Post-incident reviews-a gift to the Ward or just another procedure? Care providers' experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study.

Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients' recovery processes and care providers' ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers' experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context. METHODS: Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015-2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient's next of kin, contributed with input regarding the interview guide and analysis process. RESULTS: Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs' potential could be further exploited as they struggled to get hold on the patients' voices in the encounter. The care providers considered that issue to be attributable to the patients' conditions, the care providers' safety and skills and the characteristics of institutional and cultural conditions. CONCLUSION: Human care philosophies and a framework of care ethics seem to be preconditions for promoting patients' active participation in PIRs after restraints. Patients' voices strengthen PIRs' potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients' vulnerability, dependency and perceived dignity must be recognised. Patients' individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients' experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.

Mothers' experiences of having a premature infant due to pre-eclampsia.

AIM: Pre-eclampsia can lead to premature birth aimed at saving mothers' and infants' lives. Few studies have addressed how women with serious pre-eclampsia experience to become mothers to a premature infant. The aim was to describe the phenomenon of mothers' experience of being a seriously ill with pre-eclampsia and on the same time becoming a mother of a premature infant. METHODOLOGY: A reflective phenomenological lifeworld approach with a descriptive design was used. Nine mothers were interviewed twice, between 6 and 24 days and 16 days to 16 weeks postpartum. The analysis was done by finding meaning units, and then contemporary clusters were made. The process was a movement between figure and background. The essence with its constituents emerged. FINDINGS: Being a seriously ill mother of a premature infant requires journeying through physical and psychological suffering to be able to care and take responsibility for their beloved infants. The essence had the following constituents: conflicting feelings concerning giving birth, reflecting upon the borderline of life, longing for the infant, becoming a mother in actuality and experiencing physical exhaustion. CONCLUSION: Because of the acuteness of the birth and the infant's prematurity, the mothers had various feelings about becoming mothers. Existential issues concerning life and death were triggered regarding their own lives and those of their infants. Their experiences are different from those of other NICU mothers; their illnesses initially restricted them from being with their infants. The mothers found that their own health and the fact that their infants were premature and had to stay in the NICU restricted them from being able to take care of their infants. While they recovered, they strived to act as they felt a real mother should.

Fathers' experience of starting family life with an infant born prematurely due to mothers' severe illness.

OBJECTIVE: To describe fathers' experiences of starting family life with an infant delivered prematurely out of necessity of saving the mother's and infant's lives due to the mother's severe preeclampsia. METHODS: A descriptive, qualitative design was used. Six fathers were interviewed twice: from 6 to 24 days and from 4 to 22 weeks after delivery. Data were transcribed verbatim and analyzed using a reflective lifeworld research approach. RESULTS: The essence of the fathers' experiences of establishing a family with a seriously ill mother and a premature infant can be described as a process of becoming a family through reflection on life and death in a context of separation. The essence specifically comprised the following constituents: (1) starting fatherhood facing existential issues, (2) connecting the family, (3) becoming familiar with your infant, and (4) becoming a father in a public area. CONCLUSIONS: The fathers were able to develop their relationship to their infants; this emphasizes the importance of the fathers being able to spend their time in the NICU. The privacy of the fathers were more or less challenged, health professionals should be aware of individualize their approach to the fathers. The study reveals that family life started with separation. Health professionals should try to ensure that the family should be together. Mutual guidelines between the wards that treats mother and child should be implemented. When new mother and child-centers are planned a family friendly environment should be prioritized.

An Integrative Review of Mothers' Experiences of Preeclampsia.

OBJECTIVE: To describe and synthesize the extant research on women's experiences with preeclampsia into the postpartum period, when birth is necessary to save the mother's or infant's life. DATA SOURCES: The PubMed, PsycINFO, CINAHL, and ISI Web of Science databases were searched for relevant articles published between 2004 and 2014. STUDY SELECTION: Although a comprehensive search was performed, only eight studies were found that answered the research question and were included in the review. DATA EXTRACTION: Data were extracted and analyzed from each article that addressed women's experiences of pre-eclampsia: authors, year, country, study purpose, design, sample size, setting, main focus, data collection method, study findings, and limitations. DATA SYNTHESIS: The following themes emerged from the synthesis of how women experience severe preeclampsia: (a) From Feeling Fear and Closeness to Death to Feeling Hope, (b) Relationship With the Infant, (c) Separation From Loved Ones, and (d) Communication With Health Professionals. CONCLUSION: Fear and feeling close to death characterized the experience of childbirth for many of these women, and the premature birth was a shock for many. Having a newborn in the NICU was experienced as a transition from fear to hope as the newborn's life was sustained outside the womb. Separation of the mother from the newborn when one or both need special care remains a problem. Health care professionals must ensure that women in this situation receive the information and support they need and that the information is understood. This review revealed that more research is necessary regarding this specific mother-infant dyad and their families in the context of Western countries and developing countries.

Health and the need for health promotion in hospital patients.

BACKGROUND: Integrated health promotion improves clinical outcomes after hospital treatment. The first step towards implementing evidence-based health promotion in hospitals is to estimate the need for health promoting activities directed at hospital patients. The aim of this study was to identify the distribution and association of individual health risk factors in a Norwegian hospital population and to estimate the need for health promotion in this population. METHODS: We used a validated documentation model (HPH-DATA Model) to identify the prevalence of patients with nutritional risk (measurements of waist and weight), self-reported physical inactivity, daily smoking and hazardous drinking. We used logistic regression to describe the associations between health risk factors and demographic characteristics. RESULTS: Out of 10 included patients, 9 (N = 1522) had one or more health risk factors. In total 68% (N = 1026) were overweight, 44% (N = 660) at risk of under-nutrition, 38% (N = 574) physically inactive, 19% (N = 293) were daily smokers and 4% (N = 54) hazardous drinkers. We identified a new clinical relevant association between under-nutrition and smoking. The association between hazardous drinking and smoking was sustained. CONCLUSION: Nearly all patients included in this study had one or more health risk factors that could aggravate clinical outcomes. There is a significant need, and potential, for health-promoting interventions. Multi-factorial interventions may be frequently indicated and should be the subject of interventional studies.