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Features of Swedish municipal elderly and psychiatric group dwelling care after the health-care reforms of the 1990s
Karolinska institutet, avdelningen för omvårdnad, institution för neurobiologi, omvårdnadsvetenskap och samhälle. .ORCID iD: 0000-0001-7959-606X
2006 (English)Doctoral thesis, comprehensive summary (Other scientific)
Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2006. , 86 p.
Identifiers
URN: urn:nbn:se:miun:diva-7611ISBN: 91-7140-745-6 (print)OAI: oai:DiVA.org:miun-7611DiVA: diva2:127857
Public defence
(English)
Available from: 2008-12-12 Created: 2008-12-10 Last updated: 2008-12-12Bibliographically approved
List of papers
1. Nurses' attitudes towards older residents with long-term schizophrenia.
Open this publication in new window or tab >>Nurses' attitudes towards older residents with long-term schizophrenia.
2003 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 43, no 6, 616-622 p.Article in journal (Refereed) Published
Abstract [en]

Aim: to investigate whether the carers’ approach could be explained as referring to the clinical picture or the fact that the patient had a diagnosis of schizophrenia. Background: In institutional care, a symptom-oriented approach is a frequently used but seldom-discussed method for treating people with severe mental illness. Design/method: An exploratory study of the staff’s view of a caring approach for a fictitious elderly long-term schizophrenic resident was conducted. All the carers working in the field of psychiatry at seven different units in one municipality in northern Sweden were an integral part of the study. The units were divided into two groups and classified as ‘dwelling’ and ‘support’. The ‘dwelling group’ was characterised by carers working at traditional group dwellings, the ‘support group’ by carers working in small teams and visiting people with long-term mental illness in their homes. Answers were received from 62 women and 23 men, of whom 14 were RNs and 69 were ENs. Measurements: A questionnaire was used; it was developed from a case description of a 68-year-old woman with typical symptoms of severe cognitive decline with problematic behaviour and a diagnosis of long-term schizophrenia. Findings: The main finding in this study is that carers with long experience become less sensitive in their relationship with the resident than less experienced carers. There appears to be a tendency for long work experience to have a negative effect on the carers’ attitude towards the resident. Conclusions: The carers could be interpreted as being caught in a moral dilemma between ends and means. On the one hand, the ‘conformist mode’, with the acceptance of ends and means, and, on the other hand, the ‘innovation mode’, with acceptance of ends but with few legitimate means to achieve them.

Keyword
Long-term schizophrenia, nursing, strain theory, vignette, work experience
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-1709 (URN)10.1046/j.1365-2648.2003.02760.x (DOI)000185558100009 ()12950567 (PubMedID)2-s2.0-0141925270 (Scopus ID)358 (Local ID)358 (Archive number)358 (OAI)
Available from: 2008-12-07 Created: 2008-12-07 Last updated: 2016-09-28Bibliographically approved
2. Being an outsider: nurses' statements about a vignette of an elderly resident with a schizophrenia diagnosis and dementia behaviour.
Open this publication in new window or tab >>Being an outsider: nurses' statements about a vignette of an elderly resident with a schizophrenia diagnosis and dementia behaviour.
2004 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, Vol. 11, no 2, 213-220 p.Article in journal (Refereed) Published
Abstract [en]

In an exploratory study of nurses' approach to elderly people with a diagnosis of long-term schizophrenia, the aim was to investigate nurses' views of the care of an elderly fictitious person with long-term schizophrenia. All the nurses in one municipality in northern Sweden working at seven different units were investigated. A vignette, which was based on a case description in a previous study of an 84-year-old woman with severe dementia and problematic behaviour, was used after a minor alteration. In this study, the woman's age in the case description was changed from 84 to 68 years and the diagnosis was changed from severe dementia to long-term schizophrenia; otherwise, the description was the same as in the original case. The main finding was the nurses' inability to see the resident as anything other than what the 'label', the diagnosis, said. The nurses are interpreted as being caught in a dilemma of loyalty - on the one hand, the loyalty to the organization with its traditional goals and means and, on the other hand, the loyalty to the resident with her wishes in the forefront of their minds.

Keyword
psychiatry, nurses´attitudes
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-4915 (URN)10.1111/j.1365-2850.2003.00711.x (DOI)15009498 (PubMedID)2499 (Local ID)2499 (Archive number)2499 (OAI)
Available from: 2008-12-07 Created: 2008-11-19 Last updated: 2009-10-08Bibliographically approved
3. Living in a group dwelling: how do residents spend their time in a psychiatric group dwelling?
Open this publication in new window or tab >>Living in a group dwelling: how do residents spend their time in a psychiatric group dwelling?
2004 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 41, no 6, 651-659 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to investigate how residents at psychiatric group dwellings spend their time. The study consisted of two parts: questionnaires and an observation survey. It included all the staff at two municipal psychiatric group dwellings where the residents were primarily diagnosed as having long-term schizophrenia. This study indicated that, even if the dwellings had a creative climate, there was a negative process in terms of nurses' well-being with a high level of depersonalisation. The residents who displayed a predominant picture of negative symptoms were left alone for 84% of the day, and 29.5% of this could be explained by their illness. The remainder of the residents' time alone remains unexplained. Copyright 2004 Elsevier Ltd

Keyword
psychiatry, group dwelling
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-5180 (URN)10.1016/j.ijnurstu.2003.01.001 (DOI)000222886000009 ()2498 (Local ID)2498 (Archive number)2498 (OAI)
Available from: 2008-12-07 Created: 2008-12-07 Last updated: 2011-04-08Bibliographically approved
4. The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients
Open this publication in new window or tab >>The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients
2005 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, Vol. 12, no 6, 719-727 p.Article in journal (Refereed) Published
Abstract [en]

The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients For people afflicted with different kinds of psychiatric disorder, suffering is a common denominator. The time the nurses spend with psychiatric clients may mirror their attitudes towards and feelings for these clients. The aim of this study was to investigate the connections between the time spent together and the nurses' opinion of client behaviour and social functioning in community-based psychiatry. In this quantitative study, 29 clients were assessed by 30 nurses, who answered the Global Assessment of Functioning Scale (GAF) and the Positive and Negative Syndrome Scale (PANSS). At the same time, 11,200 non-participant observations of clients were registered using the Patient Activity Classification (PAC) to investigate how they spent their time at two psychiatric group dwellings. The PAC instrument revealed that clients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses. Based on a factor analysis, indices were made by setting cut-off points for the PANSS and the GAF scores, and four small groups of clients were generated: a relatively high level of social functioning and a low degree of psychiatric symptoms (A); a relatively high level of social functioning and a high degree of psychiatric symptoms (B); a low level of social functioning and a low degree of psychiatric symptoms (C); and, finally, a low level of social functioning and a high degree of psychiatric symptoms (D). The clients judged as having a low level of social functioning in combination with high degrees of psychiatric symptoms, that is, the most vulnerable and dependent individuals, receive less staff attention (18%) and are the clients who spend the most time alone (71.4%). It might be possible to interpret the results of this study in the light of a process of dehumanization.

Keyword
nursing
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-3821 (URN)16336597 (PubMedID)4214 (Local ID)4214 (Archive number)4214 (OAI)
Available from: 2008-11-19 Created: 2008-11-19Bibliographically approved
5. Swedish assistant nurses´experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances: An interview study
Open this publication in new window or tab >>Swedish assistant nurses´experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances: An interview study
2006 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 1, no 4, 245-256 p.Article in journal (Refereed) Published
Abstract [en]

Job satisfaction is complex and is an important component in facilitating high quality nursing care. Behavioural and psychological symptoms of dementia (BPSD) can be clustered into one of five syndromes: psychosis, aggression, psychomotor agitation, depression and apathy, and comprise signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia. BPSD can cause tremendous distress both for the patients and for their caregivers and they have been seen as the most stressful aspect of care giving. Two registered nurses, 16 assistant nurses and two nursing assistants in Sweden talked about their job satisfaction when caring for residents suffering from dementia and BPSD. Thematic content analysis was conducted. The nurses' narrations indicate exposure, insufficiency, not being valued and doubt, as well as respect and importance and devotion towards the residents. One core theme was formulated: "Job satisfaction as a process moving between breaking down and occasionally building up the working person". A positive relationship with colleagues was the primary reason for nurses continuing to work at the group dwellings. The organization and resident behaviours were seen as very negative. Some nurses described insecurity in terms of how long they could continue to take rudeness, being spat at, being scratched or physically hit by residents, without "hitting back". In order to increase the well-being of the nurses, the pressure on them needs to be relieved. The development of leadership, education, supervision and reflection might be one possible way of reducing the prevalence of BPSD-related violence, enhancing job satisfaction and handling moral stress.

Keyword
nursing, BPSD, dementia, group dwelling, Job satisfaction, narrative interviews, nurses, thematic content analysis, omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-1057 (URN)10.1080/17482620600601187 (DOI)2-s2.0-34249033750 (Scopus ID)4221 (Local ID)4221 (Archive number)4221 (OAI)
Available from: 2008-09-30 Created: 2009-06-07 Last updated: 2016-10-11Bibliographically approved
6. Left alone - Swedish nurses' and mental health workers' experiences of being care providers in a social psychiatric dwelling context in the post-health-care-restructuring era. A focus-group interview study
Open this publication in new window or tab >>Left alone - Swedish nurses' and mental health workers' experiences of being care providers in a social psychiatric dwelling context in the post-health-care-restructuring era. A focus-group interview study
2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, 427-435 p.Article in journal (Refereed) Published
Abstract [en]

The professional role of nurses and mental health workers in social psychiatry is being re-defined towards a recovery, client-focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long-term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses' and mental health workers' views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: 'Being a general human factotum not unlike the role of parents', 'Having a complex and ambiguous view of clients', 'Working in a mainly 'strangled' situation', and 'Feeling overwhelming frustration'. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.

Keyword
focus groups; group dwellings; mental health nurses; nurse roles; qualitative approaches; role- definition; thematic content analysis
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-6363 (URN)10.1111/j.1471-6712.2009.00732.x (DOI)000281000800002 ()20070597 (PubMedID)2-s2.0-77955766345 (Scopus ID)4222 (Local ID)4222 (Archive number)4222 (OAI)
Available from: 2008-12-07 Created: 2008-12-07 Last updated: 2011-01-07Bibliographically approved

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Citation style
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  • modern-language-association-8th-edition
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