Forensic Psychiatric Patients' Perspectives on Their Care: A Narrative View

PURPOSE

The purpose of this study is to describe forensic psychiatric patients' experiences of and perspectives on forensic psychiatric treatment.

DESIGN AND METHODS

Eight forensic psychiatric patients were interviewed, and the resultant research material was analyzed by narrative analysis.

FINDINGS

Patients' narratives contain different themes telling different things and the personnel need to pay attention to these.

PRACTICE IMPLICATIONS

The findings of the present study should direct the forensic psychiatric personnel's attention to the notion that forensic psychiatric patients' experiences of their treatment can improve the quality of patient-centered care and reduce bureaucracy.

The Therapeutic Approach to a Patient's Criminal Offense in a Forensic Mental Health Nurse-Patient Relationship-The Nurses' Perspectives

PURPOSE

The purpose of this study is to describe the therapeutic approach to a patient's criminal offense in a forensic mental health nurse-patient relationship from the nurse's perspective.

DESIGN AND METHODS

Eight nurses in a Finnish forensic psychiatric hospital were interviewed, and the resultant research material was analyzed by inductive content analysis.

FINDINGS

The results revealed the process of the therapeutic approach to a patient's offense, which comprises numerous steps and various phases.

PRACTICE IMPLICATIONS

For the nurse, the process of working through the offense can be divided into stages in which an attempt is made to respond to the patient's behavior and interaction in a manner that leads to working through the criminal act.

Forensic psychiatric patients' narratives of their offense

This study aims to describe forensic psychiatric patients' experiences of their offense and its meaning for their lives, and to increase the understanding of the meaning of the offense in the eyes of the patient. The data analyzed was collected by interviews with forensic psychiatric patients and analyzed by narrative analysis. The findings suggest that forensic psychiatric patients have different types of stories describing the offense and its meaning in their lives. Illness narratives can be utilized therapeutically because they may construct patients' identity, experiences, and their situation as people with an illness seek explanations and meanings for their plight.

Caregiving actions: Outgrowths of the family caregiver's conceptions of care

Caregiving actions emanate from the family caregiver's care meanings. Therefore, this article presents caregiving actions as outgrowths of the family caregiver's cultural conceptions of care and as situated within constraining sociocultural factors. Qualitative data were collected through interviews and participant observations from 18 purposively selected family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Three lines of caregiving actions performed by the participating family caregivers are presented: nutritional and medication care actions, physical care actions, and psychological and spiritual care actions. We have also explicated the problematic situations and sociocultural factors constraining the family caregivers in performing the caregiving actions. This study underlines the significance of addressing such problematic situations as are raised, as well as the sociocultural issues that constrain the family caregivers' agentic scope for planning and executing caregiving actions.

Population-based comparison of health-related quality of life between healthy subjects and those with specific psychiatric or somatic diseases

PURPOSE

The purpose of this study was to compare health-related quality of life (HRQL) of healthy subjects and those with psychiatric or somatic diseases.

DESIGN AND METHODS

Eight dimensions of the RAND 36-Item Health Survey 1.0 (RAND-36) were investigated in a population-based sample.

FINDINGS

Scores in all 8 RAND dimensions were lower in subjects with psychiatric diagnoses than in healthy subjects. In logistic regression models, poor social functioning (odds ratio [OR] 1.07-1.12) associated with psychiatric diagnoses. Lowered energy (OR 1.06) associated with major depression, poor general health with personality disorders (OR 1.06) and heart disease (OR 1.06), and physical limitations with heart (OR 1.04) and musculoskeletal disease (OR 1.07).

PRACTICE IMPLICATIONS

Acknowledging the lowest HRQL dimensions among subjects with psychiatric diagnoses may help to promote mental, physical, and social well-being more efficiently.

Representations of hysterectomy as a transition process in Finnish women's and health magazines

Representations of hysterectomy as a transition process in Finnish women's and health magazines The purpose of this article was to describe representations of hysterectomy in Finnish women's and health magazines. The data used in the study were obtained from six Finnish women's and health magazines. Using content analysis, 42 articles were analysed. We identified two main categories, information about care and treatment and women's experiences. In the first category, there emerged six subcategories: role of uterus, indications for hysterectomy, operative techniques of hysterectomy, alternative methods of treatment, pros and cons of hysterectomy and patient guidance. The second category consisted of women's experiences of hysterectomy as a period of transition. The components of the transition theory were confirmed by the women's stories. We also wanted to highlight the fact that the result shows that nurses were missing from the media coverage regarding hysterectomy.

Health-related quality of life among subjects with long-term mental symptoms in a population-based sample

Women have shown to have poorer health-related quality of life (HRQL) than men. The purpose of this study was to examine HRQL, its gender differences and correlates among subjects (n = 158) with long-term mental symptoms in a population-based sample. HRQL was assessed with the eight dimensions and the Physical (PCS) and Mental Component Summary (MCS) scales of RAND-36. Sociodemographic and lifestyle factors were recorded and psychometric scales were administered. Psychiatric diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. HRQL was quite poor in all dimensions of RAND-36 regardless of gender. Men and women had similarly poor scores for PCS and MCS. Mental health-related factors were main correlates of HRQL and this knowledge could be used in nursing practice and in health promotion.

Sociocultural factors influencing HIV/AIDS caregiving in Addis Ababa, Ethiopia

The sociocultural factors that influence care and caregiving vary from place to place, with both beneficial and harmful effects on the health of the caregivers. Therefore, this article presents the cultural and social structural factors that influence care and caregiving from the perspectives of the family caregivers of people living with HIV/AIDS in Addis Ababa, Ethiopia. Using semistructured interviews and participant observation, a purposive sample of six key participants and 12 general participants were interviewed in their home between December 2005 and January 2006. Four important sociocultural factors that influence care and caregiving have been identified: religious beliefs, economic issues, education, and social stigma and discrimination. The findings of our study underscore the importance of understanding the cultural and social structural factors that influence care and caregiving from the perspectives of family caregivers in order to provide culturally congruent care to those in need.

Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings

Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.

The Conceptions of Care Among Family Caregivers of Persons Living With HIV/AIDS in Addis Ababa, Ethiopia

This focused ethnographic study explores and describes the conceptions of care among family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Leininger's theory of culture care diversity and universality is the conceptual anchor of this ethnographic study. Using semistructured interviews and participant observation, 6 key informants and 12 general informants were interviewed in their home in Amharic language. Data were analyzed in Amharic using Leininger's phases of ethnonursing analysis for qualitative data and then translated to English. Four major themes representing family caregivers' conceptions of care were identified: nourishing the PLWA while struggling with poverty, maintenance of cleanliness and hygiene of the person and surroundings, comforting the PLWA, and sacrificing self to sustain the PLWA. Valuable data were gathered about the family caregivers' conceptions of care. Nurses can use this knowledge to design and provide culturally congruent care to family caregivers and PLWAs in the community.

Health-related quality of life in a population-based sample of men with long-term mental symptoms

It is not known whether somatic factors related to overall health and lifestyles or psychological factors, including confirmed psychiatric diagnoses, are associated with the health-related quality of life (HRQL) of men in a population-based sample. The aim of this study was to investigate socio-demographic, somatic and psychological factors associated with HRQL in men having mental symptoms during the 7 previous years. This cross-sectional sample of men (n=63) was investigated in 2004-05 and was based on a previous three-phase follow-up study that began in 1998. Blood pressure, body mass index, waist circumference, serum lipids and testosterone levels were measured. Psychiatric diagnoses were confirmed with using the Structured Clinical Interview for DSM-IV. Several mental symptoms were assessed with standardized scales. HRQL was measured with the RAND-36 using the physical (PCS) and mental component summary (MCS) scores. A poor HRQL in PCS was found in 73% of men and in MCS in 54%. Depressive symptoms, life dissatisfaction, male symptoms of aging and alexithymia were associated with both impaired PCS and MCS scores. Hopelessness, lifetime and current diagnoses of major depressive disorder and signs of suicidality only associated with a poorer MCS score. Somatic factors describing lifestyles and overall health only weakly associated with HRQL. In general, HRQL was poor in men having long-term mental symptoms. Mental health factors were strongly associated with PCS and MCS scores of HRQL. In improving HRQL in men, both physical and mental domains should be targeted in preventive and curative strategies.

Hope and schizophrenia: an integrative review

The purpose of this article is to describe the current status of research on hope and schizophrenia. The CINAHL database was used to identify the articles that met the criteria. The searches were conducted using the terms 'hope', 'hope instillation (IOWA NIC)', 'hope (IOWA NOC)', 'schizophrenia' and their combinations. The findings were limited to research articles. In addition, Pub Medical database was used by searching the words 'hope' and 'schizophrenia' from the fields 'title' or 'abstract'. Four new articles were found. The data consist of 17 articles on hope and schizophrenia published in peer-reviewed journals, which were analysed using content analysis. Existing research has focused on people with schizophrenia (n = 8), significant others (n = 4), staff (n = 2), hope-engendering interventions (n = 2) and treatment evaluation related to hope (n = 2) in the care of people with schizophrenia. Different data collection methods have been used in these studies. The most common method was interview (n = 9), followed by questionnaires (n = 8) and observation (n = 1). Most studies used quantitative methods (n = 9). Hope is considered a positive factor in the life of a person living with schizophrenia, in significant others as well as in staff members. Existing research provides evidence of the following themes: factors associated with hope and factors contributing to hope in people with schizophrenia; hope from the perspective of significant others of people with schizophrenia; staff hopefulness and factors contributing to their hope, hope-engendering interventions and treatment evaluation in regard to hope. Based on this review, research evidence of hope in the context of schizophrenia is quite scant and limited, even though the importance of hope in schizophrenia has been underlined in research reports and the literature. It is clear that hope is important to people with schizophrenia, their significant others and the healthcare personnel caring for them. It is therefore also important to study hope among these people.

'The most disgusting ever': children's pain descriptions and views of the purpose of pain

This article examines an area of a larger research project, aimed at investigating hospitalized children's experiences of pain. Descriptions of pain and views regarding the purpose of four to 11-year-old children's pain were investigated. A total of 44 hospitalized children participated in the study. The data were collected by means of a qualitative interview with the children. Using qualitative content analysis, interviews were coded and categories identified. Participant descriptions aimed at generalizing the pain. The children specified the nature of the pain and used paraphrases and metaphors. The study demonstrated that most of the children were able to articulate the purpose that they ascribe to their pain. The findings challenge nursing staff to regard the suffering child as an active partner in assessing their pain. An enhanced understanding can better prepare nurses for participating in the management of hospitalized children's pain.

Conceptions of patients and personnel concerning the substance of post-ward outpatient visits in psychiatric care

In post-ward outpatient services patients discharged from hospital are provided further care by the same ward personnel. The aim of this study was to describe and analyse the conceptions concerning the substance of post-ward outpatient visits (PWOV). A phenomenographic approach was used. The data were gathered by interviewing post-ward outpatients, personnel at psychiatric wards and in outpatient care and administrative personnel in psychiatric units. Seven main categories of describing the PWOV were formed: natural interaction, continuous assessment, follow-up of the implementation of pharmacotherapy, relapse prevention, search for coping methods, establishing motivation for treatment and family members' participation in care. The patient's health, life situation and coping in everyday life were constantly evaluated and followed up in diverse ways during the PWOV. To make PWOV successful, treatment should be planned individually based on the patient's needs, and the patient should have a close and functional cooperative relationship with the nurse.

Continuity of care in psychiatric post-ward outpatient services--conceptions of patients and personnel concerning factors contributing to the continuity of care

A structural change of the psychiatric services was started in Finland in the 1980s. Its primary objective was to shift the main emphasis from hospital to outpatient services. Hence, the number of psychiatric beds has declined to a third of the maximum rate, inpatient periods have shortened and the number of outpatient appointments has increased significantly. International research shows that when the emphasis of psychiatric services shifts to outpatient services and hospitalization becomes short-term, diverse individual alternatives are needed to support patients' coping. Several Finnish psychiatric hospitals initiated in the 1990s outpatient services provided at inpatient wards, which means, that after the period of hospitalization, further care is provided to the patient at the same ward where s/he was hospitalized. The purpose of this study was to describe and analyse the conceptions of patients, ward personnel, outpatient services personnel and administrative personnel in psychiatric units concerning the factors improving the continuity of care. A phenomenographic approach was used and the objective was to find the different empirical variations of the conceptions, through which people experience, comprehend and become conscious of the phenomena in the surrounding world. The data were gathered by interviewing post-ward outpatients (n=5), personnel at psychiatric wards and in outpatient services (n=18) and administrative personnel in psychiatric units (n=5). As a result of the analysis seven categories of the factors improving the continuity of care were formed: (1) adherence to a good cooperative relationship; (2) adherence to the care environment; (3) flexibility in tailoring care; (4) active maintenance of contacts in care; (5) constant possibility to contact the ward; (6) up-to-date patient data; and (7) active cooperation between outpatient services and other collaborators.

Primary health care practitioners' tools for mental health care

The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.

'I had this horrible pain': the sources and causes of pain experiences in 4- to 11-year-old hospitalized children

Researchers have relied, almost without exception, on adults for qualitative information about children's pain. However, adults may provide only a limited view of children's pain experience. The purpose of this article is to describe the events considered painful by children. Forty-four children participated in the study. They had been admitted for different reasons into different wards of a university hospital. The data consisted of qualitative child interviews and was analysed using inductive content analysis. The pain experience of children came from four main sources: 1. pain as a symptom of a diagnosed illness, 2. pain caused by medical and diagnostic procedures and basic nursing, 3. pain caused by accidents and 4. inexplicable pain not caused by a particular illness or injury. Children are able to report and describe their pain. Children should be regarded as experts on their pain in order to maximize the options for pain management.

Conducting a qualitative child interview: methodological considerations

BACKGROUND

Studies of children have a long history, but the literature related to young children consists for the most part of studies on rather than with children and taking little account of what is regarded as significant and meaningful by children themselves. Researchers have relied almost exclusively on adults when collecting data about children's thoughts, feelings and experiences. Interviewing children, however, gives an opportunity to gain information about their subjective experiences.

AIM

The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described.

METHOD

This paper is based on literature and the experience of one of the authors in interviewing children aged from 4 to 11 years about their experiences of pain.

FINDINGS AND CONCLUSION

A consideration of literature dealing with the principles of child interviewing shows that there is surprisingly little guidance available on conversational methods involving children. The empirical and conceptual foundation for child interviewing is not very clear. Novice researchers especially may need recommendations about how to conduct a qualitative child interview. The method must suit both the purpose and the context.

Health culture within the context of the northern environment

OBJECTIVES

This article is part of an ethnographic study that aims to describe and understand health as a phenomenon of the Sami culture.

STUDY DESIGN

The article is based on literature concerning the northern environment and the Sami culture, which is analysed from the point of view of health culture.

RESULTS

From the point of view of health culture, life in the northern regions requires adaptation to certain special features of the climate and the natural environment. Nature is also a versatile source of health care, healing and traditions. Particularly in the late 1990's, the northern environment and the Sami lifestyle were profoundly affected by changes in the sources of income caused by modernisation and the adaptation of traditional Sami livelihoods to governmental regulations. The current Sami values and beliefs are multilayered factors affecting health culture. The social growth milieu of Sami children as a source of health culture has changed over the generations. The key elements affecting the growth milieu have changed over time, due to the attitude of the government towards the Sami culture and the consequent changes and actions of society.

Practical nurses in elder care and changes in Finnish society - a biographical study

BACKGROUND

Substantial changes in the socio-economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them.

AIM

The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience.

METHODS

The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis.

FINDINGS

The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s-1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co-operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care?

CONCLUSIONS

The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.

Respect as the main lay care activity among the Bena in Ilembula village in Tanzania

The aim of this ethnographic study was to explore the cultural care practised among the Bena in the Ilembula villages in Tanzania. The purpose was to describe the cultural norms of the social and familiar relationship practices among the Bena for improving and maintaining health in terms of lay care. The data were collected through interviews, participant observation and personal working diaries in the Ilembula villages. Sixty-one villagers were interviewed. The findings show that respect has two main functions: it confirms unity and ensures well-being. Unity is important, and any violation against it is expected to be followed by a punishment, usually in the form of health deterioration. The main respective activities ensuring unity are observed in communication patterns, obedience, sharing the hardships of life and innocence. Rituals focus on the living-dead ancestors and serve both to confirm unity and to ensure well-being. Adult individuals guarantee their own and their descendants' well-being by taking care of their parents' basic needs and taking care of them when they are ill. The parents ensure their children's well-being by teaching them the Bena cultural beliefs and taboos. Respect is based on the world view of the Bena, which pivots on harmonious unity between individuals, supernatural forces and the kinship system.

Patient initiatives in psychiatric care concerning shame in the discussion in co-operative team meetings

The aim of this paper is to describe patients' experiences of shame and the way in which this experience is discussed in co-operative team meetings in acute psychiatric care. As an experience, shame is described as a painful and ugly feeling, which results in personal devaluation, isolation and a feeling of inferiority compared to others. This paper is based on 11 videotaped episodes of co-operative team meetings in two psychiatric units. The study approach was narrative. Shame was found to be the core narrative. The narrative of shame was laid out as an experience, and shame caused difficulties in the patients' daily lives and finally led to feelings of difference and loneliness. When the psychiatric patients and significant others tried to speak about the experience of shame with the professionals, the professionals either did not respond or changed the topic of discussion by asking questions about the patient's daily life and rationalizing the experience of shame. The participants did not share a common objective in the co-operative team meetings. Further research is needed to find new ways of co-operative team discussion and to develop the co-operative team meetings towards a patient-orientated model.

Factors associated with the coping of parents with a child in psychiatric inpatient care

The purpose of this study was to establish the parental coping' factors associated with having a child in psychiatric inpatient care. The data were collected from 19 hospitals with child psychiatry units. At the time of data collection, all parents of children in psychiatric inpatient care in these hospitals were recruited. The method of data collection was a questionnaire (n = 79). The data were analysed with the Statistical Package for the Social Sciences (SPSS) for Windows statistical software. The connections between variables were studied with cross-tabulation, and the chi2 test was used to determine significance. Changes in internal and external family relationships and matters related to the upbringing of the child with mental problems statistically correlated significantly with parental coping (P < 0.001). Problem-oriented and emotionally-oriented coping strategies, skills and palliative strategies correlated significantly with parental coping (P < 0.001). Emotional support, support for the care and upbringing of the child in inpatient care, and love and acceptance also had statistically significant associations with parental coping (P < 0.001).

Utilising the concept of protection in health maintenance among the Bena in Tanzania

This article reports the findings of a study of the protective health care actions by the Bena. The article is based on an ethnographic research project that dealt with cultural care among the Bena tribe in the Ilembula villages in Tanzania. The data were collected with open-ended interviews and participatory observation. Forty-nine villagers were interviewed. The findings show that childhood and adulthood include some sensitive phases of the Bena life span that require protective actions to ensure reproductive, physical, and mental health. The following main protective actions were related to health protection in the sensitive phases: taking local herbs, avoiding sexual relations, hiding menstruation and early pregnancy from others, avoiding contacts with magic, avoiding kitchen work, using one's own utensils, and omitting greeting others.

Feeling of 'lacking' as the core of envy: a conceptual analysis of envy

The aim of this paper is to explore the subjective experience of envy through concept analysis. Further, the study on which it is based aimed to answer questions about the composition and manifestations of envy. From the viewpoint of nursing science, the analysis of envy is based on a desire to understand human beings from the perspective of subjective health and illness and thus from a health promotion perspective. Envy is conceived of as a dimension of a person's health and illness. The concept is therefore meaningful from the viewpoint of nursing; it describes a phenomenon which enables us to deepen our understanding in a way relevant to nursing science. In the study the hybrid model developed by Schwartz-Barcott et al. was used for conceptual elaboration. In the theoretical phase of the study the subjective experience of envy was explored from the viewpoints of philosophy, religion, Finnish folklore and psychoanalysis, as well as nursing science. As a synthesis of these, a conceptual analysis of envy adapted from Wilson was conducted and a working definition of envy was proposed. In the fieldwork phase, envy was examined by means of an empirical analysis using a phenomenological approach. As a result, a classification describing the experience of envy was presented. The core experience of envy has been defined as a 'lacking', and the object of envy as something good possessed by someone else. Envy manifests itself in both destructiveness and creativity. The trends of development of envy are inflexibility and emancipation, and the essence of envy is multidimensional. Finally, the working definition of the concept was elaborated on the basis of the empirical phase and a new definition reflecting the composition and manifestations of envy was proposed.

Life control of members of the Kainuu Martha Organization in Finland

The purpose of this study was to describe the life control of members of the Kainuu Martha Organization (the Marthas), based on their written autobiographic material. The study material consisted of written thematized autobiographies of members of the organization (n = 41). The material was analysed using qualitative content analysis with concepts of the health portrait. The Marthas were classified into three groups (member, participating and leading) on the basis of their participation in Martha activities. According to the generational categorization of Roos, the member Marthas represented the Finnish generations of well-being, structural change and shortage. They did not participate actively in the Martha activities. Their feeling of life control was based on the sense life made to them. The member Marthas emphasized the meaning of family in their lives. The participating Marthas represented the generations of structural change and shortage. They participated in the Martha activities as observers or by attending the functions of their local organizations. Their feeling of life control was related to a favourable attitude towards life and concern for their human relations. The leading Marthas represented the generation of shortage and participated actively in the Martha activities. They believed in the continuity of the Martha Organization in Kainuu. They had a strong feeling of life control. This manifested as an enterprising spirit in everyday life, which included a skill to live life as it occurred. The lives of the leading Marthas were characterized by a favourable attitude, a feeling of responsibility and initiative.

A midwife-public-health nurse's work in northern Finland, 1950-87

This paper describes the work of Jouki Nykänen, a midwife public-health nurse in northern Finland during the years 1950-87. The material for the study was collected by a biographical interview. On the basis of content analysis, the work of the interviewee consisted of the following phases: (i) midwife-public-health nurse in the district of Sevettijärvi (1950-58); (ii) municipal midwife in Pyhäntä (1958-60); and (iii) midwife-public-health nurse in the rural district of Karunki (1962-87). In Sevettijärvi, Jouki's work emphasised independent planning and implementation. In Pyhäntä, her health-care clinics were well organised. In Karunki, another midwife-public-health nurse working with Jouki made conditions flexible, with personal districts for the two nurses. During home visits, Jouki took care of the whole family, from the grandfather to the baby. The Finnish Public Health Act (1972) changed the character of Jouki's work. The number of home visits decreased and clinics, fragmented into several fields of health care, took the place of home visits, requiring efficiency and results. The results of the study showed the core of a midwife-public-health nurse's work in Finland in a changing historical and social context, as well as showing the changes in a midwife-public-nurse's work since the post-war years.

'A good person does not feel envy': envy in a nursing community

The definition of envy is commonly based on psychoanalytical views of organizational culture. The purpose of this paper is to describe envy in a nursing community. The population study consisted of random sample of 120 subjects drawn from among the employees of one central hospital in Finland. The study material consisted of data collected by questionnaires (response rate 65%). The data were processed by various statistical methods. Open-ended questions were analysed by inductive content analysis. The results of this study indicated that the employee's view of his/her official position in the nursing community, his/her relationships with his/her fellow workers and the management as well as relationships with other nursing communities are all related to envy. The employee's view of his/her official position intensified his/her feelings of envy, if he/she had other negative feelings, anxiety, dissatisfaction with him/herself, and negative feelings towards fellow workers. The major object of envy was fellow workers' salaries. Envy towards other nursing communities was generated by alleged differences in the amount of labour, or by the charge nurse's greater interest in other sections. Employees coped with envy by hiding these feelings and being modest. Women coped with envy by being silent, while men denied the value of the object of envy.

[Parents' coping with a diabetic child]

The purpose of this study is to describe and understand the process of parental coping with diabetic children in early childhood. The parental coping process was followed for a four-week period after the diagnosis of diabetes. The parents of two girls whose diabetes was diagnosed in early childhood served as study subjects. The data were collected by interviewing and observing the parents over four separate periods, first in hospital and later at home. The data were analyzed by the timeseries and content analysis methods. The main categories were formulated on the basis of coping theories. The subcategories were developed inductively from the data. Six phases of the parental coping were identified, which were named: 1). Disbelief, 2). Lack of information and Guilt, 3). Learning of Care, 4). Normalization, 5). Uncertainty and 6). Reorganization. In the different phases of parental coping the parents' experience of stress, coping strategies and sense of control varied. In the phase of Disbelief, parents tried to explain away the child's diabetes by questioning the diagnosis. The initial information given to the parents regarding their child's diabetes proved to be very important for parental coping. In the second phase of Lacking Information and Guilt, the parents sought for a reason for their child's diabetes and they felt guilty about it. As coping responses, the parents sought support from each other and from people who have undergone the same experience. In the Learning of Care phase, they recognized the demands caused by diabetes and took responsibility for the child's care. The parents responded that supervision based on their problems was the best. In the Normalization phase, the parents prepared to go home with the diabetic child. Getting back to normal life was one of the most effective parental coping responses. In the Uncertainty phase, the care to be given to the diabetic child changed the daily routines of the family. In the Reorganization phase, the parents adapted to the diagnosis of diabetes and the care of the diabetic child. The parents felt that the life of the family became normalized and controlled. The important parental coping responses consisted of concrete models of functioning, which they developed to control the demands caused by the child's diabetes.

["A good person does not feel envy"--envy in nursing communities]

The purpose of this study was to describe the nature, manifestation, and amount of envy among the staff of a nursing community. The definition of envy is commonly based on views of essence of envy and organisational culture. The population study consisted of random sample of 120 subjects drawn from among the employees in the Kainuu Central Hospital. Frequency and percentage distributions were used to present the data. The correlations between the variables were examined using cross-tabulation. Summarized variables were formed for nature of envy, and the Cronbach alpha coefficient was used to test the internal consistency of those. Factor analysis and cross-tabulation were also used. Open-ended questions were analysed by qualitative contact analysis. These results were used to complement quantitative data. The results of this study indicated that the employee's view of his/her official position in the nursing society, his/her relations with his/her fellow workers and the management as well as the relations to other nursing societies are all related to enviousness. The employees's view of his/her official position intensified his/her feelings of envy, if he/she had other negative feelings (anxiety, dissatisfaction with him/herself, and feeling if looks could kill). If the employee was ambitious and hard-working, his/her envy manifested in a comparison of his/her own work and the work of other employees. The major object of envy was fellow workers' salary. Envy was also caused by new, proficient, and senior co-workers and possible favourites or proteges of management. Envy towards other nursing community was generated by alleged differences in the amount of labour, or by the charge nurse's greater interest in other section. Employees coped with envy by hiding these feelings and being modest. Women coped with envy by being silent.

[The work of a midwife-public health nurse in northern Finland in 1950-1987]

The purpose of this study was to describe the work of Jouki Nykänen, a midwife-public health nurse, in northern Finland in 1950-1987. The material for the study was collected by life-history interview. According to content analysis the work of the interviewee consisted of the following phases: 1) work as a midwife-public health nurse in the district of Sevettijärvi in 1950-1958, 2) work as a municipal midwife in Pyhäntä in 1958-1960, and 3) work as a midwife-public health nurse in the municipality of Karunki, in 1962-1987. In Sevettijärvi, planning and implementation of work were emphasized. The public health nurse-midwife worked whenever people needed her and when they came "to town". In Pyhantä, the clinics were well-organized. The work as a midwife-health nurse in Karunki was flexible, and another public health nurse also worked in the municipality. During home visits the interviewee took care of the whole family from the grandfather to the baby. The Public Health Act (1972) changed the character of the work: the number of home visits decreased and clinics fragmented into several fields of health care took the place of home visits, requiring efficiency and results. The results of the study showed the core of a midwife-public health nurse's work in a historically changing social context as well as the changes in the work between the postwar years and the present day.

Life after the mental hospital: the way of life of deinstitutionalized psychiatric patients

This article describes and analyses the way of life of deinstitutionalized long-term psychiatric patients in Northern Finland. The major focus of the paper is the central areas of life of the outpatients as one dimension of subjectivity. The data were collected by interviewing 25 discharged long-term psychiatric patients. The findings suggest that home was the central area of life for the outpatients but they differed in their relation to it. Some of the patients were actively building their home. For some others home was an asylum in which to hide from social life. Many patients had hobbies that only took place inside their homes. One of the problems that the outpatients had to face was lack of work. The elderly patients who generally regarded work as a virtue experienced difficulties in finding something to do in their modern suburban homes. Social participation was mostly labelled by the old and familiar hospital models. The patients had no new acquaintances. They kept contact with their former fellow patients.

Professional nursing care in Tanzania: a descriptive study of nursing care in Ilembula Lutheran Hospital in Tanzania

The purpose of this ethnonursing study is to find new knowledge of the professional nursing care practised in a Bantu cultural context in Tanzania. The main questions are: How do Bantu nurses describe nursing? What components are there in professional nursing care in Ilembula Lutheran Hospital? The data were collected through participant observation, interviews and personal working diaries in Ilembula Lutheran Hospital. Six Tanzanian nurses were interviewed. The findings indicated that nursing was based on formal training on one hand, and on a natural mother-child relationship on the other hand. The idea of respect towards life, which is central to the Bantu philosophy of life, guided nursing care. In professional nursing care there emerged curing and caring components. Protection, encouragement and comfort were distinguished as the main constructs of caring.

The life situation of a long-term psychiatric patient: some restrictions in, and possibilities of, open care

This paper describes and analyses, from a sociocultural viewpoint, the ways of life of discharged long-term psychiatric patients in northern Finland. The paper focuses on subjectivity: control of life and fundamental experiences in life. The data consist of interviews with 25 outpatients who have moved to live in residential homes, rehabilitation centres or their own homes after receiving preparatory training in the psychiatric hospital. The findings suggest that the way of life of the outpatients did not significantly differ from that of other people belonging to the same generation of Finns. With respect to control of life, a conspicuous feature was the strong tendency to let themselves be led by others, and to self-sacrifice for the good of others. For the patients, independence was the best aspect of open care. Fear for being branded as a psychiatric case or as a former mental patient threatened the patients' external control of life. The central element of control of life of the Finns is work. The outpatients thought work a matter of honour and they did not find their present, inactive way of life satisfactory.

Changes in psychiatric caring values in Finland

A shift from institutional to non-institutional caring systems took place in Finnish psychiatric care in the 1980s. This article describes the values related to caring and the changes that occurred during the time span of a decade in a ward that rehabilitates mental patients as non-institutional care in northern Finland. The changes in patient and staff values are examined by studying the changes in caring practices in the ward. The ethnonursing method developed by Leininger (1995, 1991) was used to examine the rehabilitation of psychiatric patients. Data were collected by interviewing twenty patients and eleven staff members. Results demonstrated that by the 1980s individualism was increasingly valued and personal freedom and self realization were more valued than hard work and solidarity. People's values shifted from universality to greater diversity. Transcultural nursing implications are discussed.

Caring from the point of view of a Finnish mental health nurse: a life history approach

Finnish mental health care went through a major change in the 1980s. Its institutions were being run down and there was a shift to a caring system that stresses non-institutional practices. The schooling and work of the mental health nurse had to adapt to the new situation. The purpose of my study was to describe and analyse the mental health nurse's work, i.e. caring, as it is experienced by a nurse in the preparation of long-term psychiatric patients for non-institutional care. The data consist of repeated interviews with Vuokko, who has been a mental health nurse for about 30 years and is now approaching her retirement. In the light of the data, the central features of caring are caring about and taking an overall responsibility for the patient, and teaching the patient to cope with everyday life. Caring is based on practical knowledge, the essential elements of which are intimacy and feelings.

Caring in the preparation of long-term psychiatric patients for non-institutional care: ethnonursing study

Caring is the central and unifying domain for the body of knowledge and practices in nursing. It was the purpose of this ethnonursing study to describe caring in the residential training for long-term psychiatric patients in Finland in 1977-1988. Data were collected by interviewing 20 patients and 11 members of staff. On the basis of the empirical data, four stages of caring could be distinguished: formation, reformation, fragmentation and reintegration. The changes in caring occurred on the following dimensions: work for wages vs. vocation; spontaneous social interaction vs. the systematic instruction of practical skills; and collective activities vs. individual activities.