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Accessible Summary: What is known about the subject: Treatment groups in Mental Health Service is cost‐effective, increases patients´ self‐understanding and stimulate changeResearch shows that people with mental illness have different barriers to attend group sessions which often originates from a lack of trust in other people, but it is known that the possibility to build gradual trust among the participants encourages attendance. What the paper adds to existing knowledge: This study is based on the experience from outpatients and illuminates how discovery groups from the Tidal Model can be used as introductory sessions to build gradual trust among people with mental illness before engaging in a person‐centred group intervention.The study fills a research gap in methods to create a safe and trusting environment in treatment groups for people with mental illness working with recovery‐oriented person‐centred interventions. What are the implications for practice: This study emphasizes the importance of meeting concerns about social interactions in persons with mental illness when joining treatment groups. It presents a recovery‐oriented method which meets this requirement and is easy to implement in practice. Introduction: Recovery‐oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment. Aim: The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person‐centred group intervention. Method: A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur's theory of interpretation. Results: The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators. Discussion: Feeling safe and sharing experiences and emotions contribute to the relational climate in a group. Implication for practice: Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma. Design: A qualitative study with a constructivist grounded theory design. Methods: Fifteen in‐depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology. Results: The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges. Conclusion: Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process. Impact: As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns. Reporting Method: Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. Patient or Public Contribution: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Accessible Summary: What the paper adds to existing knowledge?: Personality disorder is a serious mental health condition affecting up to 52% of psychiatric outpatients and 70% of inpatients and forensic patients. People with a diagnosis of personality disorder have higher morbidity and mortality than those without.Service users and carers reported a lack of training for staff in the management of individuals with a diagnosis of personality disorder, particularly with regard to self‐harm and suicidal behaviours.Staff burnout creates barriers to compassionate person‐centred care for individuals with a diagnosis of personality disorder as staff struggled to accommodate the nature of the presentation when under significant emotional, psychological and professional strain caused by understaffing and lack of support. What are the implications for practice?: This paper adds new knowledge by informing services of ways to improve care provision from the perspectives of both carers and service users.A more holistic and less medicalised approach to the treatment of problems associated with a diagnosis of a personality disorder should be adopted, and personality disorder training introduced for all healthcare practitioners, to improve patient outcomes. Introduction: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out‐of‐area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high‐quality care. Aim: To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out‐of‐area placements. Method: Semi‐structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. Results: Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD. Discussion: Anti‐stigma interventions for staff, research on care provision and structural changes to services including more evidence‐based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. Implications for Practice: This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: It is known that people with a diagnosis of borderline personality disorder often experience crises in their mental wellbeing.There is little evidence about the approaches of mental health nurses in community‐based crisis teams when working with people with a diagnosis of BPD. What the paper adds to the existing knowledge?: This paper highlights that limited resources, work‐patterns and issues of stigma present challenges to delivering recovery‐oriented care.The paper highlights that nurses typically try to navigate the challenges to continue to provide individualized care, though their self‐assessment is that this is with mixed success. What are the implications for practice?: The findings suggest that support is needed to develop brief interventions specific to teams working with people with a diagnosis of BPD who are at a point of crisis. Introduction: People with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis, and in the UK, this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated; however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research Aim: To understand the perceptions held by CRHTT clinicians about their provision of recovery‐orientated acute care, for people with a diagnosis of BPD. Method: From a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. Results: Five themes emerged: person‐centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. Discussion: The results demonstrate tensions between a drive to deliver person‐centred care and a range of challenges that inhibit this, with the possibility of reframing a recovery approach as "recovery‐ready". Implications for Practice: A whole‐system approach is required to enable a consistent recovery‐oriented approach, but research is also needed for brief interventions specific to this context. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The delivery of mental health recovery orientated acre is a requirement of mental health professionals and an acknowledged desired outcome for individuals presenting with mental health issues.Hope has been recognized as one of 5 key processes of mental health recovery, and critically as the key catalyst of recovery.Mental health nurses are required to be competent in cultivating service user hope. What the paper adds to existing knowledge?: Novel exploration of how people described and made sense of the lived experience of hope in mental health recovery.Participants described hope as intrinsic to life in the context of its ability to cultivate desire and provide energy for life and living.Participants with experience of attempts to end life had a very clear concept of hope as missing at these times.Participants described the concept of hope as present but hidden to explain their survival through tortuous circumstances.The themes generated contribute to a greater understanding of the dynamic role and process of hope in mental health recovery. What are the implications for mental health nursing practice?: Mental health practitioners need to be competent in understanding and cultivating hope as part of a person‐centred approach, embedded in a therapeutic relationship.All stakeholders including service users, mental health nurses and educators need a more accessible reified dialogue of "hope" that harnesses its therapeutic potential. Introduction: Mental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro‐process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential. Aim: To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method: A qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi‐structured interviews and analysed using an IPA framework. Results: Three superordinate themes emerged: "Without it we would wither up and die"—Hope as intrinsic to life; "I will be ok"—Having a sense of possibility and "Making it happen"—Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances. Discussion: Individuals were more familiar with the concept of hopelessness, had a ready‐to‐hand vocabulary of "having no hope" and used this by default to inform what hope meant. Implications for Practice: It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Frontline forensic mental health staff often face challenges when providing recovery‐orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward.Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice.Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re‐articulate power relations in therapeutic environments. What the paper adds to existing knowledge?: This paper provides insights into how using online video gaming interventions may influence the establishment of social power relations of staff and forensic psychiatric patients. It adds to existing research by providing a conceptual way to study and understand how mental health nurses may balance between care and custody, delivering care to accommodate patients' needs without compromising safety and security at the ward.This study answers a call in current research by providing qualified knowledge regarding the use of online video gaming to build and sustain therapeutic relations in mental health care. What are the implications for practice?: Our paper suggests that balancing between care and custody is possible by using online video gaming interventions in forensic psychiatry. It moreover provides practice‐close knowledge that may inspire and guide clinical mental health nurses to further develop online video gaming interventions in mental health care for the benefit of their patients. Introduction: In recovery‐oriented care, forensic psychiatric nurses must engage in care relationships with forensic psychiatric patients (FPs) whilst focussing on ward security. Online video games (OVGs) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are needed to guide clinical practice. Aim: Our aim was to study how power relations were articulated between FPs and staff in an OVG intervention in a Danish forensic psychiatric ward. Method: Data consist of three months of observational data and interviews with three staff members and six patients. We used sociologist Pierre Bourdieu's framework of field, power and capital to analyze data. Results: The OVG intervention consisted of two power fields, "in‐game" and "over‐game." In‐game concerned the practice of gaming. Over‐game described the organization of the gaming intervention. Specific logics, skills and symbolic capitals drove power in each field. Discussion: Power in‐game was open to FPs and staff, leading to symmetric power relations. Power over‐game was open to staff only, resulting in asymmetrical power relations. Implications for practice: Online video game interventions may facilitate power balancing in forensic psychiatry. These insights may guide the development of new OVG interventions for patients and nurses in mental health care. [ABSTRACT FROM AUTHOR]

Aims: To understand barriers and facilitators of recovery for critical illness survivors', who are discharged home from the hospital and do not have access to dedicated outpatient care. Design: Multi‐site descriptive study guided by interpretive phenomenology using semi‐structured interviews. Methods: Interviews were conducted between December 2017 ‐July 2018. Eighteen participants were included. Data were collected from interview recordings, transcripts, field notes, and a retrospective chart review for sample demographics. Analysis was completed using Interpretive Phenomenological Analysis which provided a unique view of recovery through the survivors' personal experiences and perception of those experiences. Results: Participants encountered several barriers to their recovery; however, they were resilient and initiated ways to overcome these barriers and assist with their recovery. Facilitators of recovery experienced by survivors included seeking support from family and friends, lifestyle adaptations, and creative management of their multiple medical needs. Barriers included unmet needs experienced by survivors such as mental health issues, coordination of care, and spiritual needs. These unmet needs left participants feeling unsupported from healthcare providers during their recovery. Conclusion: This study highlights important barriers and facilitators experienced by critical illness survivors during recovery that need be addressed by healthcare providers. New ways to support critical illness survivors, that can reach a broader population, must be developed and evaluated to support survivors during their recovery in the community. Impact: This study addressed ICU survivors' barriers and facilitators to recovery. Participants encountered several barriers to recovery at home, such as physical, cognitive, psychosocial, financial, and transportation barriers, however, these survivors were also resilient and resourceful in the development of strategies to try to manage their recovery at home. These results will help healthcare providers develop interventions to better support ICU survivors in the community. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many Western countries have abandoned the wearing of nurse uniforms on inpatient mental health wards. The adoption of a non‐uniform policy in Hong Kong was recently introduced in select rehabilitation units to align with the philosophy of the recovery model. What the paper adds to existing knowledge?: The findings suggest that nurses perceived wearing non‐uniform might help to reduce the self‐stigma of service users and develop better self‐esteem.The perceived potential benefits of the introduction of a non‐uniform policy seemed to outweigh the perceived drawbacks. What are the implications for practice?: The results further acknowledge the potential positive effects of nurses wearing non‐uniform on facilitating psychiatric service users' recovery process. However, further research on service users' perspectives is required.The wearing of non‐uniform may be considered to be extended to other psychiatric wards in Hong Kong and other similar Asian settings in order to potentially help promote patient's recovery and to reduce emotional distance between staff and service users. Introduction: A non‐uniform policy was recently adopted in selected Hong Kong rehabilitation wards to align with the philosophy of the recovery model. The change in policy is relatively novel in Asia, where no previous studies have reported how this may influence nursing care and service users' recovery. Aim: To explore Hong Kong Mental Health Nurses' views about wearing non‐uniform within an inpatient rehabilitation unit in regard to facilitating service users' recovery process. Method: A qualitative descriptive study was conducted, utilizing individual in‐depth semi‐structured research interviews. Results: A total of 12 interviews were conducted with nurse participants. The analysis process identified 3 main themes and 9 subthemes. Main themes were "building up rapport with service users," "non‐uniform helps deinstitutionalization" and "different approaches to maximize the benefit and to minimize the risk." Discussion: Despite some concerns, the majority of nurse participants positively viewed the policy of wearing non‐uniform and felt it was potentially beneficial to service users' recovery process. Implications for practice: Nurses perceived that wearing non‐uniform may facilitate meaningful therapeutic engagement, and may help to reduce the self‐stigma and develop the self‐esteem of service users. Other inpatient units in Hong Kong and similar Asian settings might consider adopting the policy. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice. Background: Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective. Design: A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions. Method: A Fairclough‐inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016–2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1). Results: From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology. Conclusion: Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self‐care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice. Relevance to clinical practice: Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery‐oriented approach, if the agenda is to be truly adopted and strengthened. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Religion plays important role in recovery from mental illness.Religion can have both positive and negative effects on recovery. What does this paper add to existing knowledge?: It is conceivable for Black African service users (BASUs) to engage with the mainstream mental health services at the onset of their symptoms.BASUs see mental illness and recovery through the lens of religion. They mostly use Pentecostalism and traditional African healing systems to aid their recovery.The mainstream mental health system and the traditional African healing system exist in harmony for BASUs who are open to simultaneously access both services. What are the implications for practice?: There is a need to recognize that most Black Africans have unique ways of practising their Christianity. Thus, broad changes are needed in the services to support religious coping tailored to the individual persons in their recovery journey.There is a need for service providers and healthcare professionals to integrate Pentecostalism and traditional African healing systems into the recovery processes. It should equally be recognized that such changes could trigger confusion, dilemmas and paradoxes.Service providers and healthcare professionals must build partnership and collaborative working with cultural practitioners and the clergy from the Black African communities to facilitate recovery and address any misunderstandings. Introduction: Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for Black African service users (BASUs) in England. Aim: The aim of this study was to explore how religion influences recovery from mental illness for BASUs in England. Method: Twelve Black African service users were purposively selected and interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). Results: The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems. Discussion: The participants' perceptions of their mental illness experiences and recovery which are characterized by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature. Implications for practice: The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of intimate partners of people with an eating disorder. Design: Qualitative grounded theory study. Methods: In‐depth interviews were conducted with 18 partners of people with an eating disorder from 2013–2016. Data were analysed using the principles of classic grounded theory including, concurrent data collection and analysis, theoretical sampling, constant comparative analysis and memo writing. Results: Partners encounter disruptions to their lives when their significant other experiences an eating disorder. As a result, partners engage in a four‐stage cyclical process involving: encountering a disruption; becoming an informed self; countering the disruption and reclaimed livability. By engaging in this process partners learn to support their significant other, remain committed to the relationship and recover their own lives. The process is drawn together and defined as the theory of 'Reconstructing Livability'. Conclusion: The theory of 'Reconstructing Livability' provides a unique conceptualization of the experiences of partners who are living with a person with an eating disorder. It highlights the challenges faced by partners when supporting the recovery of their significant other and the intimate relationship, while reclaiming their own lives. Impact: This study addresses the dearth of knowledge and understanding of partners' experiences. Partners engage in a process to enable them support recovery of their significant other and their own lives, but this is hindered by the challenges and unmet needs they experience. The theory provides a basis on which nurses can provide effective and timely supports to partners. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: While there is no single definition of the concept of recovery for people with mental illness, hope has been recognized as a guiding principle; the belief that it is possible for a person to regain a meaningful life, despite serious mental illness.Little is known about the recovery process of women diagnosed with schizophrenia per se, with only six studies offering the woman's voice identified and these all having taken place in developed countries.No studies on this topic have been carried out in Sub‐Saharan Africa, including Swaziland. What this paper adds to existing knowledge?: This study provides unique insight into what is important to Swazi women, diagnosed with schizophrenia, in their process of their recovery.Because of current trends in migration, the findings of this study may provide mental health professionals with a better understand of the needs of those from this particular Sub‐Saharan country.The study discusses a range of issues affecting women including being labelled as mentally ill, stigma and discrimination, the importance of the sociocultural context of illness and positive attributes which promote women's recovery. What are the implications for practice?: This study provides mental health practitioners with insights and understanding of the lives of women from a Sub‐Saharan developing country. This will be helpful for better understanding of the context of mental illness both for practitioners supporting the development of services in such countries and for those working in Western countries with migrant populations. Introduction: Globally, twenty‐four million people live with schizophrenia, 90% living in developing countries. While most Western cultures recognize service user expertise within the recovery process, this is not evident in developing countries. In particular, Swazi women diagnosed with schizophrenia experience stigma from family, community and care providers, thus compromising their recovery process. Aim: This study aimed to explore the experiences and meanings of recovery for Swazi women living with schizophrenia. Methodology: Interpretive phenomenological analysis was used. Fifteen women were recruited from Swaziland National Psychiatric Hospital out‐patients' department, and face‐to‐face interviews were conducted. Findings: Four super‐ordinate themes were identified: (a) The emotionality of "illness of the brain"; (b) Pain! Living with the illness and with others; (c) She is mad just ignore her; and (d) Being better. Discussion: Discussion focuses on the findings of this study and a number of positive and negative implications emanating from them: labelling, stigma and the roles of family, culture and religious beliefs on the process of recovery. Implications for practice: This study provides practitioners with insight into the importance of the sociocultural context of the lives of women diagnosed with schizophrenia and how, in understanding this, mental health care could be improved. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore patients' lived experiences of daily life and coping with recovery after transcatheter aortic valve implantation (TAVI). Background: Transcatheter aortic valve implantation is increasingly used to treat older patients with severe aortic stenosis with high surgical risk. This novel treatment has been shown to be effective in relieving symptoms, improving survival and prognosis, but its impact on patients' daily life has been sparsely explored. Design: Qualitative design. Methods: Qualitative interviews were conducted in a purposeful sample of ten patients three‐four months after TAVI. A phenomenological hermeneutical approach comprised an epistemological stance and Ricoeur's work inspired the qualitative methodological foundation. The study adhered to the COREQ guidelines. Results: This study is illuminating patients' perception of recovery after TAVI. The patients experienced a transformation of bodily sensations, a changed bodily attention and enhanced physical possibilities to cope with life. Undergoing TAVI changed the pre‐treatment symptoms that limited daily activities, allowing the patients to resume or participate in activities that were previously impossible. TAVI gives patients the feeling that they can do more than before, which strengthens their faith in the body's possibilities and means that they can live a more self‐reliant and independent life. Conclusion: For older patients, TAVI can serve to bolster a sense of trusting their own body again. A clear distinction between pre‐ and post‐TAVI is recognised. Patients may be able to resume everyday activities following TAVI. The recovery process, however, must take into account the individual patient's own resources. Relevance to clinical practice: The impact of TAVI on daily life activities should be communicated to the patient in decision‐making. Recovery depends on the patient's own effort, why identification of the patients who need support for recovery after TAVI as well as differentiated rehabilitation is required. Walking as a parameter should be integrated in the recovery trajectory. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic.Most patients with severe mental illness receive long‐term treatment from specialized mental health services.This long‐term, highly intensive treatment is not always the best option for two reasons. Firstly, because as long as a patient receives intensive treatment aimed at safety, it is hard for that patient to take full responsibility for their own life. Secondly, because care is not available unlimitedly, some patients are waiting to receive specialist mental healthcare while others who do not need it anymore still receive it. What this paper adds to existing knowledge?: Most stable patients with severe mental illness can be treated outside of specialized mental health services.Some patients are too dependent on a specific mental healthcare professional to be referred to primary healthcare. In such instances, a referral will most likely lead to destabilization and the referral will therefore be unsuccessful.Patients preferred primary healthcare to specialized mental health services, mainly because of the absence of stigma associated with the latter.There should be more attention for personal recovery (especially the social support system) of patients with severe mental illness who are referred to primary healthcare services. What are the implications for practice?: Most stable patients with severe mental illness can be treated in primary healthcare.Professionals in primary healthcare should keep personal recovery in mind when treating patients, focusing on problem solving skills and also making use of social support systems. Aim/question: Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic. In the United Kingdom and the Netherlands, most patients with severe mental illness receive long‐term specialized mental healthcare, even when they are stable. This study aims to explore the outcome of these stable patients when they are referred to primary healthcare. Methods: Patients (N = 32) receiving specialized mental healthcare that were referred to primary healthcare were interviewed in focus groups, as were the involved professionals (N = 6). Results: 84% of the participants still received primary healthcare after 12 months. Despite the successful referral, the patient's personal recovery did not always profit. The participants of the focus groups agreed that some patients were too dependent on a specific mental healthcare professional to be referred to primary healthcare. Discussion: Most stable patients with severe mental illness can be referred to primary healthcare. Personal recovery and dependency on a specific healthcare provider should be considered when referring a patient to primary healthcare. Implications for practice: Professionals in community mental healthcare teams should consider a referral to primary mental healthcare in stable patients. Professionals in primary healthcare should keep the patient's personal recovery in mind. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. What does the paper adds to existing knowledge?: This study examines the influence of three different recovery‐oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed‐methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery‐oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced.Mainly, the illness management and recovery training created a positive change in the work attitude and some work‐related practices of mental health staff and the increased presence of a person‐centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services.Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients.Psychiatric advance directives were reported as more challenging to implement and with limited impact. What are the implications for practice?: Recovery‐oriented trainings can be internalized and implemented by staff in medical model psychiatric settings.Despite recovery‐oriented training, challenges do occur—notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses.Using multiple recovery‐oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice.Ongoing comprehensive mental health staff training on recovery‐oriented care programmes is essential in order to sustain change over time.Training is not enough in itself—hospital administrations need to be actively involved in promoting recovery‐oriented policies. Introduction: Developing person‐centred recovery‐oriented care is a challenge in mental health systems, particularly psychiatric hospitals. Aim: To assess the knowledge, attitudes and practices developed following recovery‐oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery‐oriented intervention in psychiatric wards. Method: A mixed‐methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery‐oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively analysed. Results: The quantitative outcomes partially confirmed positive changes in attitudes and some practices. Qualitative interviews complemented these findings, revealing greater use of a person‐centred approach and support for patient autonomy. However, we did not find differences between groups in quantitative outcomes pertaining to personal goals or providing individually tailored services. Discussion: This study validates the implementation of recovery training and practices in psychiatric settings, and identifies the challenges involved. We discuss psychiatric nurse conflicts in implementation in acute wards. Implications for practice: Our findings support the need for broader staff training in recovery‐oriented interventions. Recruiting the support of the hospital administration for recovery‐oriented intervention programmes is key, both ethically and structurally. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users.There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self‐determination which seems to conflict with risk management.A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. What the paper adds to existing knowledge?: The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm.Risk dominates the work of mental health professionals and undermines individualized care.Service users are subject to increased surveillance and medication as a result. What are the implications for practice?: Service users' subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users.Mental health professionals should question the centrality of risk to their practice. Introduction: The emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. Aim: To explore how practitioners, experience potential tensions arising from delivering recovery‐orientated care and enforcing containment. Method: This paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. Results: Risk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. Discussion: Hilgartner's (1992, Organizations, uncertainties and risk (pp. 39–53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practice: To undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role. [ABSTRACT FROM AUTHOR]

Accessible summary?: What is known on the subject: Analysis of co‐production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co‐production as a concept is open to multiple interpretations. Core components of co‐produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. What this paper adds to existing knowledge?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co‐production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co‐trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co‐trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. What are the implications for practice?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues’ mental health needs should be established and refined during co‐produced working. Negotiating personal disclosure and professional role identity must be explored further in both co‐production research and practice. Abstract: Introduction: Co‐production between service users and clinicians is a desirable element of recovery‐oriented practice in mental health, but the effect of co‐production on clinicians has not been explored thoroughly. Aim: To explore the meaning of co‐production for clinicians based on their experience of co‐production in a Recovery College. Method: Thematic analysis of eight semi‐structured interviews with clinicians who have co‐produced and co‐delivered workshops with a Recovery College Peer Trainer. Results: The “meaning of co‐production” had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians’ experience of co‐production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion: Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co‐produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice: Engaging in co‐produced educational workshops can alter clinicians’ perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges. [ABSTRACT FROM AUTHOR]

Aim To examine whether age contributes to functional recovery and resilience after moderate-to-severe traumatic brain injury. Background The ability to recover may change across the lifespan, but the influence of age on brain injury outcome is understudied. Design Mixed methods study. Methods All adults of working age (18-64 years) discharged from a level I trauma centre between 2010-2013 after sustaining a moderate-to-severe traumatic brain injury were considered. Functional recovery was assessed during a telephone interview with the Glasgow Outcome Scale-Extended 12-36 months postinjury. A subgroup completed the Connor-Davidson Resilience Scale and a face-to-face interview about resilience. Results Ninety-seven young (mean age: 27 years; 75% male) and 47 middle-aged brain trauma survivors (mean age: 53 years; 75% male) completed the telephone interview. Eight young and five middle-aged adults were also assessed for resilience. Overall, young participants experienced more severe head injuries. Yet, they achieved slightly higher levels of functional recovery compared with middle-aged ones as per the Glasgow Outcome Scale-Extended. Controlling for CT scan findings and posttraumatic amnesia duration, age was not found to be associated to functional recovery in adults of working age. Although both groups showed similar levels of resilience, young participants discussed the challenges related to 'having more time on their hands' and 'being a changed person', two elements perceived positively by middle-aged ones. Conclusion While age does not appear to interfere with functional recovery in adults of working age, younger brain trauma survivors could benefit from nursing interventions to strengthen their resilience process related to re-employment orientation and identity. [ABSTRACT FROM AUTHOR]

Introduction: Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim: This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods: Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion: This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice: Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to co-create of an interview schedule exploring mental health recovery in collaboration with young adult service users. Background Service user involvement in research has been increasingly recognized as providing a vital authentic insight into mental health recovery. Engagement and collaboration with service users have facilitated the exploration of inaccessible or under-investigated aspects of the lived experience of mental health recovery, not only directing the trajectory of research, but making it relevant to their own contextual experience. Design A qualitative content analysis framework was employed in the co-creation of a semi-structured interview schedule through an engagement process with service users. Methods Two separate engagement groups took place at the premises of the service user organizations, between January - February 2014. Miles and Huberman's analysis framework was chosen for this phase as it enabled the visual presentation of factors, concepts or variables and the established relationship between them. Results The lived experience of mental ill health in young adulthood and how this was understood by others was a particularly relevant theme for participants. Further themes were identified between the impact of painful experiences at this developmental life stage leading to a deeper understanding of others through finding meaning in their own mental health recovery journey. Conclusion Our findings identified that suffering painful experiences is an integral aspect in the process of mental health recovery. This understanding has particular relevance to mental health nursing practice, ensuring the care delivered is cognizant of the suffering or painful experiences that young adults are encountering. [ABSTRACT FROM AUTHOR]

Aim To explore, describe and understand former patients' experiences of recovery from self-harm. Background Previous research shows that a person's development towards a more secure self-image, mastery of their emotions, an understanding of what triggers self-harm and mastery of new ways to cope with problems are central to recovery. Recovery from self-harm is still a relatively new field of research. Design A phenomenological hermeneutical approach. Methods Eight participants were interviewed in 2013. Inclusion criteria were as follows: to have committed no self-harm during the past 2 years, to have experienced recovery and to be 18 or older. We analysed data using a phenomenological hermeneutical method. Findings The findings resulted in three themes with subthemes. The first theme, the turning point, occurred at the start of the recovery process. Participants learned to choose life, verbally express their inner pain and reconcile with their life histories. In the second theme, coping with everyday life, participants learned how to choose alternative actions instead of self-harm and attend to their basic, physical needs. In the third theme, valuing close relationships and relationships with mental health nurses, participants learned to receive support from close relationships with others and mental health nurses. A tentative model illustrates the comprehensive understanding of the recovery process, described as an individual, prolonged learning process. Conclusion To achieve recovery, persons who self-harm need guidance and knowledge of how to realize a personal learning process. More research is needed on how mental health nurses can support individual transition processes and thereby facilitate recovery. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject The introduction of PSWs within mental health services has grown substantially both internationally and locally; however, no recognized studies have focused on the evolvement of this role within a Northern Ireland ( NI) context., Research is increasingly focusing on service users' and PSWs perspectives on mental health service provision. Despite this, few studies exist which exclusively report staff views in relation to the PSW role., What the paper adds to existing knowledge Results of the current study identified varying perspectives on the peer role. Some participants believed that the PSW role was tokenistic; others opposed these views, highlighting the value of this role. Clearly defined job descriptions and the importance of ensuring the PSW is a cohesive part of the team and not an 'add on,' was identified as imperative to avoid tokenistic practice., Provision of a flexible working environment, both sensitive and responsive to the peers' own mental health needs, was identified as significant in order for the peer to fulfil their role successfully., Implications for practice Services introducing PSWs within teams should engage with nursing staff at all organizational levels in the role development process to minimize the risk of tokenism, for example, the PSW role not integrated or valued within teams., Clearly defined job/role specifications for PSWs should be devised to ensure that both the PSW and the mental health nursing team have a shared understanding regarding this role., Abstract Aim Peer support worker ( PSW) roles are gaining recognition internationally as a valuable component in mental health service delivery. The aim of this study was to explore the views of mental health voluntary sector staff regarding the emergence of this role. Method A qualitative research design was used. A purposive sample was employed. Semi-structured interviews were undertaken with 10 staff members in various positions in two voluntary mental health organizations. Interview transcripts were analysed thematically. Results Views varied on the PSW role with some participants stating that it was tokenistic, whereas others highlighted the value of its contribution. Participants' expressed concerns regarding professional boundaries and organizational cultural challenges that PSWs may encounter in their role. The provision of reasonable adjustments was recommended as an integral support mechanism. Conclusion Successful integration of the PSW requires careful consideration of the role, the workplace environment and the unique needs of the peer, to prevent the role becoming constrained and diluted. Implications for practice The PSW role may impact the traditional delivery of mental health nursing services. It is therefore essential that nurses are cognizant of these potential challenges to successfully facilitate the integration of PSWs in practice. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Around the world, recovery has become a focus in mental health policy. The participation of people accessing mental health services (consumers) and carers of such individuals in decision-making related to services forms part of this recovery orientation and studies suggest positive outcomes following such participation., However, little is known about consumer and carer desires at the earliest stages of development of new services., What this paper adds to existing knowledge? Consumers and carers desire changes to how mental health services are provided., Many factors affect consumer and carer experiences, including language use, physical design of spaces, accessibility, consideration of individual needs, practical help and how well care is continued from hospital to community settings., Carers may feel sidelined in treatment and be distressed as a result. They wish to be respected and involved in recovery., Consumers and carers wish for focus on broader health, with care taken to address physical health, psychological needs, social needs and treatment of the whole person rather than just an illness., What are the implications for practice? Consumers and carers desire partnership with professionals in recovery. Tokenistic participation should be avoided., Flexibility in how services are provided and less formality may help engage consumers and carers. Specifically, professionals may help by linking consumers and carers to services that address practical needs., Professionals should communicate with carers to draw on their expertise about the individual accessing the mental health service and help carers understand how they can assist the individual's recovery., Abstract Introduction Recovery-oriented mental health policies recognize consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. Aim This study sought consumer and carer perspectives addressing the establishment of a mental health research, treatment and teaching facility in their region. Methods Two 2-hr focus groups were conducted, with separate groups held for mental health consumers ( n = 9) and carers ( n = 9), respectively. Discussions pertained to mental health literacy, gaps in current services, desires for an ideal facility (in terms of physical design and services offered) and what would help in recovery. Results Inductive thematic analysis was used to generate three themes: care outside of consultations, carer involvement in recovery and holistic approaches to mental health care. Consumers desired a facility that could cater to individual needs. Carers felt excluded in recovery and unable to provide effective support. Both groups preferred holistic approaches to mental health, expressing ambivalence towards medication and hospitalization. Discussion Consumers and carers have many needs that conventional practices may not meet. Implications for practice They have clear desires for equal partnership in recovery and for transformation of conventional treatment methods. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? This paper describes crisis resolution/home treatment (CRHT) teams, which are part of mental health services in the United Kingdom. CRHT is expected to assist individuals in building resilience and work within a recovery approach., What this paper adds to existing knowledge? This paper arises from an interview with one individual, Dale, as part of a larger study exploring service users' experiences of CRHT. It adds to the body of narrative knowledge in CRHT through Dale's co-authorship of this paper, reflecting on his original interview 4 years later, with co-authors providing critical interpretation of his experience, in turn supported by cognate literature., What are the implications for practice? Implications for practice are considered, themselves mediated through Dale's own descriptions of how CRHT interventions impacted upon him. These impacts are analysed with respect to three themes: Resilience, Recovery and Power., It is centrally contended that clinicians need to more clearly comprehend three core matters. First, what resilience 'is' for service users as well as the complex process through which these individuals move in developing resilience. Second, the distinction that service users might make between 'recovery' and 'functionality', and how this in turn can impact on individuals both in personal and socioeconomic sense. Finally, the mechanics of power within CRHT contexts and how these interpersonal dynamics can affect the relationship between service user and clinician in practice., Abstract Introduction and Aim The central purpose of this paper, part of a larger study exploring the experiences of Service Users (SUs) with CRHT, is to emphasise the importance of the SU voice itself within the domain. Following an interrogation of the historical contexts of CRHT. Method This paper uses interpretative phenomological approach around detailed thematic examination of an extended, semi-structured with a single SU: Dale. Moreover, four years after the interview was originally conducted, Dale was himself invited to reflect upon, and critically re-evaluate, his initial participation as a co-author of this paper. In this way, a genuinely participant-centred narrative on experiences with CRHT could be generated. Implications for Practice This resulted in Dale describing what 'crisis' meant to him, and his personal journey within that crisis. Although framing some experiences as negative, he primarily argues that the CRHT team was very personable, affirming his personal values and beliefs, and encouraging him to use coping skills that he had utilised effectively in prior periods of crisis. Analysis highlights three major themes permeating Dale's narrative: Resilience, Recovery and Power. It is contended that this analysis begins to demonstrate implications for practice and highlight that (and how) CRHT clinicians might more clearly engage with what resilience 'is' for SUs, and also the complex process through which these individuals move in developing it. Equally, it is proposed that practitioners should be mindful of the distinction that SUs might make between 'recovery' and 'functionality', and how this in turn can impact on individuals both in personal and socio-economic sense. Finally, the mechanics of power within CRHT contexts are foregrounded, and how these interpersonal dynamics can affect the working relationship between SU and clinician. [ABSTRACT FROM AUTHOR]

Aims To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation. Background Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging, but evidence on the long-term recovery process is very limited, especially following heart valve surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. Design A qualitative study with serial interviews analysed using narrative methods. Methods We collected data over 18 months (April 2013-October 2014). We recruited nine patients undergoing heart valve surgery from a randomized trial, CopenHeart VR and conducted 27 individual narrative interviews at 2-3 weeks, 3-4 months and 8-9 months after surgery. Findings Following heart valve surgery, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality - being in a limbo and becoming a heart patient. These deviating pathways were characterized by physical, existential and mental challenges even up to 9 months after surgery. Conclusion The recovery processes of participants' in cardiac rehabilitation were often more complicated than anticipated. Patients undergoing heart valve surgery may benefit from more extensive medical follow-up immediately after discharge, individual psychological assessment and individualized, realistic information about the recovery trajectory. [ABSTRACT FROM AUTHOR]

Aims and objective. The aim of this study was to describe and interpret the essential meaning of the lived experiences of being in a critical illness-recovery process after a life-threatening condition. Background. The critical illness-recovery process after a life-threatening condition takes several years and does not only include patients' experiences during intensive care. Previous research has mainly focused on what critically ill patients recall. However, from a phenomenological point of view, experiences are more than memories alone. To plan and perform relevant health care and social support for patients who have survived a life-threatening condition, a more profound understanding about their lived experiences is needed. Design and method. In this qualitative study, a phenomenological hermeneutical approach was used. Interviews were conducted with seven patients, two to four years after they had received care in an intensive care unit in Sweden. Results. The comprehensive understanding of the results shows that the critical illness-recovery process after a life-threatening condition means an existential struggle to reconcile with an unfamiliar body and with ordinary life. This can be understood as an 'unhomelikeness' implying a struggle to create meaning and coherence from scary and fragmented memories. The previous life projects, such as work and social life become unfamiliar when the patient's fragile and weak body is disobedient and brings on altered sensations. Conclusions. Patients who survive a life-threatening condition have an immense need for care and support during the entire critical illness-recovery process, and also after the initial acute phase. They need a coherent understanding of what happened, and support to be able to perform their changed life projects. Relevance to clinical practice. Supporting and caring for patients' recovery from a life- threatening condition involves recognising the patients' struggle and responding to their existential concerns. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge., Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service., What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital., While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision., What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices., The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms., Abstract Introduction Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users. Aim The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital. Method This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users. Results The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital. Implications for Practice This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged. [ABSTRACT FROM AUTHOR]

Aim To explore the challenges and caring activities of spouses of intensive care unit survivors during the first year of patient recovery. Background Every year, millions of people globally are discharged from an intensive care unit after critical illness to continue treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. Consequently, millions of spouses become informal caregivers. Little is known, however, about the concrete challenges spouses face in post-intensive care unit everyday life. Design Explorative, qualitative grounded theory study. Methods Participants were spouses of intensive care unit survivors. The study was undertaken in Denmark in 2009-2010. Data consisted of 35 semi-structured dyad interviews at 3 and 12 months post-intensive care unit discharge, two group interviews with patients and two with spouses. Findings 'Shifting their role from spouse to caregiver and back' was identified as the core category of the study. The role shifts progressed in a dynamic process involving four elements: (1) committing to caregiving; (2) acquiring caregiving skills; (3) negotiating level of caregiving and (4) gradually leaving the caregiver role. Post- ICU caregiving comprised five patient dimensions: observing, assisting, coaching, advocating and managing activities. Conclusions Spouses play a vital and multifaceted role in post-intensive care unit recovery. The findings can inform healthcare professionals in their efforts to prepare intensive care unit patients' families for the time following intensive care unit and hospital discharge. Hospital staff, rehabilitation experts and primary care professionals must acknowledge spouses' important contribution from intensive care unit admission throughout recovery. [ABSTRACT FROM AUTHOR]

Aim To describe experiences of recovery from bulimia nervosa among young adult women. Background Most studies into recovery from eating disorders focus on anorexia nervosa, although some include both anorexia and bulimia nervosa. Recovery has been described as beginning with renewed self-esteem. Design Qualitative interview study. Methods Fourteen women were invited to participate; five women, between 23-26 years of age, who assessed themselves as healthy for at least 2 years agreed to take part in narrative interviews. Tape-recorded interviews lasting 45-60 minutes (median 49 minutes) were conducted from February-April 2010 and transcribed verbatim. Data were analysed using qualitative content analysis. Findings The interviews revealed four themes in recovery from bulimia nervosa: feeling stuck in bulimia nervosa, getting ready to change, breaking free of bulimia nervosa and grasping a new reality, each comprising two or more subthemes. The process of recovery was not linear, but rather went back and forth between progress and relapse. The women expressed strong ambivalence about leaving the illness behind. An important part of their recovery was their ability to accept themselves. It was essential for their recovery to be supported in developing a unique explanation of the cause of their illness. Conclusion Women's ability to recover from bulimia nervosa and take control over their lives is based on their self-efficacy. Effective care should therefore strive to strengthen women's beliefs in their own abilities, to instil hope for recovery and thus to bolster their self-efficacy. [ABSTRACT FROM AUTHOR]

Aim To explore the narratives created by non-injured family members in relation to themselves and their family in the first year after head injury. Background A head injury is a potentially devastating injury. The family responds to this injury by supporting the individual and their recovery. While the perspective of individual family members has been well documented, there is growing interest in how the family as a whole makes sense of their experiences and how these experiences change over time. Design Longitudinal narrative case study using unstructured in-depth interviews. Methods Data were collected during an 18-month period (August 2009-December 2010). Nine non-injured family members from three families were recruited from an acute neurosurgical ward and individual narrative interviews were held at one, three and 12 months postinjury where participants were asked to talk about their experience of head injury. Analysis was completed on three levels: the individual; the family and between family cases with the aim of identifying a range of interwoven narrative threads. Findings Five interwoven narratives were identified: trauma, recovery, autobiographical, suffering and family. The narrative approach emphasized that the year posthead injury was a turbulent time for families, who were active agents in the process of change. Conclusion This study has shown the importance of listening to people's stories and understanding their journeys irrespective of the injured person's outcome. Change postinjury is not limited to the injured person: family members need help to understand that they too are changing as a result of their experiences. [ABSTRACT FROM AUTHOR]

Aim To explore how masculinities shape the experiences of men and their partners after survival from out-of-hospital cardiac arrest. Background Survivors of out-of-hospital cardiac arrest report depression, dependence on others for daily functioning, decreased participation in society and significant decreases in quality of life. There is growing evidence that masculine gender identities play a central role in the recovery experiences of men and their families following other major cardiac events. However, to date, there has been no examination of how masculinities shape men's experiences of recovery following out-of-hospital cardiac arrest. Design Interview study guided by an interpretive description approach. Data were subjected to thematic analysis. Method A purposive sample of seven male sudden cardiac arrest survivors and 6 female partners was recruited in 2010 from a secondary care centre in British Columbia, Canada. Results Three themes were prominent in the experiences of the participants: (1) Support and self-reliance; (2) Dealing with emotional (in) vulnerability; and (3) No longer a 'He-man'. Conclusion Masculinities played a role in men's experiences of recovery and adaptation following out-of-hospital cardiac arrest. Hegemonic masculinity partly explained men's experiences, notably their reluctance to seek professional support and reactions to changes in lifestyle. However, the study also suggests that the popular stereotype of men being 'strong and silent' in the face of ill-health may only be a part of a more complex story. Nurses would benefit from taking into consideration the potential influence of male gender identities on men's recovery postcardiac arrest. [ABSTRACT FROM AUTHOR]

Aim To determine the effectiveness of a peer-led self-management programme for people with schizophrenia in reducing psychotic symptom severity, hospital readmission and psychiatric consultation and in enhancing cognition, empowerment, functioning level, medication adherence, perceived recovery, quality of life and social support. Background Several self-management programmes have been developed to empower patients with severe mental illness in achieving recovery. Research suggests that peer-led self-management programmes have positive effects on patient recovery. However, the existing evidence is inconclusive, due to a lack of credible evidence and long-term follow-up evaluations. Design A stratified randomized controlled trial will be conducted at six community mental health rehabilitation centres Methods A sample of 242 adults with schizophrenia will be recruited. A peer-led self-management programme, comprising six 2-hour sessions, will be implemented in the intervention group and a standard rehabilitation programme in the control group. Outcomes will be measured at baseline, postintervention and at the 6- and 12-month follow-ups. The measures will include cognition, empowerment, functioning level, medication adherence, perceived recovery, quality of life, social support, symptom severity, hospital readmission and psychiatric consultation. A mixed effects model will be used to analyse the results. Semi-structured interviews will be conducted to explore the peer-trainers' and participants' perspectives on the programme. Research Ethics Committee approval was obtained in December 2011 and funding was obtained in January 2012. Conclusion This study will provide evidence on the effectiveness of a peer-led self-management programme for patient recovery. It will identify a clinically useful and potentially effective intervention that incorporates empowerment concept. [ABSTRACT FROM AUTHOR]

Accessible summary Adopting a model of personally meaningful recovery places demands on the therapeutic relationship, on clinical governance and supervision of clinicians., The recovery journey from childhood sexual abuse ( CSA) starts at the point of disclosure., Findings support the use of shame-based and compassion-focused interventions with CSA survivors., Abstract Research on survivors' experiences of recovering from childhood sexual abuse ( CSA) has been limited and focused on those with severe mental health difficulties. This study elicited experiences of recovery from CSA in male and female survivors who have/have not utilized mental health services. The tangible end-point was to propose a theoretical model of personally meaningful recovery. This is a qualitative study, which utilized semi-structured individual interviews following the critical incident technique. Transcripts were analysed using Interpretative Phenomenological Analysis to identify recurrent themes. A total 22 adult survivors of CSA. Main themes identified were: The Affected Self, Factors Hindering Recovery, Factors Enhancing Recovery, The Hurdles of Recovery and the Recovering Self. The affected self included: lack of boundary awareness and self-blame, over self-reliance, over-vigilance and guilt, shame, aloneness and social stigma. The recovering self was characterized by increasing confidence, assertiveness, ability to self-care and self-acceptance, and by embracing vulnerability. These findings have potentially major implications for clinical practice, service provision, policy development and professional training in this field. The importance of disclosure in the healing process seemed paramount and can have major implications for current service protocols. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify and describe patients' experiences of a preoperative information session with a nurse, as part of the enhanced recovery after surgery ( ERAS) concept, and its impact on patient participation in their own care. Background Enhanced recovery after surgery is a standardised, multimodal treatment programme for elective colorectal surgery, leading to faster recovery and shorter hospital stays via interprofessional collaboration. The ERAS concept is initiated for patients a week before surgery when the patient receives detailed information about the care process during a meeting with a nurse. Design The study is a qualitative interpretive study based on interviews. Methods Twelve patients, nine men and three women, were interviewed. The interviews were transcribed verbatim and analysed using interpretive phenomenological analysis ( IPA). Results The analysis identified and formulated five themes: being seen, security, trust, responsibility and participation. All themes are closely related and illustrate positive and negative sides of the patient's experience. They hang together and form a complete set of experiences: ERAS conversation and its impact on patients' participation. Conclusions The results show that patients feel confirmed in the ERAS conversation. Healthcare professionals need to be bonding more information call during hospitalisation. It is important to confirm the patient in order for them to participate and take responsibility. Reliance on caregivers is important for patients to feel safe and to participate in their own care. This study shows that the ERAS conversation was experienced as being structured and individually tailored, but the information must apply to the patients throughout the period of care. Relevance to clinical practice Some shortcomings have been revealed, which should enable improvement in the care of patients. Healthcare professionals need to raise awareness of patients' responsibilities for participation in their own recovery and care. Healthcare professionals and patients need to be aware of each other's responsibilities. [ABSTRACT FROM AUTHOR]

To describe and interpret couples' thoughts and expectations about their future life after the patient's discharge following acute myocardial infarction. An acute myocardial infarction is a challenge for both the patient and his/her partner, as it can disrupt family functioning and dynamics. Earlier research has generally focused on either the patient or the partner, and few studies have explored the experiences of the couple. Qualitative descriptive and interpretative. Fifteen couples took part in individual interviews, 4-8 weeks after discharge. Data were analysed in two phases using qualitative content analysis. The first phase of the analysis revealed two categories: 'an active approach to the future' and 'a wait-and-see approach to the future' , both of which described the participants' thoughts about the future. In the second phase, the couples' stories were interpreted and grouped into four positions: 'the life companions', 'the tightrope walkers', 'the pathfinders' and 'the observers' , which illustrated their visions of the future. Our results reveal differences in the couples' thoughts about and expectations of their future life, most of them managed the situation by having a positive attitude to life and their future. The couples discovered their resources and compensated for or balanced each other in the early recovery period. The results indicate the importance of giving both partners the opportunity to express their views of the situation, as this increases nurses' understanding of the impact of the illness on their life and relationship. However, the results also highlight the significance of seeing the couple and showing them consideration both as individuals and as a unit. [ABSTRACT FROM AUTHOR]