Implementing and evaluating patient-focused safety technology on adult acute mental health wards

WHAT IS KNOWN ON THE SUBJECT

Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines.

ABSTRACT

INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives.

AIM

Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff.

METHOD

Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits.

RESULTS

Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns.

DISCUSSION

Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context.

IMPLICATIONS FOR PRACTICE

The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.

Exploring individuals' experiences of hope in mental health recovery: Having a sense of possibility

WHAT IS KNOWN ON THE SUBJECT?: Mental health recovery is acknowledged as a process of transformation and a way of living a meaningful life despite the presence of mental ill-health. Experiencing hope has been articulated as intrinsic to service users experience of a meaningful life. The social construction of mental illness and stigma are recognised as barriers to experiencing hope. Mental health professionals have responsibility to positively influence the experience of hope. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: Individuals in mental health recovery experience hope as the embodiment of having a sense of possibility in life. Individuals' sense of possibility in life is underpinned by a belief and confidence that they will be ok. This belief is informed by 'feeling safe' and 'feeling connected'. This article generates an increased understanding of the dynamic relational processes that unpin hope generation. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health stakeholders need to be more explicit in exploring 'hope' and uncovering its therapeutic potential. Mental health practitioners need skill in enabling individuals to feel safe and connected while understanding its role in cultivating hope. ABSTRACT: Introduction The experience of hope is widely acknowledged and empirically supported as a key catalyst of mental health recovery. Lived experience accounts of hope are critical in accessing data on what has been termed a nebulous concept. This article is the second presentation of data from this study and provides further context to improve understanding of hope and optimise its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative Interpretative Phenomenological Analysis (IPA) approach was used. Results This article explores the second of three experiential group themes: Hope as Having a sense of possibility 'I will be ok' which is informed by feeling safe and feeling connected. Discussion Having a sense of possibility is easier when basic needs are met and people feel connected to self, others and the universe. The use of creativity as a pathway to the imagination is positively experienced. The role of family, friends and healthcare professionals as hope reservoirs is critical. Finally, the framing of medication use emerged as significant. Implications for Practice It is important that all stakeholders appreciate the interpretation of hope and use the understanding and skill in harnessing its therapeutic potential.

The role of nurse-client relationships in maternal and child healthcare: a qualitative study in rural Tanzania

Background

The literature suggests that poor provider-client relationships in maternal and child healthcare (MCH) continue to impact healthcare service uptake, continuity of care, and MCH outcomes. However, there is a paucity of literature on the benefits of the nurse-client relationship for clients, nurses, and the health system, particularly in rural African contexts.

Objective

This study examined the perceived benefits and disadvantages of good and poor nurse-client relationships in rural Tanzania respectively. We present the findings of a community-driven inquiry that was the first step of a broader study that sought to co-design an intervention package for strengthening nurse-client relationships in MCH in rural contexts using a human-centred design approach.

Methods

This study used a qualitative descriptive design. Nine focus group discussions and 12 key informant interviews were conducted using semi-structured interview guides. Participants were purposefully selected nurses/midwives and clients attending MCH services, and MCH administrators. Data were managed using NVivo and analysed thematically.

Results

A range of perceived benefits of good nurse-client relationships and disadvantages of poor relationships emerged. Perceived benefits of good nurse-client relationships included: (i) benefits to clients (increased healthcare-seeking behaviours, disclosure, adherence, return to care, positive health outcomes, and referral tendencies); (ii) benefits to nurses (increased confidence, efficiency, productivity, job satisfaction, trust, and community reputation and support); and (iii) benefits to healthcare facilities/systems (increased client load and consequently income, fewer complaints and legal disputes, increased trust and facility delivery, and reduced maternal and child deaths). The disadvantages of poor nurse-client relationships were basically the opposite of their benefits.

Conclusion

The benefits of good nurse-client relationships and the disadvantages of poor relationships extend beyond patients and nurses to the healthcare system/facility level. Therefore, identifying and implementing feasible and acceptable interventions for nurses and clients could pave the way for good nurse-client relationships, leading to improved MCH outcomes and performance indicators.

The role of Mental Health Care Act status in dignity-related complaints by psychiatric inpatients: A cross-sectional analytical study

Background

Globally interest has grown in promoting the rights of patients, especially psychiatric patients. Two core elements of patients’ rights are the rights to be treated in a dignified manner and to give feedback about services. Psychiatric patients may feel treated in an undignified manner, especially during involuntary hospital admissions.

Aim

We explored the relationship between Mental Health Care Act 17 of 2002 (MHCA) status and dignity-related complaints.

Setting

The study was conducted at a specialist state psychiatric hospital.

Methods

We reviewed 120 registered complaints by psychiatric inpatients, retrieved the clinical files, and analysed 70 complaints. Fisher’s exact tests described the relationship between patients’ MHCA status and the frequency of dignity-related or other categories of complaints. Logistic regression analyses were adjusted for potential covariates.

Results

Most complaints were from single, literate male patients, aged 30–39 years, with mood disorders. Most complainants were admitted involuntarily (60%). Dignity-related complaints (n = 41; 58%) outnumbered nondignity-related complaints (n = 29; 41%). The proportion of dignity-related complaints was higher in involuntary (64%) and assisted (60%) patients than in voluntary patients (44%). Dignity-related complaints were not significantly associated with MHCA status (χ² = 2.03 and p = 0.36). Involuntary patients were more than twice as likely as assisted and voluntary patients to complain about dignity-related matters (Odds ratio [OR]: 2.25; 95% confidence interval [CI] [0.71; 7.13]; p = 0.16).

Conclusion

Involuntary patients are more likely to complain about dignity-related matters. Qualitative research is recommended for a deeper understanding of patients’ experiences during admission.

Understanding the lived experiences of healthcare professionals during the COVID-19 pandemic: an interpretative phenomenological analysis

Background: Little research has examined the impact of working within the context of COVID-19 on UK healthcare professionals (HCPs) mental health and well-being, despite previous pandemic findings indicating that HCPs are particularly vulnerable to suffering PTSD and other mental health difficulties due to the nature of healthcare work. Specifically, it appears that no research has employed qualitative methodologies to explore the effects of working amidst COVID-19 on mental health for HCPs in the UK. Objective: To qualitatively examining the lived experiences of HCPs in Northern Ireland, working during the early stages of the pandemic and lockdown period (14.04.20 and 29.04.20). Method: Interpretative phenomenological analysis (IPA) was used to explore the experiences of healthcare professionals, who were working during the COVID-19 outbreak. Ten HCPs were recruited via a social media campaign and snowball sampling. All interviews were conducted via telephone and transcribed verbatim. Results: Three superordinate themes with subordinate themes were elicited through the analysis. Theme one centred on specific challenges of HCPs working during the pandemic, such as redeployment, isolation from loved ones, infection concerns, lack of PPE and impact on patient interpersonal care. Theme two offered insights into the mental health and wellbeing of HCPs, while many experienced feelings of fear, sadness and hypervigilance, all also demonstrated a marked resilience. Finally, many felt undervalued and misunderstood, and wished to press upon the general public seriousness of the disease. Conclusion: To the authors' knowledge this is the first study to explore in depth, the unique experiences of frontline HCPs in Northern Ireland, offering a detailed account of the challenges confronted in these unprecedented circumstances and highlighting support needs within this cohort.

Assessing trustworthiness: Marginalized youth and the central relational paradox in treatment

Marginalized youth are at elevated risk for mental health difficulties, yet they encounter numerous barriers to engagement with mental health services. Past negative experiences with family, social workers, and systems of care contribute to distrust of service providers and ambivalence about engaging in trusting relationships with adults. This longitudinal qualitative study explored how marginalized youth living with mental health conditions make decisions about trust in their relationships with helping professionals. Semi-structured, open-ended in-depth interviews were conducted with 13 young women living with a mood or anxiety disorder, exploring trust, mutuality, and disconnection in relationships between marginalized youth and helping professionals. Eleven of the participants also participated in a second interview, 3 months later, that explored participants' relationships with friends and family. Transcripts were analyzed using thematic analysis and interpreted through the lens of relational-cultural theory. Results indicated that the majority of interview participants described feeling unseen, judged, or invalidated in their relationships with family members. Four themes emerged as factors in the assessment of the trustworthiness of service providers: genuine caring; understanding; non-judgmental acceptance; and adult respect for youth agency. Concerns about confidentiality and mandated reporting informed participants' decisions about disclosure in these relationships. Analysis of findings reveals evidence of the central relational paradox in these descriptions of helping relationships, reflecting the simultaneous appeal and peril of vulnerability in relationships, especially relationships characterized by power differentials. Findings suggest that practitioners working with marginalized youth can expect both openness and guardedness in the treatment relationship.

'Like a human being, I was an equal, I wasn't just a patient': Service users' perspectives on their experiences of relationships with staff in mental health services

OBJECTIVES

The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users' in-depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change.

DESIGN

The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users' experiences and perceptions of their relationships with mental health practitioners.

METHODS

Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data.

FINDINGS

Three superordinate themes emerged from the analysis. These were (1) Trying to survive: am I a person or just an object in the system?; (2) Traumatic experiences within relationships; and (3) Helpful and transformative relationships. Further, the key transformative components of these relationships were power, safety, and identity.

CONCLUSIONS

Mental health services should be more focused upon care, rather than control. The Power Safety Identity (PSI) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress.

PRACTITIONER POINTS

Awareness of the relational components of power, safety, and identity has the potential to help practitioners reflect upon the tensions they experience in their relationships with service users. Mental health services and professionals that are sensitive to issues related to power, safety, and identity when responding to the needs of the service users can improve how individuals perceive the quality of care provided by them. Relationships between service users and mental health practitioners can encourage recovery if they are consistent, safe, trusting, provide protective power, and mirror a positive sense of self.

Ethical Dilemmas of Participation of Service Users with Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed.

Professionals' Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services

This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care- and support-related aspects of life.

An interpretative phenomenological analysis of dignity in people with multiple sclerosis

BACKGROUND

Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice.

RESEARCH AIM

The aim was to explore the sense of dignity experienced by people with multiple sclerosis.

RESEARCH DESIGN AND PARTICIPANTS

An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants.

ETHICAL CONSIDERATIONS

The study was approved by the faculty Ethical Committee (No. EC 1828/2016).

FINDINGS

Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity.

DISCUSSION

Continual changes in functional ability threaten an individual's identity and were experienced as violations of dignity. Based on this, participant's dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation.

CONCLUSION

Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care.

Patients participating as co-researchers in health research: A systematic review of outcomes and experiences

Aims: We aimed to map out the scope and type of health research studies with patients involved as co-researchers throughout the research process and to explore the outcomes and experiences of such research. Methods: We conducted a narrative review by systematically searching selected databases. A total of 1451 hits were identified and screened, and 17 studies were included and categorised by type of health problem, design, publication sources and modes of presentation. We conducted an inductive, iterative analysis of outcomes and experiences of patient involvement. Results: We identified two types of impact from studies with patients participating as co-researchers: (a) patient involvement as primary focus, where seven articles largely reported and reflected upon the shared experiences, and (b) patient involvement as strategy, where 10 articles presented results from empirical studies of specific health problems, with patient involvement used as a strategy to expand understanding. The first group of studies reported collaborative processes and resource investments, while the second group addressed specific health problems from a distinctive perspective due to patient involvement. Several studies in both groups repeated or confirmed positive values of user involvement rather than providing original findings. In both groups, methodological standards were often downgraded to provide access for the co-researchers. Conclusions: These articles, where the co-researcher model represents the contemporary superior level of patient involvement, may indicate that mere collaboration efforts are prioritised at the expense of knowledge outcomes and scientific quality. Collaboration formats other than participation as co-researchers may be necessary for patient involvement in medical research to add to the existing knowledge.

Determinants of the quality of care relationships in long-term care - a participatory study

Background

The quality of the care relationship between a client and a professional is important in long-term care, as most clients depend on support for a lengthy period. The three largest client groups who receive long-term care in the Netherlands are older adults who are physically or mentally frail, people with mental health problems and people with intellectual disabilities. There is little clarity about how generic and variable the determinants of the quality of care relationships are across these client groups. The aim of this study is to explore and compare the determinants of the quality of care relationships in these three client groups in long-term care.

Methods

This participatory study involving clients as co-researchers was held in three healthcare organizations, each providing long-term care to one client group. The research was conducted by three teams consisting of researchers and co-researchers. We interviewed clients individually and professionals in focus groups. The focus was on care relationships with professionals where there is weekly recurring contact for at least 3 months. Clients and professionals were selected using a convenience sample. The interviews were coded in open, axial and selective coding. The outcomes were compared between the client groups.

Results

The study sample consisted of 30 clients and 29 professionals. Determinants were categorized into four levels: client, professional, between client and professional, and context. The findings show that the majority of the determinants apply to the care relationships within all three client groups. At the professional level, eleven generic determinants were found. Eight determinants emerged at the client level of which two were found in two client groups only. At the level between a client and a professional, six determinants were found of which one applied to mental healthcare and disability care only. Five determinants were found at the contextual level of which two were specific for two client groups.

Conclusions

The study yielded a variety of determinants that came to the fore in all three client groups in long-term care. This suggests that including a homogenous client group from a single care setting is not necessary when studying the quality of long-term care relationships.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4195-x) contains supplementary material, which is available to authorized users.

'Recovery' in the Real World: Service User Experiences of Mental Health Service Use and Recommendations for Change 20 Years on from a First Episode Psychosis

Little is known about how recovery oriented policy and legislative changes influence service users’ perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for ‘full functional recovery’ and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the ‘humanising’ of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation.

Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting

Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.

Reciprocity in therapeutic relationships: A conceptual review

Reciprocity has generally been understood as a process of giving and taking, within an exchange of emotions or services, and has long been recognized as a central part of human life. However, an understanding of reciprocity in professional helping relationships has seldom received attention, despite movements in mental health care towards more collaborative approaches between service users and professionals. In this review, a systematic search of the published papers was conducted in order to explore how reciprocity is conceptualized and understood as part of the dyadic therapeutic relationship between professionals and service users. Eleven papers met our inclusion criteria and a narrative synthesis was used to synthesize the key concepts of reciprocity. The concepts of: 'dynamic equilibrium', 'shared affect', 'asymmetric alliance', and 'recognition as a fellow human being' were recurrent in understandings of reciprocity in professional contexts. These conceptualizations of reciprocity were also linked to specific behavioural and psychological processes. The findings suggest that reciprocity may be conceptualized and incorporated as a component of mental health care, with recurrent and observable processes which may be harnessed to promote positive outcomes for service users. To this end, we make recommendations for further research to progress and develop reciprocal processes in mental health care.

The significance of small things for dignity in psychiatric care

Background:

This study is based on the ontological assumption about human interdependence, and also on earlier research, which has shown that patients in psychiatric hospitals and their relatives experience suffering and indignity.

Aim:

The aim of this study is to explore the experience of patients and relatives regarding respect for dignity following admission to a psychiatric unit.

Research design:

The methodological approach is a phenomenological hermeneutic method.

Participants and research context:

This study is based on qualitative interviews conducted with six patients at a psychiatric hospital and five relatives of patients who experienced psychosis.

Ethical consideration:

Permission was given by the Regional Committee for Medical Research Ethics in Western Norway, the Norwegian Data Protection Agency and all wards within the hospital in which the patients were interviewed.

Findings:

The analysis revealed one main theme: ‘The significance of small things for experiencing dignity’ and four subthemes described as follows - ‘to be conscious of small things’, ‘being conscious of what one says’, ‘being met’ and ‘to be aware of personal chemistry’.

Discussion and conclusion:

Staff members seem not to give enough attention to the importance of these small things. Staff members need to explore this phenomenon systematically and expand their own understanding of it.

Ethical challenges in everyday work with adults with learning disabilities

BACKGROUND

Healthcare providers caring for learning-disabled individuals in institutions face challenges of what is right or wrong in their daily work. Serving this group, it is of utmost importance for the healthcare staff to raise awareness and to understand how ethical values are at stake.

RESEARCH QUESTION

What ethical challenges are discussed among healthcare providers working with adults with learning disabilities?

RESEARCH DESIGN

The study had a qualitative and investigative design.

PARTICIPANTS AND RESEARCH CONTEXT

The study was conducted in a community institution for adults with learning disabilities. Participants were healthcare providers joining regular focused group discussions. Two groups participated and each group consisted of six participants. The conversations were taped and transcribed.

ETHICAL CONSIDERATIONS

The study was reported to Norwegian Social Science Data Services and was approved by the regional ethics committee.

FINDINGS

Findings are presented in four themes: (a) feeling squeezed between conflicting actions, (b) being the client's spokesman, (c) searching shared responsibility, and (d) expecting immediate and fixed solutions. The healthcare providers wanted to be the clients' advocates. They felt obliged to speak up for the clients, however, seeking for someone with whom to share the heavily experienced responsibility. Data likewise revealed that the group discussions created expectations among the healthcare providers; they expected smart and final solutions to the problems they discussed.

DISCUSSION

The discussion focuses on everyday ethical challenges, the meaning of being in-between and share responsibility, and the meaning of ethical sensitivity.

CONCLUSION

Ethical challenges can be demanding for the staff; they might feel squeezed in-between contradictory attitudes or feel alone in decision-making. Frequent conversations about ethical challenges do not solve the ethical problems here-and-now, but they do visualize them. This also visualizes the staff's need for support.

Challenges in relating to mental health professionals: Perspectives of persons with severe mental illness

A previous analysis showed that mental health service users experienced profound loneliness, struggled to relate to other people, and were careful in considering what to share with health-care professionals. Being recognized by professionals in relationships may contribute to recovery processes characterized by 'connectedness', 'hope and optimism', 'identity', 'meaning', and 'empowerment'. This paper regards people as mainly seeking contact and meaning (relational perspective) and aims to describe service users' understanding of being in relationships with professionals, and how these relationships may limit or enhance recovery. Interpretative phenomenological analysis was used to analyze data from in-depth interviews. Participants described three levels of connectedness with professionals: (i) being detached; (ii) being cautious; and (iii) being open and trusting. Level of connectedness seemed to be associated with opportunities for promoted recovery. Trusting relationships may strengthen identity, provide opportunities for meaning and hope, and contribute to opening new perspectives, and lessen significance of internal voices. Adopting a relational perspective may assist professionals in recognizing the service user as a person involved in making sense of life experiences and in the process of connecting to other people.

Strengthening practical wisdom: mental health workers' learning and development

BACKGROUND

Practical wisdom, understood as knowing how to be or act in any present situation with clients, is believed to be an essential part of the knowledge needed to be a professional mental health worker. Exploring processes of adapting, extending knowledge and refining tacit knowledge grounded in mental health workers' experiences with being in practice may bring awareness of how mental health workers reflect, learn and practice professional 'artistry'.

RESEARCH QUESTION

The aim of the article was to explore mental health workers' processes of development and learning as they appeared in focus groups intended to develop practical wisdom. The main research question was 'How might the processes of development and learning contribute to developing practical wisdom in the individual as well as in the practice culture?'

RESEARCH DESIGN

The design was multi-stage focus groups, and the same participants met four times. A phenomenological hermeneutical method for researching lived experience guided the analysis.

PARTICIPANTS AND CONTEXT

Eight experienced mental health workers representing four Norwegian municipalities participated. The research context was community-based mental health services.

ETHICAL CONSIDERATIONS

The study was reported to Norwegian Social Data Services, and procedures for informed consent were followed.

FINDINGS

Two examples of processes of re-evaluation of experience (Association, Integration, Validation, Appropriation and Outcomes and action) were explored. The health workers had developed knowledge in previous encounters with clients. In sharing practice experiences, this knowledge was expressed and developed, and also tested and validated against the aims of practice. Discussions led to adapted and extended knowledge, and as tacit knowledge was expressed it could be used actively.

DISCUSSION

Learning to reflect, being ready to be provoked and learning to endure indecisiveness may be foundational in developing practical wisdom. Openness is demanding, and changing habits of mind is difficult.

CONCLUSION

Reflection on, and confrontation with, set practices are essential to building practice cultures in line with the aims of mental health services.

"We are all fellow human beings": mental health workers' perspectives of being in relationships with clients in community-based mental health services

Stable, trusting relationships are at the core of Norwegian community-based mental health services. Being acknowledged and respected may promote a client's recovery. The aim of this study was to explore mental health workers' experiences of relating to clients. The design involved multi-stage focus groups based on a participatory approach and using interpretative phenomenological analysis. Acknowledging the personhood of a client appears to offer opportunities for growth and development in the client as well as in the health worker, based on reciprocal processes of each person affecting the other and the health workers' openness to understanding the other person.

Coercion in a locked psychiatric ward: Perspectives of patients and staff

BACKGROUND

In spite of a national strategy for reducing coercion in the mental health services, Norway still has a high rate of involuntary treatment compared to other European countries. It is therefore crucial to study various parties involved in involuntary treatment in order to reduce coercion.

RESEARCH QUESTION

How do patients and staff in a Norwegian locked psychiatric ward experience coercion?

RESEARCH DESIGN

Participant observation and interviews.

PARTICIPANTS

A total of 12 patients and 22 employees participated in this study.

ETHICAL CONSIDERATIONS

This study is accepted by the National Committee for Medical Health Research Ethics.

FINDINGS

The participants experienced coercion in different ways. Patients often felt inferior, while many of the staff felt guilty for violating patients' dignity, although they ascribed responsibility for their actions to the "system." The main themes are (1) corrections and house rules, (2) coercion is perceived as necessary, (3) the significance of material surroundings, and (4) being treated as a human being.

DISCUSSION

The discussion draws upon the concepts of vulnerability, guilty conscience, and ethical sensitivity, related to the staffs' divergent views on coercion.

CONCLUSION

Especially among staff, there are divergent views of coercion. Professionals being physically and emotionally close to the patient are more likely to understand him or her as a unique person with individual needs. If patients are kept at a distance, professionals as a group change to understand patients as members of a group with common needs and common restrictions.

Factors influencing patients' dignity: A qualitative study

Dignity represents the essence of nursing care; hence, nurses are professionally responsible for promoting understanding about the promotion, provision, and preservation of every patient's dignity, while considering contextual differences. The aim of this study was to explore the factors that influence, promote, or compromise patient dignity. A purposeful sample of 14 participants with hospitalization experience was chosen, and individual in-depth semi-structured interviews were conducted for data collection. Using inductive content analysis, the themes and subthemes related to factors influencing patients' dignity were explored: "persona" ("personal beliefs" and "personal characteristics"), "communication behaviors" ("verbal interaction," "body language," "compassionate behavior," and "devoting enough time"), and "staff conduct" ("professional commitment," "adequate human resources," and "staff's proficiency and competency"). The findings revealed that it is essential to expand nurses' insights and knowledge about preserving patients' dignity and the factors that influence these. Recognizing and focusing on these factors will help nurses to establish practical measures for preserving and promoting patients' dignity and providing more dignified care at the bedside.