Inger Beate Larsen

Background:Fear and aggression are often reported among professionals working in locked psychiatric wards and also among the patients in the same wards. Such situations often lead to coercive intervention. In order to prevent coercion, we need to understand what happens in dangerous situations and how patients and professionals interpret them.Research questions:What happens when dangerous situations occur in a ward? How do professionals and patients interpret these situations and what is ethically at stake?Research design:Participant observation and interviews.Participants:A total of 12 patients and 22 professionals participated.Ethical considerations:This study has been accepted by the Regional Committee for Medical and Health Research Ethics in Norway.Findings:(a) Both atmosphere and material surroundings were interweaved within dangerous situations, (b) the professionals applied stereotypes when interpreting dangerous situations and (c) the professionals and the patients had different interpretations of what triggered dangerous situations.Discussion:The discussion centres on how care ethics and a dialogical practice might contribute towards combating difficult situations and the ways in which change is an ongoing ethical process of becoming.Conclusion:The ethics of care and a dialogical approach are suggested as ethical frameworks for preventing fear, danger and aggression in psychiatric wards. Both frameworks can be understood as patient-driven, including the relational and contextual perspectives. It means a shift from professionally driven processes to patient-driven dialogue.

Background:Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field.Objectives:This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis.Research design:We used qualitative content analysis.Ethical considerations:The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required.Findings:The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person.Discussion and conclusion:Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness.