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Pedersen ML, Gildberg FA, Bogh SB, Birkeland S, Tingleff EB. Staff responses to interventions aiming to reduce mechanical restraint in adult mental health inpatient settings: a questionnaire-based survey. Nord J Psychiatry 2024:1-11. [PMID: 38436663 DOI: 10.1080/08039488.2024.2323125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. METHODS We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use. Participants were asked to rate and rank the interventions based on their viewpoints regarding the relevance and importance of each intervention. RESULTS A total of 128 mental health staff members from general and forensic mental health inpatient units across the Mental Health Services in the Region of Southern Denmark completed the questionnaire (response rate = 21.3%). A total of 90.8% of the ratings scored either 'agree' (45.2%) or 'strongly agree' (45.6%) concerning the relevance of the interventions in reducing MR use. Overall and in the divided analysis, interventions labelled as 'building relationship' and 'patient-related knowledge' claimed high scores in the staff's rankings of the interventions' importance concerning implementation. Conversely, interventions like 'carers' and 'standardised assessments' received low scores. CONCLUSIONS The staff generally considered that the interventions were relevant. Importance rankings were consistent across the divisions chosen, with a range of variance and dispersion being recorded among certain groups.
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Affiliation(s)
- Martin Locht Pedersen
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Søren Bie Bogh
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, /Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Birkeland
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, /Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
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Vestphal TK, Tingleff EB, Jørgensen R, Rowaert S, Gildberg FA. Tilting at Windmills - A Qualitative Study about Family Caregiver Interactions and Perceptions in Forensic Mental Health Care. Issues Ment Health Nurs 2024; 45:322-330. [PMID: 38412043 DOI: 10.1080/01612840.2024.2308544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
In forensic mental health care (FMHC), family caregivers perceive themselves as burdened in their relationships with the service user (the family member with mental illness) and by difficult collaboration with healthcare professionals (HCPs). There is a political objective to involve this group in the care and treatment of the service user in mental health care. To improve family caregiver involvement in care and treatment in FMHC, research about their perceptions is needed. This study aims to explore family caregivers' perceptions of their interactions with the service user and HCPs. The method used was qualitative. Semi-structured, in-depth interviews with 12 family caregiver participants were carried out and analyzed thematically. The analysis resulted in three interrelated main themes: Strategies to normalize everyday living; Distrust of the quality of care; and Loss and grief. Family caregiver feelings of loss and grief may be suppressed, which additionally could prevent them from supporting the service user.
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Affiliation(s)
- Tina Kirstine Vestphal
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sara Rowaert
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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Hellzén O, Hammarström L, Ekman O, Devik SA. A Meta-Ethnographic Review of Forensic Psychiatry Inpatient Care. Nursing Staff Experiences of the Nurse-Patient Encounter. Issues Ment Health Nurs 2023; 44:1226-1236. [PMID: 37801705 DOI: 10.1080/01612840.2023.2259997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
AIM The aim of this review was to synthesise qualitative research into how nurses perceive and experience encountering patients in forensic inpatient care. REVIEW METHOD This review followed the steps of meta-ethnography developed by Noblit and Hare. DATA SOURCES Twelve studies, published from 2011 to 2021, were identified through a search of relevant databases in December 2021. FINDINGS The synthesis revealed three third-order and 10 second-order constructs during the translation of concepts in the studies. These are: Adopting the patient's perspective (liberation, comprehension and resistance), Action (security, trust, flexibility and predictability) and Activation (afraid or safe, involved or indifferent and boundaries). Further, a line of argument was developed which indicates that in forensic psychiatry inpatient care, nurses experience having to deal with internal and external resistance that affects their freedom of choice in the creation of a caring relationship. CONCLUSION The encounter is experienced as a continuous process in which the foundation is laid for the encounter (approach), the encounter unfolds and develops (action) and the nurse experiences the encounter (activation). The process is intertwined with and takes place in a context where care is influenced by the duality of the task (task), the culture of care (context), the patient's expression (patient) and the nurse's own impression of the patient's expression (oneself). IMPLICATIONS Professional communities should support initiatives that can strengthen nurses' self-awareness and provide opportunities for reflection on practice, which will both benefit the resilience of the nursing staff and the quality of care for patients in this setting.
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Affiliation(s)
- Ove Hellzén
- Department of Nursing Science, Mid-Sweden University, Sundsvall, Sweden
| | - Lars Hammarström
- Department of Nursing Science, Mid-Sweden University, Sundsvall, Sweden
| | - Oliva Ekman
- Campus Library, Mid-Sweden University, Sundsvall, Sweden
| | - Siri Andreassen Devik
- Centre for Care Research, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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Alkier Gildberg F, Wilson R. Scientific models for qualitative research: a textual thematic analysis coding system - Part 1. Nurse Res 2023; 31:36-42. [PMID: 37254707 DOI: 10.7748/nr.2023.e1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 07/14/2023]
Abstract
BACKGROUND Models are central to the acquisition and organisation of scientific knowledge. However, there are few explanations of how to develop models in qualitative research, particularly in terms of thematic analysis. AIM To describe a new technique for scientific qualitative modelling: the Empirical Testing Thematic Analysis (ETTA). Part 2 describes the ETTA model. DISCUSSION ETTA generates a semantic structure expressed through theme-code, content and functionality. It highlights the importance of authenticity markings and taxonomical and functional semantic analysis. Its primary advantage is the sequential need to account for taxonomic analysis, functionality factors, preconditioning items, cascade directories and modulation factors; this results in the production of a sound, systematic, scientific development of a model. CONCLUSION ETTA is useful for nurse researchers undertaking qualitative research who want to construct models derived from their investigations. IMPLICATIONS FOR PRACTICE This article provides a step-by-step approach for researchers undertaking research that culminates in the construction of a model derived from qualitative investigations.
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Affiliation(s)
- Frederik Alkier Gildberg
- Forensic Mental Health Research Unit, Middelfart, Faculty of Health Science, Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Rhonda Wilson
- University of Newcastle School of Nursing and Midwifery, Callaghan, NSW, Australia
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Vestphal TK, Gildberg FA, Jørgensen R, Rowaert S, Tingleff EB. Experiences of family caregivers in forensic mental health care-A qualitative evidence synthesis. J Psychiatr Ment Health Nurs 2023. [PMID: 36739887 DOI: 10.1111/jpm.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Internationally, research and policy agendas recommend that family caregivers of service users in mental health care be involved in care and treatment, to support the service user's recovery process. Family caregivers of service users in mental health care are often highly burdened. There is a lack of research-based knowledge about the experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE This study indicates a persistent caregiver presence and/or caregiver advocacy in regard to care and treatment of the service user in FMHC. This study indicates that health care professionals (HCPs) might play a role in eliciting a persistent caregiver presence and/or caregiver advocacy. WHAT ARE THE IMPLICATIONS FOR PRACTICE HCPs need to develop their collaborative skills and be more willing to listen to and understand caregivers' persistent presence and/or advocacy. HCPs need to be more skilled to understand caregivers' and families' living with the complexities of mental illness and offence. HCPs are encouraged to adjust the involvement of family caregivers in care and treatment to FMHC. ABSTRACT Introduction There is a lack of research about experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. Research shows that caregivers are burdened. Further knowledge is required, to provide a foundation for improving clinical practice. Aim To review research literature, to investigate existing knowledge about caregiver experiences and, secondly, caregivers' experiences of facilitators and barriers related to their involvement in care and treatment. Method Qualitative evidence synthesis undertaken in a thematic synthesis of thirteen peer-reviewed studies. Results The analysis identified three descriptive themes: violence against family; a great burden of responsibility; and difficult collaboration, together with an additional three analytical themes: bearing witness; persistent presence; and advocacy becomes necessary. Discussion Persistent caregiver presence and/or caregiver advocacy may be elicited by health care professionals' (HCPs') exclusion of caregivers from care and treatment. Caregivers' feelings of guilt in relation to the service user's offence may play an additional role in persistent presence and advocacy and, therefore, in HCPs' exclusion of them. Implications for Practice HCPs need to develop their collaboration with caregivers by their willingness to listen to caregivers to understand emotional complexities within families experiencing mental illness and offence.
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Affiliation(s)
- Tina Kirstine Vestphal
- Department of Regional Health Research, Forensic Mental Health Research Unit Middelfart (RFM), Faculty of Health Sciences, University of Southern Denmark, Middelfart, Denmark.,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Department of Regional Health Research, Forensic Mental Health Research Unit Middelfart (RFM), Faculty of Health Sciences, University of Southern Denmark, Middelfart, Denmark.,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sara Rowaert
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Gent, Belgium
| | - Ellen Boldrup Tingleff
- Department of Regional Health Research, Forensic Mental Health Research Unit Middelfart (RFM), Faculty of Health Sciences, University of Southern Denmark, Middelfart, Denmark.,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark.,OPEN, Odense Patient data Explorative Network Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Middelfart, Denmark
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Tingleff EB, Rowaert S, Vinding S, Vestphal TK, Wilson R, Gildberg FA. "It's still our child". A qualitative interview study with parent carers in forensic mental health. Arch Psychiatr Nurs 2022; 41:124-131. [PMID: 36428040 DOI: 10.1016/j.apnu.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 07/09/2022] [Indexed: 11/02/2022]
Abstract
The purpose of this study was to explore the experiences and perceptions of parents in forensic mental health services with regard to their cooperation with healthcare professionals and their role as parent carers. 15 participants were interviewed using qualitative, in-depth interviews and transcripts were analysed thematically. The identified themes were 'Medical dominance', 'Interactions with healthcare professionals', and 'Advocating for their daughter/son'. The themes were associated with the overall theme 'perceived impact on the parents' everyday lives'. The results suggest that parent carers perceive a malalignment between the institutional medicalised treatment focus and the need for an integrated holistic approach, which would include them as partners.
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Affiliation(s)
- Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Denmark; Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Denmark; Nursing Education, Vejle, and Health Sciences Research Center, UCL University College, Denmark; OPEN, Odense Service user data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Denmark.
| | - Sara Rowaert
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | - Stinne Vinding
- Nursing Education, Vejle, and Health Sciences Research Center, UCL University College, Denmark
| | - Tina Kirstine Vestphal
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Denmark; Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Rhonda Wilson
- School of Nursing and Midwifery, College of Health, Medicine, and Wellbeing, The University of Newcastle, Australia; School of Nursing, Massey University, New Zealand
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Denmark; Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Denmark
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Grabenstetter D, Rashid R, Whittle J. Using a process improvement approach to identifying barriers to research in a CTSA hub environment. J Clin Transl Sci 2020; 5:e30. [PMID: 33948253 DOI: 10.1017/cts.2020.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
For the past 4 years, as part of the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) grant award number UL1TR001436, the Clinical Translational Science Institute of Southeast Wisconsin (CTSI) has used process engineering approaches to identify and understand barriers that local researchers and other stakeholders face when engaging in clinical and translational science. We describe these approaches and present preliminary results. We identified barriers from published and unpublished work at other CTSA hubs, supplemented by surveys and semi-structured interviews of CTSI faculty. We then used a multifaceted approach to organize, visualize, and analyze the barriers. We have identified 27 barriers to date. We ranked their priority for CTSI to address based on the barrier's impact, the feasibility of intervention, and whether addressing the barrier aligned with CTSI's institutional role. This approach provides a systematic framework to scope and address the "barriers to research problem" at CTSI institutions.
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Abstract
Purpose: Nurses working in forensic psychiatry often encounter offenders who have a severe mental illness, which may cause ethical challenges and influence nurses' daily work. This study was conducted to illuminate the meaning of nurses' lived experiences of encounters with patients with mental illnesses in forensic inpatient care. Methods: This qualitative study employed narrative interviews with 13 nurses. Interviews were audiotaped and transcribed verbatim and analysed following a phenomenological-hermeneutic approach. Results: Four key themes were revealed: "Being frustrated" (subthemes included "Fighting resignation" and "Being disappointed"), "Protecting oneself" (subthemes included "To shy away," "Being on your guard," and "Being disclosed"), "Being open-minded" (subthemes included "Being confirmed," "Developing trust," and "Developing compassion"), and "Striving for control" (subthemes included "Sensing mutual vulnerability" and "Regulating oneself"). Further, working in forensic psychiatry challenged nurses' identity as healthcare professionals because of being in a stressful context. Conclusions: Dealing with aggressive patients with severe mental illnesses threatens nurses' professional identity. Nurses must attempt to empathize with patients' experiences and respond accordingly. Utilizing strategies rooted in compassion such as self-reflection, emotional regulation, and distancing themselves when necessary may enable nurses to more effectively respond to patients' needs.
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Affiliation(s)
- Lars Hammarström
- Department of Nursing, Mid-Sweden University , Sundsvall , Sweden
| | - Marie Häggström
- Department of Nursing, Mid-Sweden University , Sundsvall , Sweden
| | | | - Ove Hellzen
- Department of Nursing, Mid-Sweden University , Sundsvall , Sweden
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