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Persons who frequently use psychiatric emergency services: perspectives on who they are, what their needs are and howthey are encountered by healthcare professionals
Lund University, Sweden.ORCID iD: 0000-0002-3113-6432
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall objective of the thesis was to describe who persons that frequently use psychiatric emergency services (PES) in Sweden are, to explore what needs they experience as well as how healthcare professionals working at PES view the needs of those persons and experience encounters with them.

This thesis includes both quantitative (I, II) and qualitative (II, III, IV) research designs and applies a broad range of data collection methods, such as use of register data (I), use of survey data (II), individual interviews and focus group interviews (III, IV). Data were analysed with statistical tests (I, II) and with qualitative content analysis (II, III, IV).

Study I is based on visits to PES during 2013–2015. A total of 27,282 persons made 67,031 visits. Of those 27,282 persons, 8.1% could be identified as frequent PES users, accounting for nearly two fifths of all visits. In Study II, 81 persons who frequently visited PES participated. The participants in Studies III and IV were healthcare professionals working at PES, such as assistant nurses, nurses with specialised education in psychiatry, and physicians. Nineteen healthcare professionals participated in individual interviews in both Study III and Study IV, and each of the studies was complemented with a focus group interview involving five and six professionals respectively.

The findings of this thesis were as follows: persons who frequently use PES in Sweden are a small, yet highly heterogeneous group who make a disproportionately high number of visits and differ significantly from other PES visitors; persons who frequently use PES and healthcare professionals at PES are in agreement about the complex and intertwined need patterns of the patients that originate from problems in everyday living, acute psychiatric suffering, and insufficient care possibilities, and thus were found to suffer from illness, unfavourable life circumstances and inadequate care; healthcare professionals at PES experienced the encounter as consisting of caring, professional, and humane processes where persons who frequently use PES were seen as fellow human beings and as unique, and were treated with as much respect, kindness, humility, confirmation, and empowerment as possible; and that in order to have caring encounters with persons who frequently use PES, the healthcare professionals also needed to nurture the relationship with oneself and with colleagues. Those results were interpreted by means of person-centredness and in light of a recovery-oriented care approach. Even though the latter has received more acknowledgement and acceptance within psychiatric care in the last decade, it needs to be developed and implemented further in the Swedish psychiatric care context. 

Place, publisher, year, edition, pages
Lund: Lund University , 2020. , p. 101
Series
Doctoral Dissertation Series, ISSN 1652-8220 ; 2020:60
Keywords [en]
Nursing, Omvårdnad
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-58184Libris ID: 2dlhkd9202xxhjv0ISBN: 9789176199213 (print)OAI: oai:DiVA.org:hj-58184DiVA, id: diva2:1687498
Supervisors
Available from: 2022-08-16 Created: 2022-08-15 Last updated: 2025-10-13Bibliographically approved
List of papers
1. Clinical profiles and temporal patterns of psychiatric emergency room visitors in Sweden
Open this publication in new window or tab >>Clinical profiles and temporal patterns of psychiatric emergency room visitors in Sweden
2018 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, no 3, p. 197-204Article in journal (Refereed) Published
Abstract [en]

AIMS: To describe persons visiting the psychiatric emergency room (PER) in Sweden and to compare persons who frequently (PFV) and infrequently (PIFV) visit PERs in terms of group size, age, gender, PER location inside versus outside the home municipality, diagnosis (ICD 10), temporal patterns of visits and hospital admissions.

METHODS: This register study included all visits to PERs in one Swedish county over 3 years, 2013-2015 (N = 67,031 visits). The study employed descriptive statistics as well as Chi-square tests combined with Bonferroni correction to compare PFV with PIFV.

RESULTS: Of the total of 27,282 visitors, 2201 (8.1%) were identified as PFV (five or more visits within 12 months) and they accounted for 38.1% of the total visits. The study found differences between PFV and PIFV in gender, diagnostic profile, hospital admissions and temporal patterns. Differences were also detected with regard to distance between PERs and home municipalities. However, no age-related differences were found between the two groups.

CONCLUSIONS: PFV and PIFV have different clinical profiles and temporal patterns. These results may be important when planning, developing and evaluating interventions targeting the needs of each group, which is in accordance with a person-centred approach. Such an approach might eventually result in fewer visits to PERs.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
visitors, diagnosis, hospital admissions, psychiatric emergency, temporal patterns, Psychiatry, Psykiatri
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-58186 (URN)10.1080/08039488.2017.1417477 (DOI)000424948600007 ()29254427 (PubMedID)2-s2.0-85038405280 (Scopus ID)
Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2025-10-13Bibliographically approved
2. Self-reported needs for care, support and treatment of persons who frequently visit psychiatric emergency rooms in Sweden
Open this publication in new window or tab >>Self-reported needs for care, support and treatment of persons who frequently visit psychiatric emergency rooms in Sweden
2018 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 39, no 9, p. 738-745Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate self-reported needs for care, support and treatment among persons who frequently visit psychiatric emergency rooms (PERs).

DESIGN: A cross-sectional design. Qualitative and quantitative data were collected using an interview-based manual. Qualitative data were analysed using content analysis, whereas quantitative data were analysed using descriptive, non-parametric statistical tests.

RESULTS: Persons who frequently visit PERs self-reported unmet needs for care, support and treatment in life domains such as health, socialisation, daytime activities, and emotional and financial security.

CONCLUSION: To meet the needs of persons who frequently visit PERs, close cooperation between concerned welfare actors should be implemented.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Nursing, Omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-58190 (URN)10.1080/01612840.2018.1481471 (DOI)000459680300003 ()30111203 (PubMedID)2-s2.0-85052091494 (Scopus ID)
Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2025-10-13Bibliographically approved
3. Professionals' perspective on needs of persons who frequently use psychiatric emergency services
Open this publication in new window or tab >>Professionals' perspective on needs of persons who frequently use psychiatric emergency services
2020 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 41, no 3, p. 182-193Article in journal (Refereed) Published
Abstract [en]

This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care- and support-related aspects of life.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Nursing, Omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-58185 (URN)10.1080/01612840.2019.1663565 (DOI)000506948500001 ()31930924 (PubMedID)2-s2.0-85078592687 (Scopus ID)
Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2025-10-13Bibliographically approved
4. Encounters with persons who frequently use psychiatric emergency services: healthcare professionals' views
Open this publication in new window or tab >>Encounters with persons who frequently use psychiatric emergency services: healthcare professionals' views
2020 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 3, p. 1-16, article id 1012Article in journal (Refereed) Published
Abstract [en]

Encounters and interactions between healthcare professionals and patients are central in healthcare services and delivery. Encountering persons who frequently use psychiatric emergency services (PES), a complex patient group in a complex context, may be particularly challenging for healthcare professionals. The aim of the study was to explore healthcare professionals' experiences of such encounters. Data were collected via individual interviews (N = 19) and a focus group interview with healthcare professionals consisting of psychiatric nurses, assistant nurses, and physicians. The data were analyzed with qualitative content analysis. This study focused on the latent content of the interview data to gain a rich understanding of the professionals' experiences of the encounters. Two themes were identified: "Nurturing the encounter with oneself and colleagues for continuous, professional improvement" and "Striving for a meaningful connection with the patient". The professionals experienced their encounters with persons who frequently use PES as caring, professional, and humane processes. Prerequisites to those encounters were knowing and understanding oneself, having self-acceptance and self-compassion, and working within person-centered cultures and care environments.

Place, publisher, year, edition, pages
MDPI, 2020
Keywords
caring, content analysis, emergency care, encounter, experiences, interpersonal communication, mental health nursing, person-centeredness, therapeutic relationships, Nursing, Omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-58183 (URN)10.3390/ijerph17031012 (DOI)000517783300337 ()1498948 (PubMedID)
Available from: 2022-08-16 Created: 2022-08-16 Last updated: 2025-10-13Bibliographically approved

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