Being Human Under Inhuman Conditions: Meanings of Living with Severe Dissociative States Involving the Experience of Being in Parts.

Severe dissociative states involving the experience of being in parts, typically associated with diagnosis such as dissociative identity disorder and other specified dissociative disorders, continue to be a controversial and rarely studied area of research. However, because persons with severe dissociative states are at risk of being harmed instead of helped within psychiatric care, their experiences of living with such states warrant further examination, while innovative ways to include them in research remain necessary. Against that background, this study aimed to illuminate the meanings of living with severe dissociative states involving the experience of being in parts. This is a phenomenological hermeneutic study with data collected from three social media sources, one personal blog and two Instagram accounts, in February and March 2023. The results were illuminated in light of four themes; Striving to remain in the world, Balancing exposure and trust, Balancing belonging and loneliness and Owning oneselves. The interpretation of the themes suggests that living with severe dissociative states means being a human under inhuman conditions, striving for coherence and meaning in a world that is often unsupportive. This calls for a trauma-informed care to better support recovery for persons with severe dissociative states.

Psychiatric inpatient care for persons with dissociative identity disorder: a scoping review protocol.

INTRODUCTION: Psychiatric inpatient care (PIC) is often characterised by high pressure and thresholds for admission, brief periods of care and limited time for caring activities. Dissociative identity disorder (DID) is a contested diagnosis, and persons with DID are at risk of not receiving adequate support when cared for in PIC. Because the limited literature addressing the topic includes no overview on how persons with DID are cared for in psychiatric inpatient settings, the aim of this scoping review is to map the area of knowledge on PIC for persons experiencing DID. This scoping review will provide an overview with the possibility to elucidate gaps in the evidence base and needs for future research on PIC for persons experiencing DID. METHODS AND ANALYSIS: This scoping review will follow Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Reviews and steps 1-5 described in the established method for scoping reviews: identifying research question, identifying relevant studies, study selection, charting the data and collating, summarising and reporting results. ETHICS APPROVAL: Not applicable. DISSEMINATION: This scoping review will be submitted for publication in an international, peer-reviewed journal.

A comparative review of advanced practice nurse programmes in the Nordic and Baltic countries.

BACKGROUND: Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region. OBJECTIVE: The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences. DESIGN AND METHODS: This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country. RESULTS: The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies. CONCLUSION: The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country. TWEETABLE ABSTRACT: "APN programmes in the Nordic and Baltic countries correspond with international guidelines. Special attention is needed in future on the clinical training of APNs".

Patients' Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study.

Aims: Opioid agonist treatment (OAT) programs are life-saving, as they reduce opioid use, overdoses, and criminal activities. Disadvantages reported with long-term OAT include side effects of the medication, especially on cognitive ability and sexual function, which may discourage potential participants. Many of those who participate in OAT have a desire to come off treatment. The aims of this study were to explore patients' thoughts about coming off OAT and to investigate their perceptions of what support they would need in order to realize a planned withdrawal from OAT. Methods: A qualitative interview study with semi-structured interviews, using applied thematic analysis. Persons with experiences of participating in OAT were invited from Swedish programs and a private Facebook community. Results: Fifteen persons, with a mean of 9.6 (±6.4) years of treatment experience, were included. The participants underlined the need for a patient-centered focus within the treatment. They wanted to be regarded as capable of deciding if, when, and how a planned ending was to take place. They also called for staff to be supportive in making such decisions. Participants recommended staff to be sensitive to the needs of the specific patient and to have strategies for coming off OAT that could be adjusted for the single person. Conclusions: OAT programs need to be continually updated and adapted to the persons who can benefit from them. Applying a person-centered, holistic perspective would enhance the quality of the treatment by emanating from individual goals. Regulatory guidelines need to take into account research on patient experiences and perspectives on coming off.

Zombies Wanted! Descriptions of Nurses in Psychiatric-Mental Health Care in Swedish Recruitment Advertisements.

Knowledge of how nurses are described in recruitment advertisements can aid assessment of the current status of professional psychiatric-mental health nursing and inform services dealing with the challenges of nurse recruitment. This study used content analysis to explore descriptions of nurses in psychiatric-mental health care in a purposive sample of 75 recruitment advertisements collected in Sweden in February 2019. The descriptions were interpreted as focussing on their being willing and able to function in discouraging practice environments, matching the ideal of psychiatric-mental health nursing poorly. The study suggested a need to align the ideals and realities of the nursing profession.

Reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) - A pilot testing of the tool.

OBJECTIVES: To evaluate the test-retest reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) developed to measure nursing staff perceived behaviours and barriers for promotion of everyday activities in nursing home residents. METHOD: Nursing staff completed the MAINtAIN(S) questionnaire on two occasions at 3-week intervals. Relative reliability, absolute reliability and internal consistency with Cronbach's alpha were calculated. RESULTS: The test--retest reliability of MAINtAIN(S)-behaviours subscales ranged from ICC2. = 0.78--0.91 and MAINtAIN(S)-barriers subscales from ICC2.1 = 0.60--0.84. Cronbach's alpha varied between 0.60 and 0.91 for the different subscales. The MAINtAIN(S) inventory shows acceptable reliability and internal consistency. MAINtAIN(S) seems to be a promising tool for identifying behaviours and barriers in promoting everyday activities in nursing home residents and can be used to develop ward specific interventions for promotion of daily physical activity level in the care of older adults.

Ways of understanding nursing in psychiatric inpatient care - A phenomenographic study.

AIM: The aim was to describe the ways that nursing staff in psychiatric inpatient care understand nursing. BACKGROUND: Nursing in psychiatric care is marginalized with ambiguous role definitions and imperceptible activities. Nurse managers' capabilities to establish a direction and shared vision are crucial to motivate nursing staff to take part in practice development. However, before establishing a shared vision it is important to identify the different ways nursing can be understood. METHODS: Sixteen individual semi-structured interviews with nursing staff members were analysed using a phenomenographic approach. RESULTS: Five ways of understanding nursing were identified. These understandings were interrelated based on the way that the patient, nursing interventions and the goal of nursing were understood. CONCLUSION: The diversity of identified understandings illuminates the challenges of creating a shared vision of roles, values and goals for nursing. IMPLICATIONS FOR NURSING MANAGEMENT: Awareness of staff members' different understandings of nursing can help nurse managers to establish a shared vision. To be useful, a shared vision has to be implemented together with clear role definitions, professional autonomy of nurses and support for professional development. Implementation of such measures serves as a foundation to make nursing visible and thereby enhance the quality of patient care.

Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword.

AIM: To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these. BACKGROUND: Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment. METHOD: Descriptive design with 25 qualitative interviews. RESULTS: Five categories were identified: RNs feel satisfied when providing person-centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal. CONCLUSION: Registered nurses' job satisfaction could be described as a double-edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings suggest that nursing leadership can increase RNs' intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.

Identifying the Needs of Family Members in Burn Care-Nurses' Different Approaches.

The aim of this study was to explore how nurses in burn care identify family members' needs of support and what support the nurses offer. Family members are an important source of short- and long-term support for burn survivors. Being a family member in burn specific as well as general care can be challenging in several ways. Nurses are recognized as well as positioned in the team for assessing and providing such support; however, little is known about how this is done. This is an explorative study with a qualitative descriptive design. Fourteen semistructured interviews with registered nurses working in national burn centers were recorded digitally, transcribed verbatim, and analyzed using Systematic text condensation. The analysis resulted in four themes reflecting different approaches to assess the needs of family members: Active, Emotional, Passive, and Rejective Approach. Nurses in this study demonstrated different approaches to assessing needs in family members; it is possible that these differences may affect what support family members receive. Therefore, the importance of theoretical education, professional views, and local ward culture should be highlighted in ongoing work in improving care within burn care as well as similar health care contexts.

I did NOT feel like this at all before the accident: do men and women report different health and life consequences of a road traffic injury?

BACKGROUND: Worldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives. OBJECTIVE: To describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives. METHODS: The study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation. PARTICIPANTS: A total of 692 respondents with a minor or a moderate injury were included. RESULTS: The respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing. CONCLUSION: These differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

Health-related quality of life in family members of patients with burns.

A severe burn not only affects the patients, but may also have a great impact on the lives of family members. It is known that family members of patients with burns experience psychological distress, but health-related quality of life (HRQoL) has not been studied in this group. The aim was to study predictors of HRQoL in family members of patients with burns. Forty-four family members of adult patients treated in a burn center, between 2000 and 2007, completed questionnaires during care, and at 3, 6, and 12 months after injury. HRQoL was assessed with the EuroQol 5D (EQ-5D), which consists of the dimensions: mobility, self-care, usual activities, pain, and anxiety/depression. The questionnaire generates an EQ-5D index and a visual analog scale (VAS) score. Overall, the EQ-5D index was similar to that of the general population. A slight improvement in HRQoL was found in the VAS scores and in the anxiety/depression dimension over time. In regression models, HRQoL was primarily predicted by earlier life events, symptoms of post-traumatic stress disorder, and HRQoL, assessed during the patients' hospitalization. In summary, HRQoL assessed with VAS scores increased slightly during the first year postburn, and early screening for life events and psychological symptoms, and HRQoL might be useful in identifying family members in need of support.

Prediction of psychological symptoms in family members of patients with burns 1 year after injury.

AIM: To report a study of predictors of psychological symptoms in family members of patients with burns. BACKGROUND: Family members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term. DESIGN: The design of the study was prospective and longitudinal. METHODS: Forty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses. RESULTS: The mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance. CONCLUSION: Family members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.

Caregiving to patients who are culturally diverse by Swedish last-year nursing students.

With Leininger's theory of cultural care diversity and universality as a framework, the aim of this study was to describe Swedish last-year nursing students' experiences of caregiving to patients who are culturally diverse. The students participated voluntarily, 107 by completing a questionnaire with open-ended questions and 15 by participating in in-depth semistructured interviews. Three categories of experience were identified by use of qualitative method, namely, cultural awareness, cultural insufficiency, and cultural curiosity. The students were found to be on the level of Leininger's first phase of transcultural knowledge. It is concluded that cultural sensitivity should be promoted by integrating transcultural concepts into the curricula on all levels of nursing education and by offering special courses on transcultural nursing to nursing students and health care providers.