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  • 1.
    Lindgren, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundström, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strömbäck, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    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 design2018Ingår i: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, artikel-id 191Artikel i tidskrift (Refereegranskat)
    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.

  • 2.
    Lindgren, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health Sciences, University West,Trollhättan, Sweden.
    Patients' experiences of isolation in psychiatric inpatient care: insights from a meta-ethnographic study2019Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, nr 1, s. 7-21Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Time Together: a nursing intervention targeting everyday life in psychiatric inpatient care : patient and staff perspectives2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 4.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Quality of interactions influences everyday life in psychiatric inpatient care: patients' perspectives2016Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, nr 1, artikel-id 29897Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    From ideals to resignation: interprofessional teams perspectives on everyday life processes in psychiatric inpatient care2016Ingår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 23, nr 9-10, s. 595-604Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Patient experiences of taking part in Time Together – a nursing intervention in psychiatric inpatient careManuskript (preprint) (Övrigt vetenskapligt)
  • 7.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care2019Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, nr 2, s. 551-559Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Graneheim, Ulla Hällgren
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Time Together: a nursing intervention in psychiatric inpatient care : feasibility and effects2018Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, nr 6, s. 1698-1708Artikel i tidskrift (Refereegranskat)
    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.

  • 9.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 approach2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikel-id e015677Artikel i tidskrift (Refereegranskat)
    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.

1 - 9 av 9
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