The Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) instrument: Psychometric properties and staff views of the quality of forensic psychiatric services in Sweden


The aim of the present study was to evaluate the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) and to describe the perceived quality of psychiatric care among forensic inpatient service staff. A sample of 348 forensic inpatient staff from 18 forensic wards in Sweden participated in the study. A confirmatory factor analysis revealed a seven-factor structure with item loadings > 0.50 on expected factors, indicating adequate psychometric properties. The staff’s ratings of quality of care were high, 94% being positive. The highest ratings were found for the secluded-environment dimension and the lowest for the secure-environment dimension. Several factors influenced the ratings of quality of care, for instance, staff’s time to perform their duties and staff’s age. It is concluded that the QPC-FIPS can give valuable information about staff’s perceptions of the quality of care provided at inpatient forensic psychiatric care services, which can be used to identify areas for quality improvement. Use of the QPC-FIPS is an easy and inexpensive way to evaluate quality in forensic inpatient care, preferably in conjunction with the QPC-FIP instrument developed for forensic inpatients and covering the same items and dimensions.

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Schröder, A. and Lundqvist, L. (2013) The Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) instrument: Psychometric properties and staff views of the quality of forensic psychiatric services in Sweden. Open Journal of Nursing, 3, 330-341. doi: 10.4236/ojn.2013.33045.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hansson L. (1989) The quality of outpatient psychiatric care. Scandinavian Journal of Caring Sciences, 3, 71-82. doi:10.1111/j.1471-6712.1989.tb00375.x
[2] Schröder, A. (2006) Quality of care in the psychiatric setting: Perspectives of the patient, next of kin and care staff. Ph.D. Thesis, Linköping University, Sweden.
[3] Ljungren, B. (1998) Quality of health care: Patient and staff perspectives. A Study of changes 1992-1996 with special reference to diagnosis related groups. Ph.D. Thesis, Upsala University, Sweden.
[4] Vuori, H. and Roger, F. (1989) Issues in quality assurance—The European scene. Quality Assurance in Health Care, 1, 125-135. doi:10.1093/intqhc/1.2-3.125
[5] Arnetz, B. (1999) Staff perceptions of the impact of health care transformation on quality of care. International Journal of Quality in Health Care, 11, 345-351. doi:10.1093/intqhc/11.4.345
[6] Campbell, S.M., Roland, M.O. and Buetow, S.A. (2000) Defining quality of care. Social Science & Medicine, 51, 1611-1625. doi:10.1016/S0277-9536(00)00057-5
[7] DeMarco, R., Flaherty, L., Glod, C., Merril, N., Terk, K. and Plasse, M. (2004) Staff & client perceptions of unit quality—A pilot study. Journal of Psychosocial Nursing and Mental Health Service, 42, 36-43.
[8] National Board of Health and Welfare (Socialstyrelsen) (2011) Management system for systematic quality work (Socialstyrelsens föreskrifter och allmänna radom ledningssystem för systematiskt kvalitetsarbete).
[9] Crow, R., Gage, H., Hampson, S., Hart, J., Kimber, A., Storey, L. and Thomas, H. (2002) The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technology Assessment, 6, 1-90.
[10] Shiva, A., Haden, S.C. and Brooks, J. (2009) Psychiatric civil and forensic inpatient satisfaction with care: The impact of provider and recipient characteristics. Social Psychiatry and Psychiatric Epidemiology, 44, 979-987. doi:10.1007/s00127-009-0019-3
[11] Valenstein, M., Mitchinson, A., Ronis, D.L., Alexander, J.A., Duffy, S.A., Craig, T.J. and Lawton Barry, K. (2004) Quality indicators and monitoring of mental health services: What do frontline providers think? American Journal of Psychiatry, 161, 146-153.
[12] Whitehead, E. and Mason, T. (2006) Assessment of risk and special observations in mental health practice: A comparison of forensic and non-forensic settings. International Journal of Mental Health Nursing, 15, 235-241. doi:10.1111/j.1447-0349.2006.00429.x
[13] Happell, B., Martin, T. and Pinikahana, J. (2003) Burnout and job satisfaction: A comparative study of psychiatric nurses from forensic and a mainstream mental health service. International Journal of Mental Health Nursing, 12, 39-47. doi:10.1046/j.1440-0979.2003.00267.x
[14] Niskala, H. (1986) Competencies and skills required by nurses working in forensic areas. Western Journal of Nursing Research, 8, 400-413. doi:10.1177/019394598600800402
[15] Kumpula, E. and Ekstrand, P. (2012) “Doing things together”: Male caregivers’ experiences of giving care to patients in forensic psychiatric care. Journal of Psychiatric and Mental Health Nursing, 20, 64-70. doi:10.1111/j.1365-2850.2012.01887.x
[16] Jung, H.P., Wensing, M., Olesen, F. and Grol, R. (2002) Comparison of patients’ and general practitioners’ evaluation of general practice care. Quality & Safety in Health Care, 11, 315-319. doi:10.1136/qhc.11.4.315
[17] Boyer, L., Baumstarck-Barrau, K., Cano, N., Zendjidjian, X., Belzeaux, R., Limousin, S., Magalon, D., Samuelian, J.C., Lancon, C. and Auquier, P. (2009) Assessment of psychiatric inpatient satisfaction: A systematic review of self-reported instruments. European Psychiatry, 24, 540-549. doi:10.1016/j.eurpsy.2009.05.011
[18] Längle, G., Baum, W., Wollinger, A., Renner, G., U’ren, R., Schwärzler, F. and Eschweiler, G.W. (2003) Indicators of quality of in-patient psychiatric treatment: The patients’ view. International Journal for Quality in Health Care, 15, 213-221. doi:10.1093/intqhc/mzg032
[19] Schröder, A., Wilde Larsson, B. and Ahlström, G. (2007) Quality in psychiatric care: An instrument evaluating patients’ expectations and experiences. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services, 20, 141-160. doi:10.1108/09526860710731834
[20] Schröder, A., Ahlström G. and Wilde Larsson, B. (2006) Patient’s perceptions of the concept of quality of care in the psychiatric setting: A phenomenographic study. Journal of Clinical Nursing, 15, 93-102. doi:10.1111/j.1365-2702.2005.01241.x
[21] Schröder, A., Wilde-Larsson, B., Ahlström, G. and Lundqvist, L-O. (2010) Psychometric properties of the instrument Quality in Psychiatric Care and descriptions of quality of care among in-patients. International Journal of Health Care Quality Assurance, 23, 554-570. doi:10.1108/09526861011060924
[22] Schröder, A., Ahlström, G., Wilde-Larsson B. and Lundqvist, L-O. (2011) Psychometric properties of the instrument Quality in Psychiatric Care-Out-Patient (QPC-OP). International Journal of Mental Health Nursing, 20, 445-453. doi:10.1111/j.1447-0349.2011.00741.x
[23] Schröder, A., Agrim, J. and Lundqvist, L-O. (2013) The Quality in Psychiatric Care Forensic In-Patient (QPC-FIP) instrument: Psychometric properties and patient’s view of quality of forensic psychiatric services in Sweden. Journal of Forensic Nursing. doi:10.1097/JFN.0b013e31827f5d2f
[24] Gigantesco, A., Morosini, R. and Bazzoni, A. (2003) Quality of psychiatric care: Validation of an instrument for measuring inpatient opinion. International Journal for Quality Health Care, 15, 73-78. doi:10.1093/intqhc/15.1.73
[25] Woodring, S., Polomano, R.C., Haagen, B.F., Nuun, R.R. and Zarefoss, M.A. (2004) Development and testing of patient’s satisfaction measure for inpatient psychiatry care. Journal of Nursing Care Quality, 19, 137-148. doi:10.1097/00001786-200404000-00011
[26] Streiner, D.L. and Norman, G.R. (2003) Health measurement scales. A practical guide to their development and use. 2nd Edition, Oxford University Press, Oxford.
[27] Cronbach, L.J. (1951) Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297-334. doi:10.1007/BF02310555
[28] Nunnally, J. and Bernstein, I. (1994). Psychometric theory. 3rd Edition, McGraw-Hill, New York.
[29] Jöreskog, K.G. and Sörbom, D. (1996) LISREL 8: User’s reference guide. 2nd Edition, Scientific Software International, Chicago.
[30] Jöreskog, K.G. and Sörbom, D. (1988) PRELIS—A program for multivariate data screening data summarization. A preprocessor for LISREL. 2nd Edition, Scientific Software, Chicago.
[31] Bentler, P.M. (1990) Comparative fit indexes in structuralmodels. Psychological Bulletin, 107, 238-246. doi:10.1037/0033-2909.107.2.238
[32] Browne, M.W. and Cudeck, R. (1993) Alternative ways of assessing model fit. In: Bollen, K.A. and Long, J.S., Eds., Testing Structural Equation Models, Newbury Park, Sage, 136-162.
[33] Vandenberg, R.J. and Lance, C.E. (2000) A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3, 4-70. doi:10.1177/109442810031002
[34] Bollen, K.A. (1989) Structural equations with latent variables. Wiley, New York.
[35] Hu, L. and Bentler, P.M. (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55. doi:10.1080/10705519909540118
[36] Marsh, H.W., Hau, K.-T. and Wen, Z. (2004) In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in over generalizing Hu and Bentler’s (1999) findings. Structural Equation Modeling: A Multidisciplinary Journal, 11, 320-341. doi:10.1207/s15328007sem1103_2
[37] Sitzia, J. (1999) How valid and reliable are patient satisfaction data? An analysis of 195 studies. International Journal for Quality in Health Care, 11, 319-328. doi:10.1093/intqhc/11.4.319
[38] Boyle, G.J. (1991) Does item homogeneity indicate internal consistency or item redundancy in psychometric scales? Personality and Individual Differences, 12, 291-294. doi:10.1016/0191-8869(91)90115-R
[39] Olusina, A.K., Ohaeri, J.U. and Olatawura, M.O. (2002) Patient and staff satisfaction with the quality of in-patient psychiatric care in a Nigerian general hospital. Social Psychiatry and Psychiatric Epidemiology, 37, 283-288. doi:10.1007/s00127-002-0548-5
[40] von Essen, L. and Sjödén, P.O. (1993) Perceived importance of caring behaviors to Swedish psychiatric inpatients and staff, with comparisons to somatically-ill samples. Research in Nursing & Health, 16, 293-303. doi:10.1002/nur.4770160408
[41] Middelboe, T., Schjødt, T., Byrsting, K. and Gjerris, A. (2001) Ward atmosphere in acute psychiatric in-patient care: Patients’ perceptions, ideals, and satisfaction. Acta Psychiatrica Scandinavica, 103, 212-219. doi:10.1034/j.1600-0447.2001.00102.x
[42] Schröder, A. and Ahlström, G. (2004) Psychiatric care staff’s and care associates’ perceptions of the concept of quality of care: A qualitative interview study. Scandinavian Journal of Caring Sciences, 18, 204-212. doi:10.1111/j.1471-6712.2004.00271.x
[43] Barlow, K., Grenyer, B. and Ilkiw-Lavalle, O. (2000) Prevalence and precipitants of aggression in psychiatric inpatient units. Australian and New Zealand Journal of Psychiatry, 34, 967-974. doi:10.1046/j.1440-1614.2000.00802.x
[44] Ewers, P., Bradshaw, T., McGovern, J. and Ewers, B. (2002) Does training in psychosocial interventions reduce burnout rates in forensic nurses? Journal of Advanced Nursing, 37, 470-476. doi:10.1046/j.1365-2648.2002.02115.x
[45] Redfern, S., Hanna, S., Norman, I. and Martin, F. (2002) Work satisfaction, stress, quality of care and morale of older people in a nursing home. Health and Social Care in the Community, 10, 512-517. doi:10.1046/j.1365-2524.2002.00396.x
[46] Capland, C. (1993) Nursing staff and patient perceptions of the ward atmosphere in a maximum security forensic hospital. Archives of Psychiatric Nursing, 1, 23-29. doi:10.1016/0883-9417(93)90019-S
[47] Brunt, D. and Rask, M. (2007) Ward atmosphere—The scarlet pimpernel of psychiatric settings? Issues in Mental Health Nursing, 28, 639-655. doi:10.1080/01612840701354513
[48] Jaipaul, C.K. and Rosenthal, G.E. (2003) Are older patients more satisfied with hospital care than younger patients? Journal of General Internal Medicine, 18, 23-30. doi:10.1046/j.1525-1497.2003.20114.x
[49] Lundqvist, L.-O., Ahlström, G., Wilde-Larsson, B. and Schröder, A. (2012) The patient’s view of quality in psychiatric out-patient care. Journal of Psychiatric and Mental Health Nursing, 19, 629-637. doi:10.1111/j.1365-2850.2012.01899.x
[50] Dickens, G., Sugarman, P. and Rogers, G. (2005) Nurses’ perceptions of the working environment: A UK independent sector study. Journal of Psychiatric and Mental Health Nursing, 12, 297-302. doi:10.1111/j.1365-2850.2005.00836.x
[51] Räikkönen, O., Perälä, M.L. and Kahanpää, A. (2007) Staffing adequacy, supervisory support and quality of care in long-term care settings: Staff perceptions. Journal of Advanced Nursing, 60, 615-626. doi:10.1111/j.1365-2648.2007.04443.x
[52] Thomsen, S., Dallender, J., Soares J., Nolan, P. and Arnetz, B. (1998) Predictors of healthy workplace for Swedish and English psychiatrists. British Journal of Psychiatry, 173, 80-84. doi:10.1192/bjp.173.1.80
[53] Bowers, B., Lauring, C. and Jacobson, N. (2001) How nurses manage time and work in long-term care. Journal of Advanced Nursing, 33, 484-491. doi:10.1046/j.1365-2648.2001.01686.x
[54] van Campen, C., Sixma, H., Friele, R.D., Kerssens, J.J. and Peters, L. (1995) Quality of care and patient satisfaction: A review of measuring instruments. Medical Care Research and Review, 52, 109-133. doi:10.1177/107755879505200107
[55] Rat, A.C., Pouchot, J., Guillemin, F., Baumann, M., Retel-Rude, N., Spitz, E. and Coste, J. (2007) Content of quality-of-life instruments is affected by item-generation methods. International Journal for Quality in Health Care, 19, 390-398. doi:10.1093/intqhc/mzm040
[56] Bravo, G., DeWals, P., Dubois, M.F. and Charpoutier, M. (1999) Correlates of care quality in long-term care facilities: A multi-level analysis. Journal of Gerontology, 54, 180-188.

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