Aging of severely mentally ill patients first admitted before or after the reorganization of psychiatric care in Sweden.

BACKGROUND: The concept of deinstitutionalization started in the 1960s in the US to describe closing down or reducing the number of beds in mental hospitals. The same process has been going on in many countries but with different names and in various forms. In Europe, countries like Italy prescribed by law an immediate ban on admitting patients to mental hospitals while in some other European countries psychiatric care was reorganized into a sectorized psychiatry characterized by open psychiatric care. This sectorization has not been studied to the same extent as the radical closures of mental hospitals, even though it entailed major changes in the organization of care. The deinstitutionalization in Sweden is connected to the sectorization of psychiatric care, a protracted process taking years to implement. METHODS: Older people, with their first admission to psychiatric care before or after the sectorization process, were followed using three different time metrics: (a) year of first entry into a mental hospital, (b) total years of institutionalization, and (c) changes resulting from aging. Data from surveys in 1996, 2001, 2006, and 2011 were used, together with National registers. RESULTS: Examination of date of first institutionalization and length of stay indicates a clear break in 1985, the year when the sectorization was completed in the studied municipality. The results show that the two groups, despite belonging to the same age group (birthyears 1910-1951, mean birthyear 1937), represented two different patient generations. The pre-sectorization group was institutionalized at an earlier age and accumulated more time in institutions than the post-sectorization group. Compared to the post-sectorization group, the pre-sectorization group were found to be disadvantaged in that their level of functioning was lower, and they had more unmet needs, even when diagnosis was taken into account. CONCLUSIONS: Sectorization is an important divide which explains differences in two groups of the same age but with different institutional history: "modern" and "traditional" patient generations that received radically different types of care. The results indicate that the sectorization of psychiatric care might be as important as the Mental Health Care Reform of 1995, although a relatively quiet revolution.

Does the length of institutionalization matter? Longitudinal follow-up of persons with severe mental illness 65 years and older: shorter-stay versus longer-stay.

OBJECTIVES: As part of the process of de-institutionalization in the Swedish mental healthcare system, a reform was implemented in 1995, moving the responsibility for services and social support for people with severe mental illness (SMI) from the regional level to the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. The aim of this study is to investigate functional levels, living conditions, need of support in daily life, and how these aspects changed over time for older people with SMI. METHODS: In this study we used data from surveys collected in 1996, 2001, 2006, and 2011 and data from national registers. A group of older adults with severe persistent mental illness (SMI-O:P) was identified and divided into those who experienced shorter stays (less than 3 years) in a mental hospital (N = 118) and longer stays (N = 117). RESULTS: After correcting for longitudinal changes with age, the longer-stay group was more likely than the shorter-stay group to experience functional difficulties and as a result, were more likely to have experienced 're-institutionalization' to another care setting, as opposed to living independently. CONCLUSIONS: The length of mental illness hospitalization has significant effects on the living conditions of older people with SMI and their ability to participate in social life.

Assistant Nurses' Positioned Accounts for Prioritizations in Residential Care for Older People.

BACKGROUND AND OBJECTIVES: Swedish eldercare is strained by an increased administrative workload, which draws time away from individual care of and interaction with older people. This study explores how eldercare staff, working closely with residents in Swedish special housing (nursing homes), make accounts for how they prioritize work tasks. RESEARCH DESIGN AND METHODS: Openly structured, thematic interviews were conducted with 12 permanently employed, female assistant nurses, including a group interview with 3 of them. Positioned accounts (small stories) concerning prioritizations due to insufficient resources were analyzed, using Bamberg's three-level positioning analysis. RESULTS: The analysis shows that the staff take a favorable position toward the older people by distinguishing between care and "the other things." They also justify prioritizations at odds with their care values. The assistant nurses present themselves as doing the best they can in organizationally restricted situations. Organizational demands limit the space for care, giving rise to an idealization of "icing on the cake." Morale is complex in residential care. A narration of "the torn carer" was found as a co-constructed storyline explaining why the staff did not perform eldercare consistent their care values. DISCUSSION AND IMPLICATIONS: When ideals and practice differ, interaction in the peer group becomes important in order to maintain a positive professional identity. "The torn carer" is a way for the staff to escape blame for not living up to care values, but it also victimizes them. Staff could be empowered by a working environment characterized by a reflective practice.

From political correctness to reflexivity: A norm-critical perspective on nursing education.

Education is important in shaping professional identity, including how one approaches norms and normalisation. In the analysis presented in this study, nursing students' own constructions of norms and normality from the outlook of their education are highlighted and problematised. To deepen the understanding of these matters, the aim of this study was to explore constructions of norms and normality among students in nursing education. Students studying in a nursing department at a Swedish university college were approached and asked to consider open survey questions targeting their views on norms and normality; 154 of them replied. After a discourse analytic approach to the data, we could see how the students constructed norms and normality as (a) instrumental instructions, consisting of easy-to-digest statements grounded in the profession's obvious moral and ethical values, (b) limiting and frustrating obstacles for personal freedom that were important to challenge, (c) rules to be obeyed for the stability of society and (d) a matter of reflection, with each individual being responsible for understanding differences in norms, perspectives and opinions. We conclude that nursing education would benefit from norm-critical perspectives, problematising students' own positions to norms, power and privilege.

The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review.

AIMS: To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003-2013. DESIGN: An integrative literature review. METHODS: PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003-2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS). RESULTS: Meleis' four typologies were found in all studied disciplines, except development in oral health. The health-illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.

Internet addiction and sleep problems: A systematic review and meta-analysis.

The pathological use of the internet - conceptualized as 'internet addiction' - might be crucial in initiating and increasing sleep disturbances in the community. While inconsistent evidence is reported regarding the association of internet addiction and sleep disturbances, the severity of this association remains unclear. This systematic review and meta-analysis were conducted to increase our understanding of the relationship between internet addiction and sleep disturbances. A systematic review was conducted through Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and EMBASE using keywords related to internet addiction and sleep problems. Observational studies (cohort, case-control or cross-sectional studies) focusing on association between internet addiction and sleep disturbances including sleep problems and sleep duration were selected. A meta-analysis using random-effect model was conducted to calculate the odds ratio (OR) for experiencing sleep problems and standardized mean differences (SMDs) for sleep duration. Eligible studies (N = 23) included 35,684 participants. The overall pooled OR of having sleep problems if addicted to the internet was 2.20 (95% CI: 1.77-2.74). Additionally, the overall pooled SMDs for sleep duration for the IA group compared to normal internet users was -0.24 (95% CI: -0.38, -0.10). Results of the meta-analysis revealed a significant OR for sleep problems and a significant reduced sleep duration among individuals addicted to the internet.

Norm-Critical Potential in Undergraduate Nursing Education Curricula: A Document Analysis.

The documents and literature that regulate nursing education are based on certain values and knowledge, and the underlying power in the curriculum raises the question of how health care professionals are molded during the course of their education. Norm criticism is a concept with its roots in critical pedagogy and gender and queer studies, emphasizing the origins as well as the consequences of marginalization, power, and knowledge of what is generally accepted as "normal" and "true." Norm criticism is used in this article to analyze the documents and literature underlying a nursing program in Sweden, which are shown to include a sometimes politically correct rhetoric, but one lacking a firm basis in social justice values.

The myth of the total institution: Written narratives of patients' views of sanatorium care 1908-1959.

Drawing on written narratives by 72 former sanatorium patients, this article explores, from patients' perspectives, the nature of the relationships between patients and staff in a Swedish sanatorium during the first half of the twentieth century. These narratives are discussed in the context of the total institution. This article suggests that this phenomenon was marked by inconsistencies that can be understood in terms of its situational and contradictory characteristics. Simultaneously, these narratives are in opposition to the assumption of the static and powerless patient adapted only to suit the logic of the institution.

Mindful Sustainable Aging: Advancing a Comprehensive Approach to the Challenges and Opportunities of Old Age.

The primary aim of this article is to present a new concept called mindful sustainable aging (MSA), which is informed by mindfulness practices that support the physical, the mental, and especially, the social and the existential dimensions of old life. The concept of MSA is discussed and compared with four influential psychosocial theories in the field of gerontology, i.e., activity theory, disengagement theory, successful aging theory and gerotranscendence theory. The article ends with reviewing research on how mindfulness practice can help to manage, diminish and/or improve a number of serious physical conditions that are common among older people. The potential of mindfulness when it comes to facilitating for older adults in their quest for spiritual and existential meaning is discussed extensively throughout the article.

Utilization of patient resources in physiotherapy interventions: Analysis of the interaction concerning non-specific low back pain.

This paper reports on an empirical study in Sweden of how patient resources come into play in physiotherapy interventions. A qualitative analysis was conducted of five video-recorded first encounters between patients with non-specific low back pain (NSLBP) and physiotherapists in primary care, using Conservation of Resource Theory (COR) to identify and focus on how physiotherapists made use of patients' resources (objects, conditions, personal characteristics and energies). The findings reveal variations in how these resources are utilized during the intervention. Resources with implications for what happens in the examination room during the ongoing encounter and resources characterized by professional familiarity were both employed in the intervention. However, underutilized resources were featured in the broader lifeworld perspective of laypeople and of other professional frames. The findings raise questions about professional challenges that go beyond professional skills. This implies that professionals need to improve skills in understanding and integrating patient resources into interventions.