RESUMEN
AIMS: To describe persons visiting the psychiatric emergency room (PER) in Sweden and to compare persons who frequently (PFV) and infrequently (PIFV) visit PERs in terms of group size, age, gender, PER location inside versus outside the home municipality, diagnosis (ICD 10), temporal patterns of visits and hospital admissions. METHODS: This register study included all visits to PERs in one Swedish county over 3 years, 2013-2015 (N = 67,031 visits). The study employed descriptive statistics as well as Chi-square tests combined with Bonferroni correction to compare PFV with PIFV. RESULTS: Of the total of 27,282 visitors, 2201 (8.1%) were identified as PFV (five or more visits within 12 months) and they accounted for 38.1% of the total visits. The study found differences between PFV and PIFV in gender, diagnostic profile, hospital admissions and temporal patterns. Differences were also detected with regard to distance between PERs and home municipalities. However, no age-related differences were found between the two groups. CONCLUSIONS: PFV and PIFV have different clinical profiles and temporal patterns. These results may be important when planning, developing and evaluating interventions targeting the needs of each group, which is in accordance with a person-centred approach. Such an approach might eventually result in fewer visits to PERs.
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Servicio de Urgencia en Hospital/tendencias , Servicios de Urgencia Psiquiátrica/tendencias , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Adolescente , Adulto , Anciano , Femenino , Hospitalización/tendencias , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Suecia/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.
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Servicios de Salud Mental/organización & administración , Personas con Discapacidades Mentales/rehabilitación , Política , Servicio Social/organización & administración , Violencia/prevención & control , Manejo de Caso , Femenino , Humanos , Relaciones Interpersonales , Masculino , Evaluación de Necesidades , Personas con Discapacidades Mentales/psicología , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Estados Unidos , Violencia/psicologíaRESUMEN
AIMS AND OBJECTIVES: To describe lesbian, gay and bisexual parents' experiences of nurses' attitudes in child healthcare. BACKGROUND: Lesbian, gay and bisexual people are often reluctant to disclose their gender identity for fear of discrimination. This fear may lead to avoidance of healthcare for themselves or their children and may negatively affect families' health and well-being. DESIGN: A qualitative inductive design was employed. METHODS: Semistructured interviews were conducted with 14 lesbian, gay or bisexual parents (11 mothers and three fathers) with child health care experiences in southern Sweden. Interviews were analysed using qualitative content analysis. RESULTS: Two themes were identified. One, a "sense of marginalisation," included lesbian, gay and bisexual parents' experiences of heteronormative attitudes among child healthcare nurses which led them to feel alienated and questioned as parents. Another, "being respected for who you are," included experiences of being respected and included at child healthcare appointments. CONCLUSIONS: Findings paint a complex picture of lesbian, gay and bisexual parents' interactions with child healthcare nurses in that they experienced both positive and negative attitudes. Knowledge gaps about lesbian, gay and bisexual families within the child healthcare field must be filled. RELEVANCE TO CLINICAL PRACTICE: Child health care nurses should work with the entire family to provide the best care for the child; however, discrimination in health care is common and often caused by a lack of knowledge. The number of children living with same-sex parents has increased more than ten-fold since the end of the 1990s. It is therefore important to explore lesbian, gay and bisexual parents' experiences with child healthcare nurses' attitudes to improve quality of care.
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Actitud del Personal de Salud , Servicios de Salud del Niño , Enfermeras y Enfermeros/psicología , Padres/psicología , Minorías Sexuales y de Género/psicología , Niño , Femenino , Conocimientos, Actitudes y Práctica en Salud , Disparidades en Atención de Salud , Humanos , Masculino , Investigación Cualitativa , SueciaRESUMEN
BACKGROUND: Work and employees are often marginalized in studies on community-based psychiatric care and support systems. This paper highlights the role of the worker at congregated supported housing for people with severe mental illness (SMI). Housing support workers (HSW) are a fairly new professional role and have developed as a result of major changes in Swedish mental health care and services. The development of new roles is not unproblematic and raises intriguing questions. OBJECTIVE: The purpose of this article is to describe housing support workers' experiences of meaning in their work, and in addition illuminate how the work identity of HSWs can be negotiated and constructed. METHODS: Four focus group interviews were conducted with a total of 25 participants. Additionally, three follow up sessions were conducted with the same participants. The material consists of employees from four different sites. The intepretation of the material was inspired by a constructionist approach. RESULTS: The analysis generated three themes: to do a good job, everyday needs and the formal role. The work identity for HSWs is complex and not easily interpreted. CONCLUSIONS: The experience of an unclear assignment affects the description of what is meaningful and important-the work identity and significant affiliations for HSWs. In the long run, this fragmented world can have negative implications for the HSW.
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Vivienda , Enfermos Mentales , Rol Profesional , Trabajo/psicología , Adulto , Femenino , Grupos Focales , Humanos , Masculino , SueciaRESUMEN
Since the closure of large psychiatric institutions, various types of community-based supportive housing for people with serious mental illness (SMI) have been developed. There is currently limited knowledge about users' experiences of living in supportive housing. The aim of the present study was to describe user experiences of living in supportive housing for people with SMI. Twenty-nine people living in such facilities participated in open, qualitative interviews. Data were subjected to latent content analysis. Three main themes emerged from this analysis: (i) having a nest, which included the subthemes of a place to rest and having someone to attach to; (ii) being part of a group, with the subthemes of being brought together and a community spirit; and (iii) leading an oppressive life, including the subthemes of questioning one's identity, sense of inequality, and a life of gloom. It could be concluded that user experiences of living in supportive housing are complex and paradoxical. In order to provide supportive housing, staff need to recognize and work within social group processes, and perform continual and structural evaluations of users' social and emotional needs.
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Trastornos Mentales/psicología , Vivienda Popular , Adulto , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Investigación CualitativaRESUMEN
AIMS AND OBJECTIVES: To illuminate the meaning of living with alcohol dependency as a woman. BACKGROUND: The number of women suffering from alcohol dependency is increasing. Today there are shortcomings in knowledge about the lived experiences of being a woman with alcohol dependency; knowledge which might be of importance for meeting these women's specific needs of care. DESIGN: The study has a qualitative design. Fourteen women with alcohol dependency participated in open in-depth interviews. METHOD: Data were analysed according to a phenomenological-hermeneutic method, and interpreted by help from gender and caring perspectives as well as results from previous research of alcohol dependency. RESULTS: In relation to the women's senses of well-being, four main gender formations were found; An unstable self involving continual and rapid swings between emotional and bodily reactions. Ambivalence - meaning ambiguous feelings towards themselves as human beings and how they lead their lives. Introspectiveness - involving reflections, pondering and being introverted. Attempts to perform normality - covering - dealing with life through various strategies and facades to live up to the expectations of how to behave as a woman. CONCLUSION: Living with alcohol dependency as a woman constitutes of a rapid shifting everyday life resulting in senses of alienation as well as private introspection leading to self-degradation, and to a lesser extent meaningfulness and hope. It also constitutes of managing to perform normality. RELEVANCE TO CLINICAL PRACTICE: When supporting women with alcohol dependency towards wellbeing, professionals need to work towards approaching the woman's inner thoughts, share them and reflect over them together. To support these women to find balance in life, caregivers need to cooperate with the women to find out how best to live a life adjusted to the woman's abilities and wishes.
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Adaptación Psicológica , Alcoholismo/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Autoimagen , SueciaRESUMEN
The aim of the present study was to explore and illuminate the meaning of advanced nursing caring for men with alcohol dependency, as narrated by the men themselves. Ten male patients were interviewed in-depth and data were subjected to a phenomenological-hermeneutic analysis. Caring meant having the opportunity to rest in a safe haven together with professional caregivers, to struggle for liberation from dependency, and to expand the life-sphere by starting to accept oneself and broaden social participation. The findings illuminate various patterns of masculinity and point to the importance for caregivers to be open to challenging stereotypical gender assumptions.
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Enfermería de Práctica Avanzada , Alcoholismo/enfermería , Alcoholismo/rehabilitación , Empatía , Relaciones Enfermero-Paciente , Confianza , Adulto , Anciano , Alcoholismo/psicología , Actitud Frente a la Salud , Humanos , Masculino , Persona de Mediana Edad , Narración , Enfermería Psiquiátrica , SueciaRESUMEN
The purpose of this qualitative study was to explore the lived experience of fall risk from a lifeworld perspective in elderly women with previous fragility fractures. Thirteen elderly women with a high risk of fall and fracture, aged 76-86, living in their own homes in rural areas, were recruited from a voluntary fracture prevention programme. All women had a history of fragility fractures and were interviewed in their homes from spring to autumn 2004. A phenomenological reflective lifeworld approach was chosen to analyse in-depth interview data. The study was conducted within an interdisciplinary research group inspired by dialogical research. Elderly women's life space has been narrowed due to advanced age, physical injury or by efforts to prevent new injuries leading to changes in self-perception. However, the women seek strategies to challenge limitations and insecurity, and strive to retain mobility and daily life routines. The four major constituents of the phenomenon 'elderly women's experiences of fall risk' emerged in this study: a changing body, living with precaution, ambiguous dependency and influence and need for understanding. Employing the women's thoughts and resources in trust-based dialogues with caregivers may strengthen their concord and the prospects to continue an active life. Elderly women seek strategies to challenge limitations and feelings of insecurity, and strive to maintain mobility and daily life routines. A trust-based care respecting the preferences of the women seemed to stimulate behavioural change in maintaining an active life.
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Accidentes por Caídas/prevención & control , Vivienda , Anciano , Anciano de 80 o más Años , Femenino , Fracturas Óseas/prevención & control , Humanos , Entrevistas como Asunto , Riesgo , Población Rural , Estados UnidosRESUMEN
This study was aimed at investigating the psychometric properties of the Interview Schedule for Social Interaction (ISSI), in terms of construct and discriminant validity and unidimensionality, in three psychiatric samples with varying prerequisites for social interaction: 1) an outpatient sample of working age with mixed diagnoses, 2) an outpatient sample with schizophrenia, and 3) an inpatient sample composed of mentally ill, male offenders. The target constructs were psychosocial functioning and satisfaction in different life domains. It was hypothesized that the ISSI would mainly be related to psychosocial functioning and life domains characterized by social interaction, such as friends and family. A second hypothesis was that the ISSI ratings would discriminate between the three samples. The first hypothesis was confirmed, but the pattern of relationships was somewhat different between the groups. Whereas family contacts were of great importance for social integration in Samples 1 and 2, friends seemed more important for the mentally ill offenders. The second hypothesis was partly confirmed: three ISSI sub-scales out of four discriminated between the samples. Moreover, the ISSI proved to be a unidimensional construct. The support for the four proposed sub-scales was not unanimous, however, and the sub-scales targeting attachment constituted less stable factors. This study demonstrated the construct and discriminant validity of the ISSI when applied to samples with various mental disorders. The fact that similar results were obtained in all three samples, despite varying prerequisites for social interaction, strongly supports the validity of the ISSI. Providing the sub-scales are used with caution, the ISSI seems to be a reliable tool for use with patients with severe mental disorders.
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Relaciones Interpersonales , Trastornos Mentales/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Diagnóstico Diferencial , Femenino , Psiquiatría Forense , Estado de Salud , Hospitalización , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Satisfacción Personal , Psicometría , Calidad de Vida , Reproducibilidad de los Resultados , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Índice de Severidad de la Enfermedad , Apoyo SocialRESUMEN
The aims of the study were to investigate the prevalence of adult abuse in female users of psychiatric care, the relationship between abuse and self-esteem and self-reported consequences of abuse, and women's self-reported needs of support. A total of 1382 women participated in the study. A self-administrated anonymous questionnaire with both closed-ended and open-ended questions was used. Quantitative data were analysed by mainly descriptive statistics and qualitative data were analysed by content analysis. Forty-six per cent (n = 638) of the women had been exposed to emotional, sexual, and/or physical abuse in adulthood. Twenty-eight per cent (n = 385) reported experiences of moderate physical abuse, 27% (n = 373) reported threats of injury, and 20% (n = 277) reported threats of being killed. Further, 19% (n = 261) reported experience of sexual violence, and 12% (n = 164) had experiences of serious physical violence. Women who had been abused rated lower self-esteem than those who were not abused. Self-reported consequences of abuse included intrapersonal problems such as poor self-esteem, fears, anxiety, and worries but also problems in social relations especially with regard to close relationships and reliance to others. To a lesser extent, disease-specific manifestations were reported. The needs of support included interventions directed to the experiences of abuse by professionals trained in the area, family interventions, self-help groups, medical care, legal support, or practical help to find new housing situations. It is concluded that female users of psychiatric care services constitute a vulnerable group with regard to abuse. To meet the women's needs, the care system has to adopt a perspective that includes personal, social, and societal factors.
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Actitud Frente a la Salud , Trastornos Mentales/psicología , Evaluación de Necesidades/organización & administración , Psiquiatría/organización & administración , Apoyo Social , Maltrato Conyugal/psicología , Adulto , Ansiedad/psicología , Mujeres Maltratadas/psicología , Mujeres Maltratadas/estadística & datos numéricos , Estudios Transversales , Miedo , Femenino , Humanos , Relaciones Interpersonales , Trastornos Mentales/complicaciones , Investigación Metodológica en Enfermería , Prevalencia , Investigación Cualitativa , Violación/psicología , Violación/estadística & datos numéricos , Autoimagen , Grupos de Autoayuda , Maltrato Conyugal/estadística & datos numéricos , Encuestas y Cuestionarios , Suecia/epidemiología , Poblaciones VulnerablesRESUMEN
The main aim of the study was to investigate whether the three hypothesized subscales of Antonovsky's sense of coherence (SOC) scale: comprehensibility, meaningfulness and manageability, can be found when measuring SOC in a sample of patients with schizophrenia living in the community. A further aim was to study the relationship between SOC and psychopathology. The concept of SOC has been proposed to explain successful coping with life stressors. A total of 120 patients completed the SOC scale and the Brief Psychiatric Rating Scale (BPRS) was used to assess the psychopathology of the patients. The SOC scale was analysed by means of a factor analysis with a varimax rotation and the Spearman rank correlation test was used to test for associations between subscales, factors and psychiatric symptoms. A four-factor model presented the best solution and explained 48% of the total variation in SOC. The first factor, which included 12-items of the SOC scale, turned out to be the most salient factor explaining 29% of the total variation. All factors displayed some overlapping between items. Affective symptoms were negatively related to all the three subscales and the four factors of SOC, while positive symptoms were similarly related to two of the subscales and two of the factors while negative symptoms were not associated with any of the factors or subscales. The findings in this study corroborate those in studies with other patient groups and indicate that the theoretical framework of SOC should not be adopted uncritically. Furthermore, the use of the three subscales in the SOC scale in studies of patients with a severe mental illness is questioned and a further investigation of the relationship between SOC and psychopathology is proposed.
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Adaptación Psicológica , Actitud Frente a la Salud , Modelos Psicológicos , Escalas de Valoración Psiquiátrica/normas , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Análisis Factorial , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevista Psicológica , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Esquizofrenia/prevención & control , Autocuidado/psicología , Estadísticas no Paramétricas , Encuestas y Cuestionarios , SueciaRESUMEN
BACKGROUND: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients. METHOD: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning. RESULTS: The correlation between subjective and interviewer-rated quality of life was moderate (ICC = 0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1% of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5% of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network. CONCLUSION: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected.
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Variaciones Dependientes del Observador , Calidad de Vida , Esquizofrenia/fisiopatología , Adulto , Estudios Transversales , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Países Escandinavos y NórdicosRESUMEN
Research findings that link personality factors to functioning and symptoms in schizophrenia are inconsistent, and further studies are needed within the area. The purpose of this study was to investigate how personality, as measured by the Temperament and Character Inventory (TCI), was related to demographic factors, subtypes of diagnoses, level of functioning, and aspects of psychological health, including sense of coherence, perceived control, and self-esteem, among people with schizophrenia. Subjects were 104 individuals, aged 20-55 years, in psychiatric outpatient care. The results indicated that personality was not related to subtypes of diagnoses or demographic characteristics of the respondents, but to level of functioning and all aspects of psychological health. Especially self-directedness distinguished three groups of functioning and was highly correlated with the different aspects of psychological health. The article discusses how knowledge of schizophrenic patients' personality structure might be used for tailoring psychiatric treatments.
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Carácter , Trastornos de la Personalidad/etiología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Temperamento , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Esquizofrenia/diagnósticoRESUMEN
BACKGROUND: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. METHOD: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. RESULTS: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. CONCLUSIONS: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.
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Servicios de Salud Mental/estadística & datos numéricos , Esquizofrenia/rehabilitación , Asistencia Social en Psiquiatría/estadística & datos numéricos , Adulto , Estudios Transversales , Demografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Población Rural , Países Escandinavos y Nórdicos , Psicología del Esquizofrénico , Población UrbanaRESUMEN
The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.
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Servicios Comunitarios de Salud Mental , Evaluación de Necesidades , Calidad de Vida , Esquizofrenia/terapia , Adulto , Atención Ambulatoria , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Escandinavos y NórdicosRESUMEN
AIM: The study investigated clinical and social changes during an 18-month follow-up period in a group (n = 76) of schizophrenic outpatients admitted to a newly implemented outpatient psychosis team. Changes related to level of contact with the psychosis team were also examined as well as aspects of the content of the treatment interventions and work situation from a staff perspective. METHODS: Structured face-to-face interviews with the patients were performed at baseline and after 18 months. The Camberwell Assessment of Need instrument, the Lancashire Quality of Life Profile and the Interview Schedule for Social Interaction were used on both interview occasions along with Global Assessment of Functioning Scale and Brief Psychiatric Rating Scale. Thematic open-ended questions were used in staff interviews. RESULTS: Psychiatric symptoms, number of needs and number of met needs decreased, and perceived quality of life improved for the total sample during the follow-up period. Patients only in contact with a psychiatrist in the psychosis team improved more in symptoms and spent fewer days in hospital during follow-up time compared with those who had combined psychiatric and supportive contacts, and were also more satisfied with their medication. Patients with a combined contact deteriorated in psychosocial functioning compared with the group only in contact with a psychiatrist. Some of the elements in treatment interventions and work situation as well as hindrances in providing community-based care adapted to the patients' needs were identified. CONCLUSIONS: Community-based psychiatric services, to a larger extent, need to embrace evidence-based interventions and to perform regular, structured and comprehensive need assessments in order to ensure the effectiveness of interventions. Attention should be paid to staff motivation and education as well as to providing practical guidelines, supervision and support.