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  • 1.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Omvårdnad som reflekterande praktik: Att se och använda alternativ till tvång i psykiatrisk vård2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Tvångsåtgärder som fastspänning och tvångsmedicinering är vanligt förekommande inom den psykiatriska vården och motiveras ofta av personal med att det saknas alternativ. Användandet av tvångsåtgärder tycks vara särskilt vanligt när det gäller unga kvinnor med självskadebeteende. Dessa kan uppleva tvångsåtgärder som bestraffning och som ett hinder för att söka vård. Relationen mellan patient och vårdare har beskrivits som ett kraftfullt verktyg för att minska användandet av tvångsåtgärder, men det saknas i stor utsträckning forskning om tvångsvård som fokuserar på patienters perspektiv och alternativ till tvång. Avhandlingens övergripande syfte har varit att få ökad kunskap och förståelse för omvårdnad som process i psykiatrisk vård ur patienters, studenters och personals perspektiv, med särskilt fokus på alternativ till tvång vid självskadebeteende. Avhandlingen har en pragmatisk utgångspunkt där ambitionen har varit att resultat ska kunna omsättas i konkreta handlingar. Delstudierna har en kvalitativ ansats där datamaterial har analyserats med innehållsanalys. Data består av 19 skrivna berättelser från personer som vårdats för självskadebeteende och som har erfarenhet av tvångåtgärder, 14 loggböcker skrivna av sjuksköterskestudenter under deras verksamhetsförlagda utbildning inom psykiatrisk vård, samt fokusgruppsintervjuer med totalt 26 skötare, sjuksköterskor, läkare och enhetschefer med erfarenhet av att tvångsvårda patienter. Av berättelserna framkom att personer som vårdats inom psykiatrisk vård hade en önskan om att mötas av förståelse av personalen, att utveckla tillitsfulla och ömsesidiga relationer med dem, och att få vård som grundades på vetenskapliga metoder. Deras faktiska erfarenheter beskrev en vård som var oförutsägbar, kontraproduktiv och byggd på misstro och distans. Studenterna beskrev i loggböckerna vikten av att avsätta tid och engagemang för relationsskapande, något som beskrevs som en förutsättning för att kunna göra bedömningar och lära sig förstå patientens individuella tecken på hälsa och ohälsa. De beskrev hur de identifierade patienters abstrakta behov så som behov av trygghet, empowerment, självkänsla och hopp. Med dessa som grund individanpassade de åtgärder och förhållningssätt och synliggjorde samt tog tillvara patienternas förmågor. I fokusgruppsintervjuerna framkom hur personal med utgångspunkt i utmanande situationer i psykiatrisk slutenvård resonerade kring möjliga åtgärder med fokus antingen på personalens behov, patientens upplevelse, att följa rutiner eller att uppfostra patienter. Beroende på fokus skiljde sig förhållningssätt och utformning av åtgärder markant åt. I fokusgruppsintervjuerna framkom även personalens syn på samarbete utifrån olika professionella roller. Utmärkande var att skötarna, trots att de hade lägst formell kompetens, var den yrkesgrupp med störst inflytande vid beslut om tvångsåtgärder eftersom de arbetade närmast patienterna och därför hade förstahandsinformation om dem.Resultaten visade en stor överenstämmelse mellan patienters, studenters och personals perspektiv. En metasyntes av de olika delstudiernas resultat beskriver omvårdnad som en reflektiv praktik. Att vårdaren har förmågan att bygga upp en tillitsfull relation till patienten är en förutsättning för en relevant bedömning. Bedömningen innebär att patientens individuella behov och förmågor identifieras och ligger till grund för val av åtgärd och förhållningsätt med målet att minska lidande och öka välbefinnande. Vägen till åtgärden är inte statisk, till en början kan åtgärder enbart ha ett relationskapande syfte, behov kan förändras, åtgärder behöva modifieras liksom att tilliten i relationen kan påverkas av olika faktorer. Detta innebär att vägen till åtgärden inte bör ses som ett linjärt förlopp utan bättre förstås som en dynamisk process som förutsätter ett reflekterande förhållningssätt med relationen som grund, med det övergripande målet att stärka patientens förutsättningar till återhämtning och välbefinnande. Den övergripande slutsats som kan dras är att om vårdarna lyckas skapa en ömsesidig, tillitsfull relation till patienten, kan förstå dennes utryckta behov och outtalade tecken samt arbetar proaktivt, i samarbete med patienten, med åtgärder och medvetna förhållningssätt, så finns sällan behov av tvångsåtgärder. För detta krävs att vårdarna får stöd i att utveckla sin reflektiva förmåga och även i att få ta eget ansvar för varje situation och därigenom bygga upp en tillit till sin egen förmåga.

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  • 2.
    Ejneborn-Looi, Git-Marie
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    A self-destructive care: Self-reports of people who experienced coercive measures and their suggestions for alternatives2015In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 36, no 2, p. 96-103Article in journal (Refereed)
    Abstract [en]

    Coercive measures are commonly used as a method of intervention, despite insufficient evidence for their effectiveness and benefits. The aim of this study was to describe how people who self-harm perceive alternatives to coercive measures in relation to actual experiences of psychiatric care. A total of 19 self-reports have been analysed with qualitative content analysis, resulting in three categories: a wish for understanding instead of neglect; a wish for mutual relation instead of distrust; a wish for professionalism instead of a counterproductive care. In conclusion, if the caregivers can understand and collaborate with the patient, there is seldom any need for coercive measures

  • 3.
    Ejneborn-Looi, Git-Marie
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Solving the Staff's Problem or Meeting the Patients’ Needs: Staff Members’ Reasoning about Choice of Action in Challenging Situations in Psychiatric Inpatient Care2014In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 35, no 6, p. 470-479Article in journal (Refereed)
    Abstract [en]

    Coercion in challenging situations is often seen as a necessary component of psychiatric care. This study aims to describe staff members’ reasoning about their choice of action in challenging situations in inpatient psychiatric care. Focus group interviews with 26 staff members were analyzed using qualitative content analysis. The results provide an overview of the integrated structure of participants’ reasoning and suggest that staff members’ reasoning about choice of action can be described as a matter of either solving the staff's problems or meeting the patients’ needs. These results can be of use in further research, educational interventions, and staff development activities.

  • 4.
    Ejneborn-Looi, Git-Marie
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hellzén, Ove
    Nord-Tröndelag University College, Faculty of Health and Science.
    Nurse' perception of the relationship between themselves and the long-term psychiatric client: An interview study.2006In: Primary Care & Community Psychiatry, ISSN 1746-8841, E-ISSN 1746-885X, Vol. 11, no 4, p. 185-192Article in journal (Refereed)
    Abstract [en]

    Background: Even if the importance of a good relationship between staff and clients is well documented, there is a need for a deeper understanding of the interaction in communal settings. The aim of this study was to investigate how staffs at two municipal psychiatric group dwellings describe their relationships with their clients. Methods: A qualitative approach was chosen and in-depth interviews were performed and analysed through content analysis. Results: The analysis resulted in three categories: The good relationship that gives pleasure and nourishment at work', 'Relationships that are characterised by distance and frustration', and 'Striving towards mutual strategies leads to disunity and splits'. Conclusions: The main finding is the lack of general outlines in nurses' work, resulting in two different approaches to clients, which lead to conflicts in the staff group. The staff group that strives for structure and rules could be interpreted as being afraid of being engulfed by their clients. The opposite group, those who stress the close relationship, could be interpreted as engulfing their clients. This statement can be interpreted as the clients risking being alienated in both cases. The conclusion is therefore that the relationships are strongly influenced by the individual nurse's own view of what he/she sees as 'the right caring approach'

  • 5.
    Ejneborn-Looi, Git-Marie
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Easy but not simple: Nursing students’ descriptions of the process of care in a psychiatric context2016In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, no 1, p. 34-42Article in journal (Refereed)
    Abstract [en]

    The nurse-patient interaction is the cornerstone of psychiatric care, yet the concept “mental health nursing” is difficult to describe. This article aims to address this problem through the experiences of nursing students. Online journals from 14 nursing students were analyzed using qualitative content analysis, resulting in three categories: Trusting the Trusting Relationship, Voicing the Unspoken Needs, and Balancing the Dynamics of Doing and Being. This study demonstrates that providing nursing care based on trusting relationships is not a demanding task, but it takes place in a complex environment that has a tendency to make easy things complicated.

  • 6.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Att se och möta individuella behov: Introduktion till omvårdnad i psykiatrisk vård och omsorg2017 (ed. 1)Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Denna bok förklarar vad ett omvårdnadsperspektiv är och varför det är viktigt i psykiatrisk vård och omsorg. Med ett direkt språk, konkreta exempel och realistiska fallbeskrivningar tydliggörs hur abstrakta begrepp kan omsättas i praktiken. Boken vänder sig till sjuksköterskor i psykiatriska verksamheter och studenter på sjuksköterske- och specialistsjuksköterskeprogrammet. Den är också relevant för andra yrkesgrupper som i sitt arbete möter personer med psykisk ohälsa, och för studenter och elever i vård- och omsorgsutbildningar på alla nivåer Förhoppningen är att inspirera till reflektion och vidare läsning.

  • 7.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Att se och möta individuella behov: Ett nätbaserat reflektionsunderlag för personal och studenter i psykiatrisk vård och omsorg2012Other (Other (popular science, discussion, etc.))
  • 8.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Clinical reasoning on the use of containment measures in acute inpatient psychiatric care: professional roles and choices of action2012In: Vision, Knowledge and Practice in psychiatric and mental health nursing: II European Festival of Psychiatric Nursing, Stockholm, 2012, 2012Conference paper (Refereed)
  • 9.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ett personligt ansvar för god och säker vård2019In: Vårdande vid psykisk ohälsa: på avancerad nivå / [ed] Lena Wiklund Gustin, Lund: Studentlitteratur AB, 2019, 3, p. 571-594Chapter in book (Other (popular science, discussion, etc.))
  • 10.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Mot en hållbar omvårdnadsutveckling2016In: Psyche, ISSN 0283-3468, Vol. 2016, no 1, p. 14-17Article in journal (Other (popular science, discussion, etc.))
  • 11.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Psykiatrin behöver omvårdnadskompetens: farmakologi är inte sjuksköterskornas huvudsak2008In: Dagens Medicin, ISSN 1104-7488, no 25, p. 20-Article in journal (Other (popular science, discussion, etc.))
  • 12.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Psykiatrin satsar på omvårdnad2007In: Norrbottenskuriren, ISSN 1103-9760Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Recovery-Oriented Reflective Practice Groups: Conceptual Framework and Group Structure2019In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, no 12, p. 993-998Article in journal (Refereed)
    Abstract [en]

    The recovery-oriented reflective practice group (RORPG) is a staff-directed intervention aimed at achieving the recovery-focused transformation of mental health settings. This discussion paper aims to outline and reflect on the conceptual framework and group structure of recovery-oriented reflective practice groups. RORPGs build on conceptualizations of reflective practice, personal recovery, mental health nursing as a relational and reflective practice, and abductive reasoning. Dewey’s phases of reflection, together with an understanding of nursing practice as a dynamic process of care, provide a structure for group sessions in which abductive reasoning can be considered a core activity. This paper outlines a sound theoretical foundation and suggests that RORPGs might prove useful for providing a space for learning in practice, informed by both theoretical and practical knowledge.

    Download full text (pdf)
    fulltext
  • 14.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Reflekterande arbetssätt i psykiatrisk vård2019In: Omvårdnad vid psykisk ohälsa: på grundnivå / [ed] Ingela Skärsäter och Lena Wiklund Gustin, Lund: Studentlitteratur AB, 2019, 3, p. 587-602Chapter in book (Other academic)
  • 15.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hellström, Ingela
    Sjuksköterskor utvecklar psykiatrin2008In: Norrbottenskuriren, ISSN 1103-9760Article in journal (Other (popular science, discussion, etc.))
  • 16.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Knowledge of the patient as decision-making power: staff members’ perceptions of interprofessional collaboration in challenging situations in psychiatric inpatient care2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 784-792Article in journal (Refereed)
    Abstract [en]

    Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession-specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision-making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first-hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person-centred care.

  • 17.
    Marklund, Lisa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Forensic Psychiatric Care, Region Norrbotten, Piteå, Sweden.
    Wahlroos, Terese
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Forensic Psychiatric Care, Region Norrbotten, Piteå, Sweden.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology.
    ‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care2020In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 29, no 2, p. 235-243Article in journal (Refereed)
    Abstract [en]

    Patients find forensic psychiatric care inadequate in that they are not treated as individuals and not involved in their own care. The purpose of this study was to describe patients’ experiences and perceptions of forensic psychiatric inpatient care. Semi‐structured interviews were conducted with 11 inpatients. A qualitative content analysis resulted in a recurring theme, ‘I know what I need to recover’, and three main categories: ‘A need for meaning in a meagre existence’, ‘A need to be a person in an impersonal context’, and ‘A need for empowerment in a restricted life’. Participants experienced and perceived forensic care as predominantly monotonous, predetermined, and not adapted to them as individuals, forcing them to fight and adapt to get through it and not lose themselves. Perceived needs were largely ignored or opposed by staff due to the content and structure of care. Findings suggest a need for reflective practices and patient involvement in order to develop and maintain a person‐centred and recovery‐oriented nursing practice. The study adds to previous research showing the importance of patients in forensic psychiatric inpatient care being listened to and involved in their care. The study is reported in accordance with the COREQ guidelines.

1 - 17 of 17
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