PERSON-CENTRED CARE IN CLINICAL PRACTICE
4.1.1 Aim
To describe es working with PIBA related to patients with emotional instability and self-harm.
4.1.2 Design
To fulfill the purpose of achieving a deepened
PIBA, a qualitative study design was chosen. Qualitative health research has a long tradition in nursing and began in 1960s (Cypress, 2015). The methodology empathizes with the human complexity and their ability to create their own truth (Polit & Beck, 2016). To capture their real-life experiences over time, the data collection usually takes place in the field, based on a naturalistic tradition. This approach includes a dynamic and holistic perspective, with the aim to receive a rich in-depth information from people with first-hand knowledge to gain understanding about a complicated phenomenon (Polit & Beck, 2016).
The qualitative results about participants expressed emotions, beliefs, and behaviors, are often used to provide hypophysis and research questions prior to quantitative research (Cypress, 2015).
4.1.3 Setting and participants
PIBA was implemented in a psychiatric clinic in northern Stockholm. Two psychiatric wards and two psychiatric outpatient units were initially included in the overall research project.
This study was intended as a pilot study of the ward nurses' perspective on working with PIBA in inpatient care specialized in patients with emotional instability and self-harm.
Therefore, one of the two wards was chosen as target for this study. This specific ward had one patient room customized for PIBA. The implementation, including education of healthcare professionals, started in January 2016. Purposive sampling was used to select the respondents that most likely can provide useful information relevant to the study aim. This sampling method is common in qualitative research when a limited sample may be employed (Campbell et al., 2020). The inclusion criteria were set to: (1) registered nurses at the ward, and (2) working day shifts. Ten nurses met the criteria and were sent information letter about the study by e-mail. Eight of them chose to participate, including seven women and one man.
The participants working experience as a registered nurse varied from one to 33 years. Four
22
of the participants were either specialist nurses in mental healthcare with a Master of Science degree in nursing or currently working on their specialist degree.
4.1.4 Data Collection
When the overall research project plan was established, a semi-structured interview guide was made for the upcoming qualitative interviews with healthcare professionals about PIBA.
This study used this interview guide for data collection, and it had the following content:
What has it been like working with PIBA?
o What experiences have been positive?
o What experiences have been negative?
Has PIBA in some way changed your view of the patient group?
Do you think that PIBA helps patients in any way? How?
o If so, what are the most important parts / components? negative?
Has the environment changed in any way since the introduction of PIBA?
Has the nursing at the ward changed in any way after the introduction of PIBA?
How did the talks between the parties work when the PIBA contracts were worked out?
o Is there something that you have experienced particularly difficult, something that you have experienced as particularly good or appealing?
How has the planning in relation to the PIBA contracts worked in general?
Do you have any suggestions for improvements around PIBA?
If PIBA would be spread in a larger scale, what should be taken into account then?
A test interview took place with a nurse from the other PIBA ward, to evaluate whether the questions were appropriate and comprehensible. Discussions were held between the co-authors and the interview guide was assessed to be useful for the study interviews. The time and location for each interview were selected by the participants. Seven of the interviews took place at the psychiatric hospital, and one was carried out in a public place. All informants were given orally and written information, and written informed consent was obtained before the interview. The conversations began with background questions about education and work experience, following with questions according to the interview guide.
During the interviews, the informants were encouraged to freely discuss their experience of PIBA, to deepen the descriptions of their experiences. The interviews took place from December 2016 to March 2017 and were conducted by the second author (EA), an
experienced nurse educated in qualitative research methods. They lasted between 40 and 74 minutes and were audio recorded digitally and later transcribed verbatim. At the time of the interviews, 27 patients had the opportunity to use PIBA on that ward.
4.1.5 Data Analysis
Qualitative content analysis according to Elo and Kyngäs (2008) was chosen for data analysis. When there is limited knowledge about a phenomenon, an inductive approach is recommended, and the categories are derived from the data material. Unlike a deductive approach, where the structure of analysis is organized according to an earlier theory or model.
In this study an inductive approach was applied. The analysis process included following steps:
Preparation phase:
1. Selecting the unit of analysis.
2. Make sense of the data and whole.
Organizing phase:
3. Open coding, making notes and headings, while reading the transcripts.
4. The codes are collected to coding sheets.
5. Grouping, the codes are grouped into categries.
6. Categorization, creating names of the categories to describe and increase understanding of the phenomenon.
Reporting the analyzing process and the results:
7. Abstraction, the categories are during this process grouped into sub-, generic and main categories.
The authors (JE, EA, KIP and PO) read the transcripts to create an overall understanding of the data material. Meaningful units for analysis (words and sentences) that were relevant to the aim, were selected and coded. Similarities and differences among the codes were categorized. During the abstraction process the authors worked both independently and had joint discussions, and refined the categories and grouped them into sub-, generic, and main categories. The authors assessed that the information from the eight interviews fulfilled the aim of the study. The summarization of the analysis was presented in the findings.
24
4.2 STUDY II: BRIEF ADMISSION FOR PATIENTS WITH EMOTIONAL