A Vicious Circle of Hope and Despair: Stigma Experienced by Relatives of Persons with Severe Mental Illness.

Not only people suffering from severe mental illness (SMI) but also their family members experience stigma. Relatives are met with negative attitudes from healthcare professionals, which adds to the problem. This Swedish study employed a qualitative inductive explorative design in the analysis of written free-text responses from 65 persons who completed a questionnaire for relatives of persons with SMI. The overarching theme, "A vicious circle of hope and despair", was elaborated by four categories which formed a vicious circle: "Wanting openness, understanding and acknowledgement"; "Facing a lack of understanding from others"; "Seeking understanding from mental healthcare professionals but experiencing the opposite"; and "Keeping family experiences private." If this vicious circle of family stigma is to be broken, measures are needed for both relatives and health care professionals.

Patient as active partner - clue to successful early mobilization in intensive care.

BACKGROUND: The evidence for the benefits of early mobilization in intensive care is growing. Early mobilization differs from most other interventions in intensive care since the patient's participation is requested. What kind of challenges this entails for the intensive care clinicians, and what is crucial in successful early mobilization from their perspective, is sparsely explored and was therefore the purpose of this study. METHODS: Semi-structured interviews were held with 17 intensive care clinicians, seven nurses, five assistant nurses and five physiotherapists. The interviews were analyzed with a phenomenographic methodology. FINDINGS: Four descriptive categories emerged: 1) Taking responsibility; 2) Taking the patient's perspective; 3) Time or not time to mobilize; and 4) The "know-how" of early mobilization. Early mobilization was perceived as an important and crucial part of intensive care. It includes positioning and sensory stimulation, which could be used to re-orientate the patient and prevent delirium. The patients' experiences were considered individual with a mix of strong emotions. Despite the stated significance of early mobilization, different conceptions were expressed about the right time, some of them based on concerns for the patient, and some due to safety concerns. In the optimal active mobilization to upright positions there was an emphasis on careful preparation and patient involvement, including negotiation and active participation. CONCLUSIONS: The importance of early mobilization is indisputable. Successful early mobilization is achieved by applying a person-centered approach, involving the patient as an active partner. Early mobilization comprises positioning and sensory stimulation and should be included in the daily planning of patient care.

The best of both worlds - entering the nursing profession with support of a transition programme.

BACKGROUND: Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition. AIM: The phenomenological study aimed to describe newly graduated nurses' expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers. METHOD: The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology. FINDINGS: "Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme" is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge. CONCLUSION: Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

From fear to fight: Patients experiences of early mobilization in intensive care. A qualitative interview study.

Introduction: Early mobilization (EM) in intensive care is frequently used to prevent physical and psychological complications, with promising results. However, the patient´s perception of EM has been sparsely investigated. Pe: To investigate the experience of EM in patients treated in intensive care. Md: Nineteen former patients who had been treated in intensive care were interviewed. The interviews were analyzed using qualitative, inductive content analysis. Rs: The analysis resulted in three categories; 1) Facing the impossible - a too demanding situation; 2) Struggling successfully on the way back; and 3) Need of having dedicated supporters. Con: A considerable variety of experiences of EM were described in this study, both negative and positive. Prominent features were that pleasant emotions and great physical effort occurred simultaneously and that interaction and cooperation with the caregivers was paramount. To regain independence was another prominent feature, with EM considered to be of great importance in the recovery process. Moving to an upright position and ambulating appears to be beneficial to both body and mind. EM should therefore be among the first priorities in intensive care. EM should be practiced with respect and support, while encouraging and challenging the patient to strive for independence.

Relatives' Experiences of Mental Health Care, Family Burden and Family Stigma: Does Participation in Patient-Appointed Resource Group Assertive Community Treatment (RACT) Make a Difference?

The aim of this exploratory cross-sectional study was to investigate the experiences of relatives of individuals with severe mental illness with and without participation in patient-appointed Resource Group Assertive Community Treatment (RACT). A total of 139 relatives (79 with and 60 without RACT) completed the Family Involvement and Alienation Questionnaire, the Burden Inventory for Relatives of Persons with Psychotic Disturbances, and the family version of the Inventory of Stigmatizing Experiences. We found that relatives participating in RACT experienced a more positive approach from the healthcare professionals, as well as a lower degree of alienation from the provision of care. Relatives who did not participate in RACT were more afraid that their ill next of kin would hurt someone. No other differences in family burden were found. Experiences of family stigmatization were similar in both groups. In conclusion, participating in patient-appointed RACT may contribute to a higher level of satisfaction for relatives in their encounter with healthcare professionals and a more positive alliance. Implementation of RACT in new settings would require adaptation to local conditions to facilitate cooperation between healthcare staff and other relevant services. Staff training focuses on the case manager function and needs assessment, as well as how to create an alliance with the patient and his/her relatives.

Clinical Nursing Introduction Program for new graduate nurses in Sweden: study protocol for a prospective longitudinal cohort study.

INTRODUCTION: High levels of nursing turnover represent a problem for healthcare organisations and patient safety. Experiences during the first years in the nursing profession have a significant impact on nurses' future decisions concerning their careers. Nurses at the start of their professional career need to practise their hands-on skills as well as their theoretical knowledge. In addition, new graduate nurses need regular support and opportunities to reflect on experiences in their new profession. The aim of the present study is to describe the Clinical Nursing Introduction Program (CNIP) and present a study design in which the programme is used to support new graduate nurses' transition into the nursing profession. METHOD AND ANALYSIS: The present study examines the CNIP at a general hospital in southwest Sweden, which lasts for 14 months. The programme has a unique profile based on a person-centred approach and consists of five components: employment and organisation, a compulsory introduction week, two placements in different clinical settings, education days and process-oriented nursing supervision. The present study presents a protocol for a prospective longitudinal cohort study, using qualitative and quantitative methods in the collection and analysis of data. Measurements will include data collection between 2019 and 2023 when the nurses start the CNIP (baseline) and then after 1 and 2 years. ETHICS AND DISSEMINATION: This study has been approved by the Regional Ethical Review Board in Gothenburg (Dnr 1056-18). Study findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: 273573 (https://www.researchweb.org/is/vgr).

Parents of adult children with long-term mental disorder: Their experiences of the mental health professionals' approach and feelings of alienation - A cross sectional study.

The aim was to describe how parents of adult children suffering from long-term mental disorder experience the mental health professionals' approach and any feelings of alienation regarding the provision of care. A further aim was to investigate any differences according to the parents' gender or the child's age. 93 mothers and 37 fathers participated. A majority experienced the mental health professionals' approach toward them as being negative and they felt alienated from the professional care. Regardless of the age of the children, parents have a considerable need for a positive approach from the professionals that can enable them to choose how they should act and what they should do, in order to help and support their adult child.

An isolated involvement in mental health care - experiences of parents of young adults.

AIMS AND OBJECTIVES: To explore parents' involvement in the informal and professional care of their young adult child with mental illness. A further aim was to examine concepts in the caring theory of 'Involvement in the light-Involvement in the dark' in the context of mental health care. BACKGROUND: Mental illness has increased among young people in high-income countries, and suicide is now the leading cause of death for this group. Because of their disease, these young people may have difficulty in carrying out daily, taken-for-granted, tasks. Consequently, they often become dependent on their parents, and their parents shoulder a considerable responsibility. DESIGN: A secondary descriptive design with a deductive content analysis was used. METHODS: Ten parents who have a son or daughter with long-term mental illness (aged 18-25 years) were interviewed. The deductive analysis was based on the caring theory of 'Involvement in the light-Involvement in the dark'. RESULTS: The results are described using the following concepts in the theory: 'Knowing', 'Doing', 'Being' and 'Attitude of the health professionals'. The result are to a great extent consistent with the 'Involvement in the dark' metaphor, which describes an isolated involvement in which the parents were not informed, seen or acknowledged by the health professionals. Continuous support by professionals with a positive attitude was described as being of decisive importance for meaningful involvement. The theory's transferability is strengthened to the mental health care context. CONCLUSIONS: Parents have a considerable need for knowledge that can enable them to choose how they should act (be) and what they should do, in order to help and support their child. RELEVANCE TO CLINICAL PRACTICE: Since the patient, the family members and the professionals are mutually dependent, it is important to make use of each other's knowledge in a partnership to achieve a common caring strategy.

Health-related quality of life--from the perspective of mothers and fathers of adult children suffering from long-term mental disorders.

There is a lack of studies on mothers' and fathers' experiences of Health-Related Quality of Life (HRQOL) associated with caregiving of adult children suffering from mental disorder. A cross-sectional study was therefore carried out with 108 mothers and 43 fathers. Data were collected by means of the Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Family Involvement and Alienation Questionnaire (FIAQ) and the Burden Assessment Scale (BAS). Mothers' HRQOL was affected more than fathers' and lower compared to Swedish age related norms. HRQOL was predominantly related to ratings on HADS and BAS.

Conceptions of mental health care--from the perspective of parents' of adult children suffering from mental illness.

The aim of this study was to describe parents' conceptions of the mental health care provided to adult children suffering from mental illness. Data were collected using qualitative research interviews with a purposive sample of sixteen mothers and ten fathers. Phenomenographic analysis was used to identify conceptions and formulate descriptive categories. The first category, questioning the availability of care, describes mental health care as being unequal in terms of accessibility and lacking in continuity. The second category, disapproval of parental exclusion, illustrates conceptions that mental healthcare professionals disregard parents and do not provide them with adequate information. The third category, questioning the quality of care, encompasses conceptions of lack of trust in the professionals' competence, an unsatisfactory environment as well as inadequate cooperation with other healthcare providers and authorities. Positive aspects, such as being seen and confirmed, were mentioned as valuable by the parents.

Fathers' everyday experiences of having an adult child who suffers from long-term mental illness.

The purpose of this study is to describe the everyday life experiences of fathers of adult children who have various forms of long-term mental illness. Ten fathers were interviewed. Content analysis revealed one main theme: Maintaining a strong façade while balancing on a thin line, and two sub-themes: (1) A constant struggle and (2) A feeling of powerlessness. The fathers demonstrated great engagement and good will to participate in their child's life. A sense of powerlessness and frustration at not having or being allowed freedom of action emerged. Cooperation between children, parents, the care service providers, and the authorities could increase the parents' abilities to provide adequate support to the child as well as helping them to understand and make the incomprehensible manageable.

Iliac crest autogenous bone graft versus alloplastic graft and guided bone regeneration in the reconstruction of atrophic maxillae: a 5-year retrospective study on cost-effectiveness and clinical outcome.

BACKGROUND: Reconstruction of the atrophic maxillae with autogenous bone graft and jawbone-anchored bridges is a well-proven technique. However, the morbidity associated with the concept should not be neglected. Furthermore, the costs for such treatment, including general anesthesia and hospital stay, are significant. Little data are found in the literature with regard to a cost-benefit approach to various treatment alternates. PURPOSE: The aim of this retrospective study was to compare from a health-economical and clinical perspective the reconstruction of the atrophic maxillae prior to oral implant treatment either with autogenous bone grafts harvested from the iliac crest or the use of demineralized freeze-dried bone (DFDB) in combination with a thermoplastic carrier (Regeneration Technologies Inc., Alachua, FL, USA) and guided bone regeneration (GBR). MATERIALS AND METHODS: A total of 26 patients (13 + 13) were selected and matched with regard to indication, sex, and age. The study was performed 5 years after the completion of the treatment. Implant survival, morbidity, and complications were analyzed. Furthermore, a detailed analysis of the total cost for the respective treatment modality was performed, including material, costs for staff, sick leave, etc. RESULTS: The study revealed no statistical difference with regard to implant survival for the respective groups. The average total cost, per patient, for the DFDB group was 22.5% of the total cost for a patient treated with autogenous bone grafting procedures. CONCLUSIONS: The study concluded that reconstruction of atrophic maxillae with a bone substitute material (DFDB) in combination with GBR can be performed with an equal treatment outcome and with less resources and a significant reduced cost in selected cases compared with autogenous bone grafts from the iliac crest.

Mothers' everyday experiences of having an adult child who suffers from long-term mental illness.

This paper aims to describe everyday life experiences of mothers who have an adult child with a long-term mental illness. Sixteen mothers were interviewed. A content analysis resulted in one main theme: My adult child who is struggling with mental illness is always on my mind, and three subthemes: (1) living a life under constant strain, (2) living with an emotional burden, and (3) seeing light in the darkness despite difficulties. Knowledge of mothers’ everyday life experiences is of great importance in order to support them and thereby increase the possibility of these mothers being a source of strength for their child.

Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae and trends in antibiotic consumption in a county of Sweden.

In the last decade extended-spectrum beta-lactamase (ESBL)-producing bacteria have become an increasing problem. Our aims were to investigate the prevalence of ESBL-producing Enterobacteriaceae and trends in antibiotic use in the county of Östergötland, Sweden. From 2002 through 2007 there were 224 ESBL-producing Escherichia coli and 23 Klebsiella pneumoniae isolates with an ESBL-phenotype identified among all Enterobacteriaceae isolated at the clinical laboratory. Trends in antibiotic consumption expressed as defined daily doses (DDD) per 1000 inhabitants and day (DID) were studied. The prevalence of ESBL-producing isolates among Enterobacteriaceae in our region is still low (< 1%). Patients with ESBL-producing E. coli increased significantly (p < 0.001) from 5 in y 2002 to 47 in y 2007. CTX-M group 1 was the dominant enzyme group in both E. coli and K. pneumoniae. Antibiotic susceptibility testing of ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole revealed that 58% of E. coli and 50% of K. pneumoniae isolates were multi-resistant. Antibiotic use remained unchanged from 2001 through 2009, but there was a trend towards increased use of drugs with low ESBL selection potential, which was probably due to the increased prevalence of ESBL producers.

Effect of Lactobacillus F19 on the emergence of antibiotic-resistant microorganisms in the intestinal microflora.

OBJECTIVES: Probiotic lactic-acid-producing bacteria have been used for prevention of gastrointestinal diseases. The aim of the present study was to examine whether Lactobacillus F19 in conjunction with treatment with penicillin, ciprofloxacin or norfloxacin prevents establishment of resistant bacteria in the gastrointestinal tract. METHODS: Twenty patients admitted to hospital due for treatment with penicillin and 16 patients due for treatment with ciprofloxacin or norfloxacin were included in the study. In either group, the patients were randomized into two groups, receiving placebo or an active probiotic product. Faecal samples were collected before treatment, on day 10 and 1 month after the start of the treatment. Isolates of enterococci, enterobacteria and Bacteroides fragilis species were screened for resistance to penicillin and ciprofloxacin, respectively. RESULTS: Administration of penicillin did not influence resistance in enterococci while quinolone resistance increased during quinolone treatment. Susceptibility to ampicillin and piperacillin/tazobactam decreased in enterobacteria during penicillin treatment and ciprofloxacin resistance increased in the quinolone group. Penicillin and quinolones did not influence the resistance rates of Bacteroides isolates. No major differences were observed between the probiotic- and placebo-supplemented groups. CONCLUSIONS: There was a limited effect of Lactobacillus F19 on the emergence of resistant isolates during treatment with penicillin and quinolones.