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Mooney M, Kanyeredzi A. 'You get this conflict between you as a person and you in your role…that changes you': A thematic analysis of how inpatient psychiatric healthcare staff in the UK experience restraint, seclusion, and other restrictive practices. Int J Ment Health Nurs 2021; 30:1703-1712. [PMID: 34494346 DOI: 10.1111/inm.12926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
A high proportion of psychiatric inpatients experience Restrictive Practice (RP) during admission. Numerous reports have highlighted adverse effects on patients and staff. However, qualitative research focussed on experience, impact, and coping mechanisms of healthcare staff in the UK is limited. Therefore, this study explored psychiatric healthcare staff experience of RP on inpatient wards in the UK. Eight semi-structured, audio-recorded interviews, of ~60 min, were conducted via telephone/Skype and transcribed verbatim. A critical realist epistemology was used to thematically analyse data. Three themes were identified: the coexistence of accountability, power and subjection; impacts on the individual and professional relationships, and coping with difficult experiences and emotions. Restrictive practice can negatively affect staff experience, working relationships, and wellbeing. Opportunities for support could mediate adverse effects. Future research could further explore coping mechanisms and organizational factors contributing to negative staff experiences.
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Wiklund Gustin L. " Being mutually involved in recovery". A hermeneutic exploration of nurses' experiences of patient participation in psychiatric care. Int J Qual Stud Health Well-being 2021; 16:2001893. [PMID: 34823447 PMCID: PMC8843384 DOI: 10.1080/17482631.2021.2001893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose This study aims at exploring how psychiatric nurses’ experiences of patient participation could be understood from a caring science perspective. Methods The design was inspired by clinical application research., which is a hermeneutic approach developed within caring science research. . In this study data were co-created during four reflective group dialogues where five participants’ experiences of patient participation were reflected on in the light of caring science theory and research. The transcribed dialogues were subjected to a thematic, hermeneutic interpretation. Results The interpretation gave rise to three themes; giving room for the patient to find his/her own pathway, strengthening personhood, and being in a balanced communion. From these themes an underlying pattern of the meaning of participation as being mutually involved in the patients’ process of recovery arose. Conclusion From a caring science perspective the meaning of psychiatric nurses experiences of patient participation could be understood as an interpersonal process reflecting the reciprocity in human relationships. This means a shift in understanding of patient participation from procedures related to the planning of nursing care, to understanding participation as a process focusing on the mutual involvement of patients and nurses in the patients’ process of recovery.
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Affiliation(s)
- Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University Sweden, Västerås, Sweden.,Department of Health and Care Sciences, UiT/The Arctic University of Norway, Tromsø, Norway
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Lindgren BM, Molin J, Graneheim UH. Balancing between a Person-Centred and a Common Staff Approach: Nursing Staff's Experiences of Good Nursing Practice for Patients Who Self-Harm. Issues Ment Health Nurs 2021; 42:564-572. [PMID: 32937081 DOI: 10.1080/01612840.2020.1817206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to describe nursing staff's experiences of good nursing practice in psychiatric in-patient care for patients with self-harming behavior. The participants were nine nurses and eight nursing assistants working in two in-patient wards in general psychiatry. Four focus group discussions were held and subjected to qualitative content analysis. The findings showed that good nursing practice balanced a person-centred approach with a common staff approach, allowing people who self-harm and staff to share responsibility for structuring everyday life, keeping to the plan, communicating decisions, and finding individual opportunities for relief. Reflective discussions among the staff concerning prejudice, emotional stress, lack of resources, and shortcomings in care planning could also prevent a stigmatizing culture and organizational deficiencies, which would be beneficial for both the people who self-harm and the staff.
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Affiliation(s)
| | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Ulla H Graneheim
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
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Gerritsen S, Widdershoven G, van der Ham L, van Melle L, Kemper M, Voskes Y. Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations. Int J Ment Health Nurs 2021; 30:317-325. [PMID: 32936986 PMCID: PMC7891438 DOI: 10.1111/inm.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.
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Affiliation(s)
- Sylvia Gerritsen
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Guy Widdershoven
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Lia van der Ham
- Low Vision ResearchOphthalmologyAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Laura van Melle
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Institute for Medical Ethics and History of MedicineRuhr University BochumBochumGermany
| | | | - Yolande Voskes
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- GGZ BreburgTilburgThe Netherlands
- Tranzo, Tilburg UniversityTilburgThe Netherlands
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5
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Huber MA, Metze RN, Stam M, Regenmortel TV, Abma TA. Self-managed programmes in homeless care as (reinvented) institutions. Int J Qual Stud Health Well-being 2020; 15:e1719002. [PMID: 31973667 PMCID: PMC7034469 DOI: 10.1080/17482631.2020.1719002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose: Self-managed institutional homeless programmes started as an alternative to regular shelters. Using institutional theory as a lens, we aim to explore the experiences of stakeholders with the institutional aspects of a self-managed programs.Method: The data we analysed (56 interviews, both open and semi-structured) were generated in a longitudinal participatory case-study into JES, a self-managed homeless shelter. In our analysis we went back and forth between our empirical data and theory, using a combination of systematic coding and interpretation. Participants were involved in all stages of the research.Results: Our analysis revealed similarities between JES and regular shelters, stemming from institutional similarities. Participants shared space and facilities with sixteen people, which caused an ongoing discussion on (enforcement of) rules. Participants loathed lack of private space. However, participants experienced freedom of choice over both their own life and management of JES and structures were experienced more fluid than in regular care. Some structures also appeared stimulated self-management.Conclusion: Our analysis showed how an institutional context influences self-management and suggested opportunities for introducing freedom and fluidity in institutional care.
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Affiliation(s)
- Max A. Huber
- Research Center for Societal Innovation, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Rosalie N. Metze
- Research Center for Societal Innovation, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Martin Stam
- Research Center for Societal Innovation, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Tine Van Regenmortel
- Academic Collaborative Center for Social Work, Tilburg University, Tilburg, The Netherlands
- HIVA Research Institute for Work and Society, Catholic University Leuven, Leuven, Belgium
| | - Tineke A. Abma
- Department of Medical Humanities, Free University Amsterdam, Amsterdam, The Netherlands
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6
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Wiklund Gustin L. Compassion for self and others as key aspects of well-being in changing times. Scand J Caring Sci 2017; 31:427-433. [DOI: 10.1111/scs.12536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lena Wiklund Gustin
- School of Health; Care and Social Welfare; Mälardalen University Sweden; Västerås Sweden
- Department of Health and Care Sciences; UiT/The Archtic University of Norway; Campus Narvik Norway
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Looi GME, Sävenstedt S, Engström Å. "Easy But Not Simple"--Nursing Students' Descriptions of the Process of Care in a Psychiatric Context. Issues Ment Health Nurs 2016; 37:34-42. [PMID: 26818931 DOI: 10.3109/01612840.2015.1085607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The nurse-patient interaction is the cornerstone of psychiatric care, yet the concept "mental health nursing" is difficult to describe. This article aims to address this problem through the experiences of nursing students. Online journals from 14 nursing students were analyzed using qualitative content analysis, resulting in three categories: Trusting the Trusting Relationship, Voicing the Unspoken Needs, and Balancing the Dynamics of Doing and Being. This study demonstrates that providing nursing care based on trusting relationships is not a demanding task, but it takes place in a complex environment that has a tendency to make easy things complicated.
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Affiliation(s)
| | - Stefan Sävenstedt
- a Luleå University of Technology , Department of Health Sciences , Luleå , Sweden
| | - Åsa Engström
- a Luleå University of Technology , Department of Health Sciences , Luleå , Sweden
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8
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Johansson L, Wiklund-Gustin L. The multifaceted vigilance - nurses' experiences of caring encounters with patients suffering from substance use disorder. Scand J Caring Sci 2015; 30:303-11. [PMID: 26058468 DOI: 10.1111/scs.12244] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 04/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nursing care is guided by a value base focusing on promoting dignity and health by means of the caring relationship. However, previous research has revealed that negative attitudes towards 'addicted' patients, as well as these patients' behaviour, can give rise to negative emotions such as frustration and disappointment among nurses. This can contribute to a judgmental and controlling attitude towards patients. To preserve order, nursing interventions focusing on creating structure and stability could be applied in a way that challenges caring values. AIMS AND OBJECTIVES This study aimed to describe how nurses' working in inpatient psychiatric care experience caring encounters with patients suffering from substance use disorder (SUD). DESIGN This qualitative study is part of a clinical application project focusing on value-based care of patients suffering from SUD. Data were obtained during four reflective group dialogues with six nurses in a psychiatric hospital. METHODS The transcribed dialogues were subjected to latent qualitative content analysis. RESULTS The analysis facilitated the organisation of the findings into a coherent pattern. A common thread of meaning was conceptualised as a theme labelled 'the multifaceted vigilance', describing how nurses strived to deliver good care, while at the same time being vigilant towards patients' behaviour as well as their own reactions to it. Within that theme, four categories described experiences related to different challenges nurses face in caring encounters. CONCLUSION We suggest that this perhaps unavoidable aspect of caring encounters can be an asset. Thus, if acknowledged and subject to reflection, being vigilant could be understood as a strength enabling nurses to safeguard caring values, and to use their authority to promote patients' health and alleviate suffering.
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Affiliation(s)
| | - Lena Wiklund-Gustin
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Faculty of Health and Society, Narvik University College, Narvik, Norway
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Vincze M, Fredriksson L, Wiklund Gustin L. To do good might hurt bad: exploring nurses' understanding and approach to suffering in forensic psychiatric settings. Int J Ment Health Nurs 2015; 24:149-57. [PMID: 25639292 DOI: 10.1111/inm.12116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients in forensic psychiatric settings not only have to deal with their mental illness, but also memories of criminal activities and being involuntarily hospitalized. The aim of the present study was to explore how nurses working in forensic psychiatric services understand and approach patients' experiences of suffering. Data were generated by semistructured interviews with psychiatric nurses from two different forensic psychiatric units in Sweden. Data were analysed by means of a hermeneutic approach inspired by Ricoeur's hermeneutics. The findings are reflected in four main themes: (i) ignoring suffering; (ii) explaining suffering as a natural and inevitable part of daily life in the forensic context; (iii) ascribing meaning to suffering; and, (iv) being present in suffering. To engage in alleviating suffering is a struggle that demands courage and the strength to reflect on its character and consequences. To encounter suffering means that nurses are not only confronted with patients' suffering, but also their own reactions to those patients. If suffering is not recognized or encountered, there is a risk that actions may have a negative impact on patients.
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Enarsson P, Sandman PO, Hellzén O. "They can do whatever they want": Meanings of receiving psychiatric care based on a common staff approach. Int J Qual Stud Health Well-being 2011; 6:10.3402/qhw.v6i1.5296. [PMID: 21383956 PMCID: PMC3048893 DOI: 10.3402/qhw.v6i1.5296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2010] [Indexed: 11/30/2022] Open
Abstract
This study deepens our understanding of how patients, when cared for in a psychiatric ward, experience situations that involve being handled according to a common staff approach. Interviews with nine former psychiatric in-patients were analyzed using a phenomenological-hermeneutic method to illuminate the lived experience of receiving care based on a common staff approach. The results revealed several meanings: discovering that you are as subjected to a common staff approach, becoming aware that no one cares, becoming aware that your freedom is restricted, being afflicted, becoming aware that a common staff approach is not applied by all staff, and feeling safe because someone else is responsible. The comprehensive understanding was that the patient's understanding of being cared for according to a common staff approach was to be seen and treated in accordance with others' beliefs and valuations, not in line with the patients' own self-image, while experiencing feelings of affliction.
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Affiliation(s)
- Per Enarsson
- Department of Nursing and Care, Katrineholm Municipality, Sweden
- Department of Advanced Nursing, Umeå University, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ove Hellzén
- Faculty of Health and Science, Nord-Trøndelag University College, Namsos, Norway
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11
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Lindgren BM, Åström S, Graneheim UH. Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers. Int J Qual Stud Health Well-being 2010; 5:10.3402/qhw.v5i3.5482. [PMID: 20877586 PMCID: PMC2946865 DOI: 10.3402/qhw.v5i3.5482] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/31/2010] [Accepted: 09/02/2010] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to discover and describe lived experiences of professional care and caregivers among parents of adults who self-harm. Narrative interviews were conducted with six parents of daughters with self-harming behaviours and analysed using a phenomenological hermeneutic approach. The meanings of the parents' narratives of their lived experiences of professional care and caregivers were interpreted as their being involved in 'limit situations' comparable to hostage dramas. Several meaningful themes contributed to this interpretation: being trapped in a situation with no escape; being in the prisoner's dock; groping in the dark; and finding glimmers of hope. Parents of daughters who were in care because of self-harming often felt obliged to pay an emotional ransom, which included feelings of being accused, being 'broken', being confused, and feeling lost. Moments of peace occurred as welcome breaks offering a short time of rest for the parents. Situations that were understood by the parents and solved in a peaceful way were experienced as a respite and inspired parents with hope for their daughters' recovery.
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Affiliation(s)
| | - Sture Åström
- Department of Nursing, Umeå University, Umeå, Sweden
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