Self-coherence, emotional arousal and perceived health of adult children caring for a brain-impaired parent

Professional vulnerability in mental healthcare contexts: A focus group study of milieu-therapists' experiences

AIMS AND OBJECTIVES

To gain insight into how the workplace influences milieu-therapists' vulnerability in the mental healthcare context.

BACKGROUND

Mental health services have experienced substantial changes. Reduced institutional treatment capacity is replacing the development of locally based treatment. Changes in external conditions in mental health services have influenced the working conditions of nurses and milieu-therapists.

DESIGN

Qualitative design. The study complied with the COREQ checklist.

METHODS

Focus group interviews.

RESULTS

"Vulnerability due to unpredictable and threatening working context" was the common key theme that emerged in both contexts. Two key themes were different and opposite. In municipal mental health care, "Alone and unprotected" and in institutional care, "Together and protected."

CONCLUSION

The participants from both specialized and community mental health care, experienced vulnerability at different levels interpreted as a contradictory relationship between the healthcare system and their own ideals of what professional practice ought to be.

RELEVANCE TO CLINICAL PRACTICE

This study contributes to extended knowledge and understanding about the experienced influence of the working environment on professional vulnerability of nurses and milieu-therapists` in mental health services. The impact of contextual conditions on health professionals' working conditions has multi-professional relevance for milieu-therapists and managers of mental health services, and it is an important topic in health and social higher education.

Imminent concerns of filial caregivers reporting recent experiences of crisis

The purpose of this descriptive study was to generate information about imminent concerns of adult children that could serve as initial context for development of a meaningful framework for coping with an ongoing parent care situation. Ninety-two adult children pre-selected for self-reports of crisis were interviewed about their concerns and goals for caregiving and asked to discuss experiences of crisis in the previous six months of caregiving. Key issues pertaining to their experiences were extracted from notes of the interviews and classified according to their common properties. Cohen's kappa for interrater reliability of the classifications was .79 while percentage agreement was 98 percent. The results of the study point to the presence of multiple issues pertaining to significant life and death events, relational burdens, early experiences with the family of origin, and focal patterns of distress and coping. Synthesis of the findings reveals overriding concerns for making improvements in one's family of origin, created family of adulthood, and middle-aged self. Findings have implications for experiential adult education in the area of filial maturity and caregiving.