Hallett Nutmeg, Dickinson Rachel, Eneje Emachi, Dickens Geoffrey L
School of Nursing and Midwifery, University of Birmingham, Birmingham, UK; Institute of Mental Health, University of Birmingham, Birmingham, UK.
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
Int J Nurs Stud. 2025 Jan;161:104923. doi: 10.1016/j.ijnurstu.2024.104923. Epub 2024 Oct 3.
Trauma has a well-established link with poor health outcomes. Adverse experiences in mental health inpatient settings contribute to such outcomes and should impact service design and delivery. However, there is often a failure to fully address these experiences.
To describe the spectrum of negative experiences that people identify while they are inpatients in adult mental health services.
Qualitative systematic review of the international literature.
SETTING(S): Inpatient mental health settings globally.
Analysis includes findings from 111 studies across 25 countries.
CINAHL, MEDLINE and PsycINFO were searched from 2000 onwards, supplemented by Google Scholar. Studies were appraised using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using the 'best-fit' framework synthesis approach, enriched by patient and public involvement.
Adverse mental health inpatient experiences can be conceptualised under three headings: the ecosystem (the physical environment and the resources available, and other people within or influential to that environment); systems (processes and transitions); and the individual (encroachments on autonomy and traumatisation).
This paper highlights the interplay between systemic, environmental and individual factors contributing to adverse experiences in mental health inpatient settings. By recognising and addressing these factors, we can significantly enhance patient outcomes. Application of adversity to Bronfenbrenner's ecological systems theory provides a strategic approach to improving service design and delivery, advocating for environments that prioritise patient safety, dignity and respect. However, further research is needed to validate the framework and effectively integrate these insights into practice, ultimately transforming the inpatient care experience for all stakeholders.
The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022323237).
Review suggests traumatic experiences in mental health inpatient settings can worsen outcomes. Urges redesign of environment, processes and autonomy to improve care @dr_nutmeg @EmxEn @RAVresearchUoB @IMH_UoB.
创伤与不良健康结局之间存在着已被充分证实的联系。精神科住院环境中的不良经历会导致此类结局，且应对服务设计与提供产生影响。然而，这些经历往往未能得到充分解决。
描述人们在成人精神科住院服务期间所识别出的负面经历范围。
对国际文献进行定性系统评价。
全球范围内的精神科住院环境。
分析纳入了来自25个国家的111项研究的结果。
从2000年起检索CINAHL、MEDLINE和PsycINFO，并辅以谷歌学术搜索。使用批判性评价技能计划定性清单对研究进行评价。采用“最佳拟合”框架综合法对数据进行综合，并通过患者和公众参与加以丰富。
不良精神科住院经历可归纳为三个类别：生态系统（物理环境、可用资源以及该环境中的其他人或对该环境有影响力的人）；系统（流程和过渡）；以及个体（对自主权的侵犯和创伤）。
本文强调了导致精神科住院环境中不良经历的系统、环境和个体因素之间的相互作用。通过认识并解决这些因素，我们能够显著改善患者结局。将逆境应用于布朗芬布伦纳的生态系统理论，为改进服务设计与提供提供了一种战略方法，倡导营造优先考虑患者安全、尊严和尊重的环境。然而，需要进一步研究来验证该框架，并将这些见解有效地融入实践，最终改变所有利益相关者的住院护理体验。
该评价已在国际前瞻性系统评价注册库（PROSPERO；CRD42022323237）注册。
评价表明，精神科住院环境中的创伤性经历会使结局恶化。敦促重新设计环境、流程和自主权以改善护理 @dr_nutmeg @EmxEn @RAVresearchUoB @IMH_UoB 。
