Aim of the study
Setting and sample
Recruitment and randomisation
Description of the intervention
Educational intervention to support positive treatment culture and team climate in staff members in psychiatric hospitals
Patients’ conditions, treatment environment and ward culture may affect patients’ behaviour. Use of coercive methods could be prevented with staff education about user-centred if more humane approaches as well as collaboration between patients, family members and staff members could be increased. Staff education may further positively affect treatment culture and lower the need for using coercive methods in psychiatric hospital care. [46–51]
Information about evidence-based research, written information package of intervention materials, and monitoring tools.
Identification and analysis of current treatment practices, local house rules and quality of the service facilities. Identification of quality gaps, SWOT, barriers and facilitators for change. Dissemination of research evidence. One-day workshop seminars, local meetings and outreach visits. Ongoing monitoring and support by calls/emails.
Trial team: with a background of psychiatric care as nurses/researchers, an academic qualification (master and/or doctoral level) with an experience in continuing education of staff members (professor, senior researcher, project researcher, doctoral student, master students).
Staff members: different health care professionals.
Face-to-face seminars with lectures, workshops, group meetings, outreach visits, telephone and email contacts with staff members. If needed, video meetings will be organized with staff members.
At the psychiatric wards and at the University facilities (workshops, seminars).
When and how much
Intervention will take 18 months:
- Identification, analysis and sharing current treatment practices, use of coercive methods, local house rules, and quality of the service facilities (months 1–4)
- Identification of quality gaps, SWOT analysis in workshop and local meeting, barriers and facilitators for change in each ward, and dissemination of research evidence in workshop; one-day workshop seminars, local meetings and outreach visits (months 5-8),
- Ongoing support by calls/emails provided, workshop, local meetings (months 9–18).
Tailoring and modifications
The education process with specific protocol is similar at each ward. The activities taken on each ward based on the need analysis and the quality gaps may be tailored to fulfil the needs of each ward.
Feasibility of the intervention
Fidelity and quality components of the intervention
A one-day workshop (X2) for ward managers and contact persons will be organised by the trial team; the results of the information collected at baseline will be shared; preliminary action plans for units will be designed; queries from the staff will be answered.
A local ward meeting will be organised by the senior ward manager and a contact person on each intervention ward. House rules for patients will be collected and analysed from each ward.
At least one ward manager/contact person in each intervention unit will attend the one-day workshops (1st and 2nd workshop) (80%).
The first local meetings will be organised and documented on each ward (100%).
House rules will be analysed (100%).
A series of local meetings with staff members, patients, and relatives will be organised by the trial team; areas to be developed and specific steps to be taken will be identified; barriers and facilitating factors for change will be described; strengths, weaknesses, opportunities, and threats related to the educational intervention will be identified through a SWOT analysis.
The first outreach visit on each ward will be organised (100%).
At least 50% of staff on each ward will attend the first outreach visit.
An information package of an intervention to support staff’s competence will be available.
An Action Plan for each ward will be developed (100%); the content of the information package will be shared with the staff (100%).
Monthly monitoring/support calls/emails by the trial team will prompt and encourage changes on the wards.
Ward managers/contact persons or senior ward managers will report the progress of the changes (including harms) by email/telephone (12 calls or email/12 months; 100%).
The trial team will visit each ward to give hands-on support to staff members, ward managers and contact persons so that they will gain confidence in implementing the new ideas on the wards. The Action Plan will be revised if needed.
A one-day workshop for an Interim Evaluation Seminar will be organised.
The second outreach visit on each ward will be organised. At least 50% of the staff on the ward will attend the visits.
The third workshop will be organised to review the implementation process; at least one person from each unit will attend (Interim Evaluation) (95%).
Outcome assessment and house rules will be analysed by staff members and the trial team; possible differences in previous and current actions will be identified.
Patient coercive methods and house rules will be analysed (100%).
Daily practices will be monitored by the trial team.
The final workshop will be organised.
Daily practices will be monitored and outcomes of the intervention will be evaluated in a meeting on each ward.
The third outreach visit on each ward will be organised. At least 50% of the staff on the ward will attend the visits.
At least one senior ward manager/contact person in each intervention unit will attend (95%) the fourth workshop.