Background
Methods
Aim and design
Inclusion criteria and recruitment of the hospitals
Recruitment of the study participants
Data acquisition
Location | Ward characteristics | Participants | |||||
---|---|---|---|---|---|---|---|
Number and location of wardsa | Type of ward | Number of health care staff (in total) | Patients/beds/average duration of treatment (days)b | Date of the visit | Staff membersc | Service users | Family members |
1—Helsinki-Uusimaa | Acute | N = 24.5 | 324/13/7 | 31/05/2016 | 8/16 50% | 2 | 1d |
Psychiatrist, n = 3 | |||||||
Nurses, n = 15 (RN), n = 6 (PN) | |||||||
Psychologist, n = 0 | |||||||
Social worker, n = 0.5 | |||||||
2—Northern and Eastern Finland | Acute/rehabilitation | N = 34 | 280/24/27 | 20/06/2016 | 12/20 60% | 4 | 0 |
Psychiatrist, n = 1 | |||||||
Nurses, n = 16 (RN), n = 17 (PN) | |||||||
Psychologist, n = 0 | |||||||
Social worker, n = 0 | |||||||
3—Western Finland | Acute/rehabilitation | N = 48 | 469/32/17 | 07/06/2016 | 14/28 50% | 4 | 1d |
Psychiatrist, n = 3 | |||||||
Nurses, n = 26 (RN), n = 14 (PN) | |||||||
Psychologist, n = 2 | |||||||
Social worker, n = 3 | |||||||
4—Western Finland | Acute | N = 35 | 666/16/4 | 01/06/2016 | 13/23 57% | 8 | 0 |
Psychiatrist, n = 3 | |||||||
Nurses, n = 25 (RN), n = 5 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
5—Northern and Eastern Finland | Rehabilitation/forensic | N = 22 | 78/16/41 | 08/06/2016 | 10/14 71% | 2 | 1 |
Psychiatrist, n = 1 | |||||||
Nurses, n = 9 (RN), n = 10 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
6—Northern and Eastern Finland | Acute/rehabilitation | N = 37 | 237/30/10 | 09/06/2016 | 13/22 59% | 3 | 1 |
Psychiatrist, n = 1 | |||||||
Nurses, n = 19 (RN), n = 15 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
7—Northern and Eastern Finland | Acute | N = 27 | 442/12/9 | 25/05–26/05/2016 | 8/14 57% | 4 | 0 |
Psychiatrist, n = 3 | |||||||
Nurses, n = 13 (RN), n = 9 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
8—Northern and Eastern Finland | Acute | N = 23 | 259/12/9 | 25/05/2016 | 9/15 60% | 5 | 0 |
Psychiatrist, n = 2 | |||||||
Nurses, n = 12 (RN), n = 8 (PN) | |||||||
Psychologist, n = 0 | |||||||
Social worker, n = 1 | |||||||
9—Southern Finland | Acute | N = 26 | 388/23/9 | 16/06/2016 | 6/19 32% | 0 | 1d |
Psychiatrist, n = 2 | |||||||
Nurses, n = 20 (RN), n = 2 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
10—Southern Finland | Rehabilitation | N = 22 | 93/20/53 | 14/06–17/06/2016 | 9/11 82% | 4 | 0 |
Psychiatrist, n = 1 | |||||||
Nurses, n = 12 (RN), n = 6 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 2 | |||||||
11—Southern Finland | Acute | N = 26 | 412/23/9 | 14/06/2016 | 11/20 55% | 5 | 0 |
Psychiatrist, n = 2 | |||||||
Nurses, n = 20 (RN), n = 2 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
12—Southern Finland | Rehabilitation/forensic | N = 23 | 42/20/50 | 02/06/2016 | 12/16 75% | 2 | 0 |
Psychiatrist, n = 1 | |||||||
Nurses, n = 17 (RN), n = 3 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 | |||||||
13—Southern Finland | Rehabilitation | N = 22 | 67/16/65 | 15/06/2016 | 5/10 50% | 2 | 0 |
Psychiatrist, n = 1 | |||||||
Nurses, n = 15 (RN), n = 4 (PN) | |||||||
Psychologist, n = 1 | |||||||
Social worker, n = 1 |
The WHO QualityRights Tool Kit
Themes and standards | Wards | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | Total (mean, SD) | |
Theme 1 the right to an adequate standard of living | ||||||||||||||
1.1: the building is in good physical condition | 2 | 2 | 2 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 2 | 3 | 3 | 2.5 (0, 5) |
1.2: the sleeping conditions of service users are comfortable and allow sufficient privacy | 2 | 2 | 2 | 3 | 2 | 3 | 2 | 3 | 2 | 3 | 2 | 3 | 3 | 2.5 |
1.3: the facility meets hygiene and sanitary requirements | 2 | 2 | 3 | 3 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 2.8 |
1.4: service users are given food, safe drinking-water and clothing that meet their needs and preferences | 3 | 3 | 3 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 2.9 |
1.5: service users can communicate freely, and their right to privacy is respected | 2 | 3 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 2 | 2 | 2 | 2.6 |
1.6: the facility provides a welcoming, comfortable, stimulating environment conducive to active participation and interaction | 2 | 2 | 2 | 2 | 3 | 2 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 2.4 |
1.7: service users enjoy a fulfilling social and personal life and remain engaged in community life and activities | 2 | 2 | 2 | 2 | 3 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 2.5 |
Final score | 2 | 2 | 2 | 2 | 3 | 3 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 2.6 |
Theme 2 the right to enjoyment of the highest attainable standard of physical and mental health | ||||||||||||||
2.1: facilities are available to everyone who requires treatment and support | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3.0 |
2.2: the facility has skilled staff and provides good quality mental health services | 2 | 2 | 3 | 2 | 2 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 2.5 |
2.3: treatment, psychosocial rehabilitation and links to support networks and other service are elements of a service user-driven recovery plan and contribute to a service user's ability to live independently in the community | 3 | 2 | 3 | 2 | 2 | 3 | 3 | 2 | 2 | 3 | 2 | 3 | 3 | 2.5 |
2.4: psychotropic medication is available, affordable and used appropriately | 3 | 2 | 3 | 2 | 3 | 2 | 2 | 2 | 3 | 3 | 2 | 3 | 3 | 2.5 |
2.5: adequate services are available for general and reproductive health | 2 | 2 | 3 | 3 | 3 | 3 | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 2.7 |
Final score | 3 | 2 | 3 | 2 | 3 | 3 | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 2.7 |
Theme 3 the right to exercise legal capacity and the right to personal liberty and the security of person | ||||||||||||||
3.1: service users' preferences regarding the place and form of treatment are always the priority | 3 | 2 | 3 | 2 | 3 | 3 | 2 | 2 | 2 | 2 | 2 | 3 | 2 | 2.4 |
3.2: procedures and safeguards are in place to prevent detention and treatment without free and informed consent | 3 | 2 | 2 | 3 | 2 | 2 | 3 | 2 | 3 | 3 | 2 | 2 | 2 | 2.4 |
3.3: service users can exercise their legal capacity and are given the support they may require to exercise their legal capacity | 2 | 2 | 2 | 2 | 3 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 2.5 |
3.4: service users have the right to confidentiality and access to their personal health information | 3 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 2 | 3 | 2.7 |
Final score | 3 | 2 | 2 | 2 | 2 | 3 | 3 | 2 | 3 | 3 | 3 | 2 | 2 | 2.5 |
Theme 4 freedom from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse | ||||||||||||||
4.1: service users have the right to be free from verbal, mental, physical and sexual abuse and physical and emotional neglect | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 2 | 3 | 3 | 3 | 2 | 3 | 2.7 |
4.2: alternative methods are used in place of seclusion and restraint as means of de-escalating potential crises | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 3 | 2 | 2.1 |
4.3: electroconvulsive therapy, psychosurgery and other medical procedures that may have permanent or irreversible effects, whether performed at the facility or referred to another facility, must not be abused and can be administered only with the free and informed consent of the person | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3.0 |
4.4: no service user is subject to medical or scientific experimentation without his or her informed consent | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3.0 |
4.5: safeguards are in place to prevent torture or cruel, inhuman or degrading treatment and other forms of illtreatment and abuse | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3.0 |
Final score | 3 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 2.9 |
Theme 5 the right to live independently and be included in the community | ||||||||||||||
5.1: service users are supported in gaining access to a place to live and have the financial resources necessary to live in the community | 3 | 3 | 3 | 3 | 3 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 2.9 |
5.2: service users can access education and employment opportunities | 3 | 3 | 3 | 2 | 2 | 3 | 3 | 3 | 2 | 3 | 3 | 3 | 3 | 2.8 |
5.3: the right of service users to participate in political and public life and to exercise freedom of association is supported | 3 | 2 | 3 | 3 | 3 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 2.7 |
5.4: service users are supported in taking part in social, cultural, religious and leisure activities | 2 | 3 | 2 | 2 | 2 | 3 | 2 | 2 | 3 | 3 | 3 | 2 | 3 | 2.5 |
Final score | 3 | 2 | 3 | 2 | 3 | 3 | 3 | 2 | 2 | 3 | 3 | 3 | 3 | 2.7 |
Data analysis
Results
Theme 1: the right to an adequate standard of living
Ward spaces are just too small. There are too few meeting rooms. Rooms for service users are for two persons. If families come to visit, there is not much privacy.[Staff, identifier (ID) 1]This ward environment is bright and beautiful. I had expected gloomier.(Family member, ID 3)Here you are never left with hunger.(Patient, ID 19)
Theme 2: the right to enjoyment of the highest attainable standard of physical and mental health
I personally would want more occupational therapeutic and physiotherapeutic services, maybe even a dietician. These services are not provided here much.(Staff, ID 35)It would be good if you would get more information about these medications. Do they make you swell, and what other side effects might there be?(Patient, ID 37)I have not been told anything except that a doctor said, “See you tomorrow.” I have been kept in the dark. Blood samples have been taken, but I have not been told the results or why the samples were taken.(Patient, ID 38)Here, (service users) are taken care of from head to toe.(Staff, ID 102)
Theme 3: the right to exercise legal capacity and the right to personal liberty and the security of person
I have heard about Kanta.fi (to get access to electronic personal health information), but I don’t think one can see everything they want to see there. I have not visited there. Staff have not informed me about this.(Patient, ID 1)It (information about patient rights) is not given on a regular basis, but given if asked. Today, a patient came to say that they wanted to file a complaint. Then we told them how to do it. So yeah, we are taking care of these kinds of things.(Staff, ID 125)
Theme 4: freedom from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse
Human beings, after all, do not deserve seclusion. There is not even a toilet, but you have to pee in the corners. You just have a blanket around you. You have a pretty helpless and naked feeling afterwards.(Patient, ID 1)We have not made any real agreements about treatment (with the service users), like “if I’m feeling this way, treat me like this.” If there are 20 service users on the ward and each of them would like to receive different care, we would get all confused. So we have to go with our own ways of providing care.(Staff, ID 88)
Theme 5: the right to live independently and be included in the community
I need to find accommodation. I did not get a positive reaction from the social worker. I should have done it myself (sought accommodation). I don’t know why the social worker did not support my efforts or that we could not start searching together.(Patient, ID 21)If we are thinking about supported accommodation, usually a patient goes to these places with a nurse. That is before the official visit and negotiation. The patient and the nurse visit the webpages (of the accommodation place) together.(Staff, ID 114)