Reconstructing mental health nursing in home care.
BACKGROUND
Psychiatric care for people in Sweden with long-term mental health problems has shifted from institutional to community and home settings.


OBJECTIVE
The aim of this study was to explore and describe mental health nurses' experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long-term mental health problems.


METHODS
We conducted interviews with 11 mental health nurses who provided home care to people with long-term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis.


RESULTS
The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long-term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse-controlled to client-centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client-centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely.


CONCLUSIONS
Our study indicates that the process of reconstructing mental health nursing in line with a client-centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.
Magnusson
Annabella
A
Division of Psychiatry, Neurotec, Karolinska Institute, Huddinge University Hospital M58, SE-141 86 Stockholm, Sweden. annabella.magnusson@telia.com
Severinsson
Elisabeth
E
Lützén
Kim
K
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D008297:Male; D001523:Mental Disorders / Q000451:nursing; D008875:Middle Aged; D009723:Nurse-Patient Relations; D011568:Psychiatric Nursing / Q000458:organization & administration*; D013548:Sweden