umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Publications (9 of 9) Show all publications
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
Show others...
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
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. (2018). Time Together: a nursing intervention targeting everyday life in psychiatric inpatient care : patient and staff perspectives. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Time Together: a nursing intervention targeting everyday life in psychiatric inpatient care : patient and staff perspectives
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patient and staff descriptions of everyday life in psychiatric inpatient care are consistent, revealing a challenging environment with over-reliance on medication and, power imbalances. Patients and staff ask for the opportunity to develop relationships; however, the literature on nursing interventions targeting these issues is sparse. This thesis comprises four studies with a twofold overall aim. The first part constructs a theoretical understanding of everyday life processes in psychiatric inpatient care, and the second part evaluates a nursing intervention in psychiatric inpatient care.

Methods: Studies I and II used a grounded theory design with individual interviews (I, II), dyadic interviews (II) and focus group discussions (II). Study III used mixed methods, a single system experimental design with questionnaires and a qualitative process evalu­ation with logs and participant observations. Study IV used a qualitative design with individual semi structured interviews. The participants were 16 patients with experiences of psychiatric inpatient care (I), 36 staff members who worked in psychiatric inpatient care (II), 80 patients and 50 staff members in the evaluated wards (III) and 11 patients who had taken part in the nursing intervention Time Together (IV). In studies I and II the analysis followed grounded theory. In study III data were subjected to visual analysis, per­centage of non-overlapping data and qualitative content analysis, also used in study IV.

Results: Patients in psychiatric inpatient care experienced everyday life as being influenced by interactions between patients and staff, the environment and the content of care. The quality of interactions was what tied these components together. Having trustful interactions could compensate for an otherwise poor environment and a confusing care content, while adapting to absence of, or obstructive interactions contributed to experiences of the environment as stigmatizing and the care content as confusing (I). Staff had ideals regarding everyday life on the wards but obstacles hindered them from putting their ideals into practice. To cope with this, they appeared to shift their focus from the patient’s best to their own survival. This resignation made it even more difficult for them to work in a way that aligned with their ideals (II). The theoretical understanding that was constructed from study I and II revealed that what patients described as absent or obstructive interactions, or passivity, were mirrored by staff descriptions of obstacles in their everyday life on the wards. Furthermore, what patients described as trustful inter­actions and satisfying activities were mirrored by staff descriptions of having the patients’ best interest at heart. This is interpreted as when staff is able to focus on the patients’ best interests, improvements in the everyday life in psychiatric inpatient care are possible.

The nursing intervention called Time Together was feasible to introduce in psychiatric inpatient care. The intervention was enabled by shared responsibility, a friendly approach and a predictable structure, whilst it was hindered by a distant approach and unpredictable structure. Measurements showed no effect on the quality of interactions between patients and staff, but questionable effects on perceived stress and stress of conscience among staff, as well as on staff satisfaction with interactions with patients (III). Patients described their experiences of taking part in the intervention as being seen as a human among other humans, that it contributed to hope for recovery but also, that feelings of distance to staff were fostered when Time Together sessions were not offered (IV).

Conclusion: By implementing Time Together in psychiatric inpatient care, staff is allowed access to a nursing intervention that can meet patients’ needs for high-quality interactions in everyday life and that may have potential to decrease perceived stress and stress of conscience among staff and increase their satisfaction with interactions with patients. By using joint activities as bridging actions, this intervention could lead to the development of nurse-patient relationships built on reciprocity and engagement, something that is emphasised in recovery-oriented mental health nursing.

Abstract [sv]

Bakgrund: Patienters och personals beskrivningar av vardagslivet inom psykiatrisk heldygnsvård är konsekventa och avslöjar en komplex miljö med hög tilltro till medicinsk behandling och obalans i maktförhållanden. Patienter och personal efterfrågar möjligheter att utveckla relationer med varandra men omvårdnadsinterventioner med sådant fokus är sparsamt beskrivna i den vetenskapliga litteraturen. Avhandlingen har ett tvådelat syfte och omfattar fyra delstudier. Den första delen syftade till att konstruera en teoretisk förståelse för vardagliga processer inom psykiatrisk heldygnsvård och den andra delen till att utvärdera en omvårdnadsintervention inom psykiatrisk heldygnsvård.

Metod: I delstudie I och II användes en grounded theory design med individuella intervjuer (I, II), dyadiska intervjuer (II) och fokusgruppsdiskussioner (II). I delstudie III användes mixade metoder, en single system experimental design med enkäter och en kvalitativ processutvärdering med loggar och deltagande observationer. I delstudie IV användes en kvalitativ design med individuella semistrukturerade intervjuer. Deltagarna var 16 patienter med erfarenhet av psykiatrisk heldygnsvård (I), 36 personal med erfarenhet av arbete inom psykiatrisk heldygnsvård (II), 80 patienter och 50 personal från de utvärderade avdelningarna (III) och 11 patienter som deltagit i omvårdnads­interventionen Tid Tillsammans (IV). I delstudie I och II följde analysen grounded theory. I delstudie III analyserades data med hjälpa av visuell analys, percentage of non-overlapping data och kvalitativ innehållsanalys som även användes i delstudie IV.

Resultat: Patienter inom psykiatrisk heldygnsvård upplevde att vardagslivet på avdelningarna påverkades av interaktionerna med personalen, miljön och vårdens innehåll. Den gemensamma kärnan i dessa delar var kvaliteten i interaktionerna. Tillitsfulla interaktioner kompenserade för en annars fattig miljö och ett förvirrande vårdinnehåll medan anpassning till frånvaro av, eller hindrande interaktioner bidrog till upplevelser av en stigmatiserande miljö och ett förvirrande vårdinnehåll (I). Personal hade ideal gällande vardagslivet på avdelningarna men svårigheter hindrade dem från att omvandla idealen i praktiken. För att hantera detta verkade de skifta sitt fokus från patienternas bästa till att själva kunna överleva. Resignationen försvårade ytterligare för dem att kunna arbeta i linje med sina ideal (II). Den teoretiska förståelsen som konstruerats visar att det patienterna beskrev som frånvaro av, eller hindrande interaktioner samt passivitet reflekterades i personalens beskrivningar av hinder i vardagslivet på avdelningarna. Det patienterna beskrev som tillitsfulla interaktioner och tillfredsställande aktiviteter reflekterades i personalens beskrivningar av att fokusera på patienternas bästa. Detta tolkas som att när personal har möjlighet att fokuserar på patienternas bästa, då finns möjligheter till förbättringar av vardagslivet inom psykiatrisk heldygnsvård.

Omvårdnadsinterventionen Tid Tillsammans var genomförbar inom psykiatrisk hel­dygn­svård. Delat ansvar, ett vänligt bemötande och en förutsägbar struktur möjliggjorde interventionen medan ett distanserat bemötande och en oförutsägbar struktur utgjorde hinder. Mätningarna visade inga effekter på kvaliteten i interaktionerna mellan patienter och personal samt osäkra effekter på personalens upplevda stress och samvetsstress samt på personalens nöjdhet med interaktionerna med patienterna (III). Patienterna beskrev sina erfarenheter av att ha tagit del i Tid Tillsammans som att bli sedd som en människa bland andra människor, att det bidrog till hopp om återhämtning men också att känslor av distans till personalen utvecklades när Tid Tillsammans inte genomfördes (IV).

Konklusion: Genom att införa Tid Tillsammans inom psykiatrisk heldygnsvård får personal tillgång till en omvårdnadsintervention som kan möta patienternas behov av interaktioner med hög kvalitet och som kan ha potential att minska deras upplevda stress och samvetsstress samt öka deras nöjdhet med interaktionerna med patienterna. Genom att använda gemensamma aktiviteter kan relationer som bygger på ömsesidighet och engagemang mellan patienter och personal utvecklas, något som betonas inom återhämtningsinriktad psykiatrisk omvårdnad.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2018. p. 57
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1961
Keywords
engagement, everyday life, experiences, grounded theory, interaction, interprofessional teams, intervention, mental health nursing, ordinary relationships, psychiatric inpatient care, patient perspectives, single system experimental design, qualitative content analysis, engagemang, grounded theory, interaktion, interprofessionella team, intervention, kvalitativ innehållsanalys, patientperspektiv, psykiatrisk heldygnsvård, psykiatrisk omvårdnad, single system experimental design, Tid Tillsammans, upplevelser, vardagliga relationer, vardagsliv
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-147694 (URN)978-91-7601-877-4 (ISBN)
Public defence
2018-06-08, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-05-18 Created: 2018-05-14 Last updated: 2018-06-09Bibliographically 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
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
Molin, J., Hällgren Graneheim, U. & Lindgren, B.-M. (2016). Quality of interactions influences everyday life in psychiatric inpatient care: patients' perspectives. International Journal of Qualitative Studies on Health and Well-being, 11(1), Article ID 29897.
Open this publication in new window or tab >>Quality of interactions influences everyday life in psychiatric inpatient care: patients' perspectives
2016 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, article id 29897Article in journal (Refereed) Published
Abstract [en]

Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients' experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories — staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content — were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
everyday life, experiences, grounded theory, interactions, ordinary relationships, psychiatric inpatient care, patient perspectives, trust
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-114813 (URN)10.3402/qhw.v11.29897 (DOI)000369148700001 ()26806313 (PubMedID)
Available from: 2016-01-28 Created: 2016-01-28 Last updated: 2018-06-07Bibliographically approved
Molin, J., Hällgren Graneheim, U., Ringnér, A. & Lindgren, B.-M.Patient experiences of taking part in Time Together – a nursing intervention in psychiatric inpatient care.
Open this publication in new window or tab >>Patient experiences of taking part in Time Together – a nursing intervention in psychiatric inpatient care
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-147693 (URN)
Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2018-06-09
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9116-5569

Search in DiVA

Show all publications