Omvårdnadstraditioner inom svensk psykiatrisk vård under 1900-talets första hälft

Abstract

The study concerns the history of Swedish psychiatric nursing in the first half of the 20th century. Its primary purpose is to draw on the experiences and insight of nurses to increase our knowledge of the history of Swedish psychiatric nursing. Subjects for the partial studies have been selected on the basis of twenty-two interviews carried out between 1982 and 1993 with nurses who had worked in Swedish psychiatric care before 1953. In addition to interviews, literary works, contemporary scientific literature and medical archives have been used as sources. The selected subjects deal with fear and violence in psychiatric care as well as the method of prolonged baths. The dissertation consists of five partial studies. Phenomenological hermeneutics based on Paul Ricoeur's philosophy has been used as the method of analysis.

The first partial study deals with narratives about fear. A nurse's choice of psychiatric care as her field of activity, as well as professional pride, appears to be associated with perceptions of her personal ability to control fear. The narratives provide examples of strategies for coping with fear.

The second partial study concerns narratives about violence against nurses. These narratives present the perception that violence against nurses was rare. Nurses express the opinion that the common notion of mental patients as violent and dangerous is exaggerated. Patients are perceived as being able to exercise self-control. When violence is mentioned in the narratives, it is linked to specific situations that were stressful for the patient, inappropriate treatment routines, or the staffs attitudes or lack of knowledge. The term violence is used in reference to actions that represented a serious risk of violence, attempts to inflict serious injury to another person, or acts of violence resulting in serious or permanent physical injury. Less severe forms of violence were regarded as a nursing problem. Female patients are described as being more prone than male patients to violence against female personnel. Nurses appear to have developed a body language that signalled non-violence.

The third partial study discusses the method of prolonged baths on the basis of nurses' narratives. Working with prolonged baths was described as a very arduous and taxing task. Prolonged baths were said to have been used for "the most severely disturbed", "violent" or "untidy" patients. Nurses describe the patients' discomfort and protests, but also point out that the baths had the intended calming effect on severely disturbed patients.

The fourth partial study aims to provide an understanding of how prolonged baths were experienced from the patient's perspective and is based on two autobiographical novels. Both accounts feature nurses forcing their patients into the bath. While unpleasant experiences are described, baths are also described as imparting a sense of calm and physical relaxation.

The fifth partial study deals with the ideological underpinnings and practical application of prolonged baths in Swedish psychiatric care. In the early decades of the 20th century, prolonged baths in combination with bed rest came to be associated with a humane, scientifically based form of psychiatric care that offered alternatives to confinement in cells and mechanical restraints. However, prolonged baths gradually came to be increasingly associated with coercion. The water temperature was about 35°C in order not to affect the body temperature.

A review of patient records shows that prolonged baths were used primarily in the care of aggressive and motorically restless patients. The use of prolonged baths as restraints, as well as other types of restraints, was more extensive in female patients. The longest uninterrupted administration of a prolonged bath is stated as 24 hours. It is extremely rare for the effect or side effects of the bath, or the patient's attitude to the bath, to have been noted in the patient record. Prolonged baths extending over four to six hours were used as a calming, tranquillising and sleep-inducing modality. Prolonged baths also formed part of a modified sleeping cure in combination with drugs. They were used as well in the care of somatic symptoms and conditions, including the presence of ulcers, and were administered to dying patients, as in the final stage of neurosyphilis. Although most prevalent in the early decades of the 20th century, prolonged baths were still being used in the 1940s.