Through the depths and heights of darkness; mothers as patients in psychiatric care.

INTRODUCTION: This study attempts to contribute to the knowledge of caring science and mental health care by means of a profound understanding of the patients' existential world when being a mother in receipt of psychiatric care, with focus on inner processes such as health and suffering. Mothers struggle to cope with the demands of the illness and the responsibility for their children. They see themselves through their children and regard the child as an important part of themselves. Mothers experience guilt and shame related to motherhood, and when they have to relinquish their responsibility as a mother, they consider themselves a failure. Despite a range of practical and emotional difficulties, motherhood involved extremely positive experiences, which provide a purpose as well as fulfilment and meaning in life. METHODOLOGY: This study is rooted in philosophical hermeneutics inspired by Gadamer with an inductive-deductive-abductive approach. Interpretation of the data was made on different levels of abstraction described as rational, contextual, existential and ontological. The point of departure was the caring science theory about health and suffering and the hermeneutic philosophy of understanding. RESULT OF THE INTERPRETATION: The interpretation revealed the mothers' experiences of health and suffering as a struggle between the darkness of suffering and their inner source of strength. In the light of the theory of caring, the conscience became visible as the bearer of the human being's inner ethos of love and compassion. Experiences of health and suffering were interpreted as a struggle between guilt and responsibility, where conscience emerged as the road from ontological guilt to responsibility that leads the human being to what is true, beautiful and good in life.

Leadership and management in mental health nursing.

BACKGROUND: Mental health nurses are agents of change, and their leadership, management role and characteristics exist at many levels in health care. Previous research presents a picture of mental health nurses as subordinate and passive recipients of the leader's influence and regard leadership and management as distinct from the nurses' practical work. AIM: The aim was to provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing. METHOD: A literature search was conducted using EBSCO-host, Academic Search Premier, Science Direct, CINAHL and PubMed for the period January 1995-July 2010. RESULTS: Leadership and management in the context of mental health nursing are human activities that imply entering into mutual relationships. CONCLUSION: Mental health nurses' leadership, management and transformational leadership are positively related in terms of effectiveness and nurses' skills. IMPLICATION FOR NURSING MANAGEMENT: It is important to consider mental health nurses' management as a form of leadership similar to or as a natural consequence of transformational leadership (TL) and that ethical concerns must be constantly prioritized throughout every level of the organization.

Ask me what is in my heart of hearts! The core question of care in relation to parents who are patients in a psychiatric care context.

The aim is to understand the experience of being cared for in psychiatric care as a patient and as a parent. Parenthood represents the natural form of human caring, a human directedness regardless of gender. The study has its starting point in this image, as it applies to mothers who receive care as provided in a psychiatric care context. The theoretical perspective is the theory of caritative caring, and the methodological approach is the philosophical hermeneutics outlined by Gadamer. The sample was purposeful: 10 mothers who experienced being a mother while suffering from mental illness and receiving care from professionals in psychiatric specialist health care contexts. The interpretation process is inductive, deductive, and abductive, and includes different levels of rational, contextual, existential, and ontological interpretation supported by the chosen theoretical perspective and the philosophy of ethics outlined by Emmanuel Levinas. The interpretation on the contextual level shows that the patients do not talk about their inner feelings concerning themselves as mothers in the care relationship. The interpretation on the existential level reveals the meaning of the mothers' experiences of inner struggle between their inner demands and assuming a mask of silence. The patients' experiences on the ontological level were interpreted as a struggle between the responsibility inherent in human being and the fear of condemnation. At the ontological level, a new hypothesis of the understanding of the meaning of the parents' experiences was formulated: Being in care as a patient and as a parent means struggling to restore one's responsibility as a human being. This new understanding paves the way for caring of the patient who is a parent.

Experiences of motherhood when suffering from mental illness: a hermeneutic study.

Being a mother is inseparable from women's existential life. Mothers with mental illness struggle with conflicting and distressing feelings related to motherhood. They seldom obtain the necessary support to increase their control over the determinants of their role as a mother, thus their opportunity of improving their own and their children's mental health is weakened. The aim of this study was to explore the experiences of being a mother with mental illness. The research question was: How can mothers' experiences of motherhood when suffering from mental illness be understood? The understanding emerged through a hermeneutical interpretation of the empirical material on four different levels of abstraction. The inductive-deductive approach, inspired by the philosophy of Gadamer, was used. The mothers' experiences were understood in their way of struggling to become good enough mothers, managing to become the mother they longed to be, being present in the caring relationship with their child, as well as being recognized as a mother and living openly and honestly in relationships with others. Addressing the existential needs of motherhood is important for their improvement and recovery, as well as for promoting their children's mental health and well-being.