Understanding medication-related burden from patient perspectives: a qualitative study testing the applicability of the conceptual model among chronically ill outpatients in Finland.

OBJECTIVES: Disease self-management and medication therapy can cause burden to patients that can influence adherence. The conceptual model 'patients' lived experience with medicine' (PLEM) brings new insights into medication-related burden (MRB) from patient perspective. This study aimed to test the applicability of the PLEM model by interviewing chronically ill patients in Finland and to investigate the MRB experienced by the Finnish patients. DESIGN: Focus group discussion study conducted online via Zoom. Directed qualitative content analysis guided by the PLEM model. SETTING: Outpatient primary care in Finland. PARTICIPANTS: Chronically ill outpatients (n=14) divided into five focus groups according to their chronic condition: asthma (n=3), heart disease (n=3), diabetes (n=6), intestinal disease (n=2). RESULTS: Our findings were mainly in line with the PLEM model although some new contributing factors to MRB emerged. In general, the participants were satisfied with their medication, and that it enabled them to live normal lives. The most common causes of MRB were medication routines and the healthcare system. The participants introduced two new aspects contributing to MRB: medication-related environmental anxiety associated with the waste resulting from medicine use, and the effect of medication use on their working life. Our findings are consistent with previous findings that a higher level of MRB may lead to independently modifying the medication regimen or not taking the medicine. CONCLUSIONS: Our findings provide further evidence that the PLEM model is an applicable tool also in the Finnish context for gaining better understanding of MRB in chronically ill patients self-managing their long-term medications. The model provides a promising tool to understand the connection between MRB and the rationale for not always taking medicines as prescribed. Further research is needed to explore the potential of the model in extending patient perspectives in chronic disease management.

Effectiveness of Providing Information on Antipsychotic Medication to Patients with Psychotic Disorders: An Integrative Review.

The aim of this integrative literature review is to describe the information provided to patients with psychotic disorders regarding their medication and to consider the effectiveness of providing such information. Searches of four databases identified 16 articles that met inclusion criteria. Results indicated that patients had relatively poor knowledge about their medications overall. Knowledge about side effects was found to improve significantly following education, with better knowledge leading to positive patient outcomes including increased adherence. Findings offer a comprehensive description of antipsychotic medication information provided to patients and an indication of the positive impact of information provision.

The cultural meaning of Sámi language, costume, and food to the Sámi, from the perspective of well-being.

The Sámi people, a northern indigenous people, have a statutory right to receive social and health services, which should take cultural characteristics into consideration. Cultural sensitivity is integral to the ethical principles of social and health care; however, based on previous research, the Sámi's cultural rights have not been recognised. To reinforce their language rights and develop culturally sensitive health care, research is needed to determine what Sámi cultural characteristics mean to Sámi people's well-being. The aim of this study was to describe and understand the meaning of cultural characteristics to the well-being of different generations of Sámi. In this research two Sámi experts described what the Sámi language, costume and food meant to them from a well-being perspective. Data-driven content analysis was applied to their responses. During everyday life, to the Sámi their cultural characteristics represent safety, awareness of one's roots, inner strength, the ability to be oneself, continuity, and communality. These meanings are interconnected with changing environment for the different generations and reflect Sámi people's lived experiences. Consideration of their cultural characteristics in the provision of social and health care will support the Sámi peoples´ integrity and cultural uniqueness, empowering both individual Sámi and their society.

A Bayesian network model to identify the associations between the use of seclusion in psychiatric care and nursing managers' attitudes towards containment methods.

WHAT IS KNOWN ON THE SUBJECT: Seclusion is used frequently in psychiatric care, despite its potential adverse effects. Several programmes aiming to reduce the use of seclusion identify leadership and management as key strategies-however, studies concerning leaders and managers are missing. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Nursing managers' negative attitudes towards seclusion are associated with less use of the measure, and nursing managers' higher age is associated with increased use of seclusion. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Nursing managers should be encouraged to guide their staff to reduce the use of seclusion. The negative influences of seclusion and the potential of alternative measures should be highlighted in the education and training of psychiatric nursing managers. ABSTRACT: Introduction The use of seclusion in psychiatric care should be reduced. The relationship between nursing management or nursing managers' attitudes and the use of seclusion has not been investigated. Aim To describe the associations between the use of seclusion and psychiatric nursing managers' attitudes to containment methods. Method Register data concerning the use of seclusion in Finnish psychiatric care in 2017 were collected. The Attitudes to Containment Measures Questionnaire was used to illustrate psychiatric nursing managers' attitudes to containment methods. An Augmented Naive Bayes analysis was used to investigate the relationships of the use of seclusion and attitudes. Results Nursing managers' age and their attitudes towards containment methods were related to the use of seclusion. Especially nursing managers' negative perceptions of seclusion were associated with less use of seclusion, and seclusion was used more often on wards with nursing managers who were older than the average. Conclusion Nursing managers' negative attitudes towards seclusion have a potential impact on the use of seclusion, which might even result in a reduction in its use in psychiatric inpatient setting. Implications for practice The results suggest that nursing managers should be encouraged to guide their staff to decrease the use of seclusion.

Seclusion, restraint, and involuntary medication in Finnish psychiatric care: a register study with root-level data.

Purpose: Despite potentially harmful effects, seclusion, restraint, and involuntary medication continue to be frequently applied in psychiatric care. These restrictive measures are often examined by means of registers, but homogeneous practices in the measurement and description seem to be missing. This nationwide register study aimed to examine the use of seclusion, mechanical and physical restraint, and involuntary medication in Finland.Material and methods: Root-level register data concerning the year 2017 were collected directly from 140 inpatient psychiatric wards within 21 organizations. The data were analyzed statistically.Results: In 2017, the most used restrictive measure in Finnish psychiatric wards was seclusion (4006 episodes), followed by involuntary medication (2187 episodes), mechanical restraint (2113 episodes) and physical restraint (1064 events). Similarly, the duration of seclusion episodes was longer than the duration of restraint episodes. Remarkable variation between wards in the use of seclusion, restraint and involuntary medication was observable. A negative binomial regression model (NB2) was used to analyze the associations between the use of restrictive measures and regional variables concerning demography, health, substance abuse, and socio-economic status, but reliable interpretations were impossible to generate.Conclusion: This study provides detailed and unique data on the use of seclusion, restraint and involuntary medication in Finland. Compared to previous national-level data, this study highlights the importance of collecting root-level data. Future research should use registries and describe the associations between the use of restrictive measures and ward-level factors, patient-level characteristics, and societal factors.

Psychiatric nursing managers' attitudes towards containment methods in psychiatric inpatient care.

AIMS: This research was conducted to examine psychiatric nursing managers' attitudes towards containment methods. BACKGROUND: Nursing management is regarded as a key issue in the reduction of coercion and containment. However, there has been little research on managers' attitudes towards containment methods. METHODS: This descriptive, cross-sectional study utilized a survey design. Finnish inpatient psychiatric nursing managers (n = 90) completed the Attitudes to Containment Measures Questionnaire (ACMQ). The results were described with statistics, and the associations between attitudes and background variables were analysed using parametric tests. RESULTS: Psychiatric nursing managers had the most negative attitude towards net bed and mechanical restraint, and the most positive attitudes towards as necessary medication and intermittent observation. A few associations were discovered between attitudes and background variables such as gender and number of employees. CONCLUSIONS: In general, Finnish psychiatric nursing managers' attitudes towards containment methods seem to be quite negative, but more research is needed. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides fresh and unique data on the attitudes of psychiatric nursing managers towards containment methods. Managers' attitudes are important because of their ability to encourage investment in coercion reduction by nursing staff.

Psychiatric nursing staffs' attitudes towards the use of containment methods in psychiatric inpatient care: An integrative review.

One of the international objectives in psychiatric care is reducing the use of coercion. Containment methods are meant to keep patients safe, yet usually include coercion. Nurses play a key role in deciding whether or not containment should be used and, as such, their attitudes towards containment can significantly impact the extent to which these methods are applied. The aim of this integrative review was to identify, analyse, and synthesize the available research on psychiatric nursing staffs' attitudes towards containment methods in inpatient psychiatric care. An electronic search was conducted using the CINAHL, Scopus, and PsycINFO databases. In addition, the citations of identified studies were screened for relevant research. A total of 24 relevant papers published between 2002 and 2017 were selected for further analysis. These studies revealed variation in nursing staffs' attitudes towards the use of containment methods. The use of containment methods seems to be widely accepted and nurses reported rarely considering alternative measures. It appears that attitudes towards containment have continuously become more negative, although the change has not been very pronounced. The concept of attitude was only defined in two studies. Thus, future research should strive to clarify this concept, as a generally accepted definition for attitude within nursing research and the utilization of all dimensions of this concept are both essential to the nursing field. Currently, it would be important to focus on changing attitudes among psychiatric nursing staff to reduce the use of containment methods; this calls for more research on nursing staffs' attitudes.