Caring conversations are considered essential in psychiatric and mental health nursing. However, some patients are more or less silent and rarely express themselves verbally. This can be challenging for nurses who also need to find ways of communicating with these patients. Therefore, the aim of this study is to describe psychiatric nurses’ lived experiences of communication with patients who rarely speak. Five nurses were recruited from a psychiatric nursing home. Participants were encouraged in interviews to reflect on their experiences of caring for patients who are more or less silent. The transcribed interviews were subject to a phenomenological hermeneutic analysis. The findings are reflected in three main themes: (i) giving space for the unspoken narrative, (ii) remaining in uncertainty, and (iii) being in reflective vigilance. The themes were synthesised and reflected on in the light of Fredriksson’s theory of caring conversations. The comprehensive understanding reveals that nurses’ understanding of the patient’s unspoken narrative relies both on compassion and a willingness to engage, but also on a preparedness to remain in the uncertainty of not knowing. Balancing good intentions and the fear of one’s own shortcomings requires reflections not only in actions during encounters with the patient, but on actions. When nurses can apprehend and respond to what the patient expresses non-verbally, a joint narrative can emerge.
From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.
To be referred to care in forensic psychiatric services can be seen as one of the most comprehensive encroachments society can impose upon a person's life, as it entails a limitation of the individual's freedom with no time limit. This study focuses upon patients' experiences of their life situation in forensic psychiatric wards. Using a Reflective Lifeworld Research approach founded in phenomenology, we analysed 11 qualitative interviews with patients cared for on a maximum security unit in a Swedish forensic psychiatric service. Results show how forensic psychiatric care can be non-caring with only moments of good care, from the patient's perspective. By using different strategies, the patients attempt to adapt to the demands of the caregivers in order to gain privileges. At the same time the patients are lacking meaningful and close relationships and long to get away from the system of forensic care. Being cared for entails struggling against an approaching overwhelming sense of resignation.
Forensic psychiatric care in Sweden constitutes a specific institutional environment in health care in terms of gender and power relationships. This context emphasizes safety and protection in an environment where men constitute a majority of the patients and staff. It involves relationships among men's health, constructions of masculinities, and issues regarding equality between women's and men's caring work. The aim of this theoretical article is to problematize men's health in relation to constructions of masculinities. Our analysis shows how the perception of health is involved in the construction of masculinities and how this plays out in daily interactions between caregivers and patients.
Despite strong evidence for the positive relationship between physical activity and mental health, physical activity is used far too little to promote health in mental health care. Fourteen caregivers working in community mental health services were interviewed about their experiences of motivating adult persons with psychiatric disabilities to be physically active, and data were analysed using a phenomenological-hermeneutical approach. Three themes emerged: (1) An approach of conscious acts, (2) Companionship as a joint creation, and (3) Understanding as a way to create meaning. The interpreted meaning of motivating to physical activity was expressed as a dynamic way of being, relating, and understanding.
There is abundant documentation in research about the significant relationship between physical activity and mental health, but there is still more to be learned about what can enhance motivation to become more physically active. Fourteen persons with psychiatric disabilities were interviewed about their experiences of being physically active, and data was analyzed using a phenomenologicalhermeneutic method. Five themes emerged: Capability for Living, Liberation from a Heavy Mind, Companionship in Being in Motion, Longing for Living One’s Life, and Struggling with Limitations. The interpreted meaning of being physically active was to be moving toward reclaiming one’s life.
Communication in healthcare extends beyond patient care, impacting the work environment and job satisfaction. Interprofessional communication is essential for fostering collaboration, but challenges arise from differences in training, roles, and hierarchies. The study aimed to explore psychiatric outpatient clinicians' experiences of interprofessional communication and their perceptions of how the communication intersects the organizational and social work environment of healthcare. Qualitative research involved focus group interviews with clinicians from five psychiatric outpatient units in Central Sweden, representing diverse professions. The authors analyzed semi-structured interview data thematically to uncover clinicians' perspectives on interprofessional communication. An overarching theme, "Adjustment of communication," with subthemes "Synchronized communication" and "Dislocated communication," emerged. Clinicians adapted communication strategies based on situations and needs, with synchronized communication promoting collaboration and dislocated communication hindering it. Communicating with each other was highly valued, as it contributed to a positive work environment. The study underscores the importance of an open, supportive environment that fosters trust, and respect among healthcare clinicians. Consistent with prior research, collaboration gaps underscore the urgent need to improve interprofessional communication.
The idea of physical contact and touching in psychiatric care has, in many instances, been considered inappropriate. Psychiatry is often perceived as a verbal process and it has been generally believed that touching can provoke both aggressiveness and destructive manifestations of sexuality. However, recent research has suggested that touching can play an important role in psychiatric treatment once a caring relationship has been established. The aim of this study is to investigate the meaning of physical contact for patients who have been treated for psychosis. Through four in-depth interviews and a life-world analysis the results show that touching means to be in need, to yearn, and to belong. Furthermore, touching also communicates feelings between bodies and, as such, it can be a path through which one feels acknowledged as a human being. The results indicate that a feeling of affinity can originate through physical contact, which can be regarded as a driving force in the search to feel a sense of belonging to the community.
Mental health nurses use manifest and latent approaches for surveillance and observation of patients in the context of mental health care. Patient spaces in mental health organizations are subtly linked to these different means of surveillance. This article investigates these approaches, focusing in particular on the variety of spaces patients occupy and differences in the intensity of observation that can be carried out in them. The aim is to elaborate on space and surveillance in relation to the patients' and nurses' environment in psychiatric nursing care. Places where patients were observed were operationalized and categorized, yielding three spaces: those for patients, those for staff, and neutral areas. We demonstrate that different spaces produce different practices in relation to the exercise of panoptic power and that there is room for maneuvering and engaging in alternatives to "keeping an eye on patients" for nurses in mental health nursing. Some spaces offer asylum from panoptic observations and the viewing eyes of psychiatric nurses, but the majority of spaces in mental health nursing serve as a field of visibility within which the patient is constantly watched.
The aim of this study was to describe individuals' experiences of being hospitalized in psychiatric intensive care units (PICUs). Four participants who had previously been admitted in a PICU were interviewed using open-ended questions. The data were analyzed using thematic analysis. Analysis resulted in a synthesis of the various ways patients experienced limitations: (1) Descriptions of Being Limited in the Environment, (2) Descriptions of being Limited in Interactions with Staff, (3) Descriptions of Being Limited in terms of Access to Information, and (4) Descriptions of Having Limited Freedom and Autonomy. Hospitalization is experienced as a life-changing event that shows a kaleidoscopic view of limitation. We stress that the conceptualization of limitation must be considered due to its historical origins, sociopolitical aspirations, and philosophy of care. Thus, nurse practitioners and nursing leaders are advised to put the patient's experience at the center of care, and to involve and integrate patients throughout the recovery process.
This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest
Severe dissociative states involving the experience of being in parts, typically associated with diagnosis such as dissociative identity disorder and other specified dissociative disorders, continue to be a controversial and rarely studied area of research. However, because persons with severe dissociative states are at risk of being harmed instead of helped within psychiatric care, their experiences of living with such states warrant further examination, while innovative ways to include them in research remain necessary. Against that background, this study aimed to illuminate the meanings of living with severe dissociative states involving the experience of being in parts. This is a phenomenological hermeneutic study with data collected from three social media sources, one personal blog and two Instagram accounts, in February and March 2023. The results were illuminated in light of four themes; Striving to remain in the world, Balancing exposure and trust, Balancing belonging and loneliness and Owning oneselves. The interpretation of the themes suggests that living with severe dissociative states means being a human under inhuman conditions, striving for coherence and meaning in a world that is often unsupportive. This calls for a trauma-informed care to better support recovery for persons with severe dissociative states.
There is a general agreement regarding the significance of patient participation in care. In forensic psychiatric care, however, this appears to be troublesome because of the paradoxical nature of having responsibility; to give person-centered, recovery-oriented psychiatric care and to protect society from potentially dangerous individuals. The aim of this study was to describe patients’ lived experiences of participation in outpatient forensic psychiatric care. Data were collected by means of individual interviews with five patients. The phenomenological hermeneutical analysis shed light on patient participation as having two dimensions. The outer dimension focuses on participation as “doing” and as a means of developing the understanding and skills necessary for being discharged from forensic care, while the inner dimension is related to “being” and experiences of acceptance and inclusion in communion with other people. This emphasises the importance of supporting patients’ experiences of being involved in everyday life together with others, even in periods when patients’ possibilities to affect decisions regarding their care are limited.
Little attention has been given to sociable/unsociable communication in persons with dementia despite the importance of these behaviors in maintaining engagement in marital relationships. An observational measure of verbal and nonverbal communication in persons with dementia (Verbal and Nonverbal Interaction Scale-CR) who were engaged in conversations with spouses was tested for reliability and validity. Married persons with dementia were video-recorded at home conversing with spouses over 10 weeks (N = 118 recordings). Reliability [inter-coder (.92), test-retest (r =.61-.77), internal consistency (α =.65 -.79)] were adequate. Following an intervention, the Verbal and Nonverbal Interaction Scale-CR predicted improved communication over 10 weeks. The ratio of sociable to unsociable communication improved by 4.46 points per session [β = 4.46, t(10) = 1.96, p =.039]. VNVIS-CR is recommended to describe sociable and unsociable communication in persons with dementia as they engage in conversations with spouses.