Iran Journal of Nursing

Introduction
Welcoming is the first step for a good patient care. Inn nursing care, it is formed based on interpersonal relationships. For people with mental disorders, a welcoming environment promotes social participation and provide opportunities to connect with other people. In addition, proper communication with patients in the form of a welcoming program can reduce their psychological problems and speed up their recovery process. Considering the benefits that a welcoming environment can have for the patients and their families, and specifically for people with mental disorders, this study aims to launch a welcoming program in the Iran psychiatric Hospital and assess its effectiveness in improving the quality of and satisfaction with the services for patients with mental disorders.

Methods
The welcoming unit of Iran Psychiatry Hospital officially launched and began to operate since September 2017 by choosing one of the nurses with good communication skills as the “welcoming nurse”. In this program, the nurse first introduced herself to the patients and their families, and if needed, made them familiar with the hospital and its goals and environment, how to reach psychiatrists, and regulations during hospitalization. This program continued by acquainting patients with their rights, treatment team, welfare amenities, inpatient wards, electroconvulsive therapy unit, clinics, and support center. The welcoming unit was also responsible for evaluating the problems of patients and their families and reporting them, collecting their complaints and suggestions, and taking measures. The efforts to solve the problems gradually started from the first hours of hospitalization and continued during the hospitalization. The welcoming nurse submitted the report of the performed activities once a week in the form of 3 lists: the list of patients admitted to the center, the registration form for trainings and daily visits to patients, and the weekly report form to the nursing office. Updating educational pamphlets in different departments, preparing brochures specific for each department (including the names of treatment team, working hours, etc.) to be available to patients, group training (e.g., relaxation and anger control methods) for patients in the evening shift, group education for patients about planning and goals after discharge, reopening of complaints and suggestions boxes and raising issues with ethical content in the ethics committee, and holding various festivals to maintain the motivation of patients were other activities of the welcoming unit. For internal evaluation, a survey form with 5 open-ended questions was designed to measure the perceptions of patients and their families. The answers of the participants were collected and analyzed by the content analysis method. 

Results
Since the beginning of the project to the end of the year (September- December 2017), 540 patients transferred from the outpatient unit and emergency ward to the hospitalized wards were welcomed by the appointed nurse. In 2018, a total of 1167 new patients received the welcoming program. In 2019, about 1000 new patients received the welcoming program. The results of the internal evaluation showed that 92% of patients and their families were satisfied with the welcoming program and perceived it as very good to excellent. In terms of amenities and facilities of the departments, 46% suggested the need for restoration, reconstruction and making changes in the facilities. Half of the patients and their families (50%) believed that some nurses were caring and some were careless and did not deal with problems well. They were not satisfied with the psychiatrists and thought that psychiatrists and psychologists do not spent enough time with them patient, and believed that their visit were done very late and wanted to shorten the time between each visit. Regarding suggestions for improving the performance and quality of the services, 58% suggested to treat the patient sincerely and the behaviors of doctors’ assistant and the staff with the patient should be more suitable. They also emphasized the need to increase the physical activity program and the possibility of providing art therapy to the patients. Regarding educational needs, 50% of the respondents raised the need for education in the field of addiction, mental disorders, drugs, and their side effects.

Conclusion
For treatment of people with mental disorders, a good welcoming is of particular importance due to the complex nature of the disease, forced hospitalization in many cases, and interpersonal relationship problems caused by the disease. It seems that, to facilitate and create better hospitalization conditions, the use of a welcoming nurse upon admission and during hospitalization can solve many problems for them. The perceptions of the patients and their families showed that, in general, the patients are satisfied with the performance of the welcoming nurse at the beginning of admission and during hospitalization and her follow-ups. Most of patients needed more education about mental disorders, medications, and follow-up of treatment. 

Ethical Considerations
Compliance with ethical guidelines
This article is a meta-analysis with no human or animal sample. There were no ethical considerations to be considered in this research.

Funding
This study was funded by Iran University of Medical Sciences.

Authors' contributions
Conceptualization and supervision: Zahra Talebnia and Amir Abbas keshavarzakhlaghi; Methodology:Malihe Ranjbar and Mojgan Maghroor; Writing and editing: Zahra Talebnia, Fariba Masoumi and Mojgan Maghroor; Data collection and analysis: Malihe Ranjbar, Mojgan Maghroor and Fariba Masoumi; Funding acquisition: Amir Abbas keshavarzakhlaghi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the personnel of Iran Psychiatry Center, and all patients for their support and cooperation.


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