Mikael Rask

The meaning of the experiences of persons with chronic pain in their encounters with the health service

Chronic pain causes great suffering for those affected and treating it is one of the most common assignments in the health service. The aim of the study was to investigate the meaning of the experiences of persons with chronic pain in their encounters with health service staff. The study had a descriptive design with a phenomenological approach based on the perspective of caring science. Interviews were carried out with eight patients. The study showed that patients experienced a positive approach and that the staff had understood the serious nature of the situation. A positive approach can communicate hope and help to strengthen the patient. It is important to ask the patient about how he/she experiences his/her situation and thus gain an insight into this persons lifeworld. Participation entailed being active oneself and calling attention to ones needs and wishes for treatment. The study also showed that a negative approach by the staff played a prominent part in their experiences and appeared to be engraved in their memories. A negative approach is felt as being insulting and belittling. Patients with chronic pain felt that they were discredited and that their experience of their situation was called into question. They had to fight to get care and had to suggest treatments and examinations. There were also patients who had neither been asked about their pain experience nor had the opportunity to assess their pain with an assessment scale. Some of the phases in Travelbees relationship model could be seen in several of the encounters but not all. The participants did not always feel that the manner of the nursing staff was empathetic or sympathetic, which led to greater suffering.Scand J Caring Sci; 2011; 25; 444–450 The meaning of the experiences of persons with chronic pain in their encounters with the health service Chronic pain causes great suffering for those affected and treating it is one of the most common assignments in the health service. The aim of the study was to investigate the meaning of the experiences of persons with chronic pain in their encounters with health service staff. The study had a descriptive design with a phenomenological approach based on the perspective of caring science. Interviews were carried out with eight patients. The study showed that patients experienced a positive approach and that the staff had understood the serious nature of the situation. A positive approach can communicate hope and help to strengthen the patient. It is important to ask the patient about how he/she experiences his/her situation and thus gain an insight into this person’s lifeworld. Participation entailed being active oneself and calling attention to one’s needs and wishes for treatment. The study also showed that a negative approach by the staff played a prominent part in their experiences and appeared to be engraved in their memories. A negative approach is felt as being insulting and belittling. Patients with chronic pain felt that they were discredited and that their experience of their situation was called into question. They had to fight to get care and had to suggest treatments and examinations. There were also patients who had neither been asked about their pain experience nor had the opportunity to assess their pain with an assessment scale. Some of the phases in Travelbee’s relationship model could be seen in several of the encounters but not all. The participants did not always feel that the manner of the nursing staff was empathetic or sympathetic, which led to greater suffering.

WARD ATMOSPHERE—THE SCARLET PIMPERNEL OF PSYCHIATRIC SETTINGS?

Patients and staff in a forensic psychiatric setting were requested to name three distinguishing characteristics of the ward atmosphere. The manifest content analysis of the responses revealed the following categories: interpersonal relations and pre-conditions for interpersonal relations; organization; staff; treatment; daily activities; physical environment; and feeling good and secure. The patients appeared to have a peripheral role as contributors to the ward atmosphere in the views of the respondents. The easily administered single question format provided valuable information about an intangible element of psychiatric settings—the ward atmosphere.

Patient and staff perceptions of the ward atmosphere in a Swedish maximum-security forensic psychiatric hospital

The main aim of the study was to describe and compare the patient and staff perceptions of the ward atmosphere of a maximum-security forensic psychiatric hospital in southern Sweden. The main instrument used, the Ward Atmosphere Scale (WAS), was administered to both patients and staff on the eight wards of the hospital, where there was a total of 82 beds. The hospital has a regional responsibility for maximum-security forensic psychiatric care in southern Sweden. Forty-eight per cent of the patients and 82% of the staff consented to participate in the study. The results of the study showed that the patients rated intermediate levels of all the 10 subscales of WAS with the lowest mean scores for Autonomy and Involvement and the highest mean scores for Programme Clarity and Order and Organization. The staff, however, rated a low level of Staff Control and high levels of Programme Clarity, Practical Orientation and Support. The staff and patient perceptions differed on eight of the 10 WAS subscales with only Personal Problem Orientation and Anger and Aggression being rated at similar levels. The results are considered in the light of the limited available literature in the field. Furthermore, the differences between the perceptions of the two groups as well as the clinical implications of these differences are discussed.

Experiences of a Person-Centred Health Education Group Intervention–A Qualitative Study Among People with a Persistent Mental Illness

The main focus of psychoeducative interventions for people with persistent mental illnesses has been on providing information about symptoms of disease and its treatment. Supporting group contexts ...

Satisfaction with housing and housing support for people with psychiatric disabilities.

The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as others influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.

A Suggested Revision of the Community Oriented Program Environmental Scale (COPES) for Measuring the Psychosocial Environment of Supported Housing Facilities for Persons with Psychiatric Disabilities

The aim of the present study is to address issues of construct validity and reliability of a revised short version of the COPES instrument to measure the psychosocial environment of supported housing facilities for persons with psychiatric disabilities. The results revealed that the division into subscales is not sufficiently reliable for use in measuring the psychosocial environment, although the three higher order dimensions can possibly be used for the descriptive and comparative purposes. A factor analysis based on the revised short version generated new factor solutions, differing from the COPES subscales, but with sufficient psychometric properties.

Quality of community-based day centre services for people with psychiatric disabilities: psychometric properties of the Quality in Psychiatric Care - Daily Activities (QPC-DA).

Abstract Background/aims The aim of the present study was to test the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care – Daily Activities (QPC–DA) and to briefly describe the day centre attendees’ perception of the quality at community-based day centre services. Methods A sample of 218 attendees from 14 community-based day centre services in seven municipalities in Sweden participated in the study. Results Confirmatory factor analysis revealed that the QPC–DA consists of six dimensions and has a factor structure that to a large extent corresponds to that found in other studies of quality in psychiatric care settings, such as inpatient, outpatient, forensic inpatient, and housing support for people with psychiatric disabilities. The internal consistency of the factors was satisfactory and thus the QPC–DA showed adequate psychometric properties. The attendees’ ratings of quality of community-based day centre services were generally high. The highest rating was for the encounter dimension and the lowest for the participation and the secluded environment dimensions, indicating areas for improvement. Conclusion/significance The QPC–DA includes important aspects of the attendees’ assessment of quality of community-based day centre services and offers a simple and inexpensive way to evaluate quality from their perspective.

Evaluation of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) in persons with heart disease: A pilot study

Background: As part of preparation for a Swedish multicentre study, exploring sexual and married life in patients with myocardial infarction and their partners, a Swedish validated instrument was required. Aims: The aim of this pilot study was to evaluate the validity and reliability of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) among persons with a heart disease. Methods: A convenience sample of 79 persons (47 men and 32 women) living with a heart disease was recruited from the members of the National Association of Heart and Lung Patients. They completed a Swedish version of the WSFQ on two occasions. Results: Two separate factor analyses each revealed a two-factor structure on both occasions: “Sexual appetite” and “Sexual expectations” with gender-neutral questions and “Sexual sensitiveness” and “Sexual ability” with gender-specific questions. Cronbachs alpha coefficients ranged from 0.48 to 0.86 and test–retest values for all but one question exceeded 0.70. Conclusions: The Swedish version of the WSFQ showed good validity and stability and acceptable internal homogeneity. Extended evaluations of the questionnaire are recommended.

Beliefs about health and illness and health-related behavior among urban women with gestational diabetes mellitus in the south east of China.

Purpose: The incidence of gestational diabetes among Chinese women is 4.3%. No study has previously been conducted about beliefs and health-related behavior among urban Chinese women with this disease. This article aims to explore beliefs about health and illness and health-related behavior among women in this group in a Chinese sociocultural context. Design: A qualitative exploratory study was conducted and semistructured individual interviews (n = 15) were processed by content analysis. Results: Beliefs about health and illness among these women were foremost attributed to the individual, social, and natural worlds. They feared the negative influence of gestational diabetes, but some of them believed in “letting nature take its course” and “living in the present.” Their care-seeking behavior varied between the professional, popular, and folk sectors. They sought a balance between following professionals’ advice and avoiding practical difficulties. Conclusion: The beliefs and health-related behavior among them were influenced by Chinese culture, which can sometimes but not always reduce the effect of the disease.

Striving for meaning - Life in supported housing for people with psychiatric disabilities

The aim of this study was to develop a grounded theory about people with psychiatric disabilities, living in supported housing. Interviews as well as observations during the interviews were analyzed together with secondary analyses of quantitative and qualitative material from previous studies. Being deprived of self-determination emerged as the main concern for residents in supported housing and striving for meaning emerged as the pattern of behavior through which this group resolves their main concern. Striving for meaning involves living in the present, striving for self-determination, strengthening self-esteem, emotional processing and resting from the present. The strategies facilitate each other and are used singly, together simultaneously, or alternately. If they are successful, a meaning in the present is perceived. If all the strategies fail repeatedly, escaping from the present is used in order to deal with being deprived of self-determination. The implications of the findings suggest prioritizing a reduction of the institutional nature of the social and physical environment, and to support the residents’ self-determination.The aim of this study was to develop a grounded theory about people with psychiatric disabilities, living in supported housing. Interviews as well as observations during the interviews were analyzed together with secondary analyses of quantitative and qualitative material from previous studies. Being deprived of self-determination emerged as the main concern for residents in supported housing and striving for meaning emerged as the pattern of behavior through which this group resolves their main concern. Striving for meaning involves living in the present, striving for self-determination, strengthening self-esteem, emotional processing and resting from the present. The strategies facilitate each other and are used singly, together simultaneously, or alternately. If they are successful, a meaning in the present is perceived. If all the strategies fail repeatedly, escaping from the present is used in order to deal with being deprived of self-determination. The implications of the findings suggest prioritizing a reduction of the institutional nature of the social and physical environment, and to support the residents’ self-determination.