Competent help during acute psychosis. A qualitative interview study with patients admitted to acute psychiatric wards

Akutt psykose er en alvorlig tilstand. Mennesker med akutt psykose blir vanligvis innlagt på akuttpsykiatriske sengeposter for behandling og nødvendig pleie og omsorg. Formålet med denne avhandlingen er å utforske og å beskrive hva kyndig hjelp gjennom akutt psykose kan være for pasienter innlagt i akutt psykiatriske sengeposter. Avhandlingens teoretiske referanseramme er sykepleietenkning i en tradisjon etter Florence Nightingale. Avhandlingen baseres på en tredelt kvalitativ studie med et utforskende og beskrivende design. Deltakerne i studien var pasienter med en kjent psykoselidelse, innlagt i akutt psykiatriske sengeposter. De ble intervjuet om sin erfaring med pleie og omsorg gjennom sin akutte psykosetilstand. Lydfilene fra de kvalitative forskningsintervjuene ble transkribert til intervjutekst som ble innholds-analysert. Resultatene ble publisert i tre artikler vedlagt avhandlingen. Tre aspekt i utøvelsen av pleie og omsorg synes å ha sentral betydning for den kyndige hjelpen pasientene fikk. For det første er utformingen av og atmosfæren i de akuttpsykiatriske sengepostene og strukturen i pleie- og omsorgsarbeidet vesentlig. For det andre trenger sykepleiere kunnskap om psykoselidelse, om akutte psykoser og om den enkelte pasients tilstand som akutt kritisk syk. Til sist, må pleie og omsorg være nøye tilpasset den enkelte pasients tilstand som akutt kritisk syk for at pasientene skal få kyndig hjelp gjennom akutt psykose. Resultatene indikerer at for at pasienter skal få kyndig hjelp gjennom akutt psykose må akuttpsykiatriske sengeposter ha gode rom og arbeidsstrukturer som sikrer at utøvelse av akutt kritisk pleie og behandling skjer i samarbeid med pasienten selv, med pasientens familie og med lokalt helsepersonell som har oppgaven å følge pasienten opp etter utskrivelse. Videre, sykepleiere i akutt psykiatriske sengeposter trenger spesialisert kunnskap om psykoselidelse og om den enkelte pasients tilstand som akutt kritisk syk for å utøve akutt kritisk pleie til pasienten. Sist men ikke minst, foreslås ny forskning som undersøker og beskriver sykepleiere sin erfaring med å utøve kyndig pleie og omsorg til pasienter gjennom akutt psykose

"I Want to Go Home, but I Need to Stay" : The Transition to become Ready for Discharge from Acute Psychiatric Wards, as Narrated by Persons Who Experienced Acute Psychotic Illness

Background: Discharge planning for persons with psychotic illness who are admitted to acute psychiatric wards is critical for decreasing the well-known risk of new phases of psychosis and early readmissions after discharge from the ward. There is limited knowledge about admitted persons’ experience of their readiness for discharge from acute psychiatric wards. This study aims to describe and understand how persons with psychotic illness experience to become ready for discharge during their stay on an acute psychiatric ward. Method: During their hospital stay, 12 persons who recently had acute psychotic illness were interviewed about their experiences related to their upcoming discharge. The recorded interviews were transcribed and content analysed. Results: The results describe the participants experienced three phases of transition to become ready for discharge after their acute psychosis had decreased: 1)Being affected by wounds following acute psychotic illness, 2) Being in need for strength to feel better before discharge, and 3)Being ready for discharge. Conclusion: This experiential knowledge informs the transitional care that mental health nurses provide to persons during the discharge process. In addition to developing plans for discharge and for further mental health care in the community together with persons in care, nurses must seriously consider persons’ mental health care needs following psychosis to support the best of outcome of the transition to become ready for discharge

Being in a process of transition to psychosis, as narrated by adults with psychotic illnesses acutely admitted to hospital

To assist in improving early interventions for psychosis, this study explored how adult people narrated their experience of becoming psychotic, and how contact with mental health personnel was established. Narrative interviews were conducted with 12 participants with psychotic illnesses recruited from acute psychiatric wards. The interviews were content analysed. Participants described being in a process of transition to psychosis as follows: experiencing changes as well-known signs of psychosis, experiencing sudden unexpected changes as signs of psychosis and experiencing unidentified changes as signs of illness. Our results show that participants and their close others who knew the signs of psychosis established a dialogue with mental health personnel and were better equipped to prevent and mitigate the psychosis. Our results demonstrate that participants who did not perceive the signs of psychosis and did not have other people to advocate for them were at risk for delayed treatment, poor communication and coercive interventions. Furthermore, participants who did not know the signs of psychosis perceived these changes as deterioration in their health and awareness of illness.We suggest that participants’ experiential knowledge of transitioning to psychosis and an awareness of illness can be used to improve the communication during interventions for psychosis

Confirming mental health care in acute psychiatric wards, as narrated by persons experiencing psychotic illness : an interview study

BACKGROUND: It is important that mental health nurses meet the safety, security and care needs of persons suffering from psychotic illness to enhance these persons' likelihood of feeling better during their time in acute psychiatric wards. Certain persons in care describe nurses' mental health care as positive, whereas others report negative experiences and express a desire for improvements. There is limited research on how persons with psychotic illness experience nurses' mental health care acts and how such acts help these persons feel better. Therefore, the aim of this study was to explore, describe and understand how the mental health nurses in acute psychiatric wards provide care that helps persons who experienced psychotic illness to feel better, as narrated by these persons. METHOD: This study had a qualitative design; 12 persons participated in qualitative interviews. The interviews were transcribed, content analysed and interpreted using Martin Buber's concept of confirmation. RESULTS: The results of this study show three categories of confirming mental health care that describe what helped the participants to feel better step-by-step: first, being confirmed as a person experiencing psychotic illness in need of endurance; second, being confirmed as a person experiencing psychotic illness in need of decreased psychotic symptoms; and third, being confirmed as a person experiencing psychotic illness in need of support in daily life. The underlying meaning of the categories and of subcategories were interpreted and formulated as the theme; confirming mental health care to persons experiencing psychotic illness. CONCLUSION: Confirming mental health care acts seem to help persons to feel better in a step-wise manner during psychotic illness. Nurses' openness and sensitivity to the changing care needs of persons who suffer from psychotic illness create moments of confirmation within caring acts that concretely help the persons to feel better and that may enhance their health. The results show the importance of taking the experiential knowledge of persons who have experienced psychotic illness seriously to develop and increase the quality of mental health care in acute psychiatric wards