8.2 Future Directions
8.2.3 Theoretical Perspectives of PIBA
Previous research has mainly focused on implementation, experiences and effects of PIBA.
To learn more about the mechanisms of PIBA, it would be interesting to study the underlying theoretical perspectives of PIBA. How the vary in different project and how it affects the structure of the intervention
9 ACKNOWLEDGEMENTS
Nitya Jayaram-Lindström, main supervisor: I am really grateful for all your support! You are a role model to give encouragement and guidance along the way. Your leadership is the best I have seen, by showing understanding, likable approach and have a great work ethic. A true asset to CPF! Looking forward to future collaborations!
Lena Flyckt, co-supervisor: Thank you so much for making my PhD studies possible! We started to work together in 2012 (with Karolinska Schizophrenia Projekt, KaSP) and it has been an appreciated cooperation during these years. Your way of seeing new opportunities and start new collaborations, is one of you best characteristics. Looking forward for future research collaborations!
Andreas Carlborg, co-supervisor: I am really glad that you joined the research team as my co-supervisor! I have appreciated your availability and commitment during my PhD studies.
It would be great to collaborate again in the future!
Henrik Eriksson, mentor: Thank you very much for interesting conversations and encouragement during the years! It would be nice to work together in the future!
Johan Pahnke: I am really thankful that I got to know you during KI
are a true friend and like-minded in many ways. I have appreciated to share the PhD journey with you and enjoying life in general.
Camilla Gammel: It has been so fun and rewarding to work together! I have appreciated our cooperation and I think we have raised the nursing aspects of PIBA in best way possible.
There are many great memories, that I will always remember!
PIBA Coordinators: What a team! Thank you very much for your commitment during the years: Virginia Alarcon, Catarina Goldman Flodin, Henrik Lind, Cecilia Crona, Peter Margulies, Emma Hannerstam, Kristin Sundström, Andreas Pettersson and Susanne Marklund! And to those of you who were on the trip to the Netherlands, it was a great one!
Co-authors: It has been a pleasure to work together: Ingvar Rosendahl, Emelie Allenius, Marjolein Helleman and Pernilla Omerov.
PIBA Colleagues: Thank you for great collaboration so far and more to come: Mattias Strand, Maria Smitmanis Lyle, Rose-Marie Lindkvist, Emelie Allenius, Sofie Westling, Sigrid Salomonsson, Alexander Rozental and Tobias Lundgren.
Colleagues at CPF: Thank you for your everyday services and friendly welcome at the
office: and Susanna Kron. A special
thanks to my colleague and friend Johan Lundin, looking forward to a research collaboration one day, apart from all adventures outside work. Many thanks to my unofficial mentor in life, Helena Fatorous-Bergman, it was a pleasure to work together in KaSP and I appreciate our lunch talks during the years. Thanks to my former KaSP colleagues for introducing me to
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research: Lars Farde, Simon Cervenka, Göran Engberg, Sophie Erhardt, Lilly Schwieler, Fredrik Piehl, Pauliina Ikonen Victorsson, Karin Collste, Henrik Gregermark and Marie Adolfsson.
Jayaram-Hammarberg Research group: Thank you all for interesting and joyful lab meetings: Nitya Jayaram-Lindström, Anders Hammarberg, Elin Holmén, Karin Hyland, Stina Ingesson, Viktor Månsson, Anders Nilsson, Olsa Siljeholm, Maria Åbonde Garke, Simon Jangard, Håkan Wall, Annika Tiger and Joar Guterstam.
Ward 51, 24 and outpatient units, Northern Stockholm’s psychiatry: To all health care professionals, thank you a lot for your work every day with PIBA and helping patients during crisis!
Northern Stockholm’s psychiatry (NSP): A special thanks to former head of NSP, Göran Rydén, who in an early stage believed in this project and gave us needed support and encouragement. A big thanks to Åsa Steinsaphir for consultant regarding clinical documents and your work in lifting the patient perspective within NSP. Thank you for your time and work in the PIBA steering group: Anna Ekblom, Lena Hjort, Liisa Lehmussaari, Antoinette Lundahl, Edibe Can and Ann-Christin Karlström. I also want to thank former colleagues at
“Femman” for an appreciated collaboration during the years and an extra thanks to: Jaana Agvald, Michael Wiklund, Joakim Gunn, Holger Thomas, Madeleine Liljegren, Kjell Risén, Fredrik Johansson, Maria Hammargren, Inga-Lill Andersson, Åsa Stevenson, Matilda Wässing, Petter Hildebrand, Bobby Olofsson, Göran Pihl, Janine Semius, Sabina Bonde and Ingemar Walldén. And my first mentor at Ersta Psychiatric Clinic, Ann Vallestad.
Swedish Red Cross University (RKH): Thanks to all my former colleagues at RKH for the collaboration during my employment as a lecturer. Special thanks to: my roommate Petter Tinghög, supervisor colleagues Elina Scheers Andersson and Leah Okenwa Emegwa, my previous prefects for your support: Birgitta Bisholt, Pernilla Hillerås and Marja Schuster, principals Susanne Georgsson and Louise Stjernberg, my NANDA-colleagues Maria Åling and Josefin Wiking, my successor Jenny Karlsson, for your commitment for nursing Jessica Holmgren, for great teamwork Gabriella Ahlenius, Carina Faag, Cecilia Häckter-Ståhl, Mia Kraft, Gunilla Björling and Heléne Eriksson, my namesake Joakim Larsen, PhD Students Charlotta Arwidsson, Merja Hietanen, Ellinor Rydhamn Ledin, Jill Åhs and Mats Christiansen, and our professional communicator Helene Komlos Grill.
Virtual Patients project: Big thanks to Karolina Sörman and Rebecka Broman for welcoming me to your project. Looking forward to working together during my post-doc; Marianne Kristiansson, Ylva Elvin-Nowak, Karin Dahlström, Mia Barimani, Lene Lindberg, Terese Stenfors and Uno Fors!
Thanks to The Swedish Psychiatric Nurses Association (PRF) for your commitment for psychiatric nursing and to Svensk sjuksköterskeförening, Vårdförbundet and Sineva Ribeiro for your ongoing work for the profession!
Thankful for the research funding from Swedish Research Council!
Friends and family: Thank you for enriching my life!
To my parents, Anders and Agnetha, I am forever grateful for your love and support!
To the love of my life, my wife Aster, thank you for everything!
To our beloved children Oliver and Felicia, I am so proud of you, and I love you to infinity!
Thanks to God for giving me dedication, patience and perseverance during my PhD studies and career! Phil 4:13
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11 APPENDIX
11.1 ARTICLE OVERVIEW No.,
Title, Year
Authors, Journal, Country
Aim Method Results/ Conclusion
1. Patient-Initiated Brief Admission for Individuals with Emotional Instability and Self-Harm: An Evaluation of Psychiatric Symptoms and Health- Related Quality of Life.
(2022)
Eckerstrom, Carlborg, Flyckt, Jayaram-Lindstrom.
Issues Ment Health Nurs.
(Sweden)
To explore how PIBA affect psychiatric symptoms and health-related quality of life after the intervention, and whether patients perceive PIBA as a constructive crisis intervention.
A naturalistic study design with pre-post-measures.
A significant decrease in symptoms of anxiety and depression was found. Health- Related Quality of Life increased
significantly assessed with EQ-5D and 95.2% of the participants found PIBA to be constructive intervention.
2. Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation. (2021)
Strand, Bulik, Gustafsson, Welch.
BMC Health Serv Res (Sweden)
To evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified.
A cohort study evaluating the one-year outcomes of self-admission.
SA-participants reduced their need for regular specialist inpatient treatment by 67%. A sensitivity analysis showed that
-win within the entire 95% confidence interval of the inpatient treatment utilization reduction.
3.
Where I Am Welcome to Unwind When I Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study.
(2021)
Lindkvist, Westling, Eberhard, Johansson, Rask, Landgren.
Int J Environ Res Public Health.
(Sweden)
To illuminate experiences of BA.
Qualitative interviews with nineteen adolescents aged 14 to 19 years.
The individual contract was perceived to give access to professional support in a safe environment, also among adolescents not using
their contract.BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm.
4. Experiences of how brief admission influences daily life functioning among individuals with borderline personality disorder (BPD) and self-harming behaviour.
(2021)
Enoksson, Hultsjo, Wardig, Stromberg.
J Clin Nurs.
(Sweden)
To explore experiences of how BA influences daily life functioning among individuals with BPD and self-harming behavior.
Qualitative individual interviews with 16 patients.
BA was perceived as a functioning nursing intervention that promoted determination and self-care. BA contributed to increased security in daily life and helped them to maintain everyday routines,
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employment and relationships more easily.
5. Brief Admission for Patients with Self-Harm from the Perspective of Outpatient Healthcare Professionals.
(2021)
Arnold, Wardig, Hultsjo.
Issues Ment Health Nurs.
(Sweden)
To describe the role BA in treating high-risk patients with self-harm from the perspective of outpatient healthcare staff.
Ten outpatient healthcare professionals from three psychiatric clinics were interviewed.
BA serves as a useful adjunct to outpatient treatment, especially for patients with complementarily psychotherapeutic interventions. BA also strengthen the concept of person-centered care.
6. Self-admission to inpatient treatment in anorexia nervosa:
Impact on healthcare utilization, eating disorder morbidity, and quality of life.
(2020)
Strand, Bulik, Gustafsson, von Hauss-wolff-Juhlin, Welch.
Int J Eat Disord.
(Sweden)
To evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life and sick leave for patients with AN.
Cohort study, 29 SA-participants were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment.
SA-participants displayed a >50%
reduction in time spent hospitalized at 12- month follow-up, compared to nonsignificant changes in the comparison group.
7. A Brief Breathing Space:
Experiences of Brief Admission by Self-Referral for Self- Harming and Suicidal Individuals with a History of Extensive Psychiatric Inpatient Care.
(2020)
Lindkvist, Westling, Liljedahl, Landgren.
Issues Ment Health Nurs.
(Sweden)
To study self-harming individuals, with >180 days of psychiatric admission over 12 months, experiences of Brief Admission.
Qualitative inductive interview study analyzed with a phenomenological hermeneutic method.
Seven individuals participated.
The analysis formulated BA as a worthy respite, replacing an old system of having to prove and get worse.
8. Brief admission for patients with emotional instability and self-harm: A qualitative experiences during crisis. (2020)
Eckerstrom, Flyckt, Carlborg, Jayaram-Lindstrom, Perseius.
Int J Ment Health Nurs.
(Sweden)
experiences of PIBA in terms of overall experiences, what they consider to be the key components, and what
improvements are considered relevant.
A qualitative design.
15 patients were interviewed using a semi-structured interview guide.
The findings indicate that BA constructively supports patients with emotional instability and self-harm during a period of crisis.
9. Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide:
A Randomized Clinical Trial.
(2019)
Westling Daukantaite, Liljedahl, Oh, Westrin Flyckt Helleman JAMA Netw Open.
(Sweden)
To determine the effects of BA on inpatient service use and on secondary outcomes among individuals who self-harm and are at risk of suicide.
Single-masked Brief Admission Skåne Randomized Clinical Trial. Data were collected 6 months retrospectively at baseline and at 6-month and 12-6-month follow-ups.
BA appears no more efficacious in reducing use of inpatient services than usual care for individuals who self-harm and are at risk of suicide. Future studies should explore other possible beneficial effects.
10. Staff and client perspectives of the Open Borders programme for
Mortimer-Jones, Morrison, Munib,
To report the perspectives of clients and staff of
Semi-structured interviews. Thematic analysis of clients
Enhanced client outcomes included a reduction in self-harming and