Solfrid Vatne

Experiences and preferences of users with major mental disorders regarding helpful care in situations of mental crisis

Aims: To examine the experiences of and preferences for helpful care in situations of mental crisis from the perspective of people with major mental disorders. Methods: Qualitative individual interviews with 19 users with major mental disorder, 13 men and six women, aged 22–60 years. Analysis was conducted with systematic text condensation. Results: The main tendencies among a majority of the users are a clear understanding of their own problems and ways of handling these, and the desire for early help from providers whom they know well and who are open to dialogue and reflection. A clear majority perceived a high threshold for contacting the mental health system due to negative experiences and lack of user involvement in treatment planning and implementation. Conclusion: The findings challenge traditional views of professionalism and describe important implications for mental health services from the user’s perspective. Our study provides a clear indication of the importance of becoming an active participant in one’s own life, and the need for deeper understanding among the professionals in relation to user experiences and preferences for helpful care in periods of mental health crisis in order to optimize the care.

The influence of day care centres for people with dementia on family caregivers: an integrative review of the literature.

Objectives: Day care centres (DCC) for people with dementia (PWD) have received increased attention recently, due to a shift in policy from the use of residential care towards home-based services. The aim of this study is to provide an extended understanding of the influence of DCCs on family caregivers (FCs). Method: An integrative review including 19 studies was used: qualitative (n = 2), quantitative non-randomised (n = 8), quantitative descriptive studies (n = 7), and with mixed-method design (n = 2). The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT). Results: FC experienced the DCC both as a respite service, and to some extent as a support service, improving their competence in caring for the PWD. The quality of the DCC influenced its use, and the FCs motivation to care for the PWD. FCs gender, role, individual needs, PWD behavioural problems and need for assistance played an important role. Conclusion: As a respite and support service, DCCs have the potential to give FCs a feeling of safety and relief, reduce the caregivers burden, and increase their motivation towards their role as caregivers. These outcomes depend on the quality of treatment, and how the service meets the FCs needs for flexibility, support, information, and responsibility sharing.

Service users' experiences and views of aggressive situations in mental health care: a systematic review and thematic synthesis of qualitative studies.

Background Aggressive situations occurring within mental health services can harm service users, staff, and the therapeutic environment. There is a consensus that the aggression phenomenon is multidimensional, but the picture is still unclear concerning the complex interplay of causal variables and their respective impact. To date, only a small number of empirical studies include users’ views of relevant factors. The main objective of this review is to identify and synthesize evidence relating to service users’ experiences and views of aggressive situations in mental health settings. Methods We included qualitative studies of any design reporting on service users’ own experiences of conditions contributing to aggressive situations in mental health care and their views on preventative strategies. Eligible articles were identified through an electronic database search (PsycINFO, PubMed, Ovid Nursing Database, Embase, and CINAHL), hand search, and cross-referencing. Extracted data were combined and interpreted using aspects of thematic synthesis. Results We reviewed 5,566 records and included 13 studies (ten qualitative and three mixed methods). Service users recognized that both their own mental state and negative aspects of the treatment environment affected the development of aggressive situations. Themes were derived from experiential knowledge and included calls to be involved in questions regarding how to define aggression and relevant triggers, and how to prevent aggressive encounters effectively. The findings suggest that incidents are triggered when users experience staff behavior as custodial rather than caring and when they feel ignored. Conclusion The findings highlight the importance of staffs’ knowledge and skills in communication for developing relationships based on sensitivity, respect, and collaboration with service users in order to prevent aggressive situations. An important factor is a treatment environment with opportunities for meaningful activities and a preponderance of trained staff who work continuously on the development of conditions and skills for collaborative interaction with users.

Effects and Costs of a Day Care Centre Program Designed for People with Dementia-A 24 Month Controlled Study

Background: Attending day care centres with programs specifically designed for patients with dementia is believed to postpone admittance to nursing home as well as increase quality of life and well-being for both patients and their family carers. Therefore, the Norwegian Ministry of Health and Care Services is presently offering funding to all municipalities that wish to establish day care centre programs for this group of patients. There is only limited knowledge on the effectiveness of day care centre programs designed for patients with dementia. Our research group aims to investigate to what degree attendance in day care centres with programs designed for people with dementia is effective to postpone admittance to nursing home care, to enhance quality of life for the patients and to relieve burden of care for the family carers. Methods/Design: The study is a quasi-experimental trial with a comparison group and a qualitative inquiry. Four hundred patients with dementia and their family caregivers will be included in the trial. Assessments will be made at baseline, after one and two years. Data collection will be made at three levels; at patient level with measures of cognition, depression, coping, quality of life, functioning in activities of daily living, neuropsychiatric symptoms and time of death; at family carer level with measures of depression, coping and burden; and at societal level with measures of nursing home admittance, hospital stays and use of other health and social care resources. For the qualitative analysis, 20 dyads of patients receiving a day care program and their family carers will be asked to participate. The main focus will be to explore how the day care centre programs affect both the patients and the family carers’ daily life. Five of these dyads will be followed closely throughout two years. Trial registration: Clinical Trial number NCT01943071.

The influence of day care centres designed for people with dementia on family caregivers – a qualitative study

BackgroundDementia is one of the most challenging age-related illnesses for family caregivers, whose care-related burden is well known. Research indicates that day care centres (DCCs) can reduce the caregiver burden and help family caregivers to cope with demands; however, the current body of knowledge is still tentative and inconsistent, and more research is recommended. The aim of this study is to provide an extended understanding of the situation of family caregivers and to examine to what extent DCCs can meet their need for support and respite.MethodsThis study has a qualitative descriptive design using in-depth interviews with 17 family caregivers of people with dementia attending DCCs. The data analysis was undertaken using systematic text condensation.ResultsCaregivers experience a complex role, with added responsibilities, new tasks, and emotional and relational challenges that are expressed through distressing emotions and demands for interaction. Additionally, the caregiving role leads to positive experiences, such as acceptance and adaptation, support and help, and positive changes in the relationship. Day care relieves family caregivers by meeting the person with dementia’s needs for social community, nutrition, physical activity, and structure and variety in everyday life. Using a DCC led to a higher quality of time spent together and easier cooperation, but it also produced some hard feelings and challenging situations. DCCs gave the caregivers a feeling of freedom and increased the time available to be spent on their own needs, to be social and to work or do practical tasks undisturbed.ConclusionsDCCs for people with dementia can give family caregivers support and relief and have a positive impact on the relationship between the family caregiver and the person with dementia. A more individualized program, in addition to flexible opening hours, would make DCCs even more effective as a respite service, positively influencing the family caregiver’s motivation and ability to care and postponing the need for nursing home placement.

Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships

Background and objective The Individual Care Plan (ICP) was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP]) was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users’ own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care documentation and planning tools.

Feeling "overloaded" and "shortcomings": milieu therapists' experiences of vulnerability in caring for severely mentally ill patients.

Background Milieu therapists’ relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists’ vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists’ experiences of their own vulnerability in their interactions with patients in mental health services. Materials and methods The data collection method was focus-group interviews. Thirteen part-time master’s in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2–8 years). Results The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) “overloaded”, by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) “shortcomings”, connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Conclusion Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists’ vulnerability might strengthen their personal and professional integrity in professional practice in mental health services. Health care managers’ focus on the supervision of individual professionals in practice and practical training is important. Further research on the coherence between vulnerability and professionalism is recommended.

Riding a roller coaster: narrative typologies of patients with neuroendocrine tumors

Background and objective Illness stories have attracted growing attention in health care research in the context of learning from looking at the world through the patients’ eyes. No narrative studies were found about the patients with neuroendocrine tumors (NETs); a rare illness including tumors usually starting in hormone-producing cells. The aim of this article was to develop an extended understanding of these patients’ experiences and struggles, as well as their solutions to a common problem. Methods The data source was 21 letters written by the patients with NETs treated at an ambulatory treatment center at a large urban hospital in Italy. The letters were analyzed using the Arthur Frank’s narrative method. We paid particular attention to statements of self-experience, which is crucial to get the character of the story. Results We identified four different typologies: “Not illness stories”, “Living in imbalance”, “Living a new life in balance”, and “Living a normal life”. The main characteristics of these four groups could be linked to Frank’s typologies. However, the patients with this periodically changing disease were continuously in the process of attaining balance in life, and they might move between these various typologies. Conclusion The NETs are incurable illnesses that challenged the peoples to attaining a new balance in life. We will highlight stories focusing on the patients’ imbalance and chaos because they illuminated the patients’ concrete suffering, which might provide clinicians with specific information about the patients’ emotional, physical, and spiritual state. Through learning from the stories of the patients attaining new balance, it seems possible to move forward to acceptance and to develop a model for a new way of living. However, we are skeptical about labeling these stories as a model for clinical practice because they might contribute to individualistic and heroic prescriptions for life that are impossible for others to achieve.

Discourse analysis of health providers' experiences using service design

Municipal healthcare organizations are facing increasing challenges to developing more cost‐effective organizations and services, particularly in nursing homes. The background for this article is an attempt in this concern; implementing service design in a nursing home.

Encountering Ambivalence – A Qualitative Study of Mental Health Nurses' Experiences with Dual Relationships

ABSTRACT Nurses are obliged to set professional boundaries in nurse–patient relationships. Relationships with patients that are pursued outside of working hours (dual relationships) are commonly prohibited by legislation and professional codes of ethics, but some nurses still engage in them. A thematic analysis of qualitative interviews revealed that the nurses experienced ambivalence regarding how they see the patients, their assessment of the dual relationships and how people around the nurses react to the relationships. Ambivalence was characterized by contradictory and indeterminate thoughts and attitudes toward patients and dual relationships. Results indicated that dual relationship decisions were complex and highly contextually dependent.