"Being good or evil": Applying a common staff approach when caring for patients with psychiatric disease

To do good might hurt bad: Exploring nurses' understanding and approach to suffering in forensic psychiatric settings

“…The structural analysis contributed a more explanatory view by highlighting that differences were manifested not only in different opinions but also in different ways of relating to the suffering person. Therefore, literature focusing on a common staff approach (Enarsson et al 2007(Enarsson et al , 2008, different forms of presence (Fredriksson 1999) and caring conversations as a means to alleviate suffering (Fredriksson & Eriksson 2001 provides the theoretical basis for critical reflection.…”

“…If this is predominant in the caring culture, nurses who acknowledge that the patient is suffering are challenged to either approach the suffering from the standpoint of the patient or relinquish his/her own abilities to alleviate it and adjust to the system. The latter could be understood as a lack of autonomy, as the nurse tends to adjust to the demands of the culture rather than focusing on patients' individual needs (Fredriksson & Eriksson 2003, Enarsson et al 2008). …”

“…This may be controversial and give rise to conflicts among peers, as it could mean that they exceed the cultural norms. If discordance appears amongst colleagues regarding how to understand and alleviate patients' suffering, a nurse can experience insecurity and ethical conflicts, torn between longing for security and unity with his/her fellow nurses and advocacy for the patients (Enarsson et al 2008). Thus, it is not only patients who are struggling with suffering; nurses, too, are involved in a struggle, in which they can feel forced to take sides with their colleagues or advocate for the patients' perspective.…”

Self-managed programmes in homeless care as (reinvented) institutions

“…Self-managed homeless care is a form of self-organized care, which is associated with individual and collective empowerment (Brown, 2012). An institutional context appears to influence selfmanagement (Huber et al, n.d.), in line with the influence of the institutional context in regular institutional care (Abma, 2010;Enarsson, Sandman, & Hellzén, 2008;Wolins & Wozner, 1982). Goffman described care institutions or total institutions as: "a place [… .]…”

“…Especially when roles are unclear, changing or conflicted, (creating) structure can offer control and certainty (DiMaggio & Powell, 1983;Giddens, 1984;Kruiter, De Jong, Van Niel, & Hijzen, 2008). Stress, ambiguity and insecurity are inherent in the work of staff in institutional care, they are simultaneously responsible for individuals, a group and order while their clients combine complex personal problems with negative coping strategies and negative experiences with care (Enarsson et al, 2008;Goffman, 1961;Keigher, 1992). Staff and clients can get stuck in vicious circles of distrust; negative behaviour results in rule enforcement, leading to more negative behaviour and a growing divide between staff and residents (Goffman, 1961;Van Der Helm & Schaftenaar, 2014;Wolins & Wozner, 1982).…”