Family Interventions iN Dementia Mental Health Environments
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 343
- 试验地点
- 1
- 主要终点
- Focus groups with staff to assess the feasibility (acceptability, implementation, integration, relevance) of implementing co-designed strategies in practice
研究概览
简要总结
Study Goal: Understand carers' needs when someone with dementia is in a mental health ward and develop strategies to support carers as partners in care.
Research Questions:
- What are mental health wards like in terms of staff, patients, and current carer support?
- What do carers experience and need during admission, discharge, and beyond?
- How do ward routines and staff practices affect carer involvement?
- How can co-design turn research into practical strategies for carer support?
- Can these strategies be implemented effectively?
Method: The investigators will survey mental health wards nationwide, interview carers from three UK wards, observe ward practices, and talk to staff. They will use this information to create and share practical strategies to improve carer support across the UK.
详细描述
Background and rationale
Mental health wards (MHW) are a significant site of care for people living with dementia (PLWD), providing care for the most unwell, vulnerable, and high-risk individuals who are detained under the Mental Health Act (1983) for their own safety and the safety of others.
The UK has around 100 MHWs (80 NHS, 20 private) for PLWD, but there's a lack of evidence on care quality and experiences. Stays average 100 days, with most PLWD moving to institutional care rather than returning home.
Admissions often follow severe psychiatric or behavioural issues, such as self-harm or assaults. This population is at high risk to themselves and others, with high acuity and comorbidity. Admissions are complex, involving frequent unscheduled transfers to general hospitals, which are associated with high rates of falls and hospital-acquired infections.
Carer involvement can significantly improve clinical and social outcomes for people in mental health wards by reducing length of stay, promoting earlier discharge, and lowering relapse and readmission rates. Carers provide essential support that staff may not, ensuring person-centred care, advocacy, decision-making support, treatment adherence, and promoting recovery. However, carers often feel marginalized and describe MHWs as a place of 'battle,' experiencing high levels of trauma and distress with unmet emotional, social, and financial needs. Reviews and inquires highlight a culture that views carers as problematic and resource-intensive, leading to their support needs being overlooked.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Other
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Ward managers of mental health wards that provides care to PLWD
- •Ward managers from NHS wards that provides care to PLWD
- •Ward managers from private providers that provides care to PLWD
- •Ward managers that work on organic or mixed wards that provides care to PLWD
排除标准
- •Functional older adult mental health wards that do not provide care to PLWD
- •Staff members who are not the ward manager
- •Longitudinal interviews with current carers
- •Inclusion criteria:
- •Family member (any relationship) or friend of a PLWD currently receiving care on a mental health ward
- •Aged 18 years old or above
- •Has capacity to consent to participate in an interview
- •Willing to take part in 3 interviews over 12 months
- •Exclusion criteria:
- •The carer is actively involved in a safeguarding investigation.
- •The carer is under 18 years old
- •The carer does not have capacity to consent to participate in an interview
- •Interviews with discharged carers
- •Inclusion criteria:
- •Family member (any relationship) or friend of a PLWD discharged from the ward within the last 3 years
- •Aged 18 years old or above
- •Has capacity to consent to participate in an interview
- •Willing to take part in an interview
- •Exclusion criteria:
- •The carer is actively involved in a safeguarding investigation
- •The carer is under 18 years old
- •The carer does not have capacity to consent to participate in an interview
- •Interviews with People Living With Dementia (PLWD)
- •Inclusion criteria:
- •PLWD currently under the care of the mental health ward
- •PLWD discharged from the care of a dementia mental health ward within the last 3 years
- •Has capacity to give informed consent to taking part in an interview
- •Willing to take part in an interview alongside their carer
- •Exclusion criteria:
- •The PLWD is actively involved in a safeguarding investigation
- •The PLWD does not have capacity to consent to participate in an interview
- •The PLWD is not willing to take part in an interview alongside their carer
- •The PLWD has been discharged from the care of a dementia mental health ward for more than 3 years
- •Co-design study - PLWD and carers
- •Inclusion criteria:
- •PLWD who may, or may not, have experience of dementia mental health wards
- •Carers (family members or friends) of PLWD who may, or may not, have experience of dementia mental health wards
- •Willing to talk about mental health and dementia
- •Aged 18 years old or above
- •Have capacity to give informed consent
- •Exclusion criteria:
- •Participants who do not have experience of living with, or caring for someone with, dementia
- •Not willing to talk about mental health and dementia
- •Aged under 18 years old
- •Does not have capacity to give informed consent
- •Co-design study - staff
- •Inclusion criteria:
- •Members of staff working within mental health wards for PLWD
- •Members of staff of any professional group in a role that involves contact with carers (e.g. health care assistants, nurses, occupational therapists, psychologists, physiotherapists, speech and language therapists, family therapists, psychiatrists etc)
- •Members of staff of any pay band or grade
- 另有 26 项未显示
结局指标
主要结局
Focus groups with staff to assess the feasibility (acceptability, implementation, integration, relevance) of implementing co-designed strategies in practice
时间窗: 6 months
Focus groups with staff to address: i) acceptability, to what extent these strategies reflect current practice, constraints, and the potential for new approaches; ii) implementation, to what extent they can be successfully delivered; iii) integration, to what extent they can be integrated into routine practice iv) relevance and acceptability of the outputs created for PLWD, carers and families. Three online focus groups of 8-10 participants (n=30) will provide opportunity for discussion to explore the structural and organisational barriers within wards that may facilitate or impede effective implementation.
Acceptability of co-designed strategies and resources
时间窗: 6 months
PLWD, carers and families will be invited to share their perspectives around acceptability of the co-designed resources in a way that suits them most. This is a person-centered, inclusive approach to gathering feedback, where different approaches are paramount to suit different needs. People with lived experience could share their feedback by annotating printed or electronic versions of documents, having a brief conversation with the researcher online, over the phone or in person via the researcher attending their PPI meetings.
Interviews with current carers to understand their experiences and involvement in the care of their friend/relative with dementia who is receiving care on a mental health ward
时间窗: 1 year
Interviews with carers across 3 NHS sites in the UK, who currently have a friend/relative with dementia receiving care on a mental health ward (8 carers per ward = 24 carers in total). Carers will be interviewed at 3 timepoints over 12 months to understand their experiences over time. Total number of interviews = 72. The sample of carers will be identified by ward managers. A semi-structured interview schedule will be used following a narrative interview approach.
A national survey to map current care provision for people living with dementia admitted to a mental health ward across the UK
时间窗: 6 months
National mapping survey to gather data on the number/type of wards, patient and staff demographics and existing care provision for people living with dementia who are detained under the Mental Health Act and receiving care on a mental health ward.
Ethnographic observations to understand how carers are supported and involved in the care of their friend/relative with dementia receiving care on a mental health ward
时间窗: 1 year
Ethnographic observation of staff and family carers on the ward. The focus of the observations is on the organisation of care. Observations will take place from the corridor(s) of wards, in communal areas, typically at nursing stations or ward observation points. Short, 'in-situ' conversational interviews (around 5-10 minutes) will take place on the ward with staff. These will be unstructured conversations to capture 'in-the-moment' experiences. Observations and 'in-situ' conversations will be documented using a touch screen tablet device.
Interviews with ward staff to understand their experiences of supporting and involving carers in the care of their friend/relative with dementia receiving care on a mental health ward
时间窗: 1 year
Interviews with ward staff, such as nurses, healthcare assistants, psychiatrists across 3 NHS sites. 5 ward staff per site will be interviewed = 15 interviews. Ward staff will be identified in collaboration with ward managers. A semi-structured interview schedule will be used to capture their views and experiences.
Interviews with discharged carers to understand their experiences and involvement in the care of their friend/relative with dementia who had previously received care on a mental health ward
时间窗: 1 year
Interviews with 'discharged' carers across 3 NHS sites, i.e. carers whose friend/relative with dementia had previously received care on a mental health ward and have been discharged from the ward within the last 3 years. 8 carers per ward = 24 interviews in total. The sample of carers will be identified via screening of ward records completed by ward managers at each ward. A letter and Participant Information Sheet (PIS) will be sent by post to invite discharged carers to participate in an interview. A semi-structured interview schedule will be used to capture their views and experiences.
次要结局
未报告次要终点
研究者
Emma Wolverson
Professor
University of West London