Profiles of and practices in crisis resolution and home treatment teams in Norway: a longitudinal survey study

<p>Abstract</p> <p>Background</p> <p>Crisis resolution and home treatment (CRHT) is one of the more recent modes of delivering acute mental health care in the community. The objective of the study was to describe the standardizations and variations in the CRHT teams in Norway in order to gain knowledge regarding the structures and processes of CRHT teams.</p> <p>Methods</p> <p>A longitudinal survey of five CRHT teams in Norway was carried out for a period of 18 months with two sets of questionnaires-one for CRHT team profiles for a bi-yearly survey and the other for services and practices of CRHT teams for a monthly survey.</p> <p>Results</p> <p>The five CRHT teams were configured by a set of common basic characteristics in their operations, while at the same time were variant in several areas of the teams' structures and processes. Significant differences among the teams were evident in terms of the structural aspects such as service locality, staffing and team make-up, caseload, service hours, and travel time, and the process aspects such as the number of referrals received, referral source, admission, service duration, and discharge destination. These variations are reflected upon the perspectives regarding the nature of mental health crisis, the conflicting policies in mental health services, and the nature of home-based mental health care.</p> <p>Conclusions</p> <p>The diversity in the way CRHT teams are established and operate needs to be examined further in order to understand the reasons for such variations and their impact on the quality of services to service users and in relation to the total mental health service system in a community.</p

The Course of Fatigue during the First 18 Months after First-Ever Stroke: A Longitudinal Study

Background. Little is known about the course of poststroke fatigue. Objectives. To describe the course of poststroke fatigue in relation to the patient's level of physical functioning, depressive symptoms, and self-reported history of prestroke fatigue. Methods. A longitudinal study using structured face-to-face interviews, questionnaires, and patients' medical records. Data were collected from 95 patients in Norway with first-ever stroke. Fatigue was measured with the Fatigue Severity Scale 7 item version and assessed for change between the acute phase, six, 12, and 18 months after stroke using 2-way ANOVA repeated-measures analyses. Results. The patients' level of fatigue did not change over time. However, those who reported prestroke fatigue showed a relatively high level of fatigue over time in the poststroke period, while patients with no history of pre-stroke fatigue showed a stable course of relatively low fatigue over time. Conclusion. Studies on poststroke fatigue should control for the patient's pre-stroke fatigue level

Sleep-Wake Patterns during the Acute Phase after First-Ever Stroke

This study describes the pattern of day and night sleep and explores relationships between these patterns and sociodemographic and clinical factors as well as sleep environmental context and the patient's subjective sleep quality. Data from 110 patients with first-ever stroke was collected by structured interview surveys, medical record, and objective estimated sleep data from wrist actigraphy. The variability in estimated sleep is large. Half the patients slept either <6 hours or >8 hours per night, and 78% had more than nine awakenings per night. Men slept less than women, and patients sleeping at home had fewer awakenings than those who slept in hospital. It was estimated sleep during daytime in all, except 4, patients. Longer stay in hospital was related to more daytime sleep, and the subjective sleep quality correlated with estimated sleep time, wake time, and wake percentage

Double helix of research and practice—developing a practice model for crisis resolution and home treatment through participatory action research

Over the last five years Crisis Resolution/Home Treatment (CR/HT) teams have been established in Norway. These teams provide an alternative to in-patient acute care services offering assessment as well as direct care. This paper addresses a method of examining the nature of practice models that are being developed in a CR/HT team incorporating the philosophy of open dialogue and the open lifeworld approach. The overall design of this research is action research applying a cooperative inquiry perspective. Multistage focus group interviews are used as a method for generating data, followed by phenomenological–hermeneutic approach in analyzing the data. Three themes were identified: (a) “keeping the dialogue open” referring to the emphasis of openness in dialogues and opening up for a variety of perspectives on what's going on; (b) “tolerance of uncertainty” referring to the need to accept and deal with uncertainty and multiplicity; and (c) “nurturing everyday life issues” referring to the emphasis on illustrating clinical situations in detail through remaking of stories. The on-going co-processes of research and practice was a double helix that links the happenings in the practice with the findings in the research revealing the knowledge in practice and further developing that knowledge

Putting theory into practice: problems and prospects

The apparent gap between theory and practice in nursing seems to be widening as it is becoming increasingly difficult for nurses to manage multiple theories and conflicting knowledge claims for their use in practice Scientific pluralism in nursing provides, on the one hand, a rich array of knowledge about human phenomena and ways of dealing with nursing problems, while on the other a set of theoretical choices available for knowledge‐use in practice This paper presents four ideal‐type modes of theory application as viable forms for nurses in practice to deal with theoretical pluralism Copyright © 1993, Wiley Blackwell. All rights reserve

Critical reflective inquiry for knowledge development in nursing practice

This paper presents a method of inquiry which uses nurses\u27 situated, individual instances of nursing practice as the basis for developing knowledge for nursing and improving practice. This method of inquiry is founded upon the ideas in action science and reflective practice, and critical philosophy. Nursing practice is viewed as a rich source of new knowledge as practitioners are engaged in creating as well as modifying knowledge to respond to specific clinical situations. At the same time, practitioners may be in practice without recognizing deficiencies or ineffectiveness. As a method to tap these two aspects of practice, the inquiry is designed to encompass three phases, i.e. descriptive, reflective and critical/emancipatory, and is oriented to provide understanding to practitioners of the nature and meaning of their own practice, to correct and improve practice through self-reflection and critique, and to generate models of \u27good\u27 practice and theories of application as well as to discover processes of practice as played out in clinical situations. This method of inquiry can be used by nurses and nursing students in collaboration with researches or mentors to develop nursing knowledge about practice, improve individual practice, and engage in shared learning

Identifying alternative linkages among philosophy, theory and method in nursing science

The major concerns expressed in the literature regarding the development and expansion of nursing science stem from questions related to ‘what sorts of science’ and ‘which scientific methods’ are appropriate for nursing While there is a sector of nursing\u27s scientific community that advocates a unified approach to philosophy and method, a growing sentiment for the position of philosophical and methodological pluralism is apparent This paper addresses the nature of scientific pluralism by presenting a framework for alternative linkages possible among the philosophy, theory and method appropriate for nursing science The nature of nursing knowledge that is produced within the discipline will thus depend on various forms of alternative linkages adopted by nursing scientists in addressing nursing\u27s scientific questions In turn, such pluralism presents problems of choice to nurses in practice with respect to knowledge utilization Copyright © 1993, Wiley Blackwell. All rights reserve

Strategies of Middle-range Theory Development in Nursing

Theory development in nursing can be viewed to have progressed during the last 50 years in three periods: (a) the era of specifying theoretical orientations for nursing that occurred during the period of 1950s and 1960s, (b) the era of grand theorizing during the 1970s and 1980s, and (c) the era of middle-range theory development in the last two decades. The first era was characterized by the attempts of several nursing leaders and scholars to identify specific nursing orientations in an effort to disassociate and differentiate nursing from medicine. There were two distinct directions with which theoretical orientations for nursing were specified: one was the specification of what the focus of nursing is in relation to clients, namely what has been identified as the patients' needs orientation advanced by Henderson, Abdellah, and others, and the other was the focus on nursing's unique nature from the interaction perspective as was done by such scholars as Peplau, Orlando, Travelbee, and Widenbach. By specifying the theoretical and professional orientation of nursing in terms of patients' needs as with the 14 basic needs of patients by Henderson and the system of 21 nursing problems by Abdellah, nursing leaders and scholars were attempting to shift from disease-orientation to nursing-specific problem orientation. On the other hand, the interaction perspective was an attempt to provide theoretical approaches regarding how nursing is done rather than what sorts of problems in patients nursing is oriented to solving. These two groups of theoretical work in nursing during this initial period were oriented to providing general frameworks and systems of terminologies rather than in advancing specific theoretical systems. However, these proposals and developments were the impetus and foundation from which the second era of theoretical efforts emerged