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In China, government-funded free treatment programmes have substantially expanded access to mental healthcare for patients with severe mental illnesses (SMIs). However, the effectiveness and patient satisfaction associated with these programmes can vary significantly. Understanding the factors underlying these variations is crucial for optimising patient adherence and rehabilitation outcomes.
To identify factors influencing SMI patients' satisfaction with a government-funded free treatment programme in District S, Nanjing, China, and propose targeted measures to enhance the programme's effectiveness and improve patient outcomes.
A cross-sectional study.
This study was conducted in 23 community healthcare centres in District S, Nanjing, China, from January to July 2022. A total of 924 SMI patients enrolled in the programme were selected using a two-stage random sampling method. Data on patients' individual characteristics, health behaviours and satisfaction with the programme were collected by a self-developed structured questionnaire. Guided by Andersen's Behavioural Model, hierarchical logistic regression analysis was employed to determine factors associated with patient satisfaction.
Among the 924 valid responses, 51.3% of patients with SMIs reported low satisfaction with the programme. Factors associated with patient satisfaction included individual predisposing, enabling, need and health behaviour variables. Specifically, patients who were employed, had schizophrenia, experienced adverse drug reactions, feared program exposure of their condition and received treatment in hospital were more likely to report lower satisfaction.
This study revealed that satisfaction among SMI patients with the programme remains low, with patient satisfaction primarily determined by individual need and health behaviour factors. Policymakers and stakeholders should implement targeted measures to address these factors and improve patient satisfaction.
The findings offer new insights and scientific bases for policymakers seeking to improve the programme and practical recommendations for stakeholders to develop effective solutions.
STROBE guidelines.
No patient or public contribution.
To investigate evidence-based practices and examine rates of adherence to bundles on maintenance of central venous catheters among intensive care unit nurses in 22 selected hospitals.
Although there has been an overwhelming increase in the use of evidence-based practices to reduce Central Line-Associated Bloodstream Infections, also known as bundles, there continues to be a considerable gap between clinical practice and evidence.
This study employs a multi-center cross-sectional design.
Registered nurses who worked in the ICUs of 22 selected hospitals were included. Evidence-based procedures were developed based on Central Line Bundles, which include an 11-area and 35-item checklist. Rates of adherence to bundles were calculated and analysed after reaching 22,000 central line days in 22 units. The study was reported using the STROBE checklist.
The average adherence rate to evidence-based procedures for CVC maintenance among ICU nurses in the 22 units was 87.40%. The adherence rate of five areas of the evidence-based procedure based on the Central Line bundle was above 90%, including ‘Selection of regulated skin disinfectants’, ‘Tube sealing’, ‘Tube flushing’, ‘Dressing and catheter fixation’ and ‘Sterilized skin and catheter’. The three lowest-achieving areas of bundles were ‘Catheter and insertion site assessment,’ ‘Hand hygiene’ and ‘Sterilized catheter access hubs’. The lowest-achieving item of bundles is ‘Assess during multidisciplinary patient care rounds with signature confirmation’. The adherence rates in hospitals where CLABSI occurred were all less than 90%.
ICU nurses' adherence to maintenance bundles for CVC is moderate, implying that boosting adherence rates is critical for improved results. As a result, comparable studies should be done in ICUs where the bundle has been deployed to assess and improve adherence rates through effective interventions. To minimise CLABSI in future practice, novel strategies must be developed and implemented via continued education and regular evaluation.
We registered the trial with the US Clinical Trials Registry (ID: NCT06085690, Name: Multicenter Clinical Translational Study of ‘ICU-NO CRBSI’ Based on Improvement Science, https://ichgcp.net/clinical-trials-registry/NCT06085690)
Nurse administrators and policymakers can develop strategies and interventions for improving the quality of CVC care toward evidence-based practice. Minimising the gaps between evidence and practice will reduce the incidence of CLABSI to enhance the survival of critically ill patients.
In addressing the status of evidence-based practices among ICU nurses, this study enhances healthcare quality and outcomes.
There was no patient or public contribution.
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