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Table 3 Frequency distribution and examples of the focus groups contributions included in the Critical Issue subcategory (Level 4)

From: Patient empowerment in risk management: a mixed-method study to explore mental health professionals’ perspective

Critical Issue n Examples
Inappropriate setting and environment 45 “The environment would be adequate for a medical setting rather than a psychiatric setting; a psychiatric patient needs more open spaces to move safely and get relaxed…”
Patients’ low awareness, reliability 43 “We can share the responsibility with the patient only when he has totally understood and accepted what is happening to himself, otherwise it is very difficult…”
Poor teamwork 38 “Another risk is the lack of communication between different members of the team…the team communicates only regarding the diagnosis… each healthcare professional brings his personal point of view and works with the patient focusing only on his specific field.. there is no space for sharing different perspectives…”
HPs inadequately trained or inexperienced 37 “I have never done any training on this topic. I know that I may change my attitude towards the patients, but I don’t know how to do it”
Subjective risk-assessment or unpredictability of patients’ behaviors 37 “There is a wide subjectivity in the evaluation of psychiatric patients: their evaluation and behaviors may change according to the healthcare professional they are referring to in a certain moment”
Impact of risk-management on the process of care/empowerment/autonomy 36 “For example, restrictions to outdoor access for some inpatients. They would like to go out at all hours; they would like to have coffee every time they want and they would like to do all the other things they can’t due to the limitations. It is difficult to create a collaborative relationship. How can you tell them ‘You can’t go out’. They don’t understand why.”
Unsupportive/problematic caregivers 34 “If a caregiver sees his relative sedated, he may get angry..”
Potential threats to the therapeutic process/alliance 25 “Sometimes we avoid involving patients in order to preserve his saneness. In the psychiatric field is difficult to evaluate how much information the patient may tolerate”
Lack of resources and healthcare/social network 14 “They often ask us for a cigarette because they get bored. It would be much better to have a walk or a chat with the patient instead of giving him a cigarette. But unfortunately we don’t always have time to do it, even if we are aware it would be the best for the patient.”
Aggressiveness towards HPs 14 “If I don’t feel safe as healthcare operator, it is difficult to care for patient safety; I need to first ensure my safety in order to work well.”
Self-harming patients’ attitudes and behaviours 13 “It is difficult when they (the patients) do not want to collaborate and it looks like they are doing their best the get things going wrong.”
Linguistic and cultural barriers 12 “It is difficult to involve foreign patients, both because of the language and the different culture. They generally stay in contact until they are feeling bad but as soon as they get a bit better, they disappear”
Being overwhelmed and burnout of HPs 8 “Verbal aggression is generally underestimated. It may become unpleasant if you (health operator) can’t leave such a feeling at work and you take it at home with you”
Other 6 “it is difficult to control the door of the ward and to check if patients have lighters…”
Total 362