Family orientation in forensic psychiatric care: An uncertain foundation of distrust.

The patients in forensic psychiatric care (FPC) are affected by their illness and the care they receive, but their families are also affected. The family-systems nursing theory has the mutual influence of the family as constituting a core starting point for the health of both the individual and the family and focuses on helping families cope with their situation. The aim of the study was to describe healthcare professionals' experiences of their family-oriented work within FPC. The findings are presented in three themes: A longed-for reciprocity within and with the family, Maintaining a problem-oriented and individual-based tradition, and Caring built on a foundation of distrust. Family-oriented work among healthcare professionals in FPC can only be realized through a pervasive shift in perspective from a predominantly problem-oriented patient focus towards a focus on interactional interplay and patterns. This is based on the belief that there are potential resources for patients and families to change in a healthy way. An educational intervention is suggested as a core starting point for developing a family-oriented practice for healthcare professionals in forensic psychiatric settings.

Patients' Expressed Nursing Care Needs in a Forensic Psychiatric Setting.

ABSTRACT: The aim of this study was to describe the patients' nursing care needs in a forensic psychiatric setting in line with the NANDA-I classification. Ten patients sentenced to forensic psychiatric care were interviewed. Data were analyzed by means of directed content analysis with a deductive approach, where we used "served time" as a factor in the analysis, thus creating three categories: newly arrived patients with a length of stay of only a couple of years, patients with a length of stay of around 5 years, and patients with a length of stay of more than 5 years. Thirteen NANDA-I diagnoses were identified during the analyses, distributed on seven different domains. When distributing the given NANDA-I diagnoses according to the created categories, an explanatory pattern emerged, and three themes became apparent: denial, insight, and listlessness. Considering the differences in views, the patients' own recognition of what is a problem, a potential, or a risk could improve a "working relation" and, eventually, a recovery. NANDA-I nursing diagnoses may improve individualized and person-centered care as NANDA-I makes care continuously consistent over time.

Residents' perceptions of the most positive and negative aspects of the housing situation for people with psychiatric disabilities.

The major aim of the present study was to explore what people with psychiatric disabilities, living in two different types of housing, consider to be the best and the worst in their housing situation. A secondary aim was to explore to what extent additional questions to a questionnaire with a free-response format can provide complementary information to the previous knowledge in the field. The content analysis revealed that the physical attributes were of great significance for the residents in ordinary housing, while both psychosocial aspects and physical attributes were important for those living in supported housing. When providing good housing solutions for people with psychiatric disabilities, attention needs to be given to these aspects by politicians, policymakers as well as by nursing staff.

Striving for meaning-Life in supported housing for people with psychiatric disabilities.

The aim of this study was to develop a grounded theory about people with psychiatric disabilities, living in supported housing. Interviews as well as observations during the interviews were analyzed together with secondary analyses of quantitative and qualitative material from previous studies. Being deprived of self-determination emerged as the main concern for residents in supported housing and striving for meaning emerged as the pattern of behavior through which this group resolves their main concern. Striving for meaning involves living in the present, striving for self-determination, strengthening self-esteem, emotional processing and resting from the present. The strategies facilitate each other and are used singly, together simultaneously, or alternately. If they are successful, a meaning in the present is perceived. If all the strategies fail repeatedly, escaping from the present is used in order to deal with being deprived of self-determination. The implications of the findings suggest prioritizing a reduction of the institutional nature of the social and physical environment, and to support the residents' self-determination.

Engaging with Families Is a Challenge: Beliefs among Healthcare Professionals in Forensic Psychiatric Care.

Being healthcare professionals in the complex field of forensic psychiatry care (FPC) seems particularly challenging. Historically, families have almost been invisible in FPC. The aim of this study was to uncover beliefs among healthcare professionals concerning families of patients admitted for FPC. Using a hermeneutical approach inspired by Gadamer's philosophy, group interviews with healthcare professionals in four Swedish forensic psychiatric clinics were analyzed. Analysis resulted in seven key beliefs. There were three beliefs about families: family belongingness is a resource for the patient; most families are broken and not possible to trust; and most families get in the way of the patient's care. Four beliefs concerned encounters with families: it is important to achieve a balance and control over the family; it is essential to set aside one's own values and morals; family-oriented work is an impossible mission; and family oriented work requires welcoming the families. Despite ethical dilemmas of working with families in FPC, healthcare professionals showed a willingness and desire to work in a more family-oriented manner. More knowledge, understanding, and caring tools are needed in order to meet the needs of the family as well as support the family's resources.

Satisfaction with housing and housing support for people with psychiatric disabilities.

The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.

A striving towards 'normality': illness-related beliefs among individuals living with a psychotic disorder.

Beliefs related to illness constrain or facilitate health and wellbeing, and are of importance in how people understand and manage their illness. The aim of this study was to identify illness beliefs among individuals living with illness from a psychotic disorder. Data collected through two qualitative interview studies was secondary analysed by means of a method for directed content analysis. Beliefs of being different and odd, and of what constitutes 'normality', are prominent and constrain, in several respects, wellbeing among the individuals with psychotic illness. Beliefs about possible wellbeing are preferably related to existential, human desires of caretaking and responsibility for self and others. An awareness among mental healthcare staff that one does not hold the unequivocal truth about what is normal and healthy, is of importance. They need to ask questions about illness beliefs and not ignore or judge the answers received, but instead discuss them. Relationship-centred care, where a mutual dialogue occurs between the individual, the family and mental healthcare staff, is highlighted.

Beliefs about health, health risks and health expectations from the perspective of people with a psychotic disorder.

AIM: To examine beliefs about health, health risks and health expectations from the perspective of people diagnosed with a psychotic disorder. BACKGROUND: People with psychotic disorders have a threefold higher risk of developing physical health problems than the general population, and prevention of these problems is warranted. Examining patients´ health beliefs could help deepen our understanding of how to plan successful health interventions with this group. METHODS: Qualitative semi-structured interviews were conducted from November 2010 to October 2011 with 17 people with psychotic disorders. Data were analyzed using a qualitative content analysis. RESULTS: An overall positive picture of health was found despite the fact that physical health was found to be hard to verbalize and understand. Health was mainly associated with psychological wellbeing, while health risks were found to be related to uncertain bodily identity, troublesome thoughts and inner voices, and exclusion from society. Interest in learning, and visions and goals of health seemed to increase awareness of health risks and health expectations, while not worrying could be viewed as a hindrance for health expectations. CONCLUSION: There is a lack of expressed awareness of physical health risks, but such awareness is fundamental to performing life-style changes [14]. Nurses thus have an important task to help patients understand and verbalize potential physical health risks, and to find out what motivates them to adopt health behaviors.

Validity and reliability of a Swedish questionnaire for assessing satisfaction with housing and housing support for persons with psychiatric disabilities.

The aim of this study was to investigate the reliability and validity of a questionnaire for studying satisfaction with housing and housing support for people with psychiatric disabilities. Most items were gathered from English language questionnaires. These were translated and adapted to a Swedish context and items concerning housing support were added. Two studies were conducted. The first, a test-retest reliability analysis, was performed in a pilot study with 53 participants; in the second study, which had 370 participants, a five factor solution with good internal consistency emerged. Further development of the questionnaire is discussed.

Being a family in the midst of living and dying.

The aim of this study was to illuminate the way of being a family when one family member is in the midst of living and dying. A family systems frame and a life world perspective were used in interviews with five families. A qualitative analysis inspired by Giorgi revealed dialectic and dynamic processes in constant motion within and between the continua being in affinity-being in loneliness, being in power-being in helplessness, and being in continuity-being in disruption. When families were moving in the direction of being in affinity, power, and continuity, these seemed to be prerequisites for enduring their challenged life situation and for giving them a kind of repose. When the movements were in the opposite direction, existential and emotional suffering were manifested as individual embodied experiences such as depression and anxiety.