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Caring for foreign‐born persons with psychosis and their families: Perceptions of psychosis care
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Att vårda utlandsfödda personer med psykos och deras familjer! (Swedish)
Abstract [en]

The aim of this thesis was to describe and analyse perceptions of psychosis care among those involved in care, foreign-born persons with psychoses, their families and health care staff, and further to reach agreement about core components in psychosis care. This was in order to find out whether current psychosis care in Sweden is suitable for foreign-born persons and their families. The study design was explorative and descriptive. Health care staff (n=35), persons with psychosis (n=22) and families (n=26) of persons with psychosis were chosen from different regions in Southern Sweden. To capture health care staff’s experiences and to explore whether specific needs occurred within psychiatric care, nine focus group interviews were held. The perspectives of psychosis care among persons with psychoses and their families were captured through individual interviews. Finally, a study was accomplished all over Sweden in which staff, foreign-born persons with psychosis and foreign-born families of persons with psychoses answered a questionnaire to identify core components in psychosis care of foreign-born persons and their families. There was agreement that the core components in psychosis care concern general psychiatric caring, even though varying perceptions were identified. Asking about foreign-born persons’ religious and ethnic background or having the possibility to decide whether care should be provided by male or female staff were agreed to be less important. No agreement could be reached concerning the importance of considering different perceptions of psychosis care, treatments and different ways of managing the psychosis. Nor could agreement be reached as to whether staff should have specific cultural knowledge and whether interpreters should be unknown to the family but speak the right dialect. Perceptions among staff in somatic and psychiatric care as well as perceptions among foreign- and Swedish-born persons with psychosis and their families were more similar than different. General psychiatric care is important for Swedish-born as well as foreign-born persons with psychosis and their families, indicating the importance of not letting culturally determined perceptions dictate the care and take away energy from health care staff and make them lose their focus on the basic elements in general psychiatric care. However, within the general care there were individual perceptions on whose importance those involved in care did not agree. Further development suggested is to illuminate the importance of identifying individual perceptions which may differ between different persons and could be related to cultural background. Staff need to acquire strategies so they can easily manage to encounter and offer general care to foreign-born persons. Development must be achieved on both an organizational level and an individual level.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1107
Keyword [en]
Qualitative methods, migrants, psychosis care, Delphi technique
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-18086ISBN: 978-91-7393-680-4 (print)OAI: oai:DiVA.org:liu-18086DiVA: diva2:214420
Public defence
2009-06-05, Orginalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2017-07-07Bibliographically approved
List of papers
1. Immigrants in emergency care: Swedish health care staff's experiences
Open this publication in new window or tab >>Immigrants in emergency care: Swedish health care staff's experiences
2005 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 52, no 4, 276-285 p.Article in journal (Refereed) Published
Abstract [en]

Background: During the past few decades Sweden has developed into a multicultural society. The proportion of patients with different cultural backgrounds increases, which naturally makes new demands on health care staff.

Aim: To identify whether staff in somatic and psychiatric emergency care experienced problems in the care of migrants, and if so to compare these.

Method: The study design was explorative. Focus group interviews of 22 women and 13 men working as nurses and assistant nurses at an emergency ward, an ambulance service and a psychiatric intensive care unit were held.

Findings: The results showed that the main problems experienced in all wards were difficulties related to caring for asylum-seeking refugees. Some dissimilarities were revealed: unexpected behaviours in migrants related to cultural differences described by staff working in the emergency ward; migrants' refusal to eat and drink and their inactive behaviour in the psychiatric ward; and a lot of non-emergency runs by the ambulance staff because of language barriers between the emergency services centre and migrants.

Conclusion: The main problems experienced by the health care staff were situations in which they were confronted with the need to care for asylum-seeking refugees. Practice implications: These emphasize the importance of support from organizational structures and national policies to develop models for caring for asylum-seeking refugees. Simple routines and facilities to communicate with foreign-language-speaking migrants need to be developed. Health care staff need a deeper understanding of individual needs in the light of migrational and cultural background.

Place, publisher, year, edition, pages
Wiley InterScience, 2005
Keyword
Ambulance, Asylum-seeking Refugees, Emergency, Health Care Staff, Migrants, Psychiatry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18083 (URN)10.1111/j.1466-7657.2005.00418.x (DOI)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2017-12-13Bibliographically approved
2. Perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders
Open this publication in new window or tab >>Perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders
2007 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 60, no 3, 279-288 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This paper is a report of a study to explore different perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders.

BACKGROUND: Research from different countries reports a high-incidence of psychosis among migrants. The risk-factors discussed are social disadvantages in the new country. To understand and meet the needs of people from different countries, their perspective of psychiatric care must be illuminated and taken into consideration.

METHOD: A phenomenographic study was conducted in 2005-2006 using semi-structured interviews with a convenience sample of 12 foreign-born people and 10 Swedish-born people with psychosis.

FINDINGS: Three categories were identified: personal and family involvement in care; relating to healthcare staff; and managing illness and everyday life. Foreign-born people differed from Swedish-born people in that they struggled to attain an everyday life in Sweden, relied on healthcare staff as experts in making decisions, and had religious beliefs about mental illness. Among Swedish-born people, the need for more support to relatives and help to perform recreational activities was important.

CONCLUSION: It is important to identify individual perceptions and needs, which may be influenced by cultural origins, when caring for patients with psychosis. Previous experience of care, different ways of relating to staff, and individual needs should be identified and met with respect. Social needs should not be medicalized but taken into consideration when planning care, which illustrates the importance of multi-professional co-operation.

Keyword
Interviews, migrants, nursing, patients’ perceptions, phenomenography, psychiatric nursing, psychotic disorder
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18084 (URN)10.1111/j.1365-2648.2007.04391.x (DOI)17822426 (PubMedID)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2017-12-13Bibliographically approved
3. Foreign-born and Swedish-born families perceptions of psychosis care
Open this publication in new window or tab >>Foreign-born and Swedish-born families perceptions of psychosis care
2009 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 18, no 1, 62-71 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe how foreign-born and Swedish born families living in Sweden perceive psychosis care. Eleven foreign-born and 15 Swedish-born family members were interviewed and the data were analyzed using a phenomenographic approach. The findings showed three main descriptive categories: taking responsibility, access to care, and attitudes to psychosis. The degree of responsibility in the family decreased if there was easy access to care and support from health-care staff. Knowledge of psychosis was considered to be important in order to counteract prejudiced attitudes in the family and the community. Foreign-born families did not want to be treated differently from Swedes and stressed the importance of finding ways to communicate despite communication barriers. Foreign-born families also were affected by their experiences of psychiatric care and different beliefs about psychosis in their home country. The results indicate how important it is that health-care staff members treat families on equal terms. It is necessary to take the time to identify how to communicate in a good manner and to identify families previous experiences of and beliefs about psychosis care in order to help families face prejudice in society and to see beyond the psychosis.

Keyword
Family, phenomenography, psychosis, psychosis care, quality of care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17154 (URN)10.1111/j.1447-0349.2008.00587.x (DOI)
Available from: 2009-03-07 Created: 2009-03-07 Last updated: 2017-12-13Bibliographically approved
4. Identifying core components in care of foreign-born persons with psychosis and their families: Using the Delphi technique
Open this publication in new window or tab >>Identifying core components in care of foreign-born persons with psychosis and their families: Using the Delphi technique
(English)Manuscript (Other academic)
Abstract [en]

The purpose of this study was to let persons involved in psychosis care (foreign-born persons, families and health care staff) identify the core components in care of foreign-born persons with psychosis and their families in Sweden. The results from three previous qualitative studies consisting of perceptions of psychosis care were reformulated and structured into statements in a questionnaire which was delivered to 43 persons involved in psychosis care. The statements were scored in terms of perceived importance in two rounds using the Delphi technique. The results revealed agreement about the importance of general psychiatric care. Individual perceptions on which importance there was no agreement, suggested that staff must seek to understand a person’s individual perceptions to gain insight about ways to build an effective care alliance with foreign born persons with psychosis and their families.

Keyword
Delphi technique, foreign-born persons, psychosis care, nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18085 (URN)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2013-09-12Bibliographically approved

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