Medication-free mental health treatment: a focus group study of milieu therapeutic settings.

Background: Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for severely mentally ill persons in a medication-free unit requires significant changes to the traditional medication-based psychiatric setting. The present study examines how milieu therapists experience working with medication-free treatment for people with severe mental health challenges.

Professional caregivers' participation in the International Caregiver Development Programme: A qualitative study of psychosocial care in nursing homes.

Aim: This paper aims to explore professional caregivers' experiences of psychosocial care for older persons living in nursing homes following the professional caregivers' participation in the International Caregiver Development Programme (ICDP).

Design: A qualitative study.

Methods: About 15 focus group interviews and 25 participatory observations of five ICDP group courses were conducted with 31 employees in nursing homes, including registered nurses, enrolled nurses and nursing aids.

Patients with severe mental illness and the ethical challenges related to confidentiality during family involvement: A scoping review.

Background: Despite evidence on the significant potential value of family involvement during the treatment of patients with severe mental illness, research has shown that family involvement is largely underused. The duty of confidentiality is reported to be a key barrier to family involvement. To develop more insight into this barrier, this scoping review focuses on the following question: What are the reported ethical challenges related to confidentiality when involving family in the treatment of patients with severe mental illness?

Methods: A systematic search into primary studies was conducted using the following databases: Medline (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science core collection (Clarivate).

"Struck down by cancer with no old life to fall back on" a clinical study of illness experiences among Norwegian adolescent and young adult cancer survivors investigating the ethical implications of their illness narratives.

Background: Cancer is a leading cause of death among people 15-24 years of age. Increasing numbers of cancer patients survive. Extensive cancer therapy may cause wide-ranging somatic and psychosocial challenges in the lives of the survivors.

How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study.

Background: There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts.

Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis.

Introduction: Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care.

Coping with moral distress on acute psychiatric wards: A qualitative study.

Background: Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.

Methods: Qualitative individual and focus group interviews were conducted.

Ethical Considerations: Approval was received from the Norwegian Social Science Data Services.

Moral distress in acute psychiatric nursing: Multifaceted dilemmas and demands.

Background: In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.

Research Design: A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke's six analytic phases were used.

The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.

Background: Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion.

Methods: In 2013 and 2014, 20 focus group interviews with 127 participants were conducted.

Encountering Ambivalence - A Qualitative Study of Mental Health Nurses' Experiences with Dual Relationships.

Nurses are obliged to set professional boundaries in nurse-patient relationships. Relationships with patients that are pursued outside of working hours (dual relationships) are commonly prohibited by legislation and professional codes of ethics, but some nurses still engage in them. A thematic analysis of qualitative interviews revealed that the nurses experienced ambivalence regarding how they see the patients, their assessment of the dual relationships and how people around the nurses react to the relationships.

Family Members' Existential and Moral Dilemmas With Coercion in Mental Healthcare.

Coercion in mental healthcare does not only affect the patient, but also the patient's families. Using data from interviews with 36 family members of adult and adolescent people with mental health problems and coercion experiences, the present narrative study explores family members' existential and moral dilemmas regarding coercion and the factors influencing these dilemmas. Four major themes are identified: the ambiguity of coercion; struggling to stay connected and establishing collaboration; worries and distress regarding compulsory care; and dilemmas regarding initiating coercion.

Transforming nurse-patient relationships-A qualitative study of nurse self-disclosure in mental health care.

Aims And Objectives: To describe what and why nurses self-disclose to patients in mental health care.

Background: Self-disclosure is common, but controversial and difficult to delineate. Extant research suggests that self-disclosure might have several potentially beneficial effects on therapeutic alliance and treatment outcome for patients in mental health care, but results are often mixed and limited by definitional inconsistencies.

Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness.

Background: Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI.

Prioritising patient care: The different views of clinicians and managers.

Background: There is little research comparing clinicians' and managers' views on priority settings in the healthcare services. During research on two different qualitative research projects on healthcare prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare professionals talked about and understood prioritisations.

Aim: The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians and to explore how moral dilemmas are balanced and reconciled.

Next of kin's experiences of involvement during involuntary hospitalisation and coercion.

Background: Norway has extensive and detailed legal requirements and guidelines concerning involvement of next of kin (NOK) during involuntary hospital treatment of seriously mentally ill patients. However, we have little knowledge about what happens in practice. This study explores NOK's views and experiences of involvement during involuntary hospitalisation in Norway.

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.

Ethical challenges when using coercion in mental healthcare: A systematic literature review.

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature.

Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome.

Dealing with ethical challenges: a focus group study with professionals in mental health care.

Background: Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.

Methods: Within a project on ethics, coercion and psychiatry, we executed a focus group interview study at seven departments with 65 health care professionals and managers.

Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care.

Background: In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

Methods: We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields.

Evaluating clinical ethics support in mental healthcare: a systematic literature review.

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included.

Altruism and mature care: some rival moral considerations in care ethics.

Introduction: We discuss Carol Gilligan's original concept of mature care in the light of the altruistic approach to caring and good clinical judgment.

Discussion: In particular, we highlight how the concept of mature care can capture important challenges in today's nursing. Further, we illuminate how mature care might differ normatively from an altruistic approach to caring and the traditional prudential virtues in nursing.

[Use of coercion in nursing homes after new legislation].

Background: The use of coercion in nursing homes is common as well as challenging, but was not regulated by law until 2009. Two key conditions are that the patient must be without mental competence and that the coercive measures are in the patient's best interest. Inspection reports have revealed insufficient application of the law, and this is of concern to patients as well as healthcare staff.

How to avoid and prevent coercion in nursing homes: a qualitative study.

In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff.

HIV and infant feeding in Malawi: public health simplicity in complex social and cultural contexts.

Background: The question of when and how to best wean infants born to mothers with HIV requires complex answers. There are clinical guidelines on best approaches but limitations persist when applying them in diverse low-income settings. In such settings, infant-feeding practices are not only dependent on individual women's choices but are also subject to social and cultural pressures.

Attuned understanding and psychotic suffering: a qualitative study of health-care professionals' experiences in communicating and interacting with patients.

This study was initiated to examine how experiences with mental illness are perceived by health-care workers, and how insight affects assessment of their perspective and involvement. Lack of insight gives rise to problems concerning communication: if we expect what the person says and does not to have any meaning, how then can we establish a relationship based on understanding? This study was based on in-depth interviews with 11 mental health-care workers. Participants were recruited from a variety of institutions and professional backgrounds.