Individuals exposed to abuse, neglect, and household dysfunction during childhood are at increased risk of developing chronic illnesses including heart disease, cancer, and chronic emphysema. A relationship between early childhood adversity and health risk factors contributing to chronic disease such as smoking, obesity, and sedentary lifestyle has also been established in prior literature. Chronic conditions carry many negative consequences at both societal and individual levels and have been associated with significant financial cost, a decline in quality of life, and functional impairment. According to research, more than half of an average community sample has experienced at least one type of adverse childhood experience, including psychological, physical, or sexual abuse or substance abuse, mental illness, domestic violence, or criminal behavior within the household, with approximately 25% experiencing two or more. However, there is evidence that higher than usual levels of trauma exist in forensic inpatient samples, which may increase the odds of chronic disease development in this population. Despite this evidence, little research exists examining the prevalence of adverse childhood experiences in forensic mental health clients, as well as the relationship between trauma and chronic health conditions and risky health behaviors in this population. Archival data were collected from a forensic psychiatric facility in the Midwestern US. Inclusion criteria included admission since 2005, residence for at least one year, and discharge prior to data collection. A list of clients (N=182) meeting inclusion criteria was randomly generated by the facility’s research coordinator. Medical, psychiatric, social services, and annual review reports as well as discharge summaries were coded by three trained research assistants. The sample was predominantly male (N=147; 80.8%) and Caucasian (N=101; 55.5%). The average admission age was 32.5 years (SD=11.6 years) and average discharge age was 40.5 years (SD=12.7). Reasons for initial admission include transfers from lower-security facilities for aggressive behavior, lack of competency to stand trial, direct admission from the state department of corrections, suicidality or self-harm behavior, and pretrial evaluation. All participants were civilly committed to the facility at the time of discharge. In this study, frequencies and descriptive statistics will illustrate the prevalence of adverse childhood experiences broadly and categorically within a forensic inpatient facility. Logistic regression will also be used to examine the relationship between adverse childhood experience and later chronic disease diagnosis. A hierarchical regression will also be used to evaluate to what extent risky health behaviors account for relationships between chronic diseases and adverse childhood exposures. Results may explain how trauma exposure may increase the likelihood of chronic illness among forensic mental health patients.

No description available.

Background. In-hospital mortality is a measure recognized by US Agency for Healthcare Quality to represent quality of care within hospitals, that accounts for mortality based on three indicators: 1. select medical conditions and procedures; 2. procedures linked with questions of use (misuse, over/under use); 3. high volume procedures traditionally associated with lower mortality rates. Understanding how different comorbidity models measure in-hospital mortality is essential not only for determining patient health status in the hospital setting, but also help to regulating mortality risk and mortality risk predictions. One of the most widely used discriminatory models is the Charlson model, which predicts the risk of mortality within one year of hospitalization of patients with various comorbidities using CCSR codes for ICD-10 diagnoses which is quantified by the c-statistics, represented by the area under the curve (AUC). Objectives. To adapt a comorbidity index model to the National Inpatient Sample (NIS) database of 2020 to predict 1-year mortality for patients admitted with select ICD-10 codes of diagnoses. Methods Our study analysis examined mortality with comorbidity using the Charlson model in a sample population of estimated 5,533,477 adult inpatients (individuals ≥18 years of age). A multivariate logistic regression model was constructed with in-hospital mortality as the outcome variable and identifying predictor variables as defined by the Clinical Classifications Software Refined Variables (CCSR) codes for selected ICD-10 diagnoses (Table 3). Descriptive statistics and the base logistic regression analyses were conducted using SAS statistical software version 9.4. To avoid overpowering and avoid variables attaining statistical significance while only marginally changing the outcome, a subsample (n=100,000) was randomly selected from the original data set. Ultimately, 20 CCSR variables with p-values <0.20 from the base simple logistic regression models were included in the subsequent backward stepwise logistic regression analysis. Results Table 1 shows the prevalence of the selected diagnoses for our analysis. Anemia (28.32%), pulmonary disease (asthma, COPD, pneumoconiosis;21.88%), and diabetes without complications (19.47%) were the three most prevalent conditions among hospitalized patients. Table 2 shows the results of the base logistic regression analysis conducted, which excluded connective tissue/rheumatologic disorders, peptic ulcer disease, anemia, diabetes with complications, and human immunodeficiency as predictors of inpatient mortality. Results of the backward stepwise regression analysis revealed that severe liver disease/hepatic failure ([adjusted odds ratio (aOR): 10.50, (CI: 10.40-10.59)], acute myocardial infarction ([2.85, (2.83-2.87)] and malnutrition ([2.15, (2.14-2.16)] were three most important risk factors and had the highest impact on inpatient mortality (p-value <0.0001). However, smoking history, obesity, and liver disease were negatively associated with inpatient mortality. The c-statistic or the area under the curve (AUC) for the final model was 0.752. Conclusion Our findings, based on Charlson modeling procedures, indicate that independent variables representative of comorbidity with the strongest 1-year risk of mortality were among patients with ICD-10 codes relating to: severe liver disease/hepatic failure, acute myocardial infarction, and malnutrition. Hence, relevant stakeholders (patients, family members, and healthcare providers) can utilize this knowledge to advance models of care and prevention strategies that limit disease progression and improve patient outcomes.

Bakgrund: Demenssjukdom är en progressiv sjukdom som påverkar den kognitiva funktionen. Förekomsten av sjukdomen ökar globalt och uppkommer i alla samhällsklasser. Symtomen utmanar personen individuellt och påverkar livskvaliteten. Syfte: Att belysa sjuksköterskors erfarenheter av att vårda patienter med demenssjukdom inom slutenvården. Metod: En allmän litteraturstudie där nio vetenskapliga artiklar sammanfattades samt analyserades kontinuerligt. Resultat: Fyra huvudkategorier identifierades: (i) uppnå personcentrerad vård, (ii) interpersonella relationer, (iii) brist på kompetens och (iv) etiska aspekter. Sjuksköterskorna hade en vilja att bedriva personcentrerad vård trots det komplexa vårdbehovet. Miljön inom akutsjukvården var inte utformad för patientgruppen. Anhöriga sågs som en viktig resurs och ett fungerande teamarbete gynnade demensvården. Adekvat kunskap och kliniska erfarenheter saknades vilket drev sjuksköterskorna att utveckla kompensationsstrategier. Etiskt komplicerade situationer uppstod i vården av patienter med demenssjukdom. Konklusion: Rutinerna inom slutenvården är inte tillräckligt modifierbara för att möta patienter med demenssjukdoms komplexa vårdbehov. Miljön inom slutenvården är inte anpassad för denna patientgrupp. Relationen till anhöriga och teamet är en viktig resurs för sjuksköterskorna. Det visades på en kunskapsbrist och det saknades utrymme för etisk reflektion vilket skulle gynna vården av patienter med demenssjukdom. / Background: Dementia is a progressive disease that affects cognitive function. The prevalence of the disease is increasing globally and occurs in all social classes. The symptoms challenge the person individually and affect the quality of life. Aim: To illustrate nurses’ experiences caring for patients with dementia in inpatient care. Method: A general literature study was used to continuously summarize and analyze nine scientific articles. Results: Four main categories were identified: (i) achieving person-centered care, (ii) interpersonal relationships, (iii) lack of competence and (iv) ethical aspects. The nurses desired to provide person-centered care despite the complex care needs. The environment within inpatient care was not designed for the patient group. Relatives were seen as a crucial essential resource, and functioning teamwork benefited dementia care. Adequate knowledge and clinical experience were lacking, which pushed the nurses to develop compensation strategies. Ethically complicated situations arose in the care of patients with dementia. Conclusion: The routines within inpatient care is not modifiable enough to meet the patients’ complex care needs. The inpatient care environment is not adapted to the patient group. The relationship between caregivers and the team is an important resource for the nurses. There is a knowledge gap and a lack of space for ethical reflection, which would benefit the care of patients with dementia.

INTRODUCTION: Children in inpatient settings are in an unfamiliar environment that does not facilitate engagement in typical occupations. Children report multiple concerns with the hospital environment and experience including physical pain, loss of independence, loss of meaningful activities, lack of routine, and loss of control. Occupational therapists play a distinct role in improving the hospitalization experience for children by addressing these concerns. By improving the evaluation and treatment of visual deficits for children in inpatients settings, occupational therapists can increase children’s function and independence in meaningful activities and maximize psychological well-being. THEORETICAL PERSPECTIVE AND EVIDENCE: Self-determination theory posits that humans have three innate psychological needs – competence, autonomy, and relatedness. These needs are not being met for children in inpatient settings as shown by multiple qualitative studies, however occupational therapy can aid in meeting these needs through proper intervention. DESCRIPTION OF PROJECT: Resources were developed to improve the evaluation and treatment of visual deficits in children in inpatient settings including a vision screening tool, treatment protocol, referral protocol, and functional implications of visual deficits chart. METHODS: The vision screening tool and protocols were used on a small sample of patients (n=6) to identify and treat visual deficits. A survey was provided to occupational therapists to determine feasibility, usefulness, and effectiveness of the resources. CONCLUSION: The resources are useful and feasible for evaluating and treating visual deficits in children in the inpatient setting.

Background: Palliative care involves nursing and treatments aimed at alleviating suffering and promoting the patient's quality of life in the case of incurable, life-threatening illness. The patient's last days of life are valuable to both the patient and relatives, thus it is of great importance that the nurse has knowledge about how to promote quality of life and reduce suffering during the patient's last days of life. Nurses need to switch between caring for patients in the end-of-life stage and patients who can be cured within the same shift. Therefore, it is important to gain knowledge about how working with palliative care in a hospital environment affects nurses. Aim: The aim of the study was to describe nurses' experiences of caring for patients in palliative care within inpatient care. Method: A literature-based study founded on the analysis of qualitative research was selected as the method, where nine scientific articles were analyzed according to Friberg's five-step model. Results: The analysis resulted in three themes and seven subthemes: Strain of internal stress, the need for increased competence, and the impact of resource scarcity on the care environment. Conclusion: Nurses experience challenges and difficulties when caring for patients in palliative care. They need to display their professionalism while simultaneously their emotions are affected by various factors during work. Time constraints are a major obstacle for nurses in providing palliative care. / Palliativ vård innebär där omvårdnad och behandling sker för att lindra patientens lidande och främja patientens livskvalitet vid obotlig livshotande sjukdom. Varje år avlider 90000 människor i Sverige varav 80% av dessa är i behov av palliativ vård. Runtom i världen är 56,8 miljoner människor i behov av palliativ vård. Sjuksköterskor kommer att möta patienter som är i behov av palliativ vård under sitt yrkesliv. Syftet med studien var att beskriva sjuksköterskors erfarenheter av att vårda patienter i palliativ vård inom sluten vård. Metoden som valdes var en litteraturbaserad studie grundad på analys av kvalitativ forskning. Resultatet baserades på nio studier som inhämtades från vetenskapliga publikationer som efter analys ledde till tre teman och sju underteman. I resultatet framkom att sjuksköterskor som arbetar på sjukhus upplevde att de hade behövt ägna mer tid åt patienter som befann sig i livets slut vilket medförde känslor av otillräcklighet. Sjuksköterskor upplevde att det var utmanande och svårt att hantera patienter vid livets slutskede. Detta ledde till att sjuksköterskorna önskade stöd och handledning vid svåra situationer. Vidare visade resultatet att sjuksköterskor upplevde svårigheter med att bemöta familjens sorg samt önskade att de hade mer tid att stödja familjen. Sjuksköterskor ville ha kontinuerlig utbildning kring palliativ vård för att kunna utveckla vårdkvaliteten. Det framkom även vikten av samarbete i team där sjuksköterskor upplevde att de kunde vända sig till kollegor med mer erfarenheter när de behövde hjälp samt att de stöttade varandra. Vidare visade resultatet att andra ansvarsområden och tidsbristen hos sjuksköterskorna bidrog till att de inte kunde lägga så mycket tid på patienterna. Sjuksköterskorna betonade även hur viktigt det var att patienterna skulle få en lugn och fridfull miljö under sista tiden i livet. Sjuksköterskan arbetar utifrån fyra hörnstenar som består av symtomlindring, teamarbete, närståendestöd samt kommunikation och relation för att uppnå god palliativ vård. I denna studie tas utgångspunkt i begreppen lidande och medlidande. Denna studie möjliggör ökad förståelse för sjuksköterskors erfarenheter av att vårda patienter i palliativ vård inom sluten vård

Bakgrund: År 2021 uppskattades 12.9 procent av Sveriges befolkning ha ett alkohol- eller narkotikarelaterat substansbrukssyndrom. Alkohol och narkotika har skadlig inverkan och utgör en fara för hälsan. Dessutom kan det medföra ekonomiska och sociala problem. Sjuksköterskan har en betydande roll i återhämtningen och behandlingen av patienter med substansbrukssyndrom. Sjuksköterskan kan möta denna patientgrupp i alla verksamheter inom hälso- och sjukvården. Tidigare forskning visade att patienter med substansbrukssyndrom upplevde mycket stigma och negativa bemötanden under vårdtiden. Syfte: Syftet var att beskriva sjuksköterskans upplevelser av att vårda patienter med substansbrukssyndrom inom slutenvården. Metod: En beskrivande litteraturstudie genomfördes med sökningar av artiklar i databasen PubMed. Resultatet baserades på tio vetenskapliga artiklar med kvalitativ ansats. Huvudresultat: I resultatet framkom att sjuksköterskorna stod inför flertalet utmaningar vid vårdandet av patienter med substansbrukssyndrom. Sjuksköterskorna upplevde särskilda svårigheter med att behandla smärta. Att vårda patienter med substansbrukssyndrom beskrevs dessutom vara mentalt påfrestande på grund av ökad arbetsbelastning. Resultatet belyste även förekomst av hot och våld, stigma samt en stor kunskapsbrist kring denna patientgrupp. Sjuksköterskorna efterlyste mer utbildning och ökat stöd för att kunna möta patienternas behov. Slutsats: Bristande kunskap och kompetens hos sjuksköterskorna var centrala faktorer bakom de utmaningar som de mötte. För att förbättra vårdkvaliteten och främja en mer personcentrerad omvårdnad krävs ytterligare utbildning och stöd för sjuksköterskorna. Att minska stigma kring substansbrukssyndrom är också viktigt för att skapa en god vårdmiljö och omsorg för patienterna. Genom att öka kunskapen och förståelsen kan sjuksköterskorna bättre bemöta de utmaningar som uppkommer. / Background: In 2021, it was estimated that 12.9 percent of Sweden's population had an alcohol or drug-related substance use disorder. Alcohol and drugs cause various harmful effects that pose a danger to health and can also result in economic and social damages. Nurses play a significant role in the recovery and treatment of patients with substancerelated disorders. Nurses may encounter this patient group across all healthcare settings. Previous studies showed that patients experienced a lot of stigmas and negative attitudes during their care. Purpose: This study aimed to describe nurses' experiences of caring for patients with substance-related disorders in inpatient care. Method: A descriptive literature study was conducted, using the PubMed-database to search for articles. The results were based on ten primary studies with a qualitative approach. Main results: Nurses faced challenging caregiving experiences when treating patients with substancerelated disorders. Nurses found it particularly difficult to treat pain. Caring for patients with substance-related disorders was also described as mentally demanding due to increased workloads. The results also highlighted the presence of threats and violence, stigma, and lack of knowledge. Nurses expressed a need for further education and increased support. Conclusion: Nurses´ lack of knowledge and experience were central factors behind the challenges they faced. To improve the quality of care and promote person-centered nursing, further education and support is required. Reducing stigma around substance-related disorders is also crucial in creating a supportive care environment for patients. By increasing knowledge and comprehension, nurses can better address the challenges that arises.

Bakgrund: Aktivitetsbalans är ett kärnbegrepp inom arbetsterapi och kan definieras som en subjektiv upplevelse av rätt mängd och rätt variation mellan olika aktiviteter. Forskning har visat att aktivitetsbalans är en viktig faktor för hälsa och välbefinnande. Däremot finns ingen tidigare forskning gällande aktivitetsbalans hos läkare och sjuksköterskor inom slutenvård som författarna till studien kunde hitta. Syfte: Att beskriva den självskattade aktivitetsbalansen hos läkare och sjuksköterskor inom slutenvård. Metod: En kvantitativ studie med insamlat datamaterial från en webbenkätundersökning med självskattningsinstrumentet Occupational Balance Questionnaire (OBQ) samt kompletterande bakgrundsfrågor. I studien deltog sammanlagt 100 läkare och sjuksköterskor från olika slutenvårdsavdelningar i Sverige. Resultat: Det mest utmärkande resultatet var att ungefär två tredjedelar av hela urvalsgruppen inte var nöjda med sin mängd och variation av aktiviteter i vardagen. Utifrån enskild yrkesgrupp visade resultatet även att läkare var mindre nöjda med sina aktiviteter i vardagen än sjuksköterskor. Slutsats: Läkare och sjuksköterskor upplevde svårigheter att uppnå aktivitetsbalans i vardagen och därför behövs hälsofrämjande insatser av bland annat arbetsterapeuter. Vidare forskning med större population behövs göras med målgruppen läkare och sjuksköterskor inom slutenvård.

Bakgrund: Patienter som vårdas enligt lagen om psykiatrisk tvångsvård lider av en allvarlig psykisk störning och har brister i eller saknar helt förmågan att fatta hälsofrämjande beslut rörande sin vård. Detta innebär att sjukvårdspersonalen tar över ansvaret över patienten och beslutsfattande kring vården. Tvångsvården utgör stora risker för att skapa lidande för patienter, och det är därför viktigt för sjuksköterskan att utföra god omvårdnad med fokus på respekt, ansvar och värdighet. Metod: Allmän litteraturöversikt med deskriptiv design. 10 artiklar inkluderades. Artiklarna kvalitetsgranskades enligt SBU:s granskningsmall för kvalitativa artiklar och resultatet analyserades enligt Fribergs modell. Syfte: Syftet var att beskriva patienters upplevelser och erfarenheter av tvångsvård och tvångsåtgärder inom psykiatrisk slutenvård.Huvudresultat: Resultatet delades in i fyra kategorier: personalens bemötande, stöd under vårdtillfället, förlust av kontroll och konsekvenser av tvångsvården. En majoritet av deltagarna hade negativa upplevelser och erfarenheter av tvångsvård och tvångsvårdsåtgärder, medan en mindre andel av deltagarna hade positiva upplevelser och erfarenheter.Slutsats: Tvångsvård och tvångsvårdsåtgärder ledde i de flesta fall till negativa patientupplevelser. Patienternas upplevelser av tvångsvård och tvångsvårdsåtgärder påverkades synnerligen av sjuksköterskan och hennes roll i att göra patienten delaktig i sin vård, ge tydlig information och skapa en god relation till patienterna. / Background: Patients who receive involuntary treatment suffer from severe psychiatric illness and have a flawed or complete lack of ability to make decisions to promote their health. Following this condition, the healthcare workers take on the responsibility for the patient and all decisions regarding healthcare for the patient. Coercive care constitutes great risks regarding the creation of suffering for patients and therefore it is important that the nurse practices good nursing care that focuses on respect, responsibility and dignity. Aim: To describe patients experiences of coercion and psychiatric involuntary treatment.Method: A literature review with descriptive design. 10 articles were included. The article’s quality was reviewed according to SBU:s template for qualitative articles and the results were analyzed according to Friberg’s model. Main findings: The result was split into four categories: the staff’s treatment, support during the period of care, loss of control, and consequences of coercive care. A majority of the participants had negative experiences of coercive care and coercive measures, while a smaller number of participants had positive experiences.Conclusion: Involuntary treatment and coercive measures did in most cases lead to negative experiences for the patients. The patient’s experiences were particularly affected by the nurse and her ability to make the patient take part in their healthcare, give clear information and create a well-enough relationship with the patients.

Bakgrund År 2019 upptäcktes en ny variant av coronavirus i Kina som orsakade en global pandemi. Detta medförde en stor belastning på hälso- och sjukvården och den individuella sjuksköterskan. Men att arbeta med en depression kan ge konsekvenser vid vårdandet av patienter. Syfte Syftet med denna litteraturöversikt var att belysa vilka faktorer som påverkade förekomsten av depression bland sjuksköterskor inom slutenvården under Covid-19 pandemin. Metod Studien genomfördes som en strukturerad litteraturstudie men inslag av den metodologi som används vid systematiska översikter. Arbetet skrevs som en integrativ översikt där resultaten syntetiserades till en ny helhet. Resultat I resultatet framkommer de psykiska och arbetsmässiga faktorerna under Covid-19 som ledde till depression. Sjuksköterskor kände stress, oro, rädsla, utmattning och fick svårigheter att sova. Det saknades stöd från ledningen och arbetsgivaren samt att sjuksköterskor kände att de inte fick tillräckligt med kunskap under Covid-19 pandemin. Det var brist på skyddsutrustning, personal och sjuksköterskor fick arbeta långa pass vilket förvärrade situationen. Slutsats Studien genomfördes för att belysa de faktorer som ledde till en depression under Covid19 pandemin. Faktorerna som identifierades var psykiska och arbetsmässiga. De psykiska faktorerna var oro och rädsla, sömnbrist samt utbrändhet och utmattning. Arbetsmässiga faktorer som identifierades var brist på stöd, otillräcklig kunskap, resursbrist, långa arbetsveckor och pass samt personalbrist. / Background By the year 2019 a new variant of coronavirus was discovered in China and caused a global pandemic. This in turn caused a massive strain on healthcare and the individual nurse. But working with a depression can have consequences when caring for patients. Aim The aim of this literature review is to explore which factors affected the prevalence of depression among nurses in inpatient care during the Covid-19 pandemic. Method The study was conducted as a structured literature review with elements of the methodology used in systematic reviews. This literature review was written as an integrative overview where the results were synthesized to a new whole. Results The results show the mental and work-related factors during the Covid-19 pandemic that led to depression. Nurses experienced stress, worry, anxiety, fear, exhaustion and had troubles sleeping. A lack of support from management and the employer in addition to a feeling of not getting enough knowledge during the Covid-19 pandemic. There was a lack of personal protective equipment and personnel in addition the nurses had to work long hours which worsened their conditions. Conclusions This study was conducted to illuminate the factors that led to depression during the Covid-19 pandemic. The identified factors were psychological and work-related. The psychological factors were worry and fear, lack of sleep, burnout and exhaustion. Workrelated factors were lack of support, lack of knowledge, lack of resources, long workweeks and lack of personnel.