Elisabeth Severinsson

The emotional pain and distress of borderline personality disorder: A review of the literature

This paper presents a synthesis of content and assessment of the methodological rigour of published literature related to concepts of emotional pain and distress in women with a diagnosis of borderline personality disorder (BPD). In the past two decades, there has been an increase in research about the prevalence of BPD, interventions, and relative effectiveness of various forms of treatment. However, there are few studies regarding emotional pain and distress in women with BPD. Emotional pain has been reported as an adaptive response to repetitive traumatic experiences in childhood. Searches of the EBSCO host, OVID MEDLINE, CINAHL, and PsycINFO databases were carried out using the following search words: borderline personality disorder, emotional pain, distress, self, suffering, women, for the period 1996-2006. Fifteen papers were assessed for methodological rigour, followed by the analysis of the concepts of emotional pain and distress. Three themes emerged from the literature, the emotionally abused and neglected child; struggling with emotions leading to self-injury; and social problems related to difficulties regulating emotions. A high prevalence of reported childhood abuse was revealed. Emotional pain was described as intense for women suffering from BPD. A further synthesis of research findings is recommended to provide information on the effectiveness of interventions.

Parents' experiences of collaboration with community healthcare professionals.

Over the last decades there has been a reduction in the number of institutional beds in psychiatric care in Norway. This has led to more psychiatric patients being dependent on community care and consequently an increased need for collaboration with the parents of these patients. In most cases parents are an important source of support in helping patients manage their everyday life. The aim of this study was to explore how parents of adult psychiatric patients experience collaboration with health professionals in the community healthcare services. The data collection in this study is based on 12 interviews with six parents, and a qualitative analysis method was employed. Four themes emerged: (1) communication and relationship between parents and health professionals; (2) lack of information; (3) parents’ participation in the treatment of their son or daughter; and (4) the need for guidance and support. It was reported that health professionals are suspicious of parental involvement and often refuse to allow them to participate in the care. Further research on parents’ experiences of collaboration is necessary. The value of parents as an important source of support can be enhanced by means of increased collaboration.

Exploring student nurses’ reflections on moral responsibility in practice

Student nurses are faced with a demand for moral responsibility during their clinical education. In order to gain an understanding of how they reflect on the phenomenon of moral responsibility in nursing practice, repeated focus group interviews were conducted. Fourteen student nurses in their final year of the three year baccalaureate programme in nursing were interviewed during their final placement. The interpretive content analysis disclosed the manifestations of moral responsibility as being available for the patient, shielding the patient and being confronted with the voice of conscience. The findings highlighted the importance of space given to ethical reflection on a regular basis as a joint activity. This included by both student nurses and professionals.

Shared Decision-Making—Balancing Between Power and Responsibility as Mental Health-Care Professionals in a Therapeutic Milieu:

Background Shared decision-making (SDM) is supposed to position patient and expert knowledge more equal, in which will have an impact on how mental health-care professionals relate to their patients. As SDM has not yet been widely adopted in therapeutic milieus, a deeper understanding of its use and more knowledge of interventions to foster its implementation in clinical practice are required. Aim To explore how mental health-care professionals describe SDM in a therapeutic milieu as expressed through clinical supervision. The research question was “What are prerequisites for mental health-care professionals to practice SDM in a therapeutic milieu?” Methods A qualitative content analysis of data from focus groups dialogues in 10 clinical supervision sessions where eight mental health-care professionals participated was performed. Findings The theme, practicing SDM when balancing between power and responsibility to form safe care, was based on three categories: internalizing the mental health-care professionals’ attributes, facilitating patient participation, and creating a culture of trust. Conclusion SDM is a complex and arduous process requiring appropriate interventions. Clinical supervision is necessary for reflection on SDM and for improving practice in a therapeutic milieu.

First-line nurse managers' perceptions of the challenges involved in decision-making when older pateints' wish to die

The aim of this study was to explore first‐line nurse managers’ perceptions of the challenges involved in decision‐making concerning older patients who wish to die.