Academic journal article Journal of Nursing Scholarship

Factors Associated with Primary Family Caregivers' Perceptions on Quality of Family-Centered Care in Mental Health Practice

Academic journal article Journal of Nursing Scholarship

Factors Associated with Primary Family Caregivers' Perceptions on Quality of Family-Centered Care in Mental Health Practice

Article excerpt

Mental illnesses are a worldwide concern, with clinical features and healthcare costs that are vulnerable to being discredited by society (Whiteford et al., 2013). Family members who are caregivers frequently encounter accumulative demands and experience a continuum of reactions to caring for patients in psychiatric hospitalizations (Weller, Faulkner, Doyle, Daniel, & Goldston, 2015). Mental health nurses (MHNs), as the largest group of healthcare providers, are key in the delivery of direct and substantial care for individuals with mental illnesses and their families (Skärsäter et al., 2018). Family members suffer in similar ways to individuals with mental illness (Cairns, Reid, & Murray, 2015). Therefore, MHNs' attitudes toward the importance of working with families in nursing care is particularly of concern. Wallcraft et al. (2011) articulated that mental healthcare services' engagement with families is valuable to promote recovery for people experiencing mental health problems. Given that the family constitutes a critical source of support for patients, a greater emphasis should be placed on family engagement in care planning and coordination. Likewise, families often feel marginalized from mental healthcare practice (Cree et al., 2015; Doody, Butler, Lyons, & Newman, 2017; Vermeulen et al., 2015).

Schizophrenia is a highly stigmatized mental disorder that is perceived to be dangerous, unpredictable, violent, and prone to crime (Bifftu, Dachew, & Ttuneh, 2014). Stigma, as an attribute, includes labeling, stereotyping, separation, status loss, and discrimination in power circumstances (Link & Phelan, 2001). Nurjannah, Mills, Park, and Usher (2015) postulated that stigma is the most significant barrier to mental health provision in relation to negative implications for patients and their families. Attitudes of mental healthcare providers (e.g., MHNs) toward mental illness were comparable to those of the general population or more negative. These attitudes further restrict patients' recovery and provision of mental health care (de Jacq, Norful, & Larson, 2016; Schomerus et al., 2012). As such, mental health-related stigma is a matter of concern to mental healthcare providers. Less is known, however, about nurses' attitudes toward mental illness in working with patients' family members. A better understanding of this relationship helps inform efforts to combat stigma among MHNs and thereby enhance partnerships between MHNs and affected families.

Family-centered care (FCC) refers to the involvement of patients' families in care as collaborative partners with healthcare providers (Mackean et al., 2012). Partnerships in health care, information provision, coordinated and comprehensive care, respectful and supportive care, and coordinated and comprehensive care were perceived by affected families as being equally crucial to medical techniques that healthcare providers perform (Bamm, Rosenbaum, & Stratford, 2010). Further, the World Psychiatric Association (WPA) recommended developing collaboration among mental healthcare providers, patients, and their family members (Wallcraft et al., 2011). Family members generally perceived that they are blamed and alienated from the caring context without appreciation of their caretaking roles by mental healthcare providers (Cree et al., 2015; Eassom, Giacco, Dirik, & Priebe, 2014). Family engagement in care planning is fraught with issues of healthcare providers' inadequate family nursing knowledge and skills and ethical dilemmas around confidentiality (Doody et al., 2017; Keogh et al., 2017; Skärsäter et al., 2018). Approximately one in three family caregivers in the study by Vermeulen et al. (2015) felt dissatisfied with the support they received from MHNs. From nurses' standpoints, Hsiao and Tsai (2015) found that MHNs with more clinical practice in mental health care, favorable attitudes about family involvement with patient care, and relatives with serious illnesses requiring professional care positively valued their family nursing practice in mental health services. …

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