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- Englund, Anna-Lena, 1949-, et al.
(författare)
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Värdegrunden reducerad till metod
- 2009
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Ingår i: Pedagogiska magasinet. - Stockholm : Lärarförbundet. - 1401-3320. ; 13:4, s. 18-21
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Det behövs en etisk vändning i diskussionen om främjande och förebyggande program. Alltför stort intresse riktas mot frågan om evidens och effektivitet och alltför lite intresse riktas mot värdefrågorna. Vad innebäör det för lärarens professionalism om manualstyrda aktiviteter ersätter samtal och samspel?
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- Engström, Ingemar, 1952-, et al.
(författare)
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Adolescents' Experiences of the Staff's Different Interaction Styles in Coercive Youth Care in Sweden : A Qualitative Study
- 2020
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 41:11, s. 1027-1037
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Tidskriftsartikel (refereegranskat)abstract
- We interviewed 20 adolescents who were coercively placed in residential or psychiatric care. The aim was to explore their views on the way staff relate and perform their duties, favorable characteristics in staff, consequences of different treatment from staff and their safety experiences. Thematic analysis identified the following themes: Situational triggers of frustration; Care-based; rule-based; or passive-avoidant interaction styles toward adolescents and their responses; Adolescents' reflections about staff's interaction styles; and the Consequences on the unit atmosphere depending on different interaction styles toward the adolescents. Adolescents preferred staff who showed them respect and a clear wish to make life easier.
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- Engström, Ingemar, 1952-, et al.
(författare)
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Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundContinuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI.MethodsEleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518.ResultsWe identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas.ConclusionsThe results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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- Hylén, Ulrika, 1977-, et al.
(författare)
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Providing Good Care in the Shadow of Violence : An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden
- 2019
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 40:2, s. 148-157
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.
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- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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Hantering av hot och våld : Personalens syn på etik, bemötande och säkerhet i mötet med ungdomar på institutioner
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The starting point of this study was that aspects of ethics as well as safety should be taken into account in meetings with patients and clients. The purpose was to increase the understanding of how staff in inpatient and institutional settings relate to the perspectives of good care and safety simultaneously in daily meetings with young clients and patients, especially in aggressive situations. The participants were staff who worked with youngsters on a daily basis at two institutions run by the National Board of Institutional Care (SiS) and a child and adolescent psychiatric clinic. The research questions were: 1) Which values can be found in the staff’s narratives about meetings with youngsters?, 2) How do staff describe the sequence of events in incidents of violence at their workplace?, and 3) How do staff describe their work with prevention and management of violence? Data collection was done through individual interviews, focus group interviews and questionnaires based on the Critical Incident Technique method. Interviews were analyzed with qualitative content analysis. Three themes of staff values emerged in the analysis: 1) From rule to relationship, an experienced movement from a rule-based to a more individualized care, 2) Ways to manage power and responsibility, thoughts about structure and pedagogics, and 3) An institution with a conscious culture, the importance of belonging to a supportive team with common basic views and an open climate. The staff described various kinds of incidents of violence and some of these incidents had serious consequences like seclusion of youngsters and staff injuries causing need for medical care. A need for more education, improved routines and organizational support was expressed. The work to prevent violence included individually detecting risks and, if necessary, communicating with other staff members when assessing these risks. Threats were reported as common but hard to cope with when directed towards a specific staff member and his or her family. The staff stressed the need, after a serious incident, to process what happened with colleagues and youngsters concerned. The colleagues were seen as the most important support, and there were some descriptions of shortcomings in the follow-up routines of violent incidents.
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- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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Paternalism, autonomy and reciprocity : ethical perspectives in encounters with patients in psychiatric in-patient care.
- 2013
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Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939 .- 1472-6939. ; 14:1, s. 49-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.METHODS: All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.RESULTS: The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.CONCLUSIONS: Paternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients' right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.
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| 10. |
- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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Staffs’ perceptions of the ethical landscape in psychiatric inpatient care : A qualitative content analysis of ethical diaries
- 2014
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Ingår i: Clinical Ethics. - London : Sage Publications. - 1477-7509 .- 1758-101X. ; 9:1, s. 45-52
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Tidskriftsartikel (refereegranskat)abstract
- This study presents a qualitative description of situations at work that staff members perceive as giving rise to ethical issues. All staff members working with patients across seven wards were given the opportunity to freely describe ethical considerations in an ethical diary over the course of one week. One hundred and five staff members kept a diary. The diaries were analysed with qualitative content analysis where four dominant themes emerged: good care, order and clarity, loyalty, and inadequacy. These results contain statements in which patients are respected and listened to, as well as statements that express a desire for relatively strict, routine-based care. Relatively few statements were of a reflective or discussing nature which highlights the need for clinical ethical support. There is a need of a visible and supportive leadership which encourages ethical reflection. Reflections on real cases could provide an opportunity to challenge existing practices and thereby promote ethical awareness.
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