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  • 1.
    Elmberger, Eva
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Bolund, Christina
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Andershed, Birgitta
    Ersta Sköndal University College, Department of palliative care research.
    Being a Mother With Cancer: achieving a Sense of Balance in the Transition Process2008In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 31, no 1, p. 58-66Article in journal (Refereed)
    Abstract [en]

    For women with cancer and with children living at home, the demands of being a good mother while undergoing treatments and recovering from illness have been described as a difficult life process. The aim of this study was to further examine the transition process with focus on women's experience of their responsibility toward their children. Interviews from 2 previous studies investigating the transition process of women with cancer were gathered and were subjected to a qualitative secondary analysis, an analytic expansion of the transition process. The 3 phases in the transition process were used in an interpretive description: ending an earlier life situation, in-between, and new beginning. A main theme that integrated these phases was constructed: "the desire to manage ones responsibility as a parent," within the context of mothering. The women expressed moral concern about not being able to function as "good" mothers yet attempted to find a balance between experiences of exhaustion and other experiences that made it difficult to maintain their responsibility as parents. All of the women included in this study expressed the need for professional support to help them endure treatment procedures as well as to sustain their moral responsibility as good mothers.

  • 2.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Andersson, Lars
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Variations in views of life of persons with long-term mental illnessArticle in journal (Refereed)
  • 3.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Andersson, Lars
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Varying views of life among people with long-term mental illness2009In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 1, p. 54-60Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to explore views of life among people with long-term mental illnesses. The participants' possible cognitive inability to express such views dictated a research design that was both fit for purpose and respectful of their integrity. The study, based on an ethnographic framework, involved photographs and interviews with five women and three men. The participants were the photographers, as well as the authors of their own narratives, and the photographs served as a starting point for the interviews. The interview material was analysed in terms of the phases of interpretation. Four main themes were identified: ‘thoughts about God and the meaning of life and death’, ‘the meaning of relationships with others’, ‘how animals give meaning to life without demands’ and ‘the symbolic bearing of objects on life’. These four themes represent key existential issues among people with long-term mental illnesses, but they lack confidants to share or discuss these matters with.

  • 4.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Caregivers’ difficulties in activating long-term mental illness patients with low self-esteem2012In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 19, no 2, p. 140-145Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe psychiatric caregivers’ perceptions of self-esteem and activities for patients with long-term mental illness. The study design used a qualitative approach, based on an open lifeworld perspective. A total of 13 caregivers at four psychiatric hospital units in a large Swedish city were interviewed about their views on patients’ physical activity and/or other pastimes, as well as their self-esteem and its bearing on the patients’ well-being. According to the caregivers, it is up to the patients themselves to decide what they wish to occupy themselves with. In the same time the caregivers’ opinions are that patients have difficulties to occupy themselves.The caregivers believe that patients’ disability is based in a lack of self-esteem, commitment and capacity to realize their wishes. The caregivers in this study argue that activities are valuable for self-esteem and physical health of people with long-term mental illness. The caregivers consider that it is the patient’s responsibility to initiate their needs of activities. This means that the caregivers do not use their knowledge about the importance of activities for the patient’s health.Search terms: activity, caregivers, mental illness.

  • 5.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Etiska utmaningar för sjuksköterskor i psykistrisk vård2011In: "Nej, det går inte": etiska utmaningar i psykiatrisk vård / [ed] Gunilla Silfverberg, Stockholm: Ersta Sköndal högskolas förlag , 2011, p. 91-103Chapter in book (Other (popular science, discussion, etc.))
    Abstract [sv]

    -

  • 6.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Photography as a method of data collection: helping people with long-term mental illness to convey their life world.2011In: Perspectives in psychiatric care, ISSN 0031-5990, E-ISSN 1744-6163, Vol. 47, no 3, p. 145-50Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this article is to describe a method to help patients with long-term mental illness describe their life situations--their "life worlds"--through photography.

    CONCLUSIONS: Photographs and interviews are useful for data collection. The positive effect of this method is allowing informants who have long-term mental illnesses to express their perceptions.

    PRACTICE IMPLICATIONS: Nurses can use photography in conjunction with interviews to ascertain the life worlds of their patients.

  • 7.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Vård i hemmet av människor med psykisk ohälsa2010In: HEMSJUKVÅRD / [ed] Eva Drevenhorn, Lund: Studentlitteratur , 2010, 1:1, p. 157-171Chapter in book (Other (popular science, discussion, etc.))
  • 8.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Basic Attitudes toward Life Expressed by Persons with Long-Term Mental Illness Living in a Swedish Community.2012In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Issues in mental health nursing, ISSN 1096-4673 (electronic), Vol. 33, no 6, p. 387-93Article in journal (Refereed)
    Abstract [en]

    Previous research has shown that persons with long-term mental illness who require prolonged treatment and social support wish to, yet find it difficult to, find meaning or quality in life. A descriptive qualitative design using self-photography and in-depth interviews was used for data collection. The aim of this study was to explore basic attitudes to life as expressed by nine persons with long-term mental illness living in the community. The findings provide insight into the values of relationships, work, and the home for persons with long-term mental illness and indicate that they are cognizant of social norms yet have difficulty integrating these in their daily lives. The study also illuminates the informants' difficulties in creating satisfying and supporting relationships with others.

  • 9.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Cautiousness: a basic attitudes towards life for persons with long-term mental illnessArticle in journal (Refereed)
  • 10.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Karolinska institutet.
    Nyström, Maria
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Social and existential alienation experienced by people with long-term mental illness2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 373-380Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore how people suffering from long-term mental illness and who live in the community experience their daily lives. The study was based on an ethnographic framework involving participant observations with 23 individuals from two rehabilitation centres and interviews with six women and two men. The observational notes and interviews were recorded, transcribed into the data and analysed based on the phases of hermeneutic interpretation. The process consisted of identifying tentative interpretations that highlighted various impediments that prevent people with long-term mental illness from having an active life. The impediments can also be interpreted as a form of alienation, an interpersonal phenomenon and a consequence due to of the lack of social acceptance towards mental illness. The participants expressed concern about the future and lack of hope. Viewing themselves as being ‘odd’ is not a symptom of mental illness, but rather evidence of experiencing existential and social alienation not only as a consequence of other people's reactions but also their own negative attitudes towards mental illness and effects of their cognitive dysfunction.

  • 11. Högberg, Torbjörn
    et al.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences.
    Ewertzon, Mats
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Attitudes towards mental illness in Sweden: Adaptation and development of the Community Attitudes towards Mental Illness questionnaire2008In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 17, no 5, p. 302-310Article in journal (Refereed)
    Abstract [en]

    The main purpose for the expansion of supported community care for persons with serious mental illness in Sweden was to ensure the right for these persons to live as citizens in the community. However, earlier research shows that negative attitudes towards mental illness present an obstacle for social integration of persons with serious mental illness. The aim of this study, conducted in Sweden, was to evaluate an existing instrument's (Community Attitudes towards Mental Illness, CAMI), validity and reliability. An additional aim was to adapt and develop the questionnaire to Swedish circumstances. After translation and modification of the original CAMI, the Swedish version of the questionnaire (CAMI-S) was distributed to all student nurses at three different universities in Sweden. The overall Cronbach's alpha coefficient was 0.90 of the original CAMI-S. A corrected inter-item total correlation excluded 20 items because they showed loading <0.43. The overall Cronbach's alpha coefficient on the 20 items (new CAMI-S) that showed loading, >0.43, was 0.903. A factor analysis of these items revealed that the data could be extracted in three factors labelled as: open-minded and pro-integration, fear and avoidance and community mental health ideology. Finally, in order to reach reliable results in attitude research, it is important to measure the respondent's attitude towards the object in common as well as the respondent's attitude to interact with the object. Accordingly, it is important to add behavioural intention items to the ‘new CAMI-S’. Statements exemplifying how something ‘ought to be’ in an impersonal way have a good degree of stability over time and place.

  • 12. Högberg, Torbjörn
    et al.
    Magnusson, Annabella
    Karolinska institutet.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Living by themselves?: Psychiatric nurses’ views on supported housing for persons with severe and persistent mental illness2006In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 13, no 6, p. 735-741Article in journal (Refereed)
    Abstract [en]

    The main principle directing the development of supported dwellings for persons with long-term mental illness is that to live in the community would improve their quality of life. The aim of this study was to describe psychiatric nurses’ experiences of different types of supported dwelling for persons with long-term mental illness, and their views on what they consider to be important principles to provide for in order to facilitate their social integration into the community. Nine psychiatric nurses were interviewed. A qualitative content analysis revealed ‘attempting to uphold the principle, respect for the patient’s right to self-determination’ as the main theme, which was linked to three sub-themes: the nurses’ view on their moral responsibility; the nurses’ views on social norms that patients must follow in order to be accepted by their neighbours; and the nurses’ views on supported dwelling of good quality. The nurses perceived that personal contact between the neighbour and the mentally ill person was one essential way to reduce fear of the mentally ill person. They viewed themselves as a link between the mentally ill person and other neighbours. Without the personal contact between the mentally ill person and the neighbours, there may be a risk that the integration will fail no matter how excellent the supported dwelling is framed.

  • 13. Högberg, Torbjörn
    et al.
    Magnusson, Annabella
    Karolinska institutet.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    To be a nurse or a neighbour?: A moral concern for psychiatric nurses living next door to individuals with a mental illness2005In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 12, no 5, p. 468-478Article in journal (Refereed)
    Abstract [en]

    Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses' experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory was used for data collection and analysis. The process of 'behaving as a nurse or not' was identified as a core category. Four subcategories were identified: 'receiving involuntary information', 'to take action or not', 'behaving as a mediator in the neighbourhood' and 'the freedom of choice'. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time.

  • 14.
    Lützén, Kim
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Cronqvist, Agneta
    Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
    Magnusson, Annabella
    Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
    Andersson, Lars
    Ersta Sköndal University College, Department of Health Care Sciences.
    Moral stress: synthesis of a concept2003In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 10, no 3, p. 312-322Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient's vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress.

  • 15.
    Magnusson, Annabella
    Karolinska institutet.
    Home care of persons with long-term mental illness: nurses and mental health care workers' experiences of how changes in the organisation of psychiatric services have changed their work2003Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The overall aim of this thesis, consisting of five studies, was to explore nurses’ and mental health care workers’ experiences of how changes in the organisation of psychiatric care influence their daily work and how these changes may have contributed to ethical problems. The specific context in focus was the homes of mentally ill persons. Implicit to this aim was the assumption that the results of this research could be used to develop educational and mentoring programs, for nurses and mental health care workers that are suited to community psychiatric and mental health nursing. The design utilises both qualitative and quantitative research methods. In study I three focus groups with psychiatric nurses and mental health care workers were conducted in order to investigate ethical problems that arise within the framework of the caregiver-patient encounter. The constant comparative method of grounded theory was used for analysing of the data. The findings describe the central theme as a conflict concerning intrusion into patient’s privacy. Four main themes were identified; 1/ Intruding in the home of the patient; 2/ Experiencing fluctuating boundaries; 3/ Respecting or transgressing the right to privacy; and 4/ Situating mutual vulnerability. As this was a small study a questionnaire was developed from the ethical problems identified in Study I and used as data collection in Study II and III to identify whether the ethical problems in Study I could be generalised to other professional care givers working in the home of the patient. Study II shows that district nurses and mental health care personnel had different views related to issues concerning privacy and autonomy in providing care to patients with mental illness. In contrast, the difference in views between psychiatric nurses and mental health care workers are few. The results in Study III emphasise the need for clinical supervision as support for the nursing staff. The group receiving supervision felt more secure in relation with the patient as well as their decision-making compared with the group that did not received supervision. In-depth interviews were conducted with 11 psychiatric nurses in Study IV and V. In study IV a constant comparative analysis revealed the core category, the process of attempting to reconstruct mental health nursing, from nurse-controlled care to clientcentred care. Subsequently, moral values, assessment of patients’ need and way of meeting patients and establishing relationship with them were also changed for the nurses in this study. In Study V a qualitative content analysis was used. The findings show that the participants attempted to achieve a form of control of the patient’s state of health. By providing support and supervision to the patient they could help him or her in activities of daily life but not take over autonomy. In conclusion, it appears that ethical problems occur when the care of severe mentally ill patients is provided in their own homes in that nurses and mental health personnel had difficulty dealing with issues concerning privacy and autonomy; supervision is significant in supporting the professional role and may solve ethical problems arising in the home care of patient.

    This thesis indicates that nursing educational programs should be oriented towards social mental health care and that the curriculum should to a great extent include ethics and ethical analysis of problems that arise in the home care of persons with severe mental illness.

  • 16.
    Magnusson, Annabella
    et al.
    Karolinska institutet.
    Högberg, Torbjörn
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Severinsson, Elisabeth
    Swedish mental health nurses’ responsibility in supervised community care of persons with long-term mental illness2004In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 6, no 1, p. 19-27Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe psychiatric nurses’ experience of how the changing focus of mental health care in Sweden, from in-patient treatment to community-based care, has influenced their professional autonomy. Eleven psychiatric nurses were interviewed and a qualitative content analysis was used to identify major themes in the data. Three main themes were found: pattern of responsibility, pattern of clinical judgement, and pattern of control through support and supervision. All themes were related to the nurse's identity, moral responsibility and the feelings of loneliness and independence in his/her daily work. Together, the three themes were found to constitute a process. This study shows the complexity involved in nursing care provided in the patient's home. Achieving control over the patient's everyday life through support and supervision does not imply taking over the patient's autonomy, but rather reducing the stigma attached to mental illness and facilitating the process of rehabilitation.

  • 17.
    Magnusson, Annabella
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Factors that influence collaboration between psychiatric care and CSSs: experiences of working together in the interest of persons with long-term mental illness living in the community2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 1, p. 140-145Article in journal (Refereed)
    Abstract [en]

    Background: Since de-institutionalization of psychiatric care (PC) took place in Sweden during the second half of the 20th century, the intended collaboration between the two organizations, PC and community social service (CSS) has been evaluated as inadequate in providing care for persons with long-term mental illness living in the community. Aim: The aim of this explorative study was to examine factors that influence interdisciplinary teamwork between PC and CSSs based on the experience of nursing staff within two separate organizations. Method: Five focus groups were selected as an appropriate method to collect data. Two of these groups were recruited from the PC and three from the CSSs. The focus groups consisted of psychiatric nurses and mental healthcare workers. A qualitative content analysis was used to identify major themes in the data. Findings: Two main themes were found, external organizational factors and interpersonal factors that deter or enhance collaboration between PC and CSS. Separate care plans, unclear times for meetings were found to be a plausible reason for communication failure. The focus groups representing each of the two organizations viewed themselves as ‘us and them’. Different ideologies and goals for caring and service and how to use each other’s competence seemed to be explanations as well as consequences of not finding ways to work together. Conclusion: The results of this study points to the need for the two organizations to find ways to work more effectively together to realize a joint responsibility for the patient/client.

  • 18. Magnusson, Annabella
    et al.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Severinsson, Elisabeth
    Nurses' views on situations related to privacy in providing home care for persons with long-term mental illness: an exploratory study2002In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 23, no 1, p. 61-75Article in journal (Refereed)
    Abstract [en]

    The main aim of this exploratory study was to explore the views of nurses and mental health care workers on situations related to patient privacy in the home care of persons with long-term mental illness in Sweden. A specifically designed questionnaire was developed from theoretical constructs obtained in a qualitative study and distributed to 1,139 respondents. Data from 660 district nurses, psychiatric nurses, and mental health care workers revealed significant differences in perceptions by age, gender, and professional groups. For example, psychiatric nurses and mental health care workers indicated to a greater extent than district nurses feelings that relate to intrusion on patient privacy. Respondents who were 41 years or younger also indicated to a greater extent than those who were older that they felt home care was an intrusion on patient privacy. Moreover, men indicated to a greater extent than women feelings of insecurity in their professional role. Further investigation is needed, especially into how nurses deal with situations that intrude on patient privacy and how nursing intervention impacts on the patients' own sense of privacy.

  • 19. Magnusson, Annabella
    et al.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Severinsson, Elisabeth
    The influence of clinical supervision on ethical issues in home care of people with mental illness in Sweden2002In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 10, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate in what ways clinical supervision can influence district nurses', psychiatric nurses' and mental health care workers' ethical decision-making in home care of people with mental illnesses. BACKGROUND: Nursing staff frequently have to make difficult ethical decisions when caring for mentally disturbed patients in the home. METHODS: This study is a descriptive, correlational study. Data was collected by a cross-sectional survey that focused on psychiatric nurses, district nurses and mental health care workers (n = 660). RESULTS: Health care professionals, who received supervision as support in their clinical nursing work, perceived that they felt more secure in decision-making, felt safer in their relationship with the patient and had gained a deeper insight into the meaning of security for the patient as well as for the carer. Furthermore, they regarded taking over responsibility for the patient, when necessary, as their moral right and that care and treatment in the patient's home could mean that the patient's integrity was violated. CONCLUSIONS: The results emphasize the need for clinical supervision as support for nursing staff, as it leads to their acquiring a greater sense of self-esteem. There is also a need to clarify the professional role of nurses through integration of theoretical and clinical knowledge. The importance of supervision is illustrated by means of previous studies.

  • 20.
    Magnusson, Annabella
    et al.
    Karolinska institutet.
    Severinsson, Elisabeth
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Reconstructing mental health nursing in home care2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 43, no 4, p. 351-359Article in journal (Refereed)
    Abstract [en]

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

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