Psychiatric nurses' view of nursing care, clinical supervision and individualised care : interventions on a dementia and on a general psychiatric ward

University dissertation from Department of Nursing, P.O.Box 198, S-221 00 Lund, Sweden

Abstract: The aim of this thesis was to investigate nurses’ lived experience of daily nursing care and the impact and lived experiences of one years intervention with systematic clinical group supervision and supervised individually planned nur-sing care. This was carried out at an experimental ward (EW) (n=19) housing patients with dementia in comparison with a similar control ward (CW) (n=20) using a quasi-experimental design, and at a general psychiatric ward (n=22) using a pre-post test design. Results are based on interviews with the nurses regarding experiences of daily nursing care and of clinical group supervision and supervised individually planned nursing care. The effects were investigated at baseline and at 6- and 12-month inter-ventions. The instruments used were, for the nurses on the wards housing people with dementia, the CCQ, the MBI, the BM and the effects of clinical supervision, and for nurses on the general psychiatric ward the CCQ, the WRSI, and the SNCW, the SOC and view of the effects of clinical supervision. Daily nursing care for people suffering from severe dementia meant an intertwined life world emanating from making and doing together and the delicate interpretative work that the care provision required. The nurses searched for meaning and they determined the patients' inner world and saw the in as being in their hands. The core activity in everyday nursing care on the general psychiatric ward was to create a working relationship with the patient and meant being ready for unpredictable situations relying on oneself as the only tool. Being a ward-base nurse within a multidisciplinary team also meant struggling with independence and dependency regarding responsibility and authority. Significant improvements for the nurses' level of burnout and creativity on the EW compared to the CW nurses were found. At the general psychiatric ward there were some significant improvements regarding creativity and a significant positive improvement of the nurses’ view of the effect of clinical supervision on the two wards in focus for intervention. From the nurses’ perspective the intervention meant professional as well as personal development and a strengthened sense of community on the EW. The patients were seen as unique human beings and the organisation was changed to fit a more personoriented care. On the general psychiatric ward the intervention meant confronting the complexity of ongoing life in daily nursing care and strengthening the foundation for nursing care. Both possibilities and hindrances were illuminated and improvements were revealed regarding the nurses, the patient, the work conditions and the care provision. The intervention thus seemed to have positive effects on the nurses' well-being and work satisfaction, but when there are co-operation problems within the nurse group other support strategies are probably needed in addition. The study also produced deeper understanding of the meaning of everyday nursing care and of clinical supervision from the nurses' perspective in these two types of care settings.

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