Feeling “overloaded” and “shortcomings”: milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients

Figures & data

Table 1 Characteristics of the informants

Focus group	Profession	Community services	Specialized services
1	N = 3, SE = 1	2	2
2	N = 3	0	3
3	N = 2, SE = 1, SW = 3	3	3
Total	13	5	8

Abbreviations: N, nurse; SW, social worker; SE, social educator.

Table 2 Examples of informants’ perspectives on themes and subthemes

Interview text demarcated into a meaning unit	Transformation of the meaning unit	Themes	Subthemes
I have experienced a colleague being injured at work … and it is very traumatic to be terrified for your colleague, being afraid for the patients and afraid for yourself. [nurse]	The nurse experiences insecurity related to the job situation. She expresses fear that a person might be hurt or injured.	Overloaded by situations of mental and possible physical harm	The possibility of being physically hurt
I’ve had periods when I have been burned out for a long time after death threats. The patient wanted to get rid of me. I must admit that I was looking at job ads, and I actually applied for another job. I felt my cup was about to overflow. Can I manage to stand in this relationship anymore? Then I told myself: I cannot give up on him, pull yourself together, and stand by him. [social worker]	The social worker experiences exhaustion after a long period with death threats from a patient. A feeling of burnout is close, but his commitment to the patient makes him continue working in extremely demanding work conditions.		Bearing the burdens of long-lasting relationships with vulnerable patients
If you are tired or stressed, there are many factors that make you excoriated and exposed. A patient poked at me with his comments at all times, perpetually. I felt an irritation that I couldn’t hide. I was a bit cross at the patient. I walked into the trap of arguing with him. I even thought I was very clever, but I was showing signs that he hurt my feelings. [nurse]	The nurse describes a situation in which she felt emotionally hurt by comments from a patient. This had an impact on her reaction and communication. In retrospect, she reflects that she tried to hide her vulnerability, but that it was exposed by the patient.		Being mentally hurt in your “sore spots”
You sometimes experience that colleagues do not distinguish between their own emotions: they come “into play” in situations. When the patient irritates a milieu therapist verbally or through behavior, it may trigger violence. In retrospect, you may feel that you could have avoided actions that were not necessary. That’s what I call an abuse of power. [nurse]	The nurse reflects on consequences when acting in concordance with one’s own emotions. This results in the use of power on the patients, which could be avoided.	Shortcomings in regard to one’s own professional standards	Despair associated with not acting in concordance with one’s professional standards
You get a sense of hopelessness – you really do. The situations are hopeless. You get tired of going on again and again … when you don’t reach the patient … what tools do you finally have? Then, you get exhausted in a way. [nurse]	The nurse experiences a lack of tools to reach the patient, and experiences a feeling of hopelessness. This results in an experience of professional shortcoming.		Uncertain if expressing own helplessness is professional