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Caring in intensive psychiatry: rhythm and movements in a culture of stability
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-2610-8998
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to describe and explore the concept of caring in intensive psychiatry. An initial inventory was made of nursing care activities in a PICU, based on an analysis of critical incidents. This inventory resulted in four categories: supporting, protecting and use of the structured environment (Study I). Caring in intensive psychiatry was also studied through ethnographic fieldwork that that led to the conceptualization of the PICU staff as projecting a culture of stability. Within this culture, the overall goal was to prevent, maintain and restore stability as turbulence occurred. Cultural knowing, as expressed through nursing care, was further described in terms of providing surveillance, soothing, being present, trading information, maintaining security, and what has been termed reducing (Study II). A focused approach was applied to study the staff’s different approaches to observing patients in relation to the practice of surveillance in psychiatric nursing care. PICU staff moved flexibly between a latent and a manifest approach to surveillance (Study III). Having conceptualized the culture as one of stability, a concept analysis was conducted upon the concept of stability. The analysis revealed that stability is by no means a static condition; it fluctuates and can be distorted. Intervening with nursing care when turbulence occurs, can involve both the use of active and passive stability systems (Study IV). Further, I argue that caring in intensive psychiatry can be accurately described as the projection of rhythm and movements. Nursing care in terms of movements creates fluctuations in stability as it entails a rhythm of caring in intensive psychiatry. In conclusion, physical boundaries and incorporated control along with tactful sensibility involve rhythm and movements within limited structures and closeness in care. This thesis contributes to articulating advanced nursing practice within intensive psychiatry 

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2013. , p. 81
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 47
Keywords [en]
Acute psychiatric care, concept analysis, critical incident technique, ethnography, intensive psychiatry, nursing staff, psychiatric care, psychiatric hospitals, psychiatric nursing
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
URN: urn:nbn:se:oru:diva-30069ISBN: 978-91-7668-956-1 (print)OAI: oai:DiVA.org:oru-30069DiVA, id: diva2:638439
Public defence
2013-10-03, 09:15
Opponent
Supervisors
Available from: 2013-07-30 Created: 2013-07-30 Last updated: 2017-10-17Bibliographically approved
List of papers
1. The core characteristics and nursing care activities in psychiatric intensive care units in Sweden
Open this publication in new window or tab >>The core characteristics and nursing care activities in psychiatric intensive care units in Sweden
2008 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 17, no 2, p. 98-107Article in journal (Refereed) Published
Abstract [en]

Internationally, research on psychiatric intensive care units (PICUs) commonly reports results from demographic studies such as criteria for admission, need for involuntary treatment, and the occurrence of violent behaviour. A few international studies describe the caring aspect of the PICUs based specifically on caregivers' experiences. The concept of PICU in Sweden is not clearly defined. The aim of this study is to describe the core characteristics of a PICU in Sweden and to describe the care activities provided for patients admitted to the PICUs. Critical incident technique was used as the research method. Eighteen caregivers at a PICU participated in the study by completing a semistructured questionnaire. In-depth interviews with three nurses and two assistant nurses also constitute the data. An analysis of the content identified four categories that characterize the core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours, and temporarily coercive measure. Care activities for PICUs were also analysed and identified as controlling - establishing boundaries, protecting - warding off, supporting - giving intensive assistance, and structuring the environment. Finally, the discussion put focus on determining the intensive aspect of psychiatric care which has not been done in a Swedish perspective before. PICUs were interpreted as a level of care as it is composed by limited structures and closeness in care. © 2008 Australian College of Mental Health Nurses Inc.

Keywords
Coercion, Critical incident technique, Intensive care unit, Psychiatric nursing
National Category
Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-14395 (URN)10.1111/j.1447-0349.2008.00517.x (DOI)
Available from: 2011-01-31 Created: 2011-01-31 Last updated: 2017-12-11Bibliographically approved
2. Achieving equilibrium within a culture of stability: cultural knowing in nursing care on psychiatric intensive care units
Open this publication in new window or tab >>Achieving equilibrium within a culture of stability: cultural knowing in nursing care on psychiatric intensive care units
2011 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 32, no 4, p. 255-265Article in journal (Refereed) Published
Abstract [en]

This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest.

Place, publisher, year, edition, pages
New York, United States: , 2011
National Category
Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20585 (URN)10.3109/01612840.2010.549603 (DOI)21355761 (PubMedID)2-s2.0-79952156012 (Scopus ID)
Available from: 2011-12-18 Created: 2011-12-18 Last updated: 2018-05-03Bibliographically approved
3. Latent or manifest observers: two dichotomous approaches of surveillance in mental health nursing.
Open this publication in new window or tab >>Latent or manifest observers: two dichotomous approaches of surveillance in mental health nursing.
2011 (English)In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2011, p. 254041-Article in journal (Refereed) Published
Abstract [en]

Background. Surveillance is a central activity among mental health nursing, but it is also questioned for its therapeutic value and considered to be custodial. Aim. The aim of this study was to describe how mental health nurses use different approaches to observe patients in relation to the practice of surveillance in psychiatric nursing care. Methods. In this study, Spradley's twelve-step ethnographic method was used. Results. Mental health nurses use their cultural knowing to observe patients in psychiatric care in various ways. Two dichotomous approaches were identified: the latent and the manifest approach. Discussion. Different strategies and techniques for observing patients are structured along two dichotomies. The underlying relationships between these two different dichotomous positions transform the act of observing into surveillance. This is further developed in a theoretical model called the powerful scheme of observation and surveillance (PSOS).

National Category
Medical and Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20584 (URN)10.1155/2011/254041 (DOI)21994817 (PubMedID)
Available from: 2011-12-19 Created: 2011-12-18 Last updated: 2018-05-03Bibliographically approved
4. Stability in intensive psychiatry: a concept analysis
Open this publication in new window or tab >>Stability in intensive psychiatry: a concept analysis
2014 (English)In: Perspectives in psychiatric care, ISSN 0031-5990, E-ISSN 1744-6163, Vol. 50, no 2, p. 122-131Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of this concept analysis is to describe, explore, and explain stabilityin the context of mental health nursing in intensive psychiatry.

DESIGN AND METHODS: A modified version of Wilson’s method of conceptanalysis was used.

FINDINGS: Stability is the ability to be resistant to changes. Stability can take differentdirections after a distortion: re-gaining, neo-gaining, and apo-gaining. Stabilitymay also be achieved through active (adding or using power, making adjustments,parrying, and idling) and passive systems (environmental conditions and constituentmaterials).

PRACTICE IMPLICATIONS: This article contributes by providing knowledge and insight for nurses on the roles they play in intensive psychiatry as stabilizers.

Keywords
Concept analysis, intensive psychiatry, mental health nurses, nursing research, psychiatric nurses
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-30077 (URN)10.1111/ppc.12030 (DOI)000333695600007 ()24689492 (PubMedID)2-s2.0-84929518396 (Scopus ID)
Available from: 2013-07-31 Created: 2013-07-31 Last updated: 2017-12-06Bibliographically approved

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