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Fredens M, Palmhøj Nielsen C, Grønkjær M, Kjærside Nielsen B, Konstantin Nissen N, Benthien KS, Toft U, Rasmussen K, Kidholm K, Deleuran Terkildsen M. Nurses' perspectives on challenges and facilitators when implementing a self-management support intervention as an everyday healthcare practice: A qualitative study. J Adv Nurs 2024; 80:2475-2486. [PMID: 38012863 DOI: 10.1111/jan.15988] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIM To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone-based self-management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation. DESIGN Data were collected using a qualitative research design involving focus-group interviews and participant observations. METHODS We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses. RESULTS Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non-disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation. CONCLUSION Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation. IMPLICATIONS FOR THE PROFESSION From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial. IMPACT Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS. REPORTING METHOD This study adheres to the SRQR guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mia Fredens
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Kirstine Skov Benthien
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Knud Rasmussen
- Department of Data and Development Research, Zealand Region, Sorø, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Morten Deleuran Terkildsen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Shetty SR, Burke S, Timmons D, Kennedy HG, Tuohy M, Terkildsen MD. Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study. J Psychiatr Ment Health Nurs 2023. [PMID: 37929765 DOI: 10.1111/jpm.12979] [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: 12/22/2022] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 11/07/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.
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Affiliation(s)
- Shobha Rani Shetty
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Shauna Burke
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - David Timmons
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G Kennedy
- Forensic Psychiatry, Trinity College Dublin, Dublin, Ireland
- Forensic Psychiatry, Aarhus University, Dublin, Ireland
- Forensic Psychiatry, University of Bari 'Aldo Moro', Dublin, Ireland
| | - Mary Tuohy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Morten Deleuran Terkildsen
- Department of Forensic Psychiatry, Centre for Forensic Psychiatric Research and Development (CerF), Aarhus University Hospital Psychiatry, Aarhus N, Denmark
- DEFACTUM, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
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Lou S, Bollerup S, Terkildsen MD, Adrian SW, Pacey A, Pennings G, Vogel I, Skytte AB. Experiences and attitudes of Danish men who were sperm donors more than 10 years ago; a qualitative interview study. PLoS One 2023; 18:e0281022. [PMID: 36791066 PMCID: PMC9931114 DOI: 10.1371/journal.pone.0281022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND More knowledge about the long-term impact of sperm donation is essential as the donor's attitude towards donation may change over time. Personal and social developments may prompt a rethinking of previous actions and decisions, or even regret. Thus, the aim of this study was to explore the experiences and attitudes of men who were sperm donors more than 10 years ago. METHODS From May to September 2021, semi-structured, qualitative interviews were conducted with 23 former donors (> 10 years since last donation) from Cryos International sperm bank. Two participants were non-anonymous donors and 21 were anonymous. The interviews were conducted by phone or via video (mean 24 minutes). All interviews were recorded, transcribed verbatim and rendered anonymous. Data were analyzed using thematic analysis. RESULTS The analysis showed that most men had been donors for monetary and altruistic purposes, and now considered sperm donation as a closed chapter that was 'unproblematic and in the past'. Most men valued anonymity and emphasized the non-relatedness between donor and donor conceived offspring. Knowledge about recipients and donor offspring was seen as 'damaging' as it could create unwanted feelings of relatedness and responsibility towards them. All men acknowledged donor conceived persons' potential interests in knowing about their genetic heritage in order to understand appearance and personal traits, but also emphasized the donors' rights to anonymity. Potential breach of anonymity was generally considered 'highly problematic' as it was expected to disturb their families and force a relationship on them. CONCLUSION This study reports on former donors who might not have volunteered for research due to lack of interest or protection of privacy. The majority of men valued anonymity and clearly demarcated a line between sperm donation and fatherhood, which was enforced by not knowing about the donor offspring or recipients.
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Affiliation(s)
- Stina Lou
- DEFACTUM–Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Stina Bollerup
- DEFACTUM–Public Health Research, Central Denmark Region, Aarhus, Denmark
| | - Morten Deleuran Terkildsen
- DEFACTUM–Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Allan Pacey
- Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Guido Pennings
- Department of Philosophy and Moral Science, Bioethics Institute Ghent (BIG), Ghent University, Gent, Belgium
| | - Ida Vogel
- Department of Clinical Medicine, Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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Harpøth A, Kennedy H, Terkildsen MD, Nørremark B, Carlsen AH, Sørensen LU. Do improved structural surroundings reduce restrictive practices in psychiatry? Int J Ment Health Syst 2022; 16:53. [PMID: 36404331 PMCID: PMC9677911 DOI: 10.1186/s13033-022-00562-7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is sparse evidence that modern hospital architecture designed to prevent violence and self-harm can prevent restrictive practices (RP). We examine if the use of RPs was reduced by the structural change of relocating a 170-year-old psychiatric university hospital (UH) in Central Denmark Region (CDR) to a new modern purpose-built university hospital. METHODS The dataset includes all admissions (N = 19.567) and RPs (N = 13.965) in the self-contained CDR one year before and after the relocation of the UH. We compare RPs at the UH a year prior to and after relocation on November 16th (November 2017, November 2019) with RPs at the other psychiatric hospitals (RH) in CDR. We applied linear regression analysis to assess the development in the monthly frequency of RPs pre- and post-relocation and examine underlying trends. RESULTS At UH, RPs performed decreased from 4073 to 2585 after relocation, whereas they remained stable (from 3676 to 3631) at RH. Mechanical restraint and involuntary acute medication were aligned at both UH and RH. Using linear regression analysis, we found an overall significant decrease in the use of all restrictive practices at UH with an inclination of -9.1 observations (95% CI - 12.0; - 6.3 p < 0.0001) per month throughout the two-year follow-up. However, the decrease did not deviate significantly from the already downward trend observed one year before relocation. Similar analyses performed for RH showed a stable use of coercion. CONCLUSION The naturalistic features of the design preclude any definitive conclusion whether relocation to a new purpose-built psychiatric hospital decreased the RPs. However, we argue that improving the structural environment at the UH had a sustained effect on the already declining use of RPs, particularly mechanical restraint and involuntary acute medication.
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Affiliation(s)
- Astrid Harpøth
- grid.154185.c0000 0004 0512 597XDepartment of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Harry Kennedy
- grid.8217.c0000 0004 1936 9705Trinity College, Dublin University, Dublin, Ireland ,National Forensic Mental Health Service, Dundrum, Ireland ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Morten Deleuran Terkildsen
- grid.154185.c0000 0004 0512 597XDepartment of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Skejby, Denmark ,grid.425869.40000 0004 0626 6125DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Bettina Nørremark
- grid.154185.c0000 0004 0512 597XDepartment of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Anders Helles Carlsen
- grid.154185.c0000 0004 0512 597XDepartment of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Lisbeth Uhrskov Sørensen
- grid.154185.c0000 0004 0512 597XDepartment of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Skejby, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Nielsen BK, Mejdahl CT, Terkildsen MD, Mehlsen M. Changes in distress and turnover intentions among hospital-based nurses working during the first eight months of the COVID-19 pandemic in Denmark. A prospective questionnaire study. J Nurs Manag 2022; 30:2557-2567. [PMID: 36042540 PMCID: PMC9539220 DOI: 10.1111/jonm.13781] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Aim To describe changes in distress among Danish hospital‐based nurses during the early month of the COVID‐19 pandemic and to examine predictors of distress and turnover intentions. Background Outbreak of infectious diseases such as the COVID‐19 pandemic can increase the likelihood that health professionals suffer from poor mental health even after the outbreak. Methods A prospective study among 426 Danish hospital‐based nurses during the early month of the pandemic. Participants completed self‐administered questionnaires regarding mental health and COVID‐19 worries, as well as turnover intentions. Results Nurses with brief work experience reported higher increase in distress. Feeling unsafe at work, having low trust in management and being anxious for relatives were associated with increased distress. Finally, feeling unsafe at work, being anxious for relatives and having low trust in management were predictors of intention to change job. Conclusion This study suggests that the subjective experiences of uncertainty in work during the COVID‐19 pandemic have more impact on nurses' distress than COVID‐19 related conditions at hospitals. Finally, the study provides empirical support for the association between COVID‐19‐related worries and turnover intentions. Implication for nursing management Knowledge of risk factors for psychological distress as well as predictors of turnover intention is necessary and may provide nurses and health‐care systems with the ability to respond better against future pandemics and to retain nurses in the organization and in the profession.
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Affiliation(s)
- Berit Kjaerside Nielsen
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Aarhus N, Denmark
| | | | - Morten Deleuran Terkildsen
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Aarhus N, Denmark.,Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus N, Denmark
| | - Mimi Mehlsen
- Aarhus University, Department of Psychology and Behavioural Sciences, Aarhus C, Denmark
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Mejdahl CT, Nielsen BK, Mehlsen MY, Hollesen MR, Pedersen MZ, Engkjær‐Trautwein G, Funch LV, Terkildsen MD. COVID-19 as moral breakdown: Entangled ethical demands experienced by hospital-based nurses in the early onset of the pandemic. Nurs Inq 2022; 30:e12508. [PMID: 35709227 PMCID: PMC9349400 DOI: 10.1111/nin.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 01/25/2023]
Abstract
2020 saw the rapid onset of a global pandemic caused by the SARS-CoV-2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to "being a nurse" during the COVID-19 pandemic was experienced and understood by Danish hospital-based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands, and Nursing and conflicting ethical demands. These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands.
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Affiliation(s)
| | | | - Mimi Yung Mehlsen
- Department of Psychology and Behavioural SciencesAarhus UniversityAarhusDenmark
| | | | | | | | - Louise Vase Funch
- Department of Psychology and Behavioural SciencesAarhus UniversityAarhusDenmark
| | - Morten Deleuran Terkildsen
- DEFACTUM—Public Health & Health Services ResearchAarhusDenmark,Department of Forensic PsychiatryAarhus University Hospital PsychiatryAarhusDenmark
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Terkildsen MD, Kennedy HG, Jentz C, Sørensen LU. Online video games and patient-staff power relations. A qualitative study of care and custody in forensic psychiatry. J Psychiatr Ment Health Nurs 2022; 29:493-503. [PMID: 34897910 PMCID: PMC9306509 DOI: 10.1111/jpm.12813] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/12/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Frontline forensic mental health staff often face challenges when providing recovery-orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward. Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice. Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re-articulate power relations in therapeutic environments. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides insights into how using online video gaming interventions may influence the establishment of social power relations of staff and forensic psychiatric patients. It adds to existing research by providing a conceptual way to study and understand how mental health nurses may balance between care and custody, delivering care to accommodate patients' needs without compromising safety and security at the ward. This study answers a call in current research by providing qualified knowledge regarding the use of online video gaming to build and sustain therapeutic relations in mental health care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our paper suggests that balancing between care and custody is possible by using online video gaming interventions in forensic psychiatry. It moreover provides practice-close knowledge that may inspire and guide clinical mental health nurses to further develop online video gaming interventions in mental health care for the benefit of their patients. ABSTRACT: Introduction In recovery-oriented care, forensic psychiatric nurses must engage in care relationships with forensic psychiatric patients (FPs) whilst focussing on ward security. Online video games (OVGs) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are needed to guide clinical practice. Aim Our aim was to study how power relations were articulated between FPs and staff in an OVG intervention in a Danish forensic psychiatric ward. Method Data consist of three months of observational data and interviews with three staff members and six patients. We used sociologist Pierre Bourdieu's framework of field, power and capital to analyze data. Results The OVG intervention consisted of two power fields, "in-game" and "over-game." In-game concerned the practice of gaming. Over-game described the organization of the gaming intervention. Specific logics, skills and symbolic capitals drove power in each field. Discussion Power in-game was open to FPs and staff, leading to symmetric power relations. Power over-game was open to staff only, resulting in asymmetrical power relations. Implications for practice Online video game interventions may facilitate power balancing in forensic psychiatry. These insights may guide the development of new OVG interventions for patients and nurses in mental health care.
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Affiliation(s)
- Morten Deleuran Terkildsen
- DEFACTUM - Public Health & Health Services Research, Aarhus, Central Denmark Region, Denmark.,Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark
| | - Harry G Kennedy
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark.,Trinity College Dublin, University of Dublin, Ireland.,Central Mental Hospital, Dundrum, Ireland
| | - Christian Jentz
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Lisbeth Uhrskov Sørensen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
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Burau V, Nissen N, Terkildsen MD, Væggemose U. Personalised medicine and the state: A political discourse analysis. Health Policy 2020; 125:122-129. [PMID: 33158608 DOI: 10.1016/j.healthpol.2020.10.005] [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] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
The last decade has seen a range of health policy initiatives relating to personalised medicine. There is an emerging body of studies that demonstrates the continued importance of states in the development of personalised medicine. This paper contributes to this literature by focusing on how political discourses construct the role of states in personalised medicine. Based on a case study of the introduction of a national programme in Denmark, the analysis identifies specific discursive mechanisms in this construction. The material consists of documents from key national stakeholders, media coverage and interviews with experts at the national level. The analysis found three types of discursive mechanisms. Firstly, mechanisms can relate to problem definitions, and these were concerned with a number of salient problems of health services. Secondly, mechanisms can relate to underlying assumptions, and these were about the possibility of engineering healthcare improvement through data and by extension personalised medicine. Thirdly, mechanisms can relate to discursive effects, and here the state emerged as a highly influential governor. These mechanisms are likely to be highly relevant for other countries, but future research needs to test this. Health policy practitioners and health administrators thus need to invest effort into influencing political discourses around personalised medicines, in addition to the formulation of policies itself.
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Affiliation(s)
- Viola Burau
- Department of Political Science, Aarhus University, Bartholins Allé 9, 8000, Aarhus C, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Nina Nissen
- DEFACTUM - Public Health and Health Services Research, Central Denmark Region, Olof-Palmes Allé 15, 8200, Aarhus N, Denmark.
| | - Morten Deleuran Terkildsen
- DEFACTUM - Public Health and Health Services Research, Central Denmark Region, Olof-Palmes Allé 15, 8200, Aarhus N, Denmark.
| | - Ulla Væggemose
- Prehospital Emergency Department, Aarhus University Hospital, Olof Palmes Allé 34, 8200, Aarhus C, Denmark.
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Fredens M, Terkildsen MD, Bollerup S, Albæk J, Nissen NK, Winther S, Grønkjær M, Rasmussen MK, Benthien KS, Toft U, Hjarnaa L, Rasmussen K, Nielsen CP. The national implementation of 'Proactive Health Support' in Denmark since 2017: Expectations and challenges for the telephone-based self-management program. Health Policy 2020; 124:674-678. [PMID: 32507526 DOI: 10.1016/j.healthpol.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/06/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
In Denmark, as in many other Western countries, a small group of people are major hospital users and account for a large proportion of health care spending. Proactive Health Support (PaHS) is the first national Danish program that aims to reduce health care consumption targeting people at risk of becoming major users of health services. PaHS was part of the government's The sooner-the better national health policy, which includes a focus on policy programs targeting the weakest and most complex chronic patients at risk of high health care consumption. PaHS is a telephone-based self-management support program that uses a prediction model to identify people at high risk of acute hospital admissions. Reducing preventable hospital admissions and enhancing quality of life are central policy goals. The Danish policy was inspired by a Swedish policy program, and PaHS has been implemented based on policy transfer with political expectations that the Swedish results can be replicated in Denmark. The effects of PaHS are currently under study, and time will show whether expectations can be met. This paper discusses institutional conditions and expectations related to replicating a policy program and its outcomes. In addition, it highlights implementation issues that may affect the success of the policy program.
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Affiliation(s)
- Mia Fredens
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark.
| | | | - Stina Bollerup
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark
| | - Jens Albæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | | | - Susanne Winther
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Maja Kjær Rasmussen
- Centre for Innovative Medical Technologies, Odense University Hospital, Denmark
| | - Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Louise Hjarnaa
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Knud Rasmussen
- Production, Research and Innovation, Region Zealand, Sorø, Denmark
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Terkildsen MD, Wittrup I, Burau V. Micro practices of coordination based on complex adaptive systems: user needs and strategies for coordinating public health in Denmark. Int J Integr Care 2015; 15:e034. [PMID: 26528097 PMCID: PMC4628504 DOI: 10.5334/ijic.1530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/24/2015] [Accepted: 08/19/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Many highly formalised approaches to coordination poorly fit public health and recent studies call for coordination based on complex adaptive systems. Our contribution is two-fold. Empirically, we focus on public health, and theoretically we build on the patient perspective and treat coordination as a process of contingent, two-level negotiations of user needs. THEORY AND METHODS The paper draws on the concept of user needs-based coordination and sees coordination as a process, whereby needs emerging from the life world of the user are made amenable to the health system through negotiations. The analysis is based on an explorative case study of a health promotion initiative in Denmark. It adopts an anthropological qualitative approach and uses a range of qualitative data. RESULTS The analysis identifies four strategies of coordination: the coordinator focusing on the individual user or on relations with other professionals; and the manager coaching the coordinator or providing structural support. Crucially, the coordination strategies by management remain weak as they do not directly relate to specific user needs. DISCUSSION In process of bottom-up negotiations user needs become blurred and this is especially a challenge for management. The study therefore calls for an increased focus on the level nature of negotiations to bridge the gap that currently weakens coordination strategies by management.
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Affiliation(s)
- Morten Deleuran Terkildsen
- CFK - Public Health and Quality Improvement, Central Denmark Region/Interacting Minds Centre, Aarhus University, Aarhus, Denmark
| | - Inge Wittrup
- CFK - Public Health and Quality Improvement, Central Denmark Region/Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Viola Burau
- CFK - Public Health and Quality Improvement, Central Denmark Region/Department of Political Science, Aarhus University, Aarhus, Denmark
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Burau V, Terkildsen MD, Wittrup I. Coordinating complex health problems: the practice of the narrative approach to coordinating public health for ethnic minority citizens in Denmark. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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