶化。然而，最近对服务使用者住院服务体验的审查忽略了女性的独特观点，也忽略了员工和女性服务使用者之间在态度和经验方面的重要动态。
本系统评价旨在综合女性服务使用者对住院心理健康服务的体验，以及工作人员在住院心理健康服务中为女性提供护理的体验，评估该领域研究的方法学质量，并为临床实践和未来研究提供建议。
在 AMED、CINAHL plus、Embase 和 PsychINFO 数据库中进行了系统文献检索。使用定性研究的批判性评估技巧计划清单来评估数据质量。对符合纳入标准的论文进行了主题综合。
确定了 18 项研究，其中包括 168 名工作人员和 187 名服务使用者的观点，其中一篇论文同时包括工作人员和服务使用者的样本。从数据中得出了三个主题：安全港、破碎的系统和治疗环境。安全港涉及护理方面的一些方面，例如关系安全性，这使女性在医院感到更安全。破碎的系统涉及对住院环境感到恐惧、对虐待史的认识不足、女性感到被迫遵守药物治疗和服务系统资源不足的经历。住院服务的治疗环境是女性将环境体验为“安全港”或“破碎系统”的重要中介。工作人员和女性服务使用者反思了：对社会角色的影响、同伴的相互作用、物理环境和有意义活动的重要性，这些被认为是治疗环境的重要贡献者。
该审查提出了改进未来研究的建议，鼓励研究更详细地说明反思性（包括研究人员和参与者之间的关系），并提供更多关于数据分析方法的信息。临床建议包括：确保工作人员获得临床监督、工作人员接受探索和支持女性披露虐待经历的培训、工作人员在住院环境中促进选择并支持女性维持关系，特别是育儿角色。
PROSPERO 数据库（CRD42020156222）。
