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Lindgren, B.-M., Ringnér, A., Molin, J. & Hällgren Graneheim, U. (2019). Patients' experiences of isolation in psychiatric inpatient care: insights from a meta-ethnographic study. International Journal of Mental Health Nursing, 28(1), 7-21
Open this publication in new window or tab >>Patients' experiences of isolation in psychiatric inpatient care: insights from a meta-ethnographic study
2019 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, no 1, p. 7-21Article in journal (Refereed) Published
Abstract [en]

Historically, people with mental ill-health have been isolated from society. Although mental health care has moved from closed to more open forms of care, in many societies care is still provided in locked wards, and people with mental ill-health are sometimes secluded from their fellow patients, families, friends, and visitors. The aim of this study was to illuminate patients' experiences of isolation in psychiatric inpatient care. A systematic review of qualitative research was conducted, and the key findings were subjected to meta-ethnographic synthesis. The findings were twofold: 'being admitted to prison' and 'having access to shelter'. The experience of isolated care as prison-like symbolizes patients' longing for freedom and feeling restricted and limited by rules, stripped of rights, abandoned, controlled, powerless, and unsupported. In contrast, the experience of isolation as shelter symbolizes safety and the opportunity to regain control over one's own situation. A stigmatizing public view holds that people with mental ill-health are dangerous and unpredictable and, therefore, unsafe to themselves and others. Being placed in isolation because these fears contribute to self-stigma among patients. Promoting a sheltered experience in which isolation is used with respect for patients and the reasons are made explicit may encourage recovery. A shift in emphasis in ward culture from observation to engagement is needed to reduce blame, shift patient experiences from prison to shelter, and to support autonomy as a therapeutic intervention.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
experiences, isolation, locked ward, psychiatric inpatient care, seclusion
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-154952 (URN)10.1111/inm.12519 (DOI)000459619300002 ()29975446 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-03-27Bibliographically approved
Molin, J., Hällgren Graneheim, U., Ringnér, A. & Lindgren, B.-M. (2019). Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care. International Journal of Mental Health Nursing, 28(2), 551-559
Open this publication in new window or tab >>Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care
2019 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, no 2, p. 551-559Article in journal (Refereed) Published
Abstract [en]

This qualitative study aimed to illuminate patients' experiences of taking part in the nursing intervention Time Together. The data were drawn from 11 individual semi-structured interviews with patients and analysed with qualitative content analysis using an inductive approach. The results show that patients taking part in Time Together felt confirmed and participated on equal terms; thus, they experienced being seen as humans among other humans. Time Together offered patients a break, and they felt strengthened, which contributed to their hopes for recovery. Furthermore, when Time Together was absent patients felt disconfirmed, which fostered feelings of distance from staff. The results support the effectiveness of the intervention, indicating that Time Together may be a tool to facilitate patients' personal recovery. However, the success of the intervention depends on staff compliance with the predetermined structure of the intervention in combination with engagement.

Place, publisher, year, edition, pages
Australian College of Mental Health Nurses Inc., 2019
Keywords
Time Together, engagement, mental health nursing, nursing intervention, psychiatric inpatient care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155311 (URN)10.1111/inm.12560 (DOI)000460556300016 ()30501013 (PubMedID)
Funder
The Kempe Foundations
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-04-08Bibliographically approved
Lindgren, B.-M., Molin, J., Lundström, M., Strömbäck, M., Salander Renberg, E. & Ringnér, A. (2018). Does a new spatial design in psychiatric inpatient care influence patients’ and staff’s perception of their care/working environment?: A study protocol of a pilot study using a single-system experimental design. Pilot and Feasibility Studies, 4, Article ID 191.
Open this publication in new window or tab >>Does a new spatial design in psychiatric inpatient care influence patients’ and staff’s perception of their care/working environment?: A study protocol of a pilot study using a single-system experimental design
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2018 (English)In: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, article id 191Article in journal (Refereed) Published
Abstract [en]

Background: Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.

Methods: This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.

Discussion: The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration: ClinicalTrials.gov, NCT03140618, registered 4 May 2017.

Keywords
Activity, Environment, Feasibility, Intervention, Nursing, Process evaluation, Protocol, Psychiatric inpatient care, Quality interactions, Single-system design
National Category
Nursing Psychiatry
Identifiers
urn:nbn:se:umu:diva-154939 (URN)10.1186/s40814-018-0383-4 (DOI)30607254 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-11Bibliographically approved
Olsson, C., Björk, M. & Ringnér, A. (2018). The Pediatric Inventory for Parents - Swedish Translation and Psychometric Testing. Journal of Pediatric Nursing: Nursing Care of Children and Families, 42, E97-E102
Open this publication in new window or tab >>The Pediatric Inventory for Parents - Swedish Translation and Psychometric Testing
2018 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 42, p. E97-E102Article in journal (Refereed) Published
Abstract [en]

Abstract: The Pediatric Inventory for Parents (PIP) measures parental stress related to caring for a child with an illness. However, no Swedish translation is available.

Purpose: This study reports a Swedish translation of the PIP and psychometric properties of the instrument.

Design and Methods: This is a descriptive/methodological paper. The PIP was translated and culturally adapted to Swedish, and comprehensibility was tested. Data were collected twice from 48 parents of children with different illnesses, and initial psychometric properties of the instrument were examined. The IES-R (Impact of Event Scale-Revised) was used for concurrent validity.

Results: The Swedish version of the PIP demonstrated good correlations with the IES-R, and temporal changes were similar. Endorsement frequencies and test-retest were also satisfactory. When comparing groups of parents, the parents of children with cancer were statistically significantly more distressed, both on total score and for emotional distress and role function. Discriminative validity was demonstrated by comparing parents of children with cancer with parents of children with other diseases.

Conclusions: The Swedish version of the PIP seems to be a valid and reliable instrument. However, as we used relatively small sample, for the future, we suggest further testing with larger samples.

Practice Implications: Clinicians and researchers seeking to measure parental distress in chronic illness could use the Swedish version of the PIP.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
chronic illness, instrument translation, parental stress, psychometric testing, Swedish
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-152269 (URN)10.1016/j.pedn.2018.02.013 (DOI)000444524700015 ()29627285 (PubMedID)
Funder
Swedish Childhood Cancer Foundation, PR2013-0068
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-10-02Bibliographically approved
Molin, J., Lindgren, B.-M., Graneheim, U. H. & Ringnér, A. (2018). Time Together: a nursing intervention in psychiatric inpatient care : feasibility and effects. International Journal of Mental Health Nursing, 27(6), 1698-1708
Open this publication in new window or tab >>Time Together: a nursing intervention in psychiatric inpatient care : feasibility and effects
2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 6, p. 1698-1708Article in journal (Refereed) Published
Abstract [en]

The facilitation of quality time between patients and staff in psychiatric inpatient care is useful to promote recovery and reduce stress experienced by staff. However, interventions are reported to be complex to implement and are poorly described in the literature. This multisite study aimed to evaluate the feasibility and effects of the nursing intervention Time Together, using mixed methods. Data consisted of notes from participant observations and logs to evaluate feasibility, and questionnaires to evaluate effects. The primary outcome for patients was quality of interactions, and for staff, it was perceived stress. The secondary outcome for patients was anxiety and depression symptom levels, and for staff, it was stress of conscience. Data were analysed using visual analysis, percentage of nonoverlapping data, and qualitative content analysis. The results showed that Time Together was a feasible intervention, but measurements showed no effects on the two patient outcomes: quality of interactions and anxiety and depressive symptoms and, questionable effects on perceived stress and stress of conscience among staff. Shared responsibility, a friendly approach, and a predictable structure enabled Time Together, while a distant approach and an unpredictable structure hindered the intervention. In conclusion, the intervention proved to be feasible with potential to enable quality interactions between patients and staff using the enabling factors as supportive components. It also had some effects on perceived stress and stress of conscience among staff. Further evaluation is needed to build on the evidence for the intervention.

Place, publisher, year, edition, pages
Australian College of Mental Health Nurses Inc., 2018
Keywords
engagement, intervention, mental health nursing, mixed methods, psychiatric inpatient care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-147611 (URN)10.1111/inm.12468 (DOI)000451782800010 ()29691976 (PubMedID)
Funder
The Kempe Foundations
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2019-01-08Bibliographically approved
Molin, J., Lindgren, B.-M., Hällgren Graneheim, U. & Ringnér, A. (2017). Does 'Time Together' increase quality of interaction and decrease stress?: A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach. BMJ Open, 7(8), Article ID e015677.
Open this publication in new window or tab >>Does 'Time Together' increase quality of interaction and decrease stress?: A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e015677Article in journal (Refereed) Published
Abstract [en]

Introduction: Despite the long-known significance of the nurse–patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process.

Methods and analysis: This is a multisite study with a single-system experimental design using frequent measures. The primary outcomes are quality interactions for patients and perceived stress for staff. Secondary outcomes are levels of symptoms of anxiety and depression for patients and stress of conscience for staff. A process evaluation is performed to describe contextual factors and experiences. Data are collected using questionnaires, participant observations and semistructured interviews. For analysis of quantitative data, both visual and statistical methods will be used. Qualitative data will be analysed using qualitative content analysis.

Ethics and dissemination: Ethical approval was granted by the Ethical Review Board in the region (Dnr 2016/339-31). The findings will contribute to the development of nursing interventions in general, but more specifically to the development of the intervention. This is relevant both nationally and internationally as similar interventions are needed but sparse. The findings will be disseminated through conference presentations and peer-reviewed publications.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-138827 (URN)10.1136/bmjopen-2016-015677 (DOI)000411802700079 ()28851774 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2018-06-09Bibliographically approved
Minnock, P., Ringnér, A., Bresnihan, B., Veale, D., Oliver, F. & McKee, G. (2017). Perceptions of the cause, impact and management of persistent fatigue in patients with rheumatoid arthritis following tumour necrosing factor inhibition therapy. Musculoskeletal Care, 15(1), 23-35
Open this publication in new window or tab >>Perceptions of the cause, impact and management of persistent fatigue in patients with rheumatoid arthritis following tumour necrosing factor inhibition therapy
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2017 (English)In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 1, p. 23-35Article in journal (Refereed) Published
Abstract [en]

Introduction: Fatigue is a major symptom of rheumatoid arthritis (RA), the most common chronic inflammatory joint disease. The present study explored patients' experiences of RA fatigue to elucidate unique elements and management strategies.

Methods: This single site study recruited tumour necrosis factor-α inhibitor (TNFi)-treated RA patients with a moderate/good response in disease activity and persistent moderate/greater fatigue on a five-point verbal rating scale. This qualitative descriptive design used semi-structured questions, individual interviews and content analysis of narrative data.

Results: Ten patients were interviewed (six women), with age and disease duration ranges of 44–75 and 6–36 years, respectively. Perceptions of the RA fatigue experience generated four categories (experiencing a distinct, yet seldom discussed RA symptom; seeking an explanation for fatigue; being in an incapacitating state; and trying to manage) and eight subcategories. Fatigue was newly identified as a distinct part of the entity of RA. While patients proposed many plausible root causes, the only rational explanation for the nature of this fatigue was that it was integral to their RA. Singularly, fatigue contributed considerably to RA-imposed lifestyle restrictions. Patients had learnt to accommodate and self-manage fatigue in the absence of professional input. Novel management strategies proposed included patients talking about the nature of RA fatigue with others and the need for staff to alert patients to this distinct symptom of RA.

Conclusion: Fatigue, branded as a distinct symptom of RA, exerted an identifiable impact on patients. Fatigue is potentially amenable to modification; talking about fatigue was proposed as a novel management strategy.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Rheumatoid arthritis, fatigue, patient perspectives, qualitative content analysis
National Category
Rheumatology and Autoimmunity
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-121663 (URN)10.1002/msc.1136 (DOI)000395592300004 ()
Available from: 2016-06-04 Created: 2016-06-04 Last updated: 2018-06-07Bibliographically approved
Carlsson, T., Melander Marttala, U., Mattsson, E. & Ringnér, A. (2016). Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: A qualitative interview study. BMC Pregnancy and Childbirth, 16, Article ID 130.
Open this publication in new window or tab >>Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: A qualitative interview study
2016 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 130Article in journal (Refereed) Published
Abstract [en]

Background: Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.

Methods: Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.

Results: The analysis resulted in five categories: 1) “Trustworthy information”, 2) “Language barriers”, 3) “Psychosocial situation”, 4) “Peer support”, and 5) “Religious positions”.

Conclusion: The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

Keywords
Immigrants, Interview, Life change events, Pregnancy, Prenatal diagnosis
National Category
Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-121518 (URN)10.1186/s12884-016-0912-1 (DOI)000376845800002 ()27256335 (PubMedID)
Available from: 2016-06-02 Created: 2016-06-02 Last updated: 2018-06-07Bibliographically approved
Molin, J., Hällgren Graneheim, U., Ringnér, A. & Lindgren, B.-M. (2016). From ideals to resignation: interprofessional teams perspectives on everyday life processes in psychiatric inpatient care. Journal of Psychiatric and Mental Health Nursing, 23(9-10), 595-604
Open this publication in new window or tab >>From ideals to resignation: interprofessional teams perspectives on everyday life processes in psychiatric inpatient care
2016 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 23, no 9-10, p. 595-604Article in journal (Refereed) Published
Abstract [en]

Introduction: Patients and ward staff describe psychiatric inpatient care as demanding, characterized by unpredictable events, yet research on interprofessional teams perspectives of everyday life processes in psychiatric inpatient care lacks. Aim: This study aims to explore everyday life processes in psychiatric inpatient care, as reported by staff in interprofessional teams. Method: A grounded theory design was used and 36 participants were interviewed. Results: The analysis resulted in a process-oriented core category From ideals to resignation. Related to this core category were three further categories: Knowing where to go, Walking a path of obstacles and Shifting focus from the patient's best interests to self-survival. The staff had ideals about care and collaboration, but a poor environment, power asymmetry, lacking structure and demands of managing chaos meant that they appeared to resign from putting their ideals into practice. Discussion: Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge similar findings have not been reported in the international evidence. Implications: In order to support interprofessional teams to work according to their ideals, interventions such as Protected Engagement Time and reflective dialogues within the teams are suggested.

Keywords
collaboration, everyday life, experiences, grounded theory, interprofessional teams, psychiatric inpatient care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-127166 (URN)10.1111/jpm.12349 (DOI)000389034300008 ()27785861 (PubMedID)
Available from: 2016-11-01 Created: 2016-11-01 Last updated: 2018-06-09Bibliographically approved
Ringnér, A. (2016). Strategier för att minska barns obehag vid sårbehandling. Sårmagasinet (4), 21-23
Open this publication in new window or tab >>Strategier för att minska barns obehag vid sårbehandling
2016 (Swedish)In: Sårmagasinet, ISSN 2001-9920, no 4, p. 21-23Article in journal (Other (popular science, discussion, etc.)) Published
Keywords
sår, rädsla, barn, omvårdnad, förberedelser
National Category
Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-127505 (URN)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-06-09
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8801-5423

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