Structure and process factors that influence patients and nurses' perceptions of in-patient psychiatric nursing care at Mathari Hospital

Abstract

In-patient psychiatric units which play an important role in the management of patients with severe psychiatric disorders often lack structures and processes needed for quality nursing care. Patients' and Nurses' perception of care is an important indicator quality of care and should be assessed regularly (Campbell, 1999; Garry and Shannon, 1997). Yet such assessment has not been done in Kenya to evaluate standards of in-patient psychiatric nursing care despite complaints of inadequate structures and processes of care in a country where more than 25% of patients in a general out patient clinic suffer from mental disorders; And WHO having developed quality checklist for evaluation of psychiatric care (WHO, 1994). The purpose of this study was therefore to explore structure and process factors that influence the patients' and nurses' perception of quality in-patient psychiatric nursing care at Mathari hospital, Nairobi. Donbedians' (1966) Structure-Process-Outcome model of quality care and Peplau's (1952) Interpersonal Relationships Theories were the frameworks for this study. It was a descriptive, quantitative and qualitative study of a sample of 236 in-patients and 13 1 nurses selected by stratified sampling. One of inclusion criteria for patients was a score of 24/30 on the mini mental status assessment tool. Data were collected for two months using mainly semi structured questionnaires and observation checklist tools modified fro in Gigantesco (2003), Wallace (199S) and WHO (1994) and was analyzed using SPSS version 10. Differences in proportions were determined by calculation of confidence interval and summary chi square statistic. p-values of:S 0.05 were considered statistically significant. A major finding was that physical environment vias significantly related to nurses and patients' satisfaction (X2=l0.456, p=O.0012) and (X2=5.506, p=O.002) respectively. The use Interpersonal relations principles of Peplau (1952) was also found to have a positive influence on patients' and nurses perception of care. Overall WHO(l991) criteria of good quality standards "vas met by only 4 (,28.5%) out of fourteen wards. One of the recommendations by the researcher i:' that Hospital administration urgently improves structure and process factors cf care at Mathari Hospital in order to improve quality of patient care.