| 1. |
- Enarsson, Per, 1962-, et al.
(författare)
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“Being good or evil” : applying a common staff approach when caring for patients with psychiatric disease
- 2008
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : CoAction Publishing. - 1748-2623 .- 1748-2631. ; 3:4, s. 219-229
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Tidskriftsartikel (refereegranskat)abstract
- AbstractThis study was performed to gain a deeper understanding of how psychiatric staff, when caring for patients with psychiatric disease, experience situations that include a common staff approach directed toward an individual client. Nine nurses were interviewed. The interviews were analyzed with a phenomenological-hermeneutic method in order to illuminate the livedexperience of applying a common staff approach. The results revealed several meanings: shedding light on carers’ mutual relationships; being deserted by nurse colleagues; being aware of one’s own basis of evaluation, and that of others; beingjudged by the patient as good or evil; and becoming sensitive to the patient’s suffering. The comprehensive understandingwas that the nurse has a difficult choice*to focus on relations with one’s colleagues or to focus on the situation of the patient, who seems to suffer when a common staff approach is used.
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| 2. |
- Enarsson, Per, 1962-, et al.
(författare)
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Handledningsstrategier i omvårdnad : en kartläggande studie av handledningsmodeller och analys av handledarparadigm
- 1998
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Ingår i: Vård i Norden. - : SAGE Publications. - 0107-4083 .- 1890-4238. ; 18:4, s. 15-21
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed a) to describe existing models in clinical nursing supervision in Sweden and b) to obtain a deeper understanding of the paradigms governing different supervision models. All University Colleges of Nursing and Health Sciences in Sweden were mailed a questionnaire concerning different aspects of clinical nursing supervision. Of the one third (n=13) of the Colleges who had some kind of educational program in nursing supervision, five different models of supervision were identified. The Colleges educational programs in nursing supervision were used as a base to select at random four clinical nursing supervisors, who then were interviewed. The interviews were analysed using a paradigm interpreting method resulting in a chart of the paradigm components held by the clinical nursing supervisors. The results showed that although the supervision programmes of the 13 colleges were of different direction, length and content, there were some pervading components in all programmes. The Colleges showed poor knowledge about each others programs. Analysis of the interviews with the clinical nursing supervisors showed they had difficulties in articulating the theoretical frame of their supervision, whereas the practical aspects were easier to express. The rituals around the supervision sessions seemed more important than the theoretical frame. Another interpretation were that the supervisors personal paradigm also influenced the way the supervision was carried out.
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| 3. |
- Enarsson, Per, 1962-
(författare)
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Mellan frihet och trygghet : personalgemensamt förhållningssätt i psykiatrisk omvårdnad
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The common staff approach in psychiatric care has not been studied explicitly before. Earlier studies in related areas of social processes in psychiatric care highlight the importance of the interaction between the patient and the carer to understanding communication patterns and attitudes. Other studies on social order and power in psychiatric care shows carers and patients as taking part in a hierarchical system in which patients are subordinate to carers. Aim: The overall aim of this thesis is to study the phenomenon of the common staff approach in psychiatric care, how it emerges, and how it is used and experienced by both carers and patients. Method: In the first study, grounded theory was applied to data from observations and interviews carried out with carers and clients in two psychiatric care group dwellings. In the second and third studies, a phenomenological hermeneutic method was used to analyse narrative interviews conducted with nine careers working on psychiatric wards and nine patients with experience of psychiatric in-care, respectively. In the fourth study, qualitative content analysis was used to analyse data obtained by a vignette method from interviews with 13 carers with experience of working in psychiatric in-care. Results: A common staff approach can be understood as a social process in municipality-level group dwellings and psychiatric in-care, imposed by carers on clients or patients with the aim of restoring a predetermined order desired by the carers. When the order is disturbed the carers try to restore it by adopting a common and consistent approach towards the single patient perceived as the threat to order. Barriers to the success of a common staff approach, from the point of view of the carers, include the likelihood that colleagues will interpret situations differently, the chance that patients might succeed in dividing carers into “good” and “bad” camps, and the knowledge that the patient suffers under a common staff approach. The patients’ experiences partly confirm those of the carers – the dominant picture is that the patient feels persecuted and suffers under a common staff approach. However in some situations, patients can perceived the common approach as supportive and aimed to promote their recovery. Carers’ ethical reasoning about the common staff approach is usually applied on an individual basis; it can change depending upon the patient, the situation, and the proposed approach, as well as upon how the approach might affect other patients, staff members, or the carers themselves. Conclusions: The overall results from the four studies show that the common staff approach may meet carers’ needs, which under the approach take precedence over those of patients, but that the approach is more an exercise in asserting power and maintaining control than it is a therapeutic technique; that it is a difficult choice for the single carer to choose between the interests of the patient and the approval of colleagues; that the patient often suffers when a common staff approach is used; and that carers are seldom aware of the suffering experienced by the patient being managed by such an approach. A common staff approach has no part in a care-strategy; it is not an intentional care-plan; instead it appears to be a way for carers who feel vulnerable and under pressure to maintain order by controlling particular patients.
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| 4. |
- Enarsson, Per, et al.
(författare)
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The preservation of order : the use of common approach among staff toward clients in long-term psychiatric care
- 2007
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 17:6, s. 718-729
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Tidskriftsartikel (refereegranskat)abstract
- The authors performed this grounded theory study to gain a deeper understanding of the kinds of social processes that lead to a need among psychiatric nursing staff to reach a common approach on how to act toward individual clients in long-term psychiatric care. They present a theory about the development of such common approaches among staff. The main findings were that in psychiatric group dwellings, when the internal order is perceived as having been disturbed, the staff preserve or restore the internal order by formulating and reaching a common approach. The staff negotiated with each other to achieve an agreement on how to act and behave toward the individual client. The authors isolate and describe different types of order-disturbing incidents and the common approaches taken by the staff in dealing with them. However, their data also show that staff often had difficulties in maintaining a common approach over time.
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| 5. |
- Enarsson, Per, 1962-, et al.
(författare)
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'There should be something gained' : Carers’ ethical reasoning about using a common staff approach in psychiatric in-care
- 2017
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 37:4, s. 217-225
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Tidskriftsartikel (refereegranskat)abstract
- Thirteen carers were interviewed about their ethical reasoning when using a common staff approach to restricting smoking for a psychiatric in-patient. A constructed case structure and a vignette method were used in the interviews, and manifest content analysis of the texts exposed five ethical positions adopted by the carers: ‘best for the person’, ‘best for the patient’, ‘best for others involved with the person/patient’, ‘best for me as a carer’, and ‘best according to rules and regulations’. A second manifest content analysis of language showed terms that expressed value judgments in regard to the carers’ personal experiences. Some carers argued at first from one ethical position, but when the question was changed, they argued from an opposite ethical position. Results may be understood in light of dialog philosophy; ethical reasoning during use of a common staff approach tends to focus either on relations with others or with oneself.
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| 6. |
- Enarsson, Per, 1962-, et al.
(författare)
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"There should be something gained" : carers' ethical reasoning about using a common staff approach in psychiatric in-care
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Thirteen carers experienced in caring for psychiatric in-patients were interviewed about their ethical reasoning when using a common staff approach to restricting smoking for a psychiatric in-patient. A constructed case structure and a vignette method were used in the interviews, and manifest content analysis of the texts exposed five ethical positions (i.e. categories) adopted by the carers: “It is best for the person,” “It is best for the patient,” “It is best for people related to the person/patient,” “It is best for me as a carer,” and “It is best according to rules and regulations”. A second manifest content analysis of language showed 101 terms that expressed value judgments; 97 that concerned rights and obligations, mostly about responsibility and restricting other people’s actions; and 210 that concerned human actions, mainly in regard to personal experiences. Some carers argued at first from one ethical position, but when the question in the vignette was changed, abandoned their earlier position and argued from an opposite ethical position. These results may be understood in light of dialog philosophy; ethical reasoning during use of a common staff approach tends to focus either on relations with others or with oneself.
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| 7. |
- Enarsson, Per, 1962-, et al.
(författare)
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They can do whatever they want’’ : Meanings of receiving psychiatric care based on a common staff approach
- 2011
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : CoAction Publishing. - 1748-2623 .- 1748-2631. ; 6:1, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- This study deepens our understanding of how patients, when cared for in a psychiatric ward, experience situations that involve being handled according to a common staff approach. Interviews with nine former psychiatric in-patients were analyzed using a phenomenological–hermeneutic method to illuminate the lived experience of receiving care based on a common staff approach. The results revealed several meanings: discovering that you are as subjected to a common staff approach, becoming aware that no one cares, becoming aware that your freedom is restricted, being afflicted, becoming aware that a common staff approach is not applied by all staff, and feeling safe because someone else is responsible. The comprehensive understanding was that the patient's understanding of being cared for according to a common staff approach was to be seen and treated in accordance with others’ beliefs and valuations, not in line with the patients’ own self-image, while experiencing feelings of affliction.
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| 8. |
- Rastad, Cecilia, 1953-
(författare)
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Winter Fatigue and Winter Depression : Prevalence and Treatment with Bright Light
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to study prevalence of winter depressive mood and treatment effects of bright light for persons with winter fatigue and winter depression. Study I is a cross-sectional survey of a random sample (N=1657) from the general population between 18-65 years of age in Dalarna, Sweden (latitude 60°N). Study II is a similar survey of 17-18 year old students (N=756) in the municipality of Falun. Approximately 20% of both samples report seasonal symptoms, mainly fatigue, lowered mood and increased sleep duration, appetite and weight. Study III examines the effects of treatment in light rooms for persons from the sample in Study I (40 women, 10 men) with clinically assessed Seasonal Affective Disorder (SAD) or subclinical SAD (S-SAD). Subjects were randomised either to an experimental group receiving ten days of bright light treatment or to a three-week waiting-list control condition followed by bright light treatment. There was a >50% reduction of depressed mood in 13 of the 24 subjects in the experimental group, while none of the 24 controls reported a similar reduction. At the one-month follow-up, results were maintained and 39 of 47 subjects were improved >50%. Fatigue and excessive daytime sleepiness, which were high at baseline, were normal/below population norms for 39 of 47 subjects at the one-month follow-up. Mean values for the mental health aspect of health-related quality of life, which were low at baseline, improved and were close to norms at the one-month follow-up. Study IV is a person-oriented subgroup/cluster analysis of the subjects in Study III. A common trait in all three clusters was a high level of fatigue hence the denomination ´Winter Fatigue´ is used for the merged group. Even though the degree of depressive mood and daytime sleepiness differed between the subgroups, all three groups improved following bright light treatment. The results suggest that an increase in fatigue and depressed mood during the winter season is common in the general population. Bright light treatment reduces depressive mood, fatigue and excessive daytime sleepiness and improves health-related quality of life in persons with winter fatigue and winter depression.
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| 9. |
- Andersson, Åsa, et al.
(författare)
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Adverse events in nursing : a retrospective study of reports of patient and relative experiences
- 2015
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Ingår i: International Nursing Review. - : International Council of Nurses. - 0020-8132 .- 1466-7657. ; 62:3, s. 377-385
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Tidskriftsartikel (refereegranskat)abstract
- Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them. The aim was to examine adverse events in nursing care as they are experienced by patients and relatives. This was a retrospective study taking both a qualitative and quantitative approach. It was based on data regarding 242 adverse events in nursing care, as reported by patients and relatives to Sweden's Medical Responsibility Board, content analysis was used to analys the reports. Patients' and relatives' experiences were analysed into four categories of adverse events, as concerning participation, clinical judgement, nursing intervention and the essentials of care. The reports were classified by the Medical Responsibility Board, without a standardized system. The adverse events reported were few in number and were reported by patients and relatives only. Lack of participation has negative consquences and contributes to adverse events. Adverse events occur through missed care as well as through carer errors. Nurses need to improve their skills that support patient participation. Patient participation needs to be incorporated into nurses' duties. Resources for patients to participate in their own care needs to be a priority underpinning policy-making in health systems. Nursing education systems need to teach students about the value and benefits of involving patients in their care.
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| 10. |
- Andersson, Åsa, et al.
(författare)
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Factors contributing to serious adverse events in nursing homes
- 2018
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 27:1-2, s. e354-e362
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The aim of this study was to identify the most common serious adverse events that occurred in nursing homes and their most frequent contributing factors to contribute to improvement of safe nursing care. BACKGROUND: There is a need to improve safe nursing care in nursing homes. Residents are often frail and vulnerable with extensive needs for nursing care. A relatively minor adverse event in nursing care can cause serious injury that could have been preventable. DESIGN: This was a retrospective study, with a total sample of data regarding adverse events (n=173) in nursing homes, concerning nursing care reported by health care providers in Sweden to the Health and Social Care Inspectorate. The reports were analysed with content analysis and the frequencies of the adverse events, and their contributing factors, were described with descriptive statistics. RESULTS: Medication errors, falls, delayed or inappropriate intervention and missed nursing care caused the vast majority (89%) of the serious adverse events. A total of 693 possible contributing factors were identified. The most common contributing factors were 1) lack of competence 2) incomplete, or lack of documentation 3) teamwork failure 4) and inadequate communication. CONCLUSIONS: The contributing factors frequently interacted yet they varied between different groups of serious adverse events. The resident's safety depends on the availability of staff's competence as well as adequate documentation about the resident's condition. Lack of competence was underestimated by health care providers. RELEVANCE TO CLINICAL PRACTICE: Registered Nurses and assistant nurses need to have awareness of contributing factors to adverse events in nursing care. A holistic approach to improve patient safety in nursing homes requires competence of the staff, safe environments as well as resident's and relative's participation. This article is protected by copyright. All rights reserved.
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