Patients' core experiences of hospital treatment: Wholeness and self-worth in time and space

Abstract

Introduction: Few studies have addressed staff and patient experiences of the therapeutic milieus at psychiatric institutions from a learning perspective. The purpose of this study was to gain more knowledge about the meaning and value the psychiatric institution may have as a place for learning in time and space for patients with various mental disorders, and how the staff may contribute in the learning processes of the patients. We were especially interested in studying patients' experiences by taking part in their own learning processes together with others. We wanted to study the meaning this might have for them, and how the staff and the surrounding culture, context and the place might promote or obstruct learning to take place. Material and methods:In this thesis data are gathered from two different institutions. In the first part data were gathered from an open psychiatric institution. Fifteen qualitative interviews with patients with nonpsychotic mental disorders were conducted shortly before discharge, and 14 of these were reinterviewed after discharge. The other institution was a closed ward at a district psychiatric center for patients with dual diagnosis. Qualitative interviews with 20 patients and 24 staff were conducted, and nine of the staff was reinterviewed 12 months later. The study has a qualitative explorative and descriptive design with a hermeneutic-phenomenological approach, and is theoretically anchored in the learning model of Illeris (2012). This model views learning as situated, meaning that it takes place in a social and societal context, and a sociocultural understanding is emphasized. Results:The results from the four papers are condensed and discussed in five main themes; Environment (healing environment), Learning climate as a source of motivation, Insight and mastery through knowledge and experiences, Collaborative learning, and Tensions in the learning climate (barriers against learning).The surroundings-world (the physical and aesthetical aspects of the surroundings) is healing environments and give patients experiences of wholeness and self-worth. This is experienced through the atmosphere of the place and the meeting with the staff, who acknowledge them as equal human beings. The learning climate at the institution, comprising the attitudes, friendliness, engagement, professionalism, structure and flexibility from the staff, and ability for patients to take achieve part in their own treatment, motivates learning to take place and be maintained. Therapeutic methods, like cognitive therapy, physical exercise, group activities and education contribute to provide tools in the learning process for patients and staff. Sufficient time enables personal learning and acquisition of new knowledge.Physical exercise provides useful experiential knowledge and is a self-help method. It seemed especially useful for those struggling with learning the cognitive method. Appreciating relations from staff are important for motivation, learning and mastery. Fellow patients have an important role in...

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