https://www.um.edu.mt/library/oar/handle/123456789/63338 2026-04-14T03:23:45Z https://www.um.edu.mt/library/oar/handle/123456789/44863 Title: Risk factors leading to re-admission of patients to the acute psychiatric hospital - perspectives from the multidisciplinary team. Abstract: Purpose The purpose of this study was to investigate the trends and ratios of re-admissions for patients following discharge from their first admission to Mount Carmel Hospital and explore the perceptions of the multidisciplinary team regarding the implications of re-admissions for the quality of psychiatric services. Background A voiding readmission is not a direct objective of hospital care as most admissions tend to be unavoidable (Milne & Clarke, 1990). However avoiding those adverse outcomes that lead to re-admissions, and therefore identify risk factors, is crucial for the management of acute psychiatric services. It is estimated that approximately 40 to 50% of discharged patients are readmitted within one year of their discharge (Vesudeva, et a!., 2009). Such numbers have repercussions for the management and administration of acute psychiatric services and therefore it is generally agreed that the prevention of re-admission and relapse is one of the major goals of psychiatric aftercare (Ascher-Svanum, et at., 2010; Boyer, et at., 2000; Lien, 2002). Method A mixed method approach was used for this study. The basis for employing both quantitative and qualitative approaches is to expand the scope of research to offset the weaknesses of either approach alone (Bums & Grove, 2001). Statistical data was collected retrospectively from the medical records department of Mount Carmel Hospital and included patients who were admitted for the first time in one of the three acute in-patient wards of the hospital in the years 2007, 2008 and 2009 and had other re-admissions following their first discharge (n=152). Semi-structured interviews were subsequently performed with the leaders of the five leading representatives of the multidisciplinary team (Doctors, nurses, social workers, occupational therapists and psychologists). Finally to complete triangulation, a focus group was performed with seven members of the community outreach team. Results In all, 20.02% (n=152) of first time admitted patients who were discharged from acute care in the years 2007, 2008 and 2009 were re-admitted at least once by May 2010. The sample showed no significant differences in gender, status, education and habitation. The duration of hospital stay and mode of discharge showed significant relationship which, as outlined by participants, suggested that discharge planning is an important factor to avoid re-admissions. Reasons for re-admission were quite comparable between genders with severity of symptoms accounting for 61.6% of the sample followed by poor medication compliance and substance abuse. The study outlined a lacuna when using re-admission rates as outcome indicator. Discussion and Recommendations An anomaly in the referring system from in-patient to community services seems to be affecting the intensity of post hospitalisation care with the resultant risk of possible early re-admissions. Key recommendations, therefore, for this study are: management should revise referral criteria and protocols to minimize the gap between in-patient and community care; hospital performance indicators should be reviewed and endorsed by the multi-disciplinary team, early discharge planning involving community teams should become standard practice, improved communication between in-patient and community settings, the introduction of electronic medical records to facilitate improved audit capabilities and similar studies should be undertaken to establish progress in reducing re-admissions. Key words Re-admission, relapse, in-patient and community psychiatric care, performance indicators, discharge planning. Description: M.SC.HEALTH SERVICES MANGT. 2011-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/44715 Title: "Should I stay or should I go?" What are the factors that induce nurses to leave? Abstract: Widespread evidence shows that nursing shortage and nurses voluntarily leaving their jobs is an issue affecting the delivery of health care worldwide. This problem is intensified by a rapidly ageing nursing workforce together with an ageing population placing unprecedented demands on health services. One way to reduce this shortfall is to decrease the number of nurses who voluntarily leave their job. Nurses' intention to leave is a very complex theme and the literature review demonstrates that it has been associated with a number of factors namely, job satisfaction, nurse self-concept, organizational commitment, demographic factors and pay. Most of these issues are interrelated to each other. In order to investigate nurses' intention to leave in the Maltese cohort of nurses three different approaches were taken. A cross-sectional survey involving staff nurses was carried out in three different state-owned local health entities. The tool used for the survey involved a nurse self-concept questionnaire, a nurse retention index and some demographic data. This tool was created and validated by Cowin (2001). Furthermore the Department of Human Resources of a local acute hospital distributes an 'exit' questionnaire to each nurse who resigns and the data collected by this department was also analyzed as part of this study. For the third part of the study the respective senior managers of the hospitals involved for the survey were interviewed. The results obtained in the first two parts of the data collection were discussed through a face to face structured interview. On average most nurses who took part in the study have no intention to leave. The nurse self-concept tool had six dimensions and all of them resulted inversely correlated to nurse intention to leave. The importance of these dimensions was also evident in the exit questionnaires and in the interviews. The findings of this study also indicate that locally the problem with retention lies more in the younger nurses. Contradictory findings were obtained while investigating the education dimension with nurses' intention to leave. One should also note that nurses' intention to leave does not seem to vary between nurses working in different local hospitals. The main recommendation of the study is the need to build better communication system between different hierarchal levels in the hospitals. Description: M.SC.HEALTH SERVICES MANGT. 2011-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/44714 Title: Needs assessment for sexual health services development. Abstract: Rates of sexually transmitted infections have been reported to be on the increase in Malta and worldwide, affecting mostly young people (Health Protection Agency London, 2006; European Centre for Disease Prevention and Control, 2011). In addition high rates of teenage pregnancies are also reported (National Statistics Office, Malta, 2010). These trends demand stakeholders to further investigate and evaluate the need for further support services which help in achieving sexual health. However, if one fails to take into consideration the needs and demands of all the stakeholders involved in delivering and receiving sexual health services, one will be missing the opportunity to provide services which suite these needs (Sheaff, 2002). The purpose of this study was to compare sexual health services needs of Maltese young people with what experts in the sexual health field propose as part of a needs analysis for the development of sexual health services in Malta. In order to reach the aim of the study an epidemiological review of the literature reporting matters related to sexual health was carried out. Young people's knowledge, attitudes and demands related to sexual health in Malta were then explored together with the perceptions of experts in the sexual field. The results for Malta were then compared to published data from other countries. A mixed method approach of data collection was chosen to explore the various dimensions of needs related to sexual health. Quantitative data were collected by self-administering questionnaires to 300 students in a state postsecondary school in Malta. On the other hand, one-to-one in-depth interviews with two experts in the sexual health field were carried out in parallel. The results of these interviews generated qualitative data. Results revealed that young people's knowledge of sexually transmitted infections and sexual health services was limited, particularly in males. Results also threw light on young people's sexual activity, these showing that they were sexually active at a young age. No major differences emerged between the experts' perspectives and young people's needs. Two important needs that resulted from this study were the need for an adequate sexual health information dissemination system, incorporating schools and the need of educating professionals who deal with young people. The need and importance of involving parents in sexual health education was also recognised. Indications were also given about the need of designing new quality sexual health services which are accessible to all, are provided in reachable areas and have adequate opening hours. These services must be free of charge and cater for all young people while providing confidentiality. Influenced by the needs that emerged from the study, several management implications and a number of recommendations were identified. Effective sexual health promotion was regarded as an asset in delivering accurate and timely information to young people thus, it is imperative that the present health promotion and education strategies are revised. The current sexual health services offered must be evaluated together with the possibility of developing new services. Finally the results obtained reflect that sexual health is an essential part in leading a healthy lifestyle. This makes it crucial to have the appropriate sexual health services in place. Description: M.SC.HEALTH SERVICES MANGT. 2011-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/44704 Title: The importance of improving patient safety in a mental health setting Abstract: Patient safety is an emerging issue in mental health that has only recently received attention. Whilst patient safety has moved to the forefront of the health care agenda nationally and internationally there is to date a shortage of research to guide patient safety systems, practices, policies and care delivery in mental health. The aim of the study was to explore the prevailing knowledge and attitudes of staff in a mental health setting with regards to patient safety. To achieve this aim, the following objectives were set: to identify the knowledge, practices and attitudes of different categories of workers employed within the mental health hospital; to identify prevalent risks to health and safety; to identify existing policies, protocols or documents within the hospital and obtain feedback from staff regarding their utility in upholding patient safety. The literature review focused on six patient safety incidents in mental health setting. These included: patient victimization; aggression and self-harm; seclusion and restraint; slips and falls; absconding and missing patients and adverse medication events. An exploratory design making use of qualitative methods was used. Data was collected through a focus group discussion and through personal interviews with experienced personnel working in a mental health setting in Malta. Semi-structured interviews were audio-recorded. A topic guide guided the questions in the interviews and focus group followed by specific topics that were raised by the participants. Thematic analysis which involved the search for themes was considered appropriate for this study. It involved the systematic qualitative analysis of transcripts of semi-structured interviews conducted with participants and a focus group. Several findings emerged from the research pertaining to planning, policies, guidelines, practices and research. The findings suggested that for patient safety in mental health to improve, a safety culture needs to be embedded within all levels of an organization. It requires leadership, effective communication, service integration and inter-professional collaboration. Further, it requires ongoing training and education programs to all health care workers, better reporting of incidents, better documentation and handover system. Moreover, the impact of stigma against mental illness was also revealed. Finally, this research study identified several potential important future directions for improving patient safety in mental health setting. A link between patient safety and service availability, quality of care and mental illness stigma was found. The main recommendations that have emerged from the findings are suggestions for management, for education and for future research. Therefore, promoting a culture of patient safety, involving various multidisciplinary workers and professionals in the organisation will improve patient safety in mental health setting. Description: M.SC.HEALTH SERVICES MANGT. 2011-01-01T00:00:00Z