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  • 1.
    Engqvist, Inger
    University of Skövde, School of Life Sciences.
    Experiences of postpartum psychosis from the perspectives of women with the diagnosis and psychiatric nurses2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Postpartum psychosis occurs in approximately two out of every 1000 women after childbirth. Although rare, it is a very serious illness with a potential for suicide and infanticide. The suffering associated with this illness and the effects on the entire family system are severe. Nurses need a comprehensive understanding of this disorder, how women present andexperience the illness and the nursing care required to keep women and their newborns safe. They also need to promote early detection to facilitate prompt treatment. To date, there is little research examining the women’s experiences and the nursing care provided to this population.Two descriptive qualitative studies were completed. One study analyzed internet narratives of ten women with the diagnosis of postpartum psychosis and the other study analyzed ten interviews with psychiatric nurses working on inpatient psychiatric units in Sweden. These two studies and subsequent secondary analyses addressed four research questions. How do women diagnosed with postpartum psychosis describe theirexperience?What are psychiatric nurses’ descriptions of women with postpartum psychosis and what are their responses to these women when caring for them on an inpatient psychiatric unit?What nursing care strategies are used by nurses in caring for women with postpartum psychosis?How do psychiatric nurses describe the use of presence when caring for women with PPP?The women described overwhelming fear, a detachment and inability to care for their babies, delusions and hallucinations, shame and guilt, sleep deprivation, a sense of being controlled, disorganized, confused and paranoia during hospitalization. A number also felt abandoned and discontented with the nursing staff and the nursing care they received. The nurses described a kaleidoscope of symptoms and a range of positive and negative emotionalresponses they had towards the women. Nursing strategies included satisfying basic needs, keeping the women and babies safe and secure, connecting the women with reality, creating a partnership, teaching the women and their family members, giving hope and facilitating recovery. The nurses described their use of physical presence in great detail and the learning that took place in the context of caring for this population.Future research studies need to examine the on-going interaction ofpatients and nurses on inpatient psychiatric units. Nurses and nursing studentsneed education about disease manifestations, women’s experiences, nursingcare strategies and ways to address nurses’ own emotional reactions.

  • 2.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Ferszt, Ginete
    University of Rhode Island.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Swedish registered psychiatric nurses' descriptions of presence when caring for women with post-partum psychosis: An interview study2010In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 19, no 5, p. 313-321Article in journal (Refereed)
    Abstract [en]

    The concept of nursing presence has been widely used in nursing and is a significant component of nursing practice. In order to increase our understanding of nursing presence, it needs to be studied in different contexts. In this study, a secondary analysis of interviews with 10 registered psychiatric nurses (RPN) in Sweden was conducted to explore nurses’ descriptions of presence when caring for women with post-partum psychosis (PPP). Based on the research question: ‘How do RPN describe nursing presence in the context of caring for women with PPP?’ content analysis was used to analyze the data. Three categories emerged: the use of presence to protect, the use of presence to facilitate recovery, and the use of presence for learning. The findings underscore the importance of recognizing nursing presence as a strategy to improve psychiatric nursing for the benefit of the woman and her child, and as an important part of psychiatric nursing when providing compassionate and effective nursing care to this population.

  • 3.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Ferszt, Ginette
    College of Nursing, University of Rhode Island, Kingston, RI, United States.
    Åhlin, Arne
    Skaraborg Hospital, Skövde, Sweden / Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Solna, Sweden.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Psychiatric Nurses' Descriptions of Women with Postpartum Psychosis and Nurses' Responses: An Exploratory Study in Sweden2009In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 30, no 1, p. 23-30Article in journal (Refereed)
    Abstract [en]

     Postpartum psychosis is the most serious type of psychiatric illness related to childbirth. This interview study with nine psychiatric nurses in Sweden explored psychiatric nurses’ descriptions of women with psychosis occurring in the postpartum period and nurses’ responses when providing care to these women. Content analysis was used to analyze the data. The nurses described delusions, disconnection, aggression, changed personality, self-absorption, insomnia, chaos, quietness, suicidal ideation, and ‘strange eyes.’ The description of strange eyes noted by the nurses has not been found in the literature, warranting further investigation. When providing care, the nurses responded with sadness, sympathy, empathy and compassion, discomfort, anger, anxiety, and happiness. These findings underscore the importance of nurses recognizing their negatively charged emotions which could interfere with providing compassionate and effective nursing care to this population.

     

  • 4.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Ferszt, Ginette
    College of Nursing, University of Rhode Island, Kingston, United States.
    Åhlin, Arne
    Skaraborg Hospital.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Women's Experience of Postpartum Psychotic Episodes: Analyses of Narratives From the Internet2011In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 25, no 5, p. 376-387Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to gain an insight into women's experiences of postpartum psychosis (PPP). Ten narratives taken from the Internet, which met the definition of PPP, were analyzed using cross-case and content analyses. The results revealed women's experience of having unfulfilled dreams, being enveloped by darkness, having disabling symptoms, and being abandoned. The women's experiences point to the importance of further education of nurses and doctors concerning PPP. It is vital not only for those working in psychiatric health care but also midwives and nurses who are working in maternity wards and child welfare centers. This would facilitate early recognition of signs and symptoms of the disorder, which, in turn, would make early treatment possible, thus supporting recovery. Furthermore, greater knowledge could contribute to providing more effective and compassionate care for these women.

  • 5.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Nilsson, Agneta
    Academy of Sahlgrenska, University of Gothenburg, Institute of Nursing, Gothenburg, Sweden.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Strategies in caring for women with Postpartum Psychosis: an interview study with psychiatric nurses2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 7, p. 1333-1342Article in journal (Refereed)
    Abstract [en]

    Aim and objective. The aim of this study was to explore strategies in caring for women with postpartum psychosis used by nurses.

    Background. The most serious type of psychiatric illness in connection with childbirth is postpartum psychosis. Nearly two in 1000 newly delivered women are stricken by postpartum psychosis. Most of these patients need psychiatric care to recover. While earlier studies point to the need for psychiatric care, knowledge of specific nursing strategies in caring for postpartum psychosis patients remains limited.

    Methods. Interviews with 10 experienced psychiatric nurses were carried out, transcribed verbatim and an inductive content analysis was made.

    Result. The main strategies for care found in this study were: (i) To create a patient–nurse relationship and (ii) To apply nursing therapeutic interventions. Presence, continuity and nurse-patient partnership contributed to create a relationship and incorporate the rest of the care team. To satisfy the patients’ basic needs and feeling of security was the foundation of the nursing therapeutic interventions. Confirmation and giving hope were also used as nursing therapeutics as well as information to the patient and her relatives about her illness.

    Conclusion. The conclusion of the study is that strategies used by nurses are a combination of general and psychiatric nursing approaches but the specificity in caring knowledge for caring patients with postpartum psychosis requires further development.

    Relevance to clinical practice. The result of the study indicates that it is important to organize patient care for postpartum psychosis with continuity and consistency and to support the nurse to create a relationship and therapeutic intervention with the patient. The present study shows the importance of further developing specific nursing theories that can be applied when caring for patients with postpartum psychosis. It also shows the need for further pedagogical education for mental health

  • 6.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Nilsson, Kerstin
    Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg , Sweden.
    Experiences of the first days of postpartum psychosis: An interview study with women and next of Kin in Sweden2013In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 34, no 2, p. 82-89Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore accounts of the first days of postpartum psychosis from different perspectives, that is, that of the women and their next of kin. Interviews were conducted with seven women with postpartum psychosis and six interviews were done with the next of kin. The overall theme was Shades of Black with A Ray of Light, revealing a difficult experience of darkness, despair, and suffering. For the women, the experience cannot be shared fully other than with those who have lived through it themselves. For the next of kin, the illness is incomprehensible and it proved difficult to express in words what these relatives believe the women were going through. The women and their next of kin spoke about loss of sleep, being in an unreal world, thoughts that moved from having a wanted to an unwanted baby, being infanticidal, and having suicidal ideation. The women and their next of kin described the situations in different ways. The women gave an account of their illness in the strongest of terms, while the language used by the next of kin was much milder. The findings underscore the importance of recognizing the next of kin as key sources in early recognition of the disorder, which would make early treatment possible and support recovery. © 2013 Informa Healthcare USA, Inc.

  • 7.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences. Department of Psychiatry, Skaraborg Hospitals, Falköping, Sweden.
    Nilsson, Kerstin
    Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Involving the family in the care and treatment of women with postpartum psychosis: Swedish psychiatrists' experiences2013In: Psychiatry Journal, ISSN 2314-4327, E-ISSN 2314-4335, article id 897084Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe Swedish psychiatrists’ experiences of involving the family in the treatment of women with postpartum psychosis. A qualitative design was used, and semistructured qualitative research interviews were conducted with nine psychiatrists from the south of Sweden. Data were analysed using qualitative content analysis. Four categories were found: the family as a resource, the family as coworkers, preparing the family for the future, and the family as a burden. The result showed that the psychiatrists considered the family to be a resource to which they devoted a great deal of care and effort. It was particularly important to involve the partner, informing about the course of the illness and the steps that need to be taken in the event of a relapse and reducing any guilt feelings. The psychiatrists instilled confidence and hope for a future of health and further child bearing. The family members’ limited understanding of the treatment may impede the involvement of the family. Conclusion of the study was that the goal for family involvement was to facilitate the women’s care and treatment. Further studies are needed to provide suggestions on how to develop family involvement in the care of women suffering from postpartum psychosis.

  • 8.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Nilsson, Kerstin
    Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Men's experience of their partners' postpartum psychiatric disorders: narratives from the internet2011In: Mental Health in Family Medicine, ISSN 1756-834X, Vol. 8, no 3, p. 137-146Article in journal (Refereed)
    Abstract [en]

    Objectives: Postpartum psychiatric disorders (PPPD) can be serious and disabling, and may lead to long-term adverse consequences. Partners of women with PPPD are also affected by the illness, but their experiences are seldom described. The aim of this study was to explore men's experience of women with PPPD.

    Methods: Eleven written narratives from the internet were used to analyse men's perceived experience of their partner's PPPDs. Data were analysed using content analysis.

    Results: The men revealed a major disruption in their lives. They expressed fear, confusion and anger; they were also extremely concerned about their partners, and felt unable to help in overcoming the disorder. Most of the men described making sacrifices in order to hold the relationship and the family together. Although the disorder improved over time, they were left to face an uncertain future with a woman who seemed to be very different from the person they had known previously. Most of the men gained maturity and increased self-esteem, but for some the result was divorce, custody disputes and loneliness.

    Conclusions: The men in this study experienced the woman's PPPD as a difficult time, when everything familiar was turned upside down. Health professionals should pay more attention to men's mental health in the postpartum period. Furthermore, information regarding the possibility of these disorders should be given to expectant couples in prenatal classes. Further research is needed to ascertain how and to what extent this should be included in the education.

  • 9.
    Engqvist, Inger
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Skaraborg Hospitals, Falköping, Sweden.
    Nilsson, Kerstin
    Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The recovery process of postpartum psychosis from both the woman's and next of kin's perspective: An interview study in Sweden2014In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 8, no 1, p. 8-16Article in journal (Refereed)
    Abstract [en]

    Abstract: Objectives: The most serious type of psychiatric disorder in connection with childbirth is postpartum psychosis. With this disorder occasionally follows emotional rejection of the infant which has serious long term effect on mother and child. The aim of this study was to explore the experiences of the recovery process of postpartum psychosis from the women, from the partners of the women, and their next of kin.

    Methods: Interviews were conducted with seven women, who had previously suffered postpartum psychosis, and six of their next of kin. The interviews were transcribed verbatim and analysed using content analysis.

    Results: Two categories emerged: the recovery process and the circumstances of the support provided. The women and their next of kin spoke about the turning point in the illness, their own personal as well as their social recovery, the importance of support not only from relatives and friends, but also from professionals, and the use of medication. However, the key to recovery was an internal decision by the women themselves.

    Conclusion: Conclusion is that the recovery from this severe mental disorder requires hard work and the key to their recovery was the decision made by the women. This disorder causes a mental darkness to descend, but at the start of the recovery a dim light shines in the dark tunnel. The nursing staff must be made aware that good sleep is important for the psychiatric treatment and that recovery may take a long time. The nurse needs to provide hope and encouragement, as well as help the woman to recognise the strength that exists within her. To reduce the risk of a recurrence of the disorder, the staff needs to offer follow up visits.

  • 10.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Åhlin, A.
    University of Rhode Island.
    Ferszt, G.
    Skaraborg Hospital, Skövde.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Nurses - psychiatrists' main collaborators when treating women with postpartum psychosis2010In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 17, no 6, p. 494-502Article in journal (Refereed)
    Abstract [en]

    The focus was to describe Swedish psychiatrists’ experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. Data were analysed using manifest and latent content analysis. The results of these experiences were categorized in this study as: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards; and decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses’ competence, and was exceedingly important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams, e.g. outpatient clinic, child health clinic and community services, was required. The conclusions were that psychiatrists collaborate with different professionals in the various phases of the caring process. They rely extensively on nurses’ competence when caring for women with PPP, and consider nurses to be their most important collaborators. Collaboration with midwives and obstetricians was

  • 11.
    Engqvist, Inger
    et al.
    University of Skövde, School of Life Sciences.
    Åhlin, Arne
    Skaraborg Hospitals, Skövde, Sweden.
    Ferszt, Ginette
    University of Rhode Island, Rhode Island, United States.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences. University of Gothenburg, Gothenburg, Sweden.
    Comprehensive Treatment of Women with Postpartum Psychosis across Health Care Systems from Swedish Psychiatrists' Perspectives2011In: Qualitative Report, ISSN 1052-0147, Vol. 16, no 1, p. 66-83Article in journal (Refereed)
    Abstract [en]

    Studies concerning the psychiatrist’s experiences of treating women with postpartum psychosis (PPP) or how they react to these women are limited in the literature. In this study a qualitative design is used. Data collection includes semi-structured interviews with nine Swedish psychiatrists working in psychiatric hospitals. The audio-taped interviews are transcribed verbatim and analyzed using content analysis. The findings consist of the categories: Protection, Treatment, Care, and Reactions.The psychiatrists describe emotions such as compassion, empathy and distress. A conclusion is that the psychiatrists focus on protecting the women from suicide and/or infanticide. Given the degree of stress the psychiatrists can experience caring for high risk challenging patients, health care organizations need to provide support and/or opportunities for peer supervision.

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