Bakgrund: Den psykiska ohälsan ökar och den vuxenpsykiatriska heldygnsvården har stor press på sig, både utifrån personalbrist, ökat behov och efterfrågan av personcentrerad vård samt med ett ansvar att behandla och möta ett brett spektrum av komplicerade psykiatriska diagnoser och tillstånd. Sjuksköterskor inom psykiatrisk vård besitter ofta stor kunskap och erfarenhet och kan bidra till att stärka vården men får inte alltid utrymme att kliva fram och ta det ansvar som professionen representerar. Rebellsjuksköterskor kan genom sitt driv, patientfokuserade och ledande egenskaper bana väg för andra sjuksköterskor att våga kliva fram och ta sitt professionella ansvar, samt bidra till en positiv utveckling av en säker, personcentrerad vård. Denna studie vill öka kunskapen kring erfarenheter av rebelledarskap för att skapa större förståelse för hur detta kan främjas och användas för att bidra till utvecklingen av vården. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av rebelledarskap i vuxenpsykiatrisk heldygnsvård. Metod: Studien har genomförts med deskriptiv design och kvalitativ ansats. Datainsamlingen har skett genom semistrukturerade intervjuer med åtta sjuksköterskor med erfarenhet av rebelledarskap inom vuxenpsykiatrisk heldygnsvård i Sverige och har analyserats med en induktiv, kvalitativ innehållsanalys. Resultat: Analysen mynnade ut i tre huvudkategorier: att rebelledarskap kan vara en ensam resa på en väg kantad av utmaningar, att rebelledarskap kan driva verksamheten framåt och stärka en personcentrerad vård, samt att rebelledarskap är en inre drivkraft som utgår från profession och kompetens. Slutsats: Genom sitt driv att förbättra vården och hitta mer individanpassade lösningar utifrån patientens unika omvårdnadsbehov kan rebellsjuksköterskan utgöra en viktig resurs för utvecklandet av en mer personcentrerad psykiatrisk heldygnsvård. Mer forskning behövs för att klargöra hur rebellsjuksköterskans insatser påverkar patienternas återhämtning, samt för att potentiellt kunna bidra till en tydligare arbetsbeskrivning för sjuksköterskor inom vuxenpsykiatrisk heldygnsvård.

Bakgrund: Social arbetsmiljö innefattar upplevelser av kulturen på en arbetsplats. Det finns flera olika faktorer som påverkar den sociala arbetsmiljön, till exempel socialt samspel, samarbete och socialt stöd från kollegor och chefer. Det kan vara psykiskt belastande att möta svårt sjuka personer och deras anhöriga. Den psykiska belastningen kan resultera i stress och vidare till utmattning. Fysiska besvär som muskelspänningar kan vara orsakade av psykisk belastning. Syfte: Litteraturstudien syftade till att undersöka sjuksköterskans upplevelse av den sociala arbetsmiljön inom slutenvård. Metod: En sammanställning och analysering genomfördes av kvalitativa empiriska studier. Artiklarna inhämtades från Cinahl och Pubmed som är databaser med inriktning på omvårdnad och medicin. Litteraturstudien baserades på 10 studier utan geografisk avgränsning. Resultat: Utifrån granskning och analysering framkom två huvudkategorier: Hög arbetsbelastning och Relation mellan kollegor. Utifrån dessa bildades sju subkategorier. Konklusion: Det stora antalet patienter i relation till en liten andel sjuksköterskor resulterade i en känsla av hög arbetsbelastning med fysiska och psykiska påfrestningar. Avgörande för en positiv arbetskultur är att ha stöttande chefer och bra relationer med kollegor. Den sociala arbetsmiljön är viktig för att sjuksköterskan ska kunna trivas på sin arbetsplats och kunna ge god omvårdnad. / Background: Social work environment involve perceptions of the culture at a workplace. There are multiple factors that contribute to the social work environment, for example social interactions, cooperation and support from colleagues and managers. It can be mentally taxing to meet severe ill patients and their relatives. The mental strain can result in stress and continue to fatigue. Physical issues such as muscle tension could be associated with psychological strains. Aim: The literature review aims to investigate nurses´ perceptions of the social work environment in inpatient care. Method: A literature review was conducted with qualitative empirical studies. The articles were gathered from Cinahl and Pubmed which are databases for nursing and medicine. The literature study was based on 10 studies without any geographical limitations. Result: The result produced two main categories: High workload and Relationship among colleagues. Seven subcategories emerged from these. Conclusion: High workload related to too many patients in relation to the amount of nurses could lead to both physical and psychological strains. Crucial for a positive work culture is to have a supportive manager and good relationship with colleagues. The social work environment is important for the nurse to be able to thrive in the workplace and to conduct good care.

Bakgrund: Demenssjukdomar är ett samlingsbegrepp för kognitiva sjukdomar som leder till försämring av hjärnans funktioner. I takt med att befolkningen blir äldre ökar risken för att drabbas av en demenssjukdom och prevalensen ökar inom slutenvården. Att vårda personer med demenssjukdom är komplext och sjuksköterskor besitter en viktig roll i utformningen av omvårdnaden. Syfte: Att beskriva sjuksköterskors erfarenheter vid omvårdnad av personer med demenssjukdom inom slutenvården. Metod: En litteraturöversikt med induktiv ansats som inkluderar 12 kvalitativa artiklar genomfördes. Databaser som användes var CINAHL, MEDLINE och PsycInfo. Data analyserades med hjälp av Fribergs fyra analyssteg. Resultat: Resultatet sammanställdes i två kategorier samt åtta subkategorier. Första kategorin var; organisationens roll med subkategorierna; erfarenheter av tidsbrist, konsekvenser av personalbrist, otillräcklig kunskap och utbildning, brist på organisatoriskt stöd samt miljöns betydelse för omvårdnaden vid demenssjukdom. Den andra kategorin var omvårdnadens roll med subkategorierna; fördelarna av personcentrerad vård, betydelsen av teamarbete och känslor av otillräcklighet som sjuksköterska Slutsats: Utmaningar som erfors av sjuksköterskor var tids- och personalbrist, ogynnsam miljö, otillräcklig kunskap och utbildning samt otillräckliga resurser från organisationen. Personcentrerad vård ansågs vara viktig för att kunna bedriva god omvårdnad för patienter med demenssjukdom. / Background: Dementia is an umbrella term for cognitive disorders that lead to deterioration of brain functions. As the population ages, the risk of being diagnosed with dementia increases and the prevalence of persons with dementia increases in inpatient care. Caring for persons with dementia is complex and nurses have an important role in framing care. Aim: To describe nurses' experience of caring for persons with dementia in inpatient care. Method: A literature review with an inductive approach including 12 qualitative articles was conducted. Databases used were CINAHL, MEDLINE and PsycInfo. Data were analysed using Friberg's four analysis steps. Results: The results were summarized in two categories and eight subcategories. The first category was the role of the organization with the subcategories; experiences of lack of time, consequences of staff shortages, insufficient knowledge and training, lack of organizational support and the importance of the environment in dementia care. The second category was the role of nursing with the subcategories; the benefits of person-centred care, the importance of teamwork and feelings of inadequacy as a nurse. Conclusion: Challenges perceived by nurses were lack of time and staff, unadapted environment, insufficient knowledge and education, and insufficient resources from the organization. Person-centred care was considered important to provide good nursing care for persons with dementia.

Bakgrund: Psykisk ohälsa är ett växande problem och drabbar de flesta under sin livstid. Patienter under lagen om psykiatrisk tvångsvård vårdas mot sin vilja och får sin autonomi och integritet fråntagen. Tvångsåtgärder kan ge konsekvenser för patientens fysiska och psykiska hälsa. Personcentrerad vård är en central del av omvårdnaden i psykiatrisk kontext, vilket inkluderar kommunikation och delaktighet. Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser av tvångsåtgärder inom psykiatrisk heldygnsvård. Metod: Denna kvalitativa litteraturstudie grundades på tolv studier inhämtade från databaserna PubMed, PsycInfo och CINAHL och analyserades med Popenoe m.fl. analysmetod. Resultat: Patienternas upplevelse presenterades i tre kategorier – Förlust av autonomi och integritet, Psykiskt och fysiskt lidande samt Upplevelse av tacksamhet och acceptans. Konklusion: Resultatet visar att patienterna övergripande hade negativa upplevelser av tvångsåtgärder och att deras autonomi och integritet fråntagits dem. Personalens beteende påverkade både upplevelsen negativt och positivt. Litteraturstudien visade att det finns behov av förbättringar i bemötandet av patienter som behöver tvångsvård och vikten av att arbeta personcentrerat. / Background: Mental illness is a growing problem and can affect anyone during their lifetime. Patients under the Compulsory Psychiatric Care Act are cared for against their will and have their autonomy and integrity taken away. Coercive measures can have consequences for the patient's physical and mental health. Person-centered care is a central part of nursing in the psychiatric context, which includes communication and active participation. Aim: The purpose of the literature study was to shed light on patients' experiences of coercive measures within psychiatric inpatient care. Method: This qualitative literature study was based on twelve studies obtained from the databases PubMed, PsycInfo and CINAHL and analyzed with Popenoe et al. analysis method. Results: The patients' experience was presented in three categories - Loss of autonomy and integrity, Mental and physical suffering and Experience of gratitude and acceptance. Conclusion: The results show that the patient's overall had negative experiences of coercive measures and that their autonomy and integrity were taken away from them. The staff's behavior affected the experience both negatively and positively. The literature study showed that there is a need for improvements in the treatment of patients who need compulsory care and the importance of person-centered care.

No description available.

Bakgrund: Vårdmiljön inom psykiatrisk heldygnsvård har beskrivits framkalla olika känslor och präglas av en hård miljö där patienter bland annat kan vårdas mot sin vilja och vara utsatta för tvångsåtgärder och restriktioner. Aggressivitet är vanligt förekommande på dessa avdelningar och bedöms vara ett problem. En kunskapslucka finns vad gäller vilka patienter och situationer som ökar risken för aggressivitet inom kontexten psykiatrisk heldygnsvård. Syfte: Att identifiera karaktäristiska drag hos patienter med aggressivt beteende och identifiera aspekter som påverkar situationer där hot- och våldsincidenter uppstått inom psykiatrisk heldygnsvård samt syntetisera en förklaringsmodell. Metod: En integrativ litteraturöversikt beståendes av både kvalitativa och kvantitativa artiklar. Materialet analyserades med hjälp av Whittemore och Knafls (2005) arbetsprocess. Resultat: Resultatet genererade i tre huvudteman och tio underteman. Följande tre huvudteman identifierades: patienten som en trigger, vårdmiljön som en trigger och personalen som en trigger. Diskussion: Metoden diskuteras utifrån begreppen: trovärdighet, pålitlighet, bekräftelsebarhet och överförbarhet. Resultatets huvudfynd diskuteras med stöd av tidigare forskning och i relation till Phil Barkers teori tidvattenmodellen. / Background: The care environment within psychiatric inpatient care has been described to create different emotions and is characterized as a hard environment where patients sometimes are treated against their will and can be exposed to coercive measures and restrictions. Aggressiveness is common at these wards and is considered a problem. There is a knowledge gap when it comes to patients and situations that increase the risk for aggressiveness in the context of psychiatric inpatient care. Aim: To identify characteristic features of aggressive patients and to identify aspects that effects situations where threats and violence has occurred in psychiatric inpatient care and to synthesise an explanatory model. Method: An integrative literature overview containing both qualitative and quantitative articles. The data were analysed using Whittemore and Knafl’s (2005) working procedure. Results: The result generated in three main themes and ten subthemes. Following three main themes were identified: the patient as a trigger, the care environment as a trigger and the staff as a trigger. Discussion: The method is discussed in relation to these concepts: trustworthiness, dependability, confirmability and transferability. The results are discussed with support of previous research and in relation to Phil Barker's theory the Tidal model.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced. This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment. The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded. The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated. An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.

This is a study of the spatial affordances of buildings that allow them to organize and transmit cultural ideas and to support the performance of organizational roles. The particular affordances under consideration are those that arise from the manner in which buildings structure the visual fields that are potentially available to a situated observer. In studying directed visibility patterns, supported by the development of appropriate analytical tools, we focus on a previously specified set of visual targets and ask how many become visible from each occupiable location. Parametric restrictions concerning the direction into which a subject faces and the viewing angle sustained by the target object are also taken into consideration. The aim is to demonstrate how such refinements of visibility analysis, lead to more precise and penetrating insights as to how building users tune their behavior to the spatial affordances of environment, and how the environment impacts their understanding in turn. Three different studies were presented. The fist used directed visibility measures to evaluate the affordances of different nursing-unit designs relative to how well nurses are able to survey patients in different rooms as they go about their duties. The second study focuses on the manner in which nurses and physicians position themselves in a Neuro Intensive Care Unit (ICU), particularly when interacting. The third study investigates how aware exhibition visitors become of the visual structure of environment and how the visibility structure of exhibitions affects the ability of visitors to conceptually group paintings according to their thematic content. The case studies support the following conclusions. 1) The way in which people position themselves in an environment as they perform their assigned tasks is tuned to the way in which visual fields are structured. 2) The visual structure of environment is contingent upon the interaction between the underlying structure of visual fields and paths of movement. 3) Directed visibility analysis leads to stronger correlations with behavior and performance than generic visibility analysis. This implies that environments are layered. Their underlying spatial structure is charged by the distribution of the contents that are programmatically primary.

<p>Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced.</p><p>This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment.</p><p>The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded.</p><p>The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated.</p><p>An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.</p>