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Activity and participation in psychiatric institutional care
Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
2008 (engelsk)Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, nr 3, s. 131-142Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

National action plans emphasize the importance of strengthening the role of patients in health and medical care. Patients should feel that they can participate and that they are seen as a resource. In occupational therapy, the client-centred approach has developed, whereby it is key to enable patients to participate in their treatment. The International Classification of Functioning Disability and Health (ICF) has inspired this study, in which concepts such as activity and participation are central. The purpose of the study was to describe how patients in psychiatric institutional care conceive their opportunities to be active, and how they participate in their own treatment. Questionnaires were sent to patients who had received care during a six-month period. Ten patients were then selected for interview. The study shows that younger patients and patients who were treated involuntarily were generally more dissatisfied than other patients. The patients' perceptions of their environment were influenced by the values in the ward. Topics such as atmosphere in the ward, reception, continuity, and support were presented. Important factors related to activity and participation were: agreement concerning the treatment plan, discussions about expectations, creating conditions for engagement in activities, and providing the patients with opportunities to take responsibility for themselves.

sted, utgiver, år, opplag, sider
2008. Vol. 15, nr 3, s. 131-142
Emneord [en]
Client-centred approach_evaluation_ICF_occupational therapy
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-43105DOI: 10.1080/11038120801900050Lokal ID: 71679OAI: oai:DiVA.org:liu-43105DiVA, id: diva2:263963
Tilgjengelig fra: 2009-10-10 Laget: 2009-10-10 Sist oppdatert: 2017-12-13
Inngår i avhandling
1. Participation in occupational therapy in psychiatric care
Åpne denne publikasjonen i ny fane eller vindu >>Participation in occupational therapy in psychiatric care
2010 (engelsk)Licentiatavhandling, med artikler (Annet vitenskapelig)
Abstract [en]

One of the most important challenges of health and medical care is to strength the role of the patient in the treatment. In psychiatric care the patient must be seen as a resource and should be given the opportunity to participate in his treatment. The overall aim of the thesis was to investigate and describe how patients in psychiatric care perceive participation, and how existing assessments support participation.

Study I describes how patients in psychiatric institutional care perceived their opportunities to be active and to participate in their own treatment. The ICF (International Classification of Functioning Disability and Health) inspired the study. By means of a questionnaire, 61 patients reported their opinions of the value of received care, highlighting concepts such as activity and participation. Ten of those patients were then selected for a semi-structured interview. The study showed that patients who were treated according to compulsory care (LPT) were generally more dissatisfied with their opportunities to be active and participate in their own care than patients treated according to the law of health and medical care (HSL). Younger patients in particular were more dissatisfied. Some important factors in the environment were continuity and reception from the staff. Facilitating factors for activity and participation were agreement between patient and staff about the treatment plan, discussions about expectations, and creating conditions for engagement in activities and or responsibility.

Study II investigates if there is harmony between the CPRS-S-A (Comprehensive Psychopathological Rating Scale-Self-Assessment), the OCAIRS–S (Occupational Circumstances Interview and Rating Scale) and the OSA (Occupational Self Assessment), and if they can replace each other when the occupational therapist collects information about the patient. Another aim was to investigate how occupational therapist uses the collected information in the treatment plan process. Fourteen patients with depression disorders took part in the study. The study showed that even if the symptoms of the disease were improved at the end of the treatment period the patients still had problems with occupational performance, reduced self-confidence and the structure of their day. Consequently the assessments cannot replace each other. The study emphasized the importance of using both interview and self-assessments when collecting information about the patient, since these methods complement each other in identifying the needs and goals of the treatment. Many problems were related to the patient’s social environment but this was not reflected in the treatment plan; few goals were identified in this area.

In conclusion, occupational therapists should use self-assessments and interviews in order to support the patient’s participation in psychiatric care. Furthermore, it is important to use assessments for both occupational performance and medical symptoms when identifying the patient’s needs and goals of treatment since there is a discrepancy between the two areas; symptoms are reduced earlier than perceived problems in occupational performance. Regardless of what kind of law the patient is treated under, all patients have the right to participate in their own treatment. This thesis also shows that the social environment is important in enabling the participation of patients in their psychiatric care.

Abstract [sv]

En av de viktigaste utmaningarna inom hälso- och sjukvården är att stärka patientens ställning i behandlingen. Inom psykiatrisk vård så måste patienten ses som en resurs och ges möjlighet att vara delaktig i sin behandling. Det övergripande syftet med denna avhandling var att undersöka och beskriva hur patienter inom psykiatrisk vård uppfattar delaktighet och hur existerande instrument stödjer delaktighet.

Studie I beskriver hur patienter inom psykiatrisk slutenvård uppfattar sina möjligheter till aktivitet och delaktighet under vårdtiden. ICF (Klassifikation av funktionstillstånd, funktionshinder och hälsa ) inspirerade studien. Genom en enkät svarade 61 patienter på värdet av den vård som de erhöll, där begrepp som aktivitet och delaktighet belystes. Tio patienter valdes sedan ut för en semistrukturerad intervju. Studien visar på att patienter som vårdats utifrån Lagen om Psykiatrisk Tvångsvård (LPT) var generellt mer missnöjda än de patienter som vårdats utifrån Hälso- och Sjukvårdslagen (HSL). Även yngre patienter var mer missnöjda. Några viktiga faktorer i miljön som påverkar möjlighet till delaktighet var kontinuitet och bemötande från personalen. Underlättande faktorer för aktivitet och delaktighet var att det fanns en samstämmighet mellan patient och personal i vårdplaneringen, att förväntningar diskuterades, att förutsättningar till engagemang i aktiviteter gavs och att patienten fick möjlighet att ta eget ansvar.

Studie II undersöker om det finns harmoni mellan CPRS-S-A (Comprehensive Psychopathological Rating Scale-Self-Asessment), OCAIRS-S (Occupational Circumstances Interview and Rating Scale) och OSA (Occupational Self Assessment) och om de kan ersätta varandra när arbetsterapeuten samlar information kring patienten. Ett annat syfte var att undersöka hur arbetsterapeuten använder den insamlade informationen i behandlingsplanen. Fjorton patienter med depressionssjukdom deltog i studien. Studien visar att även om de medicinska symptomen förbättras i slutet av behandlingen så har patienten fortfarande problem i aktivitetsutförande, nedsatt självkänsla och struktur på dagarna. Bedömningsinstrumenten kan inte ersätta varandra. Studien betonar vikten av att använda både intervju och självskattning vid datainsamling kring patienten, då de kompletterar varandra vid identifiering av behov och mål i behandlingen. Många problem var relaterade till patientens sociala miljö, dock saknades detta i behandlingsplanerna; få mål och åtgärder identifierades inom detta område.

Sammanfattningsvis, arbetsterapeuten bör använda självskattningar och intervjuer i syfte att stödja delaktighet inom psykiatrisk vård. Dessutom är det betydelsefullt att använda bedömningsinstrument både för aktivitetsutförande och medicinska symptom för att identifiera patientens behov och mål i behandlingen då det är en diskrepans mellan dessa två områden; medicinska symptomen reduceras tidigare än upplevda problem i aktivitetsutförandet. Oavsett vilken lag som styr vårdformen så har alla patienter rätt till delaktighet i sin egen behandling. Denna avhandling visar också på att den sociala miljön är viktigt för delaktighet för patienter inom psykiatrisk vård.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2010. s. 35
Serie
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 110
Emneord
Participation, Assessment, ICF, Mental health, Occupational therapy, Delaktighet, Bedömningsinstrument, ICF, Psykisk hälsa, Arbetsterapi
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-53776 (URN)978-91-7393-456-5 (ISBN)
Presentation
2010-02-12, K2, Kåkenhus, Campus Norrköping, Linköpings universitet, Linköping, 10:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2010-02-03 Laget: 2010-02-03 Sist oppdatert: 2019-10-12bibliografisk kontrollert

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