Therapeutic writing in a programme for binge eating disorder - A tool to come closer to clarifying feelings

Introduction Therapeutic writing involving affect consciousness (AC) can be used to put difficult topics into words. In this study, we investigated how patients with binge eating disorder (BED) experienced therapeutic writing and AC in the context of cognitive behavioural therapy. The elements were included in an existing cognitive behavioural therapy group programme and the participants' experiences investigated qualitatively. Aim To investigate therapeutic writing as experienced by patients in the context of a BED group programme focusing on AC. Method A phenomenological, hermeneutic design with semi-structured interviews was employed. Eight participants were recruited after completing the BED programme at a Community Mental Health Centre on the West Coast of Norway. Findings Four sub-themes emerged: Struggling to achieve a flow in the writing process, Deeper understanding of eating patterns through writing, Moving specific feelings towards the surface by writing and Greater insight into oneself as a human being by shared writing. Based on the sub-themes, one main theme was developed: Therapeutic writing in a binge eating disorder programme means focusing on oneself as a human being by becoming closer to one's feelings. Conclusion Therapeutic writing offered in treatment for BED involves individual movements at different levels, including processes of awareness of feelings, cognitions and oneself as a human being.publishedVersio

Binge Eating Disorders – Experience of Change in the Relationship with Food and the Body during Treatment

Background: Binge eating disorder is a multidimensional mental health condition associated with a complicated relationship to food and the body. Non-pharmacological treatments such as psychoeducation are common, but there is a lack of knowledge regarding patients’ experience of completing a treatment programme. To our knowledge, no study has been conducted exploring the lifeworld of patients with binge eating disorder regarding changes in their relationship with food and the body during treatment. Aim: The aim was to develop a deeper understanding of how changes related to food and the body are experienced by patients with binge eating disorder during psychological treatment. Method: A qualitative approach was employed to explore the lifeworld of the participants. Eight patients were purposely sampled and interviewed, after which the interviews were transcribed verbatim and analysed using systematic text condensation. Results: Four categories emerged: Transition from senseless towards sensible handling of feelings, Transition from body-hatred towards body-benevolence, Transition from anxiety towards confidence in relation to others and Transition from mindless towards conscious eating. Conclusion: Patients suffering from binge eating disorder experience a disruption in their lifeworld, which creates a sense of distance between themselves and the world. Several transition processes emerged after treatment, which were experienced as unifying in the patients’ lifeworld and enhanced their sense of closeness to themselves.publishedVersio

Living with obesity — existential experiences

Aims and objectives: The aim was to gain in-depth understanding about individuals’ existential experiences of living with obesity. Background: People living with obesity face great vulnerability and existential challenges. The different treatments offered do not seem to meet the individual needs of persons with obesity. A deeper understanding of existential experiences from an individual perspective is needed to individualize treatment. Design: An exploratory phenomenological–hermeneutical design was used to gain a greater understanding of the existential experiences involved in living with obesity. Methods: The participants represented a convenient sample. 18 qualitative interviews were conducted and subjected to phenomenological–hermeneutical analysis. Results: Four themes emerged: shaped by childhood; captured by food; depressed by the culture; and judged by oneself. Conclusions: The burden of being obese can be experienced as being objectified and alienated as a human being. We need to turn towards a life-world perspective, seeing each human being as a living body to overcome objectification and alienation, and then move them towards becoming subjects in their own lives, through giving space for self-love. Health care workers need to assist persons living with obesity to reduce objectification and alienation. It is important to develop intervention that has an individual, holistic approach.publishedVersio

Homeworld/Alienworld: a qualitative study about existential experiences after cancer treatment

Background As a group, cancer survivors experience significant vulnerability and existential challenges. The biomedical approach dominating health care is insufficient to meet such existential challenges in an individualistic, holistic way. Objective This study aimed to explore the existential experiences of those treated for different cancers. Methods An exploratory phenomenological–hermeneutical design was used to obtain an understanding of existential experiences after cancer treatment. Data were collected through in‐depth interviews with 21 individuals who represented a purposive sample and were recruited from a cancer organisation. Results Three overriding themes emerged from the phenomenological–hermeneutical analysis are as follows: Experiencing an unfamiliar tiredness; Experiencing not being fully oneself; and Experiencing a feeling of being alone. Conclusions Existential suffering after cancer treatment involves living on the edge of the old homeworld and the experience of a new alienworld. Individuals undergoing such suffering need a transformational process, from the alienworld to the homeworld, which must be supported by the healthcare system.publishedVersio

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study

Introduction: Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. Methods: This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. Ethics and dissemination: This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients.publishedVersio

Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis

Abstract Background The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention. Methods A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review. Results Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring. Conclusion Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced.publishedVersio

Qualitative evaluation in nursing interventions — A review of the literature

Aim To identify and synthesize qualitative evaluation methods used in nursing interventions. Design A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre-defined terms. The included papers were published from 2014–2018. Methods We followed the guidelines of Dixon-Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach. Results Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme. Conclusion Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.publishedVersio

Antibiotics for gastroenteritis in general practice and out-of-hours services in Norway 2006-15

Background When patients with gastroenteritis (GE) seek health care, they are generally managed in primary care. Little is known about the use of antibiotic treatment in these cases. Objective The aim of this study was to investigate time trends and patient characteristics associated with antibiotic treatment for GE in Norwegian primary care in a 10-year period. Methods We linked data from two nationwide registries, reimbursement claims data from Norwegian primary care (the KUHR database) and The Norwegian Prescription Database, for the period 2006–15. GE consultations were extracted, and courses of systemic antibiotics dispensed within 1 day were included for further analyses. Results Antibiotic treatment was linked to 1.8% (n = 23 663) of the 1 279 867 consultations for GE in Norwegian primary care in the period 2006–15. The proportion of GE consultations with antibiotic treatment increased from 1.4% in 2006 to 2.2% in 2012 and then decreased to 1.8% in 2015. Fluoroquinolones (28.9%) and metronidazole (26.8%) were most frequently used. Whereas the number of fluoroquinolones courses decreased after 2012, the number of metronidazole courses continued to increase until year 2015. The antibiotic treatment proportion of GE consultations was lowest in young children and increased with increasing age. Conclusion Antibiotic treatment is infrequently used in GE consultations in Norwegian primary care. Although there was an overall increase in use during the study period, we observed a reduction in overall use after year 2012. Young children were treated with antibiotics in GE consultations less frequent than older patients.publishedVersio

Guilt and shame as an enigma in mothers who suffer from eating difficulties : A hermeneutical study

PhD thesis in Health, medicine and welfareSearching for new understanding about the enigma of guilt and shame in mothers suffering from ED led to a focus on the power of motherhood and the mothers’ ability to suffer in silence. The desire to be a good mother and not transfer problems to the next generation seemed to intensify the sense of guilt and shame, as well as the will to keep the suffering associated with the mental health problem a secret. This was interpreted and understood as follows: Suffering from mental health problems in secret was found to intensify feelings of guilt and shame. Responsibility (guilt) and self-judgement (shame) have a powerful emotional and cognitive influence on important qualities of a woman’s daily life and can lead to both strength and vulnerability. Implications for mental health nurses are suggested. The conditions described in this study may cause mothers with ED to avoid seeking help. It is therefore necessary for the health services to offer mothers suffering from ED an environment in which they can articulate their problems. Improvement may be facilitated by means of emotional, cognitive and behavioural knowledge. By understanding the characteristics of a mother suffering from ED, mental health nurses will be able to identify such mothers. The knowledge that guilt and shame prevent mothers from verbalising their vulnerabilities will place mental health nurses in a better position to provide an environment for iv articulation. This approach may help such mothers to make health promoting choices rather than searching for strategies to hide their problems under a veil of secrecy. Guilt and shame need to be focused upon and allowed space for articulation in the dialogue in order to help these women to express important everyday issues and problems in daily life when suffering from concealed health problems. More research is needed on interventions that help to reveal guilt and shame and encourage the participants to open up and talk about the problems related to ED in the therapeutic situation. Further research should also focus on how to cope with motherhood in the context of ED as well as on how guilt and shame should be re-articulated so as to become understandable and thus be interpreted in ways that are recognisable to sufferers. The findings from this study concerning guilt and shame can be transferred to other areas related to persons suffering from mental health problems or to mothers with ED in the area of preand postnatal care and district health care

Suicidal patients’ experiences regarding their safety during psychiatric in-patient care: a systematic review of qualitative studies

Background: In-patient suicide prevention is a high priority in many countries, but its practice remains poorly understood. Patients in a suicidal crisis who receive psychiatric care can provide valuable insight into understanding and improving patient safety. The aim of this paper was therefore to summarize the qualitative literature regarding suicidal patients’ in-patient care experiences. The following question guided the review: How can we describe suicidal patients’ experiences regarding safety during psychiatric in-patient care? Methods: Systematic searches were conducted in the MEDLINE, Academic Search Premier, CINAHL, SOCINDEX and PsycINFO databases, identifying 20 qualitative studies on suicidal patients and their psychiatric in-patient care experiences. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, synthesized via thematic analysis and subjected to quality appraisals. Results: Patients described safety as “feeling safe”, and three components, i.e., connection, protection and control, were vital to their experiences of safety. Fulfilling these needs was essential to patients recovering from suicidal crises, feeling safe during encounters with health care professionals and feeling safe from suicidal impulses. Unmet needs for connection, protection and control left patients feeling unsafe and increased their suicidal behaviour. Conclusion: Our review addresses the importance of adopting a wider perspective of patient safety than considering safety solely in technical and physical terms. Safety for the suicidal patient is highly dependent on patients’ perceptions of their psychological safety and the fulfilment of their needs. The three patient-identified factors mentioned above – connection, protection and control – should be considered an integral part of patient safety practices and should form the basis of future efforts to understand the safety of suicidal patients during psychiatric in-patient care