Forensic Psychiatric Patients' Perspectives on Their Care: A Narrative View.

PURPOSE: The purpose of this study is to describe forensic psychiatric patients' experiences of and perspectives on forensic psychiatric treatment. DESIGN AND METHODS: Eight forensic psychiatric patients were interviewed, and the resultant research material was analyzed by narrative analysis. FINDINGS: Patients' narratives contain different themes telling different things and the personnel need to pay attention to these. PRACTICE IMPLICATIONS: The findings of the present study should direct the forensic psychiatric personnel's attention to the notion that forensic psychiatric patients' experiences of their treatment can improve the quality of patient-centered care and reduce bureaucracy.

The Therapeutic Approach to a Patient's Criminal Offense in a Forensic Mental Health Nurse-Patient Relationship-The Nurses' Perspectives.

PURPOSE: The purpose of this study is to describe the therapeutic approach to a patient's criminal offense in a forensic mental health nurse-patient relationship from the nurse's perspective. DESIGN AND METHODS: Eight nurses in a Finnish forensic psychiatric hospital were interviewed, and the resultant research material was analyzed by inductive content analysis. FINDINGS: The results revealed the process of the therapeutic approach to a patient's offense, which comprises numerous steps and various phases. PRACTICE IMPLICATIONS: For the nurse, the process of working through the offense can be divided into stages in which an attempt is made to respond to the patient's behavior and interaction in a manner that leads to working through the criminal act.

Forensic psychiatric patients' narratives of their offense.

This study aims to describe forensic psychiatric patients' experiences of their offense and its meaning for their lives, and to increase the understanding of the meaning of the offense in the eyes of the patient. The data analyzed was collected by interviews with forensic psychiatric patients and analyzed by narrative analysis. The findings suggest that forensic psychiatric patients have different types of stories describing the offense and its meaning in their lives. Illness narratives can be utilized therapeutically because they may construct patients' identity, experiences, and their situation as people with an illness seek explanations and meanings for their plight.

Caregiving actions: Outgrowths of the family caregiver's conceptions of care.

Caregiving actions emanate from the family caregiver's care meanings. Therefore, this article presents caregiving actions as outgrowths of the family caregiver's cultural conceptions of care and as situated within constraining sociocultural factors. Qualitative data were collected through interviews and participant observations from 18 purposively selected family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Three lines of caregiving actions performed by the participating family caregivers are presented: nutritional and medication care actions, physical care actions, and psychological and spiritual care actions. We have also explicated the problematic situations and sociocultural factors constraining the family caregivers in performing the caregiving actions. This study underlines the significance of addressing such problematic situations as are raised, as well as the sociocultural issues that constrain the family caregivers' agentic scope for planning and executing caregiving actions.

Involvement in mental health and substance abuse work: conceptions of service users.

Service user involvement (SUI) is a principal and a guideline in social and health care and also in mental health and substance abuse work. In practice, however, there are indicators of SUI remaining rhetoric rather than reality. The purpose of this study was to analyse and describe service users' conceptions of SUI in mental health and substance abuse work. The following study question was addressed: what are service users' conceptions of service user involvement in mental health and substance abuse work? In total, 27 users of services participated in the study, and the data was gathered by means of interviews. A phenomenographic approach was applied in order to explore the qualitative variations in participants' conceptions of SUI. As a result of the data analysis, four main categories of description representing service users' conceptions of service user involvement were formed: service users have the best expertise, opinions are not heard, systems make the rules, and courage and readiness to participate. In mental health and substance abuse work, SUI is still insufficiently achieved and there are obstacles to be taken into consideration. Nurses are in a key position to promote and encourage service user involvement.

Population-based comparison of health-related quality of life between healthy subjects and those with specific psychiatric or somatic diseases.

PURPOSE: The purpose of this study was to compare health-related quality of life (HRQL) of healthy subjects and those with psychiatric or somatic diseases. DESIGN AND METHODS: Eight dimensions of the RAND 36-Item Health Survey 1.0 (RAND-36) were investigated in a population-based sample. FINDINGS: Scores in all 8 RAND dimensions were lower in subjects with psychiatric diagnoses than in healthy subjects. In logistic regression models, poor social functioning (odds ratio [OR] 1.07-1.12) associated with psychiatric diagnoses. Lowered energy (OR 1.06) associated with major depression, poor general health with personality disorders (OR 1.06) and heart disease (OR 1.06), and physical limitations with heart (OR 1.04) and musculoskeletal disease (OR 1.07). PRACTICE IMPLICATIONS: Acknowledging the lowest HRQL dimensions among subjects with psychiatric diagnoses may help to promote mental, physical, and social well-being more efficiently.

Representations of hysterectomy as a transition process in Finnish women's and health magazines.

Representations of hysterectomy as a transition process in Finnish women's and health magazines The purpose of this article was to describe representations of hysterectomy in Finnish women's and health magazines. The data used in the study were obtained from six Finnish women's and health magazines. Using content analysis, 42 articles were analysed. We identified two main categories, information about care and treatment and women's experiences. In the first category, there emerged six subcategories: role of uterus, indications for hysterectomy, operative techniques of hysterectomy, alternative methods of treatment, pros and cons of hysterectomy and patient guidance. The second category consisted of women's experiences of hysterectomy as a period of transition. The components of the transition theory were confirmed by the women's stories. We also wanted to highlight the fact that the result shows that nurses were missing from the media coverage regarding hysterectomy.

Sociocultural factors influencing HIV/AIDS caregiving in Addis Ababa, Ethiopia.

The sociocultural factors that influence care and caregiving vary from place to place, with both beneficial and harmful effects on the health of the caregivers. Therefore, this article presents the cultural and social structural factors that influence care and caregiving from the perspectives of the family caregivers of people living with HIV/AIDS in Addis Ababa, Ethiopia. Using semistructured interviews and participant observation, a purposive sample of six key participants and 12 general participants were interviewed in their home between December 2005 and January 2006. Four important sociocultural factors that influence care and caregiving have been identified: religious beliefs, economic issues, education, and social stigma and discrimination. The findings of our study underscore the importance of understanding the cultural and social structural factors that influence care and caregiving from the perspectives of family caregivers in order to provide culturally congruent care to those in need.

The conceptions of care among family caregivers of persons living with HIV/AIDS in Addis Ababa, Ethiopia.

This focused ethnographic study explores and describes the conceptions of care among family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Leininger's theory of culture care diversity and universality is the conceptual anchor of this ethnographic study. Using semistructured interviews and participant observation, 6 key informants and 12 general informants were interviewed in their home in Amharic language. Data were analyzed in Amharic using Leininger's phases of ethnonursing analysis for qualitative data and then translated to English. Four major themes representing family caregivers' conceptions of care were identified: nourishing the PLWA while struggling with poverty, maintenance of cleanliness and hygiene of the person and surroundings, comforting the PLWA, and sacrificing self to sustain the PLWA. Valuable data were gathered about the family caregivers' conceptions of care. Nurses can use this knowledge to design and provide culturally congruent care to family caregivers and PLWAs in the community.

Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings.

Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.

"You just have to make the pain go away"--children's experiences of pain management.

This paper reports a study of the descriptions young children use and their expectations for pain management interventions experienced during hospitalization. The alleviation of children's pain has been investigated through the eyes of health care providers and parents, but the children's own perspective has largely been ignored. To date, there is a growing tendency to listen to the children when making final decisions on treatment in child health care. The evidence shows that children should be regarded as experts on their pain to maximize the options for pain management and to provide high-quality care. Forty-four children who were inpatients in four pediatric units in a university hospital participated in the study. The data were collected by means of a qualitative interview with the children until theoretic saturation was reached. The data analysis was based on inductive content analysis. The findings indicate that the children used multiple strategies while trying to deal with their pains during hospitalization and expected professional competence from health care professionals. Moreover, the children valued the care and attention provided by significant others. When managing pain in hospitalized children with a wide diversity of sources, the complexity of pain as a physiologic, psychologic, social, and cultural phenomenon must not be overlooked.

Health-related quality of life in a population-based sample of men with long-term mental symptoms.

It is not known whether somatic factors related to overall health and lifestyles or psychological factors, including confirmed psychiatric diagnoses, are associated with the health-related quality of life (HRQL) of men in a population-based sample. The aim of this study was to investigate socio-demographic, somatic and psychological factors associated with HRQL in men having mental symptoms during the 7 previous years. This cross-sectional sample of men (n=63) was investigated in 2004-05 and was based on a previous three-phase follow-up study that began in 1998. Blood pressure, body mass index, waist circumference, serum lipids and testosterone levels were measured. Psychiatric diagnoses were confirmed with using the Structured Clinical Interview for DSM-IV. Several mental symptoms were assessed with standardized scales. HRQL was measured with the RAND-36 using the physical (PCS) and mental component summary (MCS) scores. A poor HRQL in PCS was found in 73% of men and in MCS in 54%. Depressive symptoms, life dissatisfaction, male symptoms of aging and alexithymia were associated with both impaired PCS and MCS scores. Hopelessness, lifetime and current diagnoses of major depressive disorder and signs of suicidality only associated with a poorer MCS score. Somatic factors describing lifestyles and overall health only weakly associated with HRQL. In general, HRQL was poor in men having long-term mental symptoms. Mental health factors were strongly associated with PCS and MCS scores of HRQL. In improving HRQL in men, both physical and mental domains should be targeted in preventive and curative strategies.

'The most disgusting ever': children's pain descriptions and views of the purpose of pain.

This article examines an area of a larger research project, aimed at investigating hospitalized children's experiences of pain. Descriptions of pain and views regarding the purpose of four to 11-year-old children's pain were investigated. A total of 44 hospitalized children participated in the study. The data were collected by means of a qualitative interview with the children. Using qualitative content analysis, interviews were coded and categories identified. Participant descriptions aimed at generalizing the pain. The children specified the nature of the pain and used paraphrases and metaphors. The study demonstrated that most of the children were able to articulate the purpose that they ascribe to their pain. The findings challenge nursing staff to regard the suffering child as an active partner in assessing their pain. An enhanced understanding can better prepare nurses for participating in the management of hospitalized children's pain.

'I had this horrible pain': the sources and causes of pain experiences in 4- to 11-year-old hospitalized children.

Researchers have relied, almost without exception, on adults for qualitative information about children's pain. However, adults may provide only a limited view of children's pain experience. The purpose of this article is to describe the events considered painful by children. Forty-four children participated in the study. They had been admitted for different reasons into different wards of a university hospital. The data consisted of qualitative child interviews and was analysed using inductive content analysis. The pain experience of children came from four main sources: 1. pain as a symptom of a diagnosed illness, 2. pain caused by medical and diagnostic procedures and basic nursing, 3. pain caused by accidents and 4. inexplicable pain not caused by a particular illness or injury. Children are able to report and describe their pain. Children should be regarded as experts on their pain in order to maximize the options for pain management.

Health culture within the context of the northern environment.

OBJECTIVES: This article is part of an ethnographic study that aims to describe and understand health as a phenomenon of the Sami culture. STUDY DESIGN: The article is based on literature concerning the northern environment and the Sami culture, which is analysed from the point of view of health culture. RESULTS: From the point of view of health culture, life in the northern regions requires adaptation to certain special features of the climate and the natural environment. Nature is also a versatile source of health care, healing and traditions. Particularly in the late 1990's, the northern environment and the Sami lifestyle were profoundly affected by changes in the sources of income caused by modernisation and the adaptation of traditional Sami livelihoods to governmental regulations. The current Sami values and beliefs are multilayered factors affecting health culture. The social growth milieu of Sami children as a source of health culture has changed over the generations. The key elements affecting the growth milieu have changed over time, due to the attitude of the government towards the Sami culture and the consequent changes and actions of society.

Conducting a qualitative child interview: methodological considerations.

BACKGROUND: Studies of children have a long history, but the literature related to young children consists for the most part of studies on rather than with children and taking little account of what is regarded as significant and meaningful by children themselves. Researchers have relied almost exclusively on adults when collecting data about children's thoughts, feelings and experiences. Interviewing children, however, gives an opportunity to gain information about their subjective experiences. AIM: The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described. METHOD: This paper is based on literature and the experience of one of the authors in interviewing children aged from 4 to 11 years about their experiences of pain. FINDINGS AND CONCLUSION: A consideration of literature dealing with the principles of child interviewing shows that there is surprisingly little guidance available on conversational methods involving children. The empirical and conceptual foundation for child interviewing is not very clear. Novice researchers especially may need recommendations about how to conduct a qualitative child interview. The method must suit both the purpose and the context.

Practical nurses in elder care and changes in Finnish society - a biographical study.

BACKGROUND: Substantial changes in the socio-economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them. AIM: The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience. METHODS: The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis. FINDINGS: The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s-1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co-operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care? CONCLUSIONS: The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.

Respect as the main lay care activity among the Bena in Ilembula village in Tanzania.

The aim of this ethnographic study was to explore the cultural care practised among the Bena in the Ilembula villages in Tanzania. The purpose was to describe the cultural norms of the social and familiar relationship practices among the Bena for improving and maintaining health in terms of lay care. The data were collected through interviews, participant observation and personal working diaries in the Ilembula villages. Sixty-one villagers were interviewed. The findings show that respect has two main functions: it confirms unity and ensures well-being. Unity is important, and any violation against it is expected to be followed by a punishment, usually in the form of health deterioration. The main respective activities ensuring unity are observed in communication patterns, obedience, sharing the hardships of life and innocence. Rituals focus on the living-dead ancestors and serve both to confirm unity and to ensure well-being. Adult individuals guarantee their own and their descendants' well-being by taking care of their parents' basic needs and taking care of them when they are ill. The parents ensure their children's well-being by teaching them the Bena cultural beliefs and taboos. Respect is based on the world view of the Bena, which pivots on harmonious unity between individuals, supernatural forces and the kinship system.