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Wergeland NC, Fause Å, Weber AK, Fause ABO, Riley H. Health professionals' experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study. BJPsych Open 2022; 8:e183. [PMID: 36217299 PMCID: PMC9634590 DOI: 10.1192/bjo.2022.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Norway introduced capacity-based legislation in mental healthcare on 1 September 2017 with the aim of increasing patient autonomy and legal protection and reducing the use of coercion. The new legislation was expected to be particularly important for patients under community treatment orders (CTOs). AIMS To explore health professionals' experiences of how capacity-based legislation affects healthcare services for patients whose compulsory treatment order was revoked as a result of being assessed as having capacity to consent. METHOD Nine health professionals responsible for treatment and care of patients whose CTO was revoked owing to the new legislation were interviewed in depth from September 2019 to March 2020. We used a hermeneutic approach to the interviews and analysis of the transcripts. RESULTS The participants found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They also felt a need for more frequent assessments of patients' condition and capacity to consent and more flexibility between levels of care. CONCLUSIONS The study shows that health professionals found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They sought closer dialogue with patients, providing information and advice, and more frequently assessing patients' condition to adjust treatment and care to enable them to retain their capacity to consent. This could be challenging and required competence, continuity and close collaboration between personnel in different healthcare services at primary and specialist level.
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Affiliation(s)
- Nina Camilla Wergeland
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway; and Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Åshild Fause
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Astrid Karine Weber
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | | | - Henriette Riley
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway; and Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Ko CJ, Huang HL, Gao ZT, Chiang HH. Re-figuration of suffering: Transitional phenomena of people living with schizophrenia in group analysis. Arch Psychiatr Nurs 2022; 39:13-19. [PMID: 35688539 DOI: 10.1016/j.apnu.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
This study examined how people living with schizophrenia recognize their lived experiences in free-floating group discussions. Interpretative phenomenological and group analyses were employed to collect qualitative data from 14 patients. The identified superordinate theme was "re-figuration of suffering" including: "being treated as an object," "encountering the self through others," and "returning to the self." Participants shared their traumatizing stories of being alienated, discovered the realities of their lives and responsibilities through inward and outward observations, and progressed to a self-returning stage while regaining their appreciation of others and hope for the future. The contributions of psychiatric nursing practice were identified.
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Affiliation(s)
- Chen Ju Ko
- School of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan, ROC.
| | - Hseuh-Li Huang
- Department of Medical Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, ROC
| | - Zih Ting Gao
- Department of Nursing, Tongxin Long-term Health Care Center, Taoyuan, Taiwan, ROC
| | - Hsien-Hsien Chiang
- School of Nursing, National Yang Ming Chiao Tung University, Taiwan, ROC.
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Wergeland NC, Fause Å, Weber AK, Fause ABO, Riley H. Increased autonomy with capacity-based mental health legislation in Norway: a qualitative study of patient experiences of having come off a community treatment order. BMC Health Serv Res 2022; 22:454. [PMID: 35392904 PMCID: PMC8987267 DOI: 10.1186/s12913-022-07892-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background Capacity-based mental health legislation was introduced in Norway on 1 September 2017. The aim was to increase the autonomy of patients with severe mental illness and to bring mental health care in line with human rights. The aim of this study is to explore patient experiences of how far the new legislation has enabled them to be involved in decisions on their treatment after they were assessed as capable of giving consent and had their community treatment order (CTO) revoked due to the change in the legislation. Method Individual in-depth interviews were conducted from September 2019 to March 2020 with twelve people with experience as CTO patients. Interviews were transcribed and analysed using thematic analysis inspired by hermeneutics. Results Almost all interviewees were receiving the same health care over two years after their CTO was terminated. Following the new legislation, they found it easier to be involved in treatment decisions when off a CTO than they had done in periods without a CTO before the amendment. Being assessed as having capacity to consent had enhanced their autonomy, their dialogues and their feeling of being respected in encounters with health care personnel. However, several participants felt insecure in such encounters and some still felt passive and lacking in initiative due to their previous experiences of coercion. They were worried about becoming acutely ill and again being subjected to involuntary treatment. Conclusion The introduction of capacity-based mental health legislation seems to have fulfilled the intention that treatment and care should, as far as possible, be provided in accordance with patients’ wishes. Systematic assessment of capacity to consent seems to increase the focus on patients’ condition, level of functioning and opinions in care and treatment. Stricter requirements for health care providers to find solutions in cooperation with patients seem to lead to new forms of collaboration between patients and health care personnel, where patients have become more active participants in their own treatment and receive help to make more informed choices.
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Affiliation(s)
- Nina Camilla Wergeland
- Division of Mental Health and Substance Abuse, University Hospital of North Norway and UiT, The Arctic University of Norway, Norway, Tromsø.
| | - Åshild Fause
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Astrid Karine Weber
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | | | - Henriette Riley
- Division of Mental Health and Substance Abuse, University Hospital of North Norway and UiT, The Arctic University of Norway, Norway, Tromsø
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Todorova L, Johansson A, Ivarsson B. Perceptions of ambulance nurses on their knowledge and competence when assessing psychiatric mental illness. Nurs Open 2021; 8:946-956. [PMID: 33570281 PMCID: PMC7877124 DOI: 10.1002/nop2.703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/10/2020] [Accepted: 10/28/2020] [Indexed: 12/05/2022] Open
Abstract
AIMS AND OBJECTIVES To obtain the current perception of the knowledge and competence of pre-hospital emergency specialist nurses (ambulance) in attending patients with psychiatric symptoms. BACKGROUND Psychiatric illnesses have increased throughout the population. Consequently, pre-hospital emergency services frequently attend individuals with suspected or known mental illnesses. DESIGN We employed a set of quantitative and qualitative methods to gain a deeper understanding of ambulance nurses' self-evaluated knowledge. METHODS Seven ambulance nurses received and completed a survey questionnaire prior commencing employment in November 2019. Then, we conducted interviews to explore ambulance nurses' perceptions of their own knowledge and competence when attending individuals with mental disorders. The surveys were analysed with descriptive statistics, followed by content analysis. RESULTS Three topics emerged: the encounter of patients with mental illness; the awareness of lacking knowledge about mental illnesses; and the expectations for future Prehospital Emergency Psychiatric Response Teams. Although ambulance nurses already possessed basic knowledge regarding psychiatric illnesses, it was insufficient, based on their perception of appropriate care. Ambulance nurses considered that combining pre-hospital and psychiatric expertise in the pre-hospital emergency unit would increase their in-depth knowledge about various psychiatric illnesses, the treatment options and the alternatives regarding where to deliver patients for continued care.
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Affiliation(s)
- Lizbet Todorova
- Office of Medical ServicesRegion SkaneMalmöSweden
- Department of Clinical ScienceLund UniversityLundSweden
| | - Anders Johansson
- Office of Medical ServicesRegion SkaneMalmöSweden
- Department of Clinical ScienceLund UniversityLundSweden
| | - Bodil Ivarsson
- Office of Medical ServicesRegion SkaneMalmöSweden
- Department of Clinical ScienceLund UniversityLundSweden
- Department of Cardiothoracic SurgeryIKVLLund UniversityLundSweden
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Schmidt M, Uman T. Experiences of acute care by persons with mental health problems: An integrative literature review. J Psychiatr Ment Health Nurs 2020; 27:789-806. [PMID: 32083776 DOI: 10.1111/jpm.12624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development-oriented solutions for the improvements of these experiences. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Acute care can be understood through patients' experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post-discharge well-being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. ABSTRACT: Aim The provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure-process-outcome framework (Prospero ID: CRD42019116652). Method and results An integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. Discussion The review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients' satisfaction and their well-being after discharge, were also predominantly experienced negatively. Implications for practice Using Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the field's development.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Timur Uman
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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Ould Brahim L, Hanganu C, Gros CP. Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study. J Am Psychiatr Nurses Assoc 2020; 26:250-261. [PMID: 31587601 DOI: 10.1177/1078390319878773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse's role to include evidence-based responses to substance use is recommended.
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Affiliation(s)
- Lydia Ould Brahim
- Lydia Ould Brahim, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Cezara Hanganu
- Cezara Hanganu, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Catherine Pugnaire Gros
- Catherine Pugnaire Gros, MSc, RN, McGill University, Montreal, Quebec, Canada; Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal; Douglas Mental Health University Institute, Verdun, Quebec, Canada
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8
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McAllister S, Robert G, Tsianakas V, McCrae N. Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. Int J Nurs Stud 2019; 93:106-118. [PMID: 30908958 DOI: 10.1016/j.ijnurstu.2019.02.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/18/2019] [Accepted: 02/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement. DESIGN A systematic integrative review using an established framework specific to the integrative review methodology. DATA SOURCES Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report. REVIEW METHODS Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement. RESULTS Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework. CONCLUSION A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.
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Affiliation(s)
- Sarah McAllister
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom.
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Niall McCrae
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
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Wyder M, Roennfeldt H, Rosello RF, Stewart B, Maher J, Taylor R, Pfeffer A, Bell P, Barringham N. Our Sunshine place: A collective narrative and reflection on the experiences of a mental health crisis leading to an admission to a psychiatric inpatient unit. Int J Ment Health Nurs 2018; 27:1240-1249. [PMID: 29920905 DOI: 10.1111/inm.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/27/2022]
Abstract
Acute mental health inpatient units are complex environments where tensions between clinical and personal recovery can be amplified. The focus for mental health staff is often centred on providing clinical care, whereas from the patient perspective, the admission can represent a profound existential crisis. There are very few user-led accounts of their experiences of psychiatric inpatient unit. This project was developed in the traditions of Analytic Auto-Ethnography, a research methodology which provides a systematic process to reflect on our own experience while still producing trustworthy findings. Through this process, a collective narrative and critical reflection of a group of over 20 individuals with experiences of either providing or receiving care in an acute psychiatric inpatient unit was developed. The narrative developed shows that for some the hospital admission was a time of healing; for others, the inpatient unit represented an alien and unsafe environment, which accentuated the strangeness of the experiences of mental ill health. Common themes among the group were that of an overarching need to make sense of what happened leading up to the admissions and to come to terms with the potential impact of the illness on identity and future. This journey can be best described as a process of healing and moving towards 'wholeness'. Safety, connection, autonomy and control were identified as factors which either facilitated or hindered the process of successfully integrating the various experiences.
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Affiliation(s)
- Marianne Wyder
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Helena Roennfeldt
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Rise Faith Rosello
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Bridie Stewart
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - John Maher
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Rosslyn Taylor
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Amanda Pfeffer
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Peter Bell
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Neil Barringham
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
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Myklebust KK, Bjørkly S, Råheim M. Nursing documentation in inpatient psychiatry: The relevance of nurse-patient interactions in progress notes-A focus group study with mental health staff. J Clin Nurs 2017; 27:e611-e622. [PMID: 29048775 DOI: 10.1111/jocn.14108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To gain insight into mental health staff's perception of writing progress notes in an acute and subacute psychiatric ward context. BACKGROUND The nursing process structures nursing documentation. Progress notes are intended to be an evaluation of a patient's nursing diagnoses, interventions and outcomes. Within this template, a patient's status and the care provided are to be recorded. The therapeutic nurse-patient relationship is recognised as a key component of psychiatric care today. At the same time, the biomedical model remains strong. Research literature exploring nursing staff's experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse. DESIGN Qualitative design. METHODS Focus group interviews with mental health staff working in one acute and one subacute psychiatric ward were conducted. Systematic text condensation, a method for transverse thematic analysis, was used. RESULTS Two main categories emerged from the analysis: the position of the professional as an expert and distant observer in the progress notes, and the weak position of professional-patient interactions in progress notes. CONCLUSIONS The participants did not perceive that the current recording model, which is based on the nursing process, supported a focus on patients' resources or reporting professional-patient interactions. This model appeared to put ward staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process. Essential aspects of nursing care related to recovery and person-centred care were not prioritised for documentation. RELEVANCE TO CLINICAL PRACTICE This study contributes to the critical examination of the documentation praxis, as well as to the critical examination of the documentation tool as to what is considered important to document.
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Affiliation(s)
- Kjellaug K Myklebust
- Institute of Health and Social Sciences, Molde University College, Molde, Norway
| | - Stål Bjørkly
- Institute of Health and Social Sciences, Molde University College, Molde, Norway.,Centre for Forensic Psychiatry, Oslo University Hospital, Molde, Norway
| | - Målfrid Råheim
- Institute of Health and Social Sciences, Molde University College, Molde, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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11
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Delaney KR, Shattell M, Johnson ME. Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement. Arch Psychiatr Nurs 2017; 31:634-640. [PMID: 29179832 DOI: 10.1016/j.apnu.2017.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022]
Abstract
Staff members' engagement with patients is a critical element of inpatient psychiatric care, essential to safety, the hospitalization experience and the development of a culture of care. Currently broad concerns exist around the amount of time inpatient psychiatric nurses expend in patient engagement and the quality of these interactions. In this paper we present a model of engagement that clarifies necessary skills to support the engagement process. The model is based on Peplau's theory of interpersonal relations, patients' ideas on healing elements of psychiatric hospitalization and research on inpatient therapeutic relationships. We are currently using this model for a web-based teaching/learning course to cultivate interpersonal engagement, and to explicate how through operationalizing their inpatient role, nurses support patients in the development of their mental health and well-being.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
| | - Mona Shattell
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
| | - Mary E Johnson
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
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12
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Salzmann-Erikson M, Söderqvist C. Being Subject to Restrictions, Limitations and Disciplining: A Thematic Analysis of Individuals' Experiences in Psychiatric Intensive Care. Issues Ment Health Nurs 2017; 38:540-548. [PMID: 28388251 DOI: 10.1080/01612840.2017.1299265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to describe individuals' experiences of being hospitalized in psychiatric intensive care units (PICUs). Four participants who had previously been admitted in a PICU were interviewed using open-ended questions. The data were analyzed using thematic analysis. Analysis resulted in a synthesis of the various ways patients experienced limitations: (1) Descriptions of Being Limited in the Environment, (2) Descriptions of being Limited in Interactions with Staff, (3) Descriptions of Being Limited in terms of Access to Information, and (4) Descriptions of Having Limited Freedom and Autonomy. Hospitalization is experienced as a life-changing event that shows a kaleidoscopic view of limitation. We stress that the conceptualization of limitation must be considered due to its historical origins, sociopolitical aspirations, and philosophy of care. Thus, nurse practitioners and nursing leaders are advised to put the patient's experience at the center of care, and to involve and integrate patients throughout the recovery process.
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Affiliation(s)
- Martin Salzmann-Erikson
- a Department of Health and Caring Sciences , Faculty of Health and Occupational Studies, University of Gävle , Gävle , Sweden
| | - Cecilia Söderqvist
- b School of Health, Care and Social Welfare, University of Mälardalen , Västerås , Sweden.,c Centre for Clinical Research, Västmanland County Hospital , Västerås , Sweden
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