The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvemen work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.

Objective. The present study will contribute to knowledge of how practitioners in a healthcare region engage in quality improvement initiatives. The focus is on individual placement needs, problems/issues and the ability to organize work on the development, implementation and institutionalization of ideas for the healthcare sector.

Design and settings. This study is based on the Kalmar county council Improvement Program. Healthcare departments and primary healthcare centers in the county council were invited to apply for money to accomplish improvement projects. The aim is to empirically identify and present the different kinds of practice-based improvement ideas developed in healthcare services. The 202 applications received from various healthcare departments and primary healthcare centers are analyzed using qualitative content analysis.

Outcome and Results. Five types of improvement projects were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. In addition, a common characteristic among the studied project applications is to increase patient safety, effectiveness and availability of care, and education/training. Those intentions are found in many of the applications and therefore give the impression of being most important to caregivers today.

Conclusions. These projects point to the various problems and experiences healthcare professionals encounter in their day-to-day work. This paper provides valuable insights into the current state of improvement work in Swedish healthcare, and will serve as a foundation for further investigations in this quality program.

Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables.

Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council.

Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP.

Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments.

Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings.

Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.

BACKGROUND:

Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare.

METHODS:

A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted.

RESULTS:

The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach's alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach's alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work.

CONCLUSIONS:

The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.

The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorisation of the projects' intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.

There is an increased interest in exploring the use of sensory rooms in psychiatric inpatient care. Sensory rooms can provide stimulation via sight, smell, hearing, touch and taste in a demand-free environment that is controlled by the patient. The rooms may reduce patients' distress and agitation, as well as rates of seclusion and restraint. Successful implementation of sensory rooms is influenced by the attitudes and approach of staff. This paper presents a study of the experiences of 126 staff members who worked with sensory rooms in a Swedish inpatient psychiatry setting. A cross-sectional descriptive survey design was used. Data were collected by a web based self-report 12-item questionnaire that included both open- and closed-ended questions. Our findings strengthen the results of previous research in this area in many ways. Content analyses revealed three main categories: hopes and concerns, focusing on patients' self-care, and the room as a sanctuary. Although staff initially described both negative and positive expectations of sensory rooms, after working with the rooms, there was a strong emphasis on more positive experiences, such as letting go of control and observing an increase in patients' self-confidence, emotional self-care and well-being. Our findings support the important principals of person-centred nursing and recovery-oriented mental health and the ability of staff to implement these principles by working with sensory rooms.

Purpose: Emotional instability and self-harm pose major problems for society and health care. There are effective interventions in outpatient care, but when patients need inpatient care, nurses often struggle meeting their patient’s needs. Brief admission (BA) is a newly implemented crisis intervention and novel form of inpatient care. The aim of this study is to describe nurses’ experiences working with BA related to patients with emotional instability and self-harm.

Methods: Eight nurses were interviewed according to a semi-structured interview guide. The data was analysed using qualitative content analysis.

Results: Four main categories emerged regarding nurses’ experiences with BA: provides security and continuity, fosters caring relationships, shifts focus towards patient’s health and empowers the patient. The nurse’s role shifted from “handling problems” to establishing caring relationships with a focus on the person’s health and possibilities for recovering instead of psychiatric symptoms.

Conclusions: Previous studies on patients’ perspective of BA describe positive experiences such as increased autonomy and participation in the healthcare process. This study supports those findings, albeit from the perspective of nurses. Our findings suggest that BA may reduce work-related stress experienced by nurses while caring for persons with emotional instability and self-harm. BA may also support nurses in their ability to provide more meaningful and constructive psychiatric inpatient care.

Previous studies report that individuals diagnosed with borderline personality disorder have been met by negative attitudes from healthcare professionals and their care needs have often been neglected during hospitalizations. When symptoms of emotional instability are combined with self-harm, the resulting crisis often becomes difficult to handle for patients and healthcare professionals. To meet their care needs during these crises, an intervention called 'brief admission' (BA) has been developed. The purpose of BA is to provide a timeout, in situations of increased stress and threat, in order to foster self-management in a safe environment. In the present study, we explored the following research questions: What are patients' experiences with BA? What do patients consider to be the key components of BA? What improvements are considered relevant by patients? A qualitative design was employed, and 15 patients (13 females, 2 males; mean age 38.5 ± 12.9, range 20-67 years) were interviewed using a semi-structured interview guide. Thematic analyses were performed, which yielded four themes related to the patients' experiences: 'a timeout when life is tough', 'it is comforting to know that help exists', 'encouraged to take personal responsibility', and 'it is helpful to see the problems from a different perspective'. Four themes also described the key components: 'a clear treatment plan', 'a smooth admission procedure', 'a friendly and welcoming approach from the staff', and 'daily conversations'. Lastly, three themes described areas for improvements: 'feeling guilty about seeking BA', 'room occupancy issues', and 'differences in staff's competence'. Collectively, the findings indicate that BA constructively supports patients with emotional instability and self-harm during a period of crisis.

Aim: The aim was to describe significant others’ experiences of dialectical behaviour therapy- family skills training (DBT-FST), their life situation before and after DBT-FST, and measurement of their levels of anxiety and depressive symptoms. Methods: The study had a descriptive mixed method design. Data were collected with free text questionnaires (n= 44), group interviews (n= 53) and the HAD scale (n= 52) and analysed by qualitative content analysis and descriptive and inferential statistics. Results: The results show that life before DBT-FST was a struggle. DBT-FST gave hope for the future and provided strategies, helpful in daily life. For the subgroup without symptoms of anxiety and depression before DBT-FST, anxiety increased significantly. For the subgroup with symptoms of anxiety and depression the symptoms decreased significantly. This indicates, despite increased anxiety for one group, that DBT-FST is a beneficial intervention and most beneficial for those with the highest anxiety- and depressive symptoms.

Aim

The aim of this study was to describe significant others' experiences of living close to a person with borderline personality disorder and their experience of encounter with psychiatric care.

Methods

Data were collected by free-text questionnaires and group interviews and were analyzed by qualitative content analysis.

Results and Conclusion

The results revealed four categories: a life tiptoeing; powerlessness, guilt, and lifelong grief; feeling left out and abandoned; and lost trust. The first two categories describe the experience of living close to a person with BPD, and the last two categories describe encounter with psychiatric care.

The use of sensory rooms and similar sensory approaches in psychiatric inpatient settings is becoming increasingly common. In sensory rooms, patients can choose different sensory stimulating items that may help regulate distress and enhance well-being. Outcomes are often measured as effects on patients' self-rated distress and rates of seclusion and restraint. The subjective experiences of patients using sensory rooms have been less explored. This paper presents a qualitative study of the experiences of 28 patients who chose to use sensory rooms on seven different types of psychiatric inpatient wards. Data were collected by individual patient interviews and by texts written by patients. A qualitative content analysis resulted in four categories: emotional calm, bodily calm, empowerment, and unexpected effects. A majority of the participants described several positive experiences, such as enhanced well-being, reduced anxiety, increased self-management, and enhanced self-esteem. Our findings align with previous research that has shown similar positive patient experiences, and support the use of sensory rooms as part of person-centred care.

The aim of this paper was to investigate the feasibility and impact of dialectical behaviour therapy (DBT) for patients with borderline personality disorder (BPD) in a clinical outpatient setting. Eighteen clinicians were trained and supervised in using DBT. Twenty-seven female patients were assessed on a number of variables before the treatment, as well as 5 and 12 months after the start of the DBT. Despite some barriers, DBT could be implemented successfully, and the professionals reported increased competence 1 year after the start of the therapy. Low treatment dropout rates suggested that DBT was well accepted by the patients. One year after the start of treatment, the patients reported significant decrease on most variables measuring psychological distress and number of parasuicidal behaviours. The study provides preliminary support for the feasibility and impact of DBT in the outpatient treatment of BPD in a cultural setting outside the United States.

Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

OBJECTIVE: Lengthy sick leave makes demands on work ability enhancing interventions in primary health care. Problem-based method (PBM) and cognitive behavioural therapy (CBT) are interventions aimed at people with common mental disorders. This study aimed to describe how individuals experienced interventions and the impact the interventions had on the individuals' ability to work and perform other everyday activities.

METHOD: Fourteen women and two men, eight each from two interventions, were interviewed. The interviews were analysed using qualitative content analysis.

RESULTS: The analysis revealed one overarching theme: "Reaching safe ground or continuing to seek help". Four categories were identified: "From being passive to making one's own efforts in the rehabilitation process", "Being stuck on a treadmill or daring to change", "Evolving from routine to more aware behaviour", and "Fitting in or not fitting in with workplace situations".

CONCLUSIONS: According to the participants, experiences from both PBM and CBT had a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. In general, the results support the use of active coping-developing interventions rather than passive treatments.

Healthcare-associated infections are the most frequent adverse event in healthcare delivery worldwide. The theory of planned behavior has proven helpful in hospital hygiene interventions and might be useful in community care. This study explored how medically-responsible nurses in Swedish community care perceived and ranked the impact of factors related to the theory of planned behavior, the factors" probability to change, enhancing the healthcare staff's adherence to infection control guidelines, and identified which theory of planned behavior subquestions should be focused on to enhance adherence to infection control. Medically-responsible nurses (n = 268) in Swedish communities answered a Web-based questionnaire regarding impact and probability to change theory of planned behavior factors in relation to infection control. Four theory of planned behavior factor constructs were found: (i) knowledge and encouragement from management; (ii) access and availability to materials and equipment, and interest among staff; (iii) influence by colleagues; and (iv) workload, and influence by patients and significant others. The theory of planned behavior factors are relevant for infection control in a home-like environment, and findings could be used as a basis for interventions enhancing hygiene in community care.

Aims and objectives:  The aim of the study was to describe factors influencing compliance to hygiene routines in community care in Swedish municipalities from the perspective of medically responsible nurses (MRN).

Method:  A web-based questionnaire was sent to all MRNs in Swedish municipalities, N = 268. Beside demographical background data, the questionnaire contained two core open-ended questions generating free text data. Data were analysed with descriptive statistics and qualitative content analysis.

Result:  Four categories of factors were found: resources, management, staff and external factors. All four categories contained subcategories.

Conclusion:  To some extent, the challenges to uphold adequate compliance to hygiene routines seem different in community care than in hospitals. Resources regarding equipment and supplies seem as an uncertain asset and uneven distributed among municipalities. Home likeness was seen as a major obstacle for upholding adequate hygiene routines. To uphold sufficient hygiene routines in a person’s home or in a home-like environment might be one of the major challenges for community health care in the future. The MRN’s narratives suggest that Registered Nurses have a key role in upholding sufficient hygiene in community care. This report might contribute in providing them with more knowledge to take on this urgent task.

The aim of the present study was to describe patients’ and health professionals’ experiences of a multidisciplinary stress-focused clinical evaluation with prolonged engagement as an intervention for patients with long-term orofacial pain. Data in the patient part of this study were collected by free-text questionnaires using open-ended questions. Data were collected by group interview in the part of the study concerning health professionals. All data were analyzed according to qualitative content analysis. Data from patients revealed three categories for the intervention, ie, “helpful for most and crucial for some”, “being listened to, respected and validated”, and “gives important coping strategies”. The results showed that a vast majority of patients described themselves as having been helped by the intervention. Some patients reported that meeting with the orofacial pain consultant team was crucial to the future course of their lives. Most patients described still having residual pain and symptoms, and only a few described their pain as being fully remitted. However, because of the intervention, the patients reported being able to adopt more constructive coping strategies. They also described their perception of the pain as being different, in that it was not so frightening once they had been given a model with which to understand it. Data from the health professionals revealed similar categories. Concordance between the patients' and health professionals' experiences was striking. In their descriptions, the health professionals and patients underscored the same components as being effective, with understanding, respect, and validation being the most important. The multidisciplinary approach was highlighted as being key to success by both the patients and health professionals.

The aims of the present thesis were: * To investigate how women patients with borderline personality disorder (BPD) perceive their suffering, quality of life and encounter with psychiatric care (paper 11 and III). * To describe BPD patients' and psychiatric professionals' perceptions of receiving and giving dialectical behavioural therapy, DBT (paper I). * To investigate how starting treatment of BPD patients with DBT affected the psychiatric professionals' experience of occupational stress and professional burnout (paper IV) Due to the different types of research questions the thesis deal with, it uses a mix of qualitative and quantitative research methods. In two of the studies (11 and 111) the main methods were qualitative. Data from free format questionnaires, individual- as well as group interviews and biographical texts, were analysed with content analysis or a hermeneutic approach. In study Ill the methods were quantitative. A summated rating scale measuring healthrelated quality-of-life (HRQOL) was analysed with descriptive and inferential statistics. In study IV quantitative and qualitative methods were combined. Two burnout inventories were analysed with descriptive and inferential statistics, and data from free format questionnaires and group interviews were analysed with qualitative content analysis. The main findings were that BPD patients suffer to an extent that is often unendurable, leading to deliberate self-harm (DSH) and suicide attempts to relieve suffering or just try to get away from it all (paper 11). In study Ill the BPD patients showed significantly poorer quality-of-life (even physical) than normal population controls of comparable age. The suffering, suicide attempts, DSH and poor quality-of-life (paper 11 and 111) put the patients in a position of voluntarily or involuntarily getting involved with psychiatric care. Study II revealed a double role of the psychiatric care in relation to BPD patients. On one hand, psychiatric professionals can add to the suffering by not being understanding and being disrespectful, on the other hand they can be helpful and relieve suffering by being respectful, understanding and validating. There was a clear relationship between the patients' experience of validation and the experience of being helped. DBT seems (both from the patients' and psychiatric professionals' perspective) to be a treatment with a philosophy, content and structure being able to relieve BPD patients suffering and helping them to independence and a bearable life-situation (paper I). Study IV confirms previous findings that psychiatric professionals experience treatment of self-harming patients as profoundly stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients due to its high degree of structure and specific techniques. The DBT team-work and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some professionals felt also improved their handling of other work stressors not related to DBT. This finding also corresponds to BPD patients' perceptions of the mindfulness component in DBT, which they reported as particularly helpful (paper 1). It should be noted that the patient samples in the thesis may be considered as a "worse off" subgroup among BPD patients, as they usually entered special treatment programs after a period of escalating symptoms, which standard psychiatric services had had difficulties handling. The rather small number of participants and the lack of equivalent andlor concurrent control groups in the quantitative studies limit the generalization of the results.

OBJECTIVES: The aims of the study were to: (i) test the reliability of a health-related quality of life (HRQOL) instrument [Swedish Health-Related Quality of Life Survey (SWED-QUAL)] on women patients with borderline personality disorder (BPD); (ii) compare their HRQOL to a normal population group comparable in age; and (iii) test for subgroup differences in HRQOL considering psychiatric DSM axis-I comorbidity. METHOD: The study was conducted in connection to a randomized, controlled trial of psychotherapy for women BPD patients. Seventy-five women with BPD diagnosis were administered the SWED-QUAL. Statistic reliability was evaluated with inter-item correlations, total-item correlations and internal consistency criterions. The BPD patients' SWED-QUAL results were compared with data extracted from a published study and subgroup differences due to axis-I comorbidity were analysed. RESULTS AND CONCLUSIONS: SWED-QUAL could be considered as an instrument with acceptable reliability when assessing HRQOL in BPD patients. The BPD patients suffered significant impairments in HRQOL overall health dimensions compared to normal population. There were no subgroup differences due to axis-I comorbidity, which indicate that BPD in itself might be a predictor of substantial HRQOL impairment.

The aim of the study was to investigate life situations, suffering, and perceptions of encounter with psychiatric care among 10 patients with borderline personality disorder. The results are based on a hermeneutic interpretation of narrative interviews in addition to biographical material (diary excerpts and poems). The interpretation revealed three comprehensive theme areas: life on the edge , the struggle for health and dignity-a balance act on a slack wire over a volcano , and the good and the bad act of psychiatric care in the drama of suffering . These theme areas form a movement back and forth-from despair and unendurable suffering to struggle for health and dignity and a life worth living. Common beliefs regarding these patients among personnel and implications for psychiatric care are discussed in relation to the results.

The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.

The aim was to investigate patients and therapists perception of receiving and giving dialectical behavioral therapy (DBT). Ten deliberate self-harm patients with borderline personality disorder and four DBT-therapists were interviewed. The interviews were analyzed with qualitative content analysis. The patients unanimously regard the DBT-therapy as life saving and something that has given them a bearable life situation. The patients and the therapists are concordant on the effective components of the therapy: the understanding, respect, and confirmation in combination with the cognitive and behavioral skills. The experienced effectiveness of DBT is contrasted by the patient's pronouncedly negative experiences from psychiatric care before entering DBT.

Objective: In order to assess costs - consequences of dialectal behavioural therapy (DBT) in suicidal women with borderline personality disorder (BPD), the present study takes advantage of pilot data collected during a training phase, in relation to a large scale randomised controlled trail (RCT). Method: Under a 18 month period, 22 suicidal women with BPD were treated with outpatient DBT, with focus on reducing parasuicidal behaviour. Outcome data collected retrospectively 12 months before therapy start, were compared to prospective data collected up to 18 months in therapy. The cost - analysis included direct health care costs only. Results & Conclusions: The results suggest that DBT may have a positive impact on treatment costs, which decreased significantly during the last 12 months in a 18 month therapy period. The reduction of costs is due to decrease in the number of psychiatric inpatient days. The conclusions that can be drawn from the results are, however, limited as the study was not made in RCT conditions and indirect costs to society were not assessed.

Purpose: Perfectionism has been found to predict outcomes in the treatment of eating disorders (ED). In the present study, we took advantage of longitudinal data to: a) investigate whether there are different patterns of perfectionism during the first six months after admission in a clinical sample of patients with ED, and b) describe how these patterns are related to long-term outcome. Methods: A sample of patients (N=294) from the Coordinated Evaluation and Research at Specialized Units for Eating Disorders database was divided into clusters according to perfectionism patterns measured with the EDI-2 perfectionism scale at baseline, and six months in treatment. Cluster analysis was performed on the extent and perseverance/changeability of self-oriented and socially described perfectionism. Outcome was measured with the EDI-2 and the SCL-63. Frequencies of eating disorder diagnoses were investigated. Results: Five clusters were identified. Low perfectionism was associated with lower levels of ED and psychiatric symptomatology at baseline. There were no significant differences between clusters on outcome variables at 36-month follow-up. Conclusions: Results indicated better psychiatric and psychological health three years after the initial measure. Patterns of relations between the extent and possible changes of perfectionism, measured with the EDI-P at baseline and after six months, did not appear to be associated with long-term outcomes on psychiatric health ratings.

BACKGROUND: Despite the theoretical links between eating disorders and perfectionism, the definition of perfectionism in practice is complicated. The present study explored descriptions and experiences of perfectionism described by a transdiagnostic sample of patients.

METHODS: In-depth, semi-structured interviews were carried out with 15 patients. The interviews were analyzed by Thematic Analysis. A comparison between the patients' scorings on the Eating Disorder Inventory-Perfectionism scale was also performed.

RESULTS: Seven themes were found: The origins of perfectionism, Top performance, Order and self-control, A perfect body, Looking good in the eyes of others, A double-edged coping strategy, and A Sisyphean task. The women in this study did not emphasize weight and body as the main perfectionistic strivings. Core descriptions were instead order, self-control and top performances. All of the participants described the awareness of reaching perfectionism as impossible. Scorings of self-oriented perfectionism was significantly higher compared to socially prescribed perfectionism. No differences in the narratives related to perfectionism scores or eating disorder diagnoses were found.

CONCLUSIONS: The results showed that psychometric measures do not always capture the patients' definitions of perfectionism, but regarding that perfectionism serves as a means to regulate affects and may lead into an exacerbation of the eating disorder, and the development of obsessive-compulsive symptoms, it is important to investigate the personal definitions of perfectionism.

Background: There is a substantial body of research on eating disorders and perfectionism. Also there are several studies on eating disorders and sense of coherence (SOC), but studies regarding all three subjects are sparse. Perfectionism and the degree of SOC are considered central and aggravating aspects of psychiatric conditions, not least in relation to eating disorders. Aims: The present study aimed to describe the relationship between perfectionism as operationalized by Garner in the Eating Disorder Inventory-2 and SOC as defined by Antonovsky in the SOC-29 scale. The hypothesis was that SOC should be negatively associated with perfectionism. Methods: Data from the two self-measuring instruments collected from 95 consecutively recruited eating disorder outpatients were analysed with descriptive and inferential statistics. Results: The patients in the present study scored consistently with other Swedish eating disorder samples on the Perfectionism subscale in the Eating Disorder Inventory-2 (EDI-P) and on the SOC-29, indicating a higher degree of perfectionism and weaker SOC than normal population groups. Perfectionism was significantly correlated to SOC. The correlation was negative, confirming the study hypothesis. The hypothesis was further confirmed in a subgroup analysis comparing patients with different degrees of SOC related to their EDI-P scores. Conclusions: Perfectionism is associated with SOC in patients with eating disorders. Clinical implications: The clinical implications derived from the study could be a recommendation to focus on the SOC in patients with an eating disorder with the hope of lowering the patients’ perfectionism as well.

Aims and objectives.  This study aimed to describe the significant others’ experiences and needs when a person is critically ill or injured in an acute care setting.

Background.  Being a significant other to a hospitalised critically ill or injured patient is a heavily distressing life event. Addressing significant others’ needs adequately has been shown to be essential to mitigate the psychological consequences of such distressing events.

Design.  A systematic review of qualitative research.

Methods.  Meta-ethnographic synthesis was used for analysis.

Results.  The key findings are described in five major themes: uncertainty and emotional ‘roller coaster’; information – balancing hope and reality; to guard and to protect the loved one; alliance with caregivers – crucial support; and social network – support and disequilibrium.

Conclusions.  The study can provide a broader understanding of the significant others’ situation. They are facing an overwhelming and emotionally challenging situation and need to be seen and heard.

Relevance to clinical practice.  The results point towards the nurses’ key position in handling the needs of the significant others. This kind of description might be helpful in taking on this delicate task and might also serve as a body of knowledge to influence clinical practice guidelines and nursing interventions in this field.