Patient Assessments of the Factors Facilitating and Impeding User Involvement During the First Phase of Substance Abuse Treatment.

User involvement in the first phase of treatment is essential for treatment satisfaction among patients with substance use disorders (SUDs). This study explores how patients perceive the first phase of specialized SUD treatment and identifies what promotes and inhibits user involvement. We used a qualitative approach, and semi-structured interviews were conducted with 14 informants admitted to a substance abuse treatment unit in central Norway. The analysis was inspired by a phenomenographical analysis approach, and 4 categories were identified as the core experiences of user involvement during the first phase of SUD treatment: (a) a new hold on life, (b) missing information, (c) the importance of a sense of community, and (d) ambivalence about the usefulness of the treatment. Overlapping elements with Aaron Antonovsky's theoretical framework of salutogenesis were used to support the main findings. The study indicates that activating personal resources (eg, the ability to envision a different life), conveying information in a matter sensitive to patients' current cognitive state, a sense of community, and therapeutic alliance are essential factors to promote user involvement in the first phase of specialized SUD treatment. Based on the findings, we suggest a salutogenesis approach to promote user involvement and provide several ways to employ this approach in the crucial first phase of specialized SUD treatment.

User involvement in interprofessional team meetings within services for substance use disorders.

Background: People with substance use disorders (SUD) and concurrent mental health disorders often need prolonged, coordinated health and welfare services. Interprofessional team meetings are designed to tailor services to users' needs and should be based on interprofessional collaboration involving the user. Aims: To investigate service users' experiences with interprofessional team meetings and to identify potential barriers to successful user involvement. Methods: Semi-structured interviews with five male service users aged 27-36 years with concurrent substance use and psychiatric disorders, and observations of team meetings involving both users and relevant professionals. Users were interviewed shortly after commencing treatment and after the team meeting. A phenomenographical approach framed the data analysis. Results: Users described the interprofessional team meetings as less than useful, and perceived that lack of a targeted process and of information hindered their collaboration with professionals. Observations revealed that users were given a subordinate role in the meetings, which largely undermined their involvement. Three categories reflecting lack of information as a core obstacle to user involvement emerged from the data material: (i) unclear role responsibilities and unclear professional role functions, (ii) unclear practices regarding rules and routines, and (iii) absence of user knowledge. Conclusions: User involvement in team meetings may be improved by facilitating adequate information, clarifying role expectations, emphasising user knowledge, increasing professionals' awareness of the importance of collaboration, and by teaching skills that enhance user involvement.

Constructing togetherness throughout the phases of dementia: a qualitative study exploring how spouses maintain relationships with partners with dementia who live in institutional care.

AIMS AND OBJECTIVES: To explore and describe how spouses involve themselves in the relationship with their partners with dementia who live in institutional care. BACKGROUND: Positive reciprocity between partners has been proven to be significant for spouses with partners living with dementia at home. However, little is known about spousal involvement after placement of a partner in an institutional setting. This subject was therefore the focus of this study. DESIGN: Constructivist grounded theory was used to develop meaningful concepts considering the relational processes experienced and described by the spouses. METHODS: Interviews were conducted with 15 spouses (eight women and seven men ranging in age from 64-90 years) of dementia-afflicted persons living in institutional care. Theoretical sampling, constant comparison and memo-writing guided the data collection and analysis. RESULTS: The analysis showed how the spouses adopted different visiting routines to preserve continuity in their relationship throughout the phases of dementia. Three categories described how these visiting routines were used and adapted along with their partners' dementia progressions in the process of constructing togetherness: 'maintaining involvement and intimacy to preserve continuity in their relationship,' 'structuring visits to facilitate interaction and communication' and 'pursuing moments of mutuality to preserve continuity in a deteriorating relationship.' CONCLUSIONS: Being involved and experiencing continuity in the relationship seemed important to the spouses after their partners' placement in institutional care. In the process of constructing togetherness, visiting routines were used to facilitate situations in which they could connect with their partners. These routines were continuously adjusted throughout the phases of dementia. RELEVANCE TO CLINICAL PRACTICE: There is a need for a systematic approach to provide sufficient support to spouses throughout their partners' dementia progressions to assist their ongoing involvement.

The loss of a shared lifetime: a qualitative study exploring spouses' experiences of losing couplehood with their partner with dementia living in institutional care.

AIMS AND OBJECTIVES: To explore and describe spouses' experiences of losing couplehood with their dementia-afflicted partner living in institutional care. BACKGROUND: Despite the losses and experiences of discontinuity due to the cognitive decline caused by dementia, the feelings of belonging and reciprocity in close relationships are still crucial to many couples. However, these experiences of spouses with partners living in institutional care are not well documented and are thus the focus of this study. DESIGN: A constructivist grounded theory approach was used to capture the relational processes described by the spouses. METHODS: Conversational interviews were conducted with n = 10 spouses of dementia-afflicted persons living in institutional care. Data were analysed using the constant comparative method. RESULTS: The spouses' experiences of losing couplehood were primarily connected to separation from the partner and the sense of being alone. They were also related to the loss of the shared past and future. However, these experiences did not seem to be constant; short glimpses of connectedness, reciprocity and interdependence contributed to a feeling of couplehood, although these were only momentary. CONCLUSIONS: The spouses' experiences of losing couplehood were dynamic and were related to the couple's entire life. The spouses wavered between senses of loss and belonging to couplehood, depending on the conditions characterising the moment. RELEVANCE TO CLINICAL PRACTICE: Healthcare personnel must recognise the severity of some spouses' experiences of losing couplehood and be aware of how these experiences can fluctuate and be situation dependent.