Development of combined assessment of psychiatric environments (CAPE) profiles: A patient-centered quality measure for inpatient psychiatric treatment

Individuals who require psychiatric hospitalization need a safe environment that supports stabilization and service planning that promotes a meaningful life in the community. Both processes require a recovery-oriented, patient-centered treatment environment where care reflects the patient's needs, values, and choices. It also requires a nursing staff that builds a unit culture which instills hope, self-direction, and empowerment. Currently there is no method to assess the delivery of recovery oriented, patient-centered care in the psychiatric inpatient environment. The focus of this study was development of an instrument (Combined Assessment of Psychiatric Environments- the CAPE) that assesses quality of care by gauging the extent patients have experiences during inpatient treatment that promote recovery and patient-centered care; i.e., ones marked by safety, engagement, respect, choice, achievement, and significance. A staff-form of the tool gauges the extent the environment supports nurses ability to provide an empowering, patient-centered environment of care. This presentation will report on the conceptual framework of the instrument, how items were derived from staff interviews and patient focus groups and then further refined by consumer/staff frequency ratings of the initial item pool. In the second phase of the study the instrument was tested on six inpatient psychiatric units. The resultant data and psychometrics of the instrument will be presented. Included is a discussion of how the instrument facilitates quality assessment and patient-centered care of inpatient psychiatric environments. The instrument also has the potential to detect outcomes of a staff group's efforts at recovery-oriented culture change.