This study describes the daily life and management strategies of young informal carers of family members or friends with mental illness. Twelve young adults (three men and nine women; 16-25 years old) in Sweden were voluntarily recruited between February and May 2008. Data collected through eight individual semi-structured interviews and one focus group interview were analysed using qualitative content analysis. The findings revealed nine subthemes that were further grouped into three main themes: showing concern, providing support and using management strategies. Participants lived in constant readiness for something unexpected to happen to the person they cared for, and their role in the relationship could change quickly from family member or friend to guardian or supervisor. Supporting a friend was considered as large a personal responsibility as supporting a family member. Their management strategies were based on individual capacities and their ability to step aside should the situation become too demanding. These young informal carers need support in caring for the mentally ill. As the internet becomes increasingly fundamental to daily life, support could be provided most effectively through person-centred web sites.

Notes that being affected by aphasia influences the total life experience. The aim of this study was to generate a theoretical model, from a nursing perspective, of what 12 aphasic persons (aged 28-92 yrs old) experience in encounters with other people. Data were collected through interviews which adopted a biophysical, socio-cultural and psychological approach and then analyzed using grounded theory method. Two main categories emerged, namely: interaction and support. Encountered experiences led to (1) a feeling of having ability, (2) a feeling of being an outsider, and (3) a feeling of dejection or uncertainty. The feeling state was dependent on whether the interaction was obstructed or secure and on whether the support resulted in strengthened or impaired self-esteem. Therefore, nurses need to give support that enhances patients self-esteem and which results in them gaining a positive and realistic view of their aphasia, as well as involving those around them in this perspective. This then will give the possibility for the patient to turn the interaction process from an obstructed into a secure one.

The purpose of the study was to describe patients' conceptions and experiences of care in compulsory treatment for acute onset of psychosis. Twelve patients with experience of compulsory treatment were interviewed in 2008-2009, and phenomenographic analysis was used to analyse the data. Two descriptive categories emerged in the results: receiving needed support and perceiving respectful care. Patients perceived that coercive interventions were positive if they were given good care, if they were given the shelter they needed, if they got help with understanding and if the setting was healing. Patients felt respected if they were treated like human beings, if they were allowed to retain as much of their autonomy as possible and if they were invited to participate even though they were under compulsory treatment. The results show that it is important to prevent patients from being traumatized during compulsory treatment and to take advantage of patients' inner resources. Patients' experiences of compulsory treatment can form the basis for preparing an individual action plan for future compulsory treatment. Individual action plans could empower patients during compulsory treatment and improve their experience of care.

The aim of this study was to elucidate the experience of participation in four sessions of cognitive behavioural group therapy for psychological distress for female university students' (n = 19), aged 22–45 years. Data were gathered with semi-structured interviews during March and April 2008 and analysed according to thematic content analysis. The results identified four themes: ‘Gaining knowledge and understanding’, ‘Becoming more balanced and positive in thinking’, ‘Feeling more self-confident and in control’ and ‘Opportunities for practice and in-depth reflections’. Future recommendations include an increase in sessions from four to five, with one booster session to follow-up on newly acquired skills. © 2013 John Wiley & Sons Ltd.

Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a ‘struggle to be perceived as a competent and equal person’ while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions. © 2015 John Wiley & Sons Ltd.

The aim of the study was to generate a theoretical model of what nursing students experience in their first professional encounter with people having mental disorders. Data was collected by interviewing 11 nursing students (aged 20-40 yrs). Grounded theory analysis was chosen for the study. Findings showed that the students' personal qualities and the patients' behavior affected the students' experience. When nursing students who had their own needs in focus met patients who rejected them, they felt helpless, and patients wishing to establish a relationship with them confirmed their positive or negative expectations. Nursing students who were focused on patients' needs met the patient as a unique person and felt confident despite being rejected by the patient, as well as proud when the patients wished to establish a relationship with them. Clinical university teachers can use the findings to gain knowledge about how each student feels as well as to guide them through their psychiatric training. The sample is small and further research is needed to generalize the findings of this study and to explore how nursing students, specialist psychiatric nurses and nurses in other disciplines experience the encounter with patients as well as how patients describe encounters with caregivers.

Persons with psychiatric disabilities often lead an isolated life, and their living conditions are usually not as good as those of other people. There are few studies that describe these individuals' own opinions of what can contribute to increased health. The aim of this study was therefore to describe the importance of health for persons with psychiatric disabilities. The study group comprised 12 persons, living in the community in west of Sweden, who were interviewed during 2005. The data were analysed by means of qualitative content analysis. The findings revealed five categories: (1) help and support in daily life; (2) being part of a social context; (3) having a meaningful daily life; (4) using resources in the right way; and (5) experiencing well-being. The result showed that interventions that promote health need to be clarified and strengthened by means of coordinated efforts from the healthcare services and the local community. In addition, persons with psychiatric disabilities should be invited and encouraged to participate in society as well as being listened to and having their needs addressed.

This focused ethnographic study aims at describing encounters in the healthcare environment on a locked psychiatric ward. It was carried out in Sweden on an acute psychiatric ward for patients with affective and eating disorders. Data were collected through participant observations and informal interviews, and analysed by qualitative content analysis. The result shows that the healthcare environment on this locked psychiatric ward offered a space for encounters between people, in a continuum from professional care to private meetings and social events. It included joy and friendship as well as unintentional insights into other patients' suffering. The characteristics of the encounters formed three themes: the caring relationship, the uncaring relationship and the unrecognized relationship. The caring and the uncaring relationship concerned relationships between staff and patients or their next of kin. These revealed contrasting qualities such as respect and flexibility as well as lack of respect and mistrust. The unrecognized relationship theme visualized the patients' relationships with each other and included both supportive and intrusive elements that were probably significant for the outcome of care. The unrecognized relationship contributes with new knowledge about conditions for patients in inpatient care, and indicates that the patients' relationships with each other merit greater attention. © 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd.

This study’s aim was to elucidate health-care staff experience of working on a lockedacute psychiatric ward. In many countries changes in health care has contributed tofewer beds available in inpatient care, and a concentration of patients with severepsychiatric conditions. This implies a changing work environment in acute psychiatriccare. Qualitative interviews with health-care staff (n = 10) were carried out on a wardfor patients with affective disorder and eating disorder in a Swedish hospital. Qualitativecontent analysis was used. Four themes were identified from the data: ‘undergoingchanges in care delivery’, ‘feeling a need for security and control’, ‘managing thedemands at work’ and ‘feeling a sense of responsibility’. This study adds to earlierresearch into how a sense of responsibility can place a significant burden on health-carestaff working on a locked psychiatric ward and also contribute to increased control ofpatients. This study also shows that relationships and power structures among healthcarestaff need to be addressed when organizational changes are made in care delivery.Further research is needed to reach a comprehensive understanding of care on lockedacute psychiatric wards, including a development of nursing and medicine as knowledgedomains in one common context.

Mental health services have been lacking systematic health-promoting activities, and health is often perceived as the absence of disease from a biomedical perspective. It is vital to develop methods to assess perceived health among patients in a broader perspective. The aim of the study was to investigate construct validity of a newly developed health questionnaire intended to measure subjectively experienced health among patients in mental health services. A cross-sectional study, including a randomly selected sample of 139 outpatients in contact with the mental health services, was performed in order to explore the relationship between perceived health and self-reported levels of self-esteem, symptoms, empowerment, quality of life and experiences of stigmatization. Self-esteem, symptoms, empowerment and quality of life altogether accounted for 70% of the variation in overall perceived health. Overall perceived health showed positive associations to self-esteem, empowerment and quality of life and negative associations to psychiatric symptoms, discrimination and rejection experiences. The findings suggest that perceived health as measured by the health questionnaire can be a meaningful and valid construct that may be useful for measuring health in clinical mental healthcare practice and in mental health services research.

The health and well-being of the individual is a central goal in nursing, and health promotion seeks to enable people to increase control over and improve their health. In mental health care, health is often described in negative terms such as the absence of mental illness, which may create hopelessness and constitute a barrier to a policy of health promotion. The aim of this study was to describe nurses' conceptions of how health processes are promoted in mental health nursing. Twelve nurses working in mental health care were interviewed and the data were analysed using a phenomeographic approach. The nurses expressed 11 different conceptions of the phenomenon, which were summarized into three descriptive categories: presence, balance of power, and focus on health. The findings show that the nurses expressed ambiguous attitudes towards meeting the patient in mental health care. It is suggested that the goal of nursing care should be clarified for nurses in practice, otherwise they may adopt the perspectives of other mental health professionals.

This study aimed to analyse the outcomes of an educational intervention for family members living with a person with bipolar disorder. A longitudinal study was conducted comprising a 10-session educational intervention designed for families with members in outpatient mental health care. Thirty-four family members agreed to participate. Data were collected on five occasions, at baseline and during a 2-year follow-up through self-assessment instruments: the Carers of Older People in Europe Index, the Jalowiec Coping Scale-40, the Sense of Coherence questionnaire and the Social Adaptation Self-evaluation Scale. The results showed that the condition had a considerable negative impact on the family members as carers, but the educational intervention increased their understanding, which facilitated the management of their lives. A significant improvement in stress management was seen over time and social functioning was retained. The study showed that families living with one member with bipolar disorder benefited from the educational intervention in terms of increasing understanding of the condition and reducing stress. Mental health care needs to develop educational interventions further and offer the families support to strengthen their ability to manage with the situation.

This article describes the life circumstances of persons with a psychiatric disability living in one urban and six rural areas in a single region in Sweden. Furthermore, the life circumstances of persons with a psychiatric disability are discussed in relation to the aims of social policies in Sweden. Data were collected by means of a survey study exploring the formal support provided by local authorities to its citizens and the informal support given by family members and volunteers. The results reveal how the respondents themselves describe their life circumstances in terms of their living conditions, occupation and activities, health, and formal and informal support. The results indicate that persons with a psychiatric disability, regardless of where they live, need both formal and informal support in order to cope with their everyday lives. The family plays an important role in this, and it is essential for the formal and informal support systems to cooperate with each other. The lack of activities and opportunities for work experienced by persons with a psychiatric disability indicates that the sociopolitical goal of fostering access to employment and work and to earning a living for this group is far from having been attained.

The aim of this study was to analyse the level of severity of major depression and its relation to functioning and health-related quality of life over time in patients treated for their first episode of major depression. Thirty-three adult patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression were included in the study. Semi-structured interviews and self-assessment questionnaires were used at baseline and at 6-monthly intervals in a 2-year follow-up, in order to measure the level of severity of depression, functioning and quality of life. The results showed that the first episode of major depression was rated as severe in 43% of cases. Multiple domains of functioning as well as quality of life were strongly affected in patients at baseline, although the level of functioning increased significantly over the study period, as did quality of life, but not concurrently with the decrease in the level of severity of the depression. Psychosocial functioning is an important outcome measure related to major depression, which underlines the importance of separate evaluations initiated and conducted by mental health nurses in order to determine whether or not patients have actually achieved a state of health.

The aim of this study was to characterize and compare patients with major depression and healthy volunteers concerning stressful negative life events, social support and social network occurring during a 12-month period. Forty outpatients who fulfilled DSM-IV criteria for major depression and 19 healthy volunteers were included in the study. The results showed no significant differences between the patients and the volunteers concerning the number of independent life events, perceived sufficient persons in the network, the number of family members, having a partner, and perceiving family members as offering the best support. Thus, there were differences in the number of both dependent stressful life events, especially increased arguments with partner and family members, and life events including personal illness. The patient group had experienced a greater number of these events compared with the volunteer group. Comparisons between the two groups revealed differences concerning social support and social network. Fewer patients, especially women, felt they had sufficient social support, had fewer persons in the network, less contact with persons in the network, and fewer confidants compared with the volunteers.

The most important goal of nursing care is to promote the subjective experience of health. The health promoting efforts of mental health care nurses must be aimed at creating encounters where the patient will be confirmed both existentially and as an individual worthy of dignity. The patient in mental health care is often viewed by the nurse as nothing more than a passive recipient of care and the belief in the patient's potential is minimal. This can lead to a situation where the patient loses control in the caring situation and feels unable to improve his/her health, which conflicts with the goal of the nursing care. The aim of the study was to describe patients' conceptions of how health processes are promoted in mental health nursing. Twelve patients with experience of mental health nursing were interviewed, and the data material was analysed using a phenomenographic approach. The results show 13 different conceptions of the phenomenon, and these were summarized into four descriptive categories: interaction, attention, development and dignity. The conceptions described show that the patients need to be treated as equals and that the nurse must trust the patient's ability to make decisions and to promote his/her health process. It is suggested that mental health nursing should be built on humanistic science and its view that every individual has the ability to grow and develop. This view is one of the most important preconditions for the promotion of health processes in mental health nursing.

Health promotion has become a widespread concept, although little empirical research as to its importance and outcome has been performed in the mental health field. The aim of the present study was to investigate the construct validity of a newly developed Health Promotion Intervention Questionnaire, intended to measure patients' subjectively experienced health-promoting interventions within mental health services. A total of 135 participants responded to the questionnaire and to validation measures assessing psychiatric symptoms, empowerment, helping alliance and satisfaction with care. Bivariate correlations showed that overall perceived health-promoting interventions were positively correlated to, helping alliance, client satisfaction with care and empowerment. Stepwise multiple regression analysis showed that the strongest relationship was found between perceived health promotion intervention and helping alliance. In conclusion, the construct validity of the scale was satisfactory, except for one of its subscales where further investigations are needed.