'Acknowledge me as a capable person': How people with mental ill health describe their experiences with general emergency care staff - A qualitative interview study

People with mental ill health attend general emergency care more often than others for physical and psychiatric care needs. Staff in general emergency care report they lack knowledge and strategies to meet with and care for people with mental ill health. This study aimed to describe how people with mental ill health experience encounters with staff in general emergency care. We conducted individual semi-structured interviews with 11 people with mental ill health about their experiences in general emergency care and subjected the interview data to qualitative content analysis. Our results show the importance to people with mental ill health of being acknowledged as capable persons, and how this relates to their experiences of being recognized, ignored, or dismissed by staff in general emergency care. Even small, ordinary aspects of staff/patient interactions can have major impacts on a person's recovery and well-being. The study is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

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.

Problematizing Boundaries of Care Responsibility in Caring Relationships

INTRODUCTION

Nursing care takes place within nurse-patient relationships that can be demanding. In exceptional circumstances, the relationship may be destructive, and when this happens, significant onerous demands, appeals, or challenges can arise from patients and be placed upon nurses.

AIM

The aim is to explore what can be termed boundaries of care responsibility when relationships with patients place significant destructive demands on nurses.

METHOD

Based on a hermeneutical approach, this study introduces aspects of phenomenological philosophy as described by the Danish theologian and philosopher Knud E. Løgstrup and provides examples of nurses' experiences in everyday nursing practice drawn from a Norwegian empirical study focusing on remaining in everyday nursing practice. Data in that original study consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses working in somatic and psychiatric health service.

DISCUSSION

The exploration of empirical examples demonstrates that nurses consider confronting demands from patients which manifest themselves as onerous and that they have to set limits to safeguard themselves. When the nurses had to manage acting out or actions from patients by opposing what was said and done, they experienced the situation as more than very unpleasant or connected to a perversion. Significant destructive caring relationships cannot be without boundaries, and explicating boundaries are of relevance to protect nurses from onerous demands. Protecting them implies reducing a hazard, that is, that nurses carry on even when this may be unhealthy for them.

CONCLUSION

Consistently pinpointing boundaries between demands is assumed to be essential in caring relationships, as onerous or destructive demands are strongly connected to a content where boundlessness is involved. To protect both nurses and patients as valued human beings, thus raising and preserving the status of the nurse and the patient, the nature and possible detrimental effects of destructive caring relationships should be considered and examined.

"I now have a life!" Lived experiences of participation in music and theater in a mental health hospital

Participation in activities perceived to be meaningful is of importance in recovery processes among people with mental illness. This qualitative study explored experiences of participation in music and theater among people with long-term mental illness. Data were collected through in-depth interviews with 11 participants in a music and theater workshop carried out in a Norwegian mental health hospital context. Through a hermeneutical-phenomenological analysis, three central themes emerged: (a) engaging in the moment, (b) reclaiming everyday life, and (c) dreaming of a future. The findings indicate that participation in music and theater provided an opportunity to focus on enjoyable mundane activities and demonstrate how arts have the potential to bring meaning and more specifically small positive moments into participants' lives. Despite seeming to be small in nature, these moments appeared to be able to add pleasure and meaning to the lives of those experiencing them. Consequently, there is a need to raise professionals' awareness of these small positive moments of meaning, the power these experiences carry, and how to facilitate arenas which can provide such moments for people with long-term mental illness.

What facilitates the delivery of dignified care to older people? A survey of health care professionals

Background

Whilst the past decade has seen a growing emphasis placed upon ensuring dignity in the care of older people this policy objective is not being consistently achieved and there appears a gap between policy and practice. We need to understand how dignified care for older people is understood and delivered by the health and social care workforce and how organisational structures and policies can promote and facilitate, or hinder, the delivery of such care.

Methods

To achieve our objective of understanding the facilitators and to the delivery of dignified care we undertook a survey with health and social care professionals across four NHS Trusts in England. Participants were asked provide free text answers identifying any facilitators/barriers to the provision of dignified care. Survey data was entered into SPSSv15 and analysed using descriptive statistics. These data provided the overall context describing staff attitudes and beliefs about dignity and the provision of dignified care. Qualitative data from the survey were transcribed verbatim and categorised into themes using thematic analysis.

Results

192 respondents were included in the analysis. 79 % of respondents identified factors within their working environment that helped them provide dignified care and 68 % identified barriers to achieving this policy objective. Facilitators and barriers to delivering dignified care were categorised into three domains: ‘organisational level’; ‘ward level’ and ‘individual level’. Within the these levels, respondents reported factors that both supported and hindered dignity in care including ‘time’, ‘staffing levels’, training’,’ ‘ward environment’, ‘staff attitudes’, ‘support’, ‘involving family/carers’, and ‘reflection’.

Conclusion

Facilitators and barriers to the delivery of dignity as perceived by health and social care professionals are multi-faceted and range from practical issues to interpersonal and training needs. Thus interventions to support health and social care professionals in delivering dignified care, need to take a range of issues into account to ensure that older people receive a high standard of care in NHS Trusts.