Hintergrund: Anorexia nervosa (AN), allgemein als Magersucht bezeichnet, gehört zu den häufigsten psychischen Erkrankungen im Kindes- und Jugendalter. Dabei kommt es aufgrund einer gestörten Wahrnehmung der eigenen Figur zu einem erheblichen, selbst herbeigeführten Gewichtsverlust. Die Mehrheit der Patientinnen muss aufgrund der Schwere der Erkrankung mindestens einmal stationär behandelt werden. Cortisol ist ein lebenswichtiges Steroidhormon, das dafür sorgt, dass der menschliche Körper länger andauernde Belastungen bewältigen kann. Halten diese Stresssituationen jedoch zu lange an, kann es erhebliche Störungen des Stoffwechsels, des Wachstums, der Reproduktion und der Immunkompetenz verursachen. Cortisol und seine Stoffwechselprodukte werden überwiegend mit dem Urin ausgeschieden. Die Bestimmung der Urincortisolkonzentration (UCC) gehört daher zur klinischen Standarddiagnostik. In der Forschung hat sich die UCC als zuverlässige Methode zur Untersuchung des Stresshormons bei gesunden Probanden und psychischen Erkrankungen bewährt. Auch im Haar kann das Stresshormon nachgewiesen werden. Hauptsächlich gelangt es aus dem Blut in die Zellen des wachsenden Haarschaftes. Haaranalysen werden seit langer Zeit als zuverlässige Methode in der Forensik und Toxikologie angewandt. Mittlerweile hat sich die Analyse von Haarproben zur Bestimmung der Haarcortisolkonzentration (HCC) auch in der Forschung als valide Methode etabliert. Dabei bietet diese nicht-invasive und leicht durchführbare Methode einen retrospektiven Blick auf die Langzeitausschüttung von Cortisol. In zahlreichen Studien wurde bei AN eine Erhöhung des Stresshormons Cortisol nachgewiesen (sog. Hypercortisolismus). Dabei scheinen sich der Hypercortisolismus, die körperlichen Symptome und die psychischen Veränderungen in einer komplexen Krankheitspathologie wechselseitig zu beeinflussen. Mehrere Studien konnten bei AN bereits eine erhöhte Cortisolausscheidung im Urin nachweisen, die mit zunehmender Gewichtsnormalisierung rückläufig ist. Die HCC wurde bei AN bisher nur in einer Querschnittstudie untersucht. Entgegen des bekannten Hypercortisolismus konnte hier eine signifikant niedrige HCC nachgewiesen werden. Fragestellung: Die vorliegende Studie untersucht die HCC bei Patientinnen mit AN zum ersten Mal in einer Längsschnittstudie. Durch Beobachtung von Patientinnen über den Verlauf einer stationären, krankheitsbildspezifischen Therapie und zusätzlicher Erhebung der UCC als Vergleichsvariable sollte die Anwendbarkeit der HCC bei AN untersucht werden. Material und Methoden: Neben der Anwendung psychopathologischer Testverfahren (EDI-2) und regelmäßiger Bestimmung des BMI wurde wöchentlich durch einen 24-h-Sammelurin die UCC bestimmt. Eine Substichprobe gab am Ende des durchschnittlich 13-wöchigen Therapiezeitraumes eine Haarprobe ab, anhand derer eine monatliche HCC bestimmt wurde. Die Analyse der Urinproben erfolgte mittels immunochemischer Verfahren, die Haarproben wurden mittels Hochleistungsflüssigkeitschromatographie mit Tandem-Massenspektrometrie analysiert. Durch individuelle Zuordnung einer medianen UCC zu jeder HCC wurden für jede Patientin schließlich drei HCC-UCC-Wertepaare erzeugt, die den Anfang, die Mitte und das Ende der stationären Therapie abbildeten. Ergebnisse: Insgesamt nahmen 33 Patientinnen des Zentrums für Essstörungen der Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie teil (Stichprobe 1), wobei 16 Patientinnen der Entnahme einer Haarprobe zustimmten (Stichprobe 1a). Während der stationären Therapie kam es zu einer leitliniengerechten Gewichtsrehabilitation. Die UCC war deutlich erhöht und fiel während des Therapieverlauf signifikant ab. Die HCC zeigte hingegen keine Veränderung. Bei der Korrelation der HCC mit der medianen UCC konnte lediglich ein Trendeffekt nachgewiesen werden. Separate Analysen der einzelnen Zeitabschnitte ergaben eine signifikante Korrelation von HCC und UCC am Ende der stationären Therapie. Bei Analyse des EDI-2 korrelierte die Unzufriedenheit mit dem eigenen Körper zu Beginn und am Ende der Therapie mit der UCC, jedoch nicht mit der HCC. Haareigenschaften und Haarbehandlungen hatten keinen Einfluss auf die HCC. Schlussfolgerungen: Insgesamt konnte die UCC den bekannten Hypercortisolismus abbilden und bildete eine valide Grundlage für die Überprüfung der HCC bei AN. Trotz ihres Absinkens blieb die UCC nach erfolgreicher Gewichtsrehabilitation erhöht. Zudem konnte eine Korrelation der UCC mit einer zentralen psychopathologischen Veränderung bei AN nachvollzogen werden. Dies bestätigt die Hypothese einer komplexen Krankheitspathologie mit somatischen und psychiatrischen Einflussfaktoren auf den Hypercortisolismus. Bei einem Literaturvergleich der HCC mit gesunden Probanden konnte kein Hypercortisolismus nachvollzogen werden. Insgesamt konnte die HCC die UCC insbesondere in der Phase der akuten Erkrankung und beginnenden Gewichtsrehabilitation nicht zuverlässig abbilden. Nach Gewichtsnormalisierung schienen sich HCC und UCC jedoch wieder dem bei gesunden Probanden bestätigten Verhältnis anzunähern. Als Ursache für diese fehlende Korrelation kommen trophische Störungen des Haarwachstums bei AN in Betracht. So ist aufgrund eines verminderten Haarwachstums eine gestörte Einlagerung des Hormons in den Haarschaft möglich. Auch enzymatische Störungen des Cortisolabbaus werden diskutiert. Ein gestörtes Gleichgewicht des Enzyms 11-β-HSD, welches die Umwandlung von Cortisol zu Cortison (und umgekehrt) katalysiert, scheint ebenfalls die Einlagerung in das Haar zu beeinflussen. Insgesamt ergaben sich zahlreiche Hinweise, dass die HCC entgegen den Studienergebnissen bei gesunden Probanden und anderen stressassoziierten Zuständen bzw. Erkrankungen nicht zur Untersuchung des Hypercortisolismus bei AN im akuten Erkrankungszustand und im Verlauf einer stationären Therapie angewendet werden kann. Eine Nutzung dieser Methode zur Untersuchung gewichtsrehabilitierter Patientinnen bleibt offen und bedarf weiterer Forschungen. / Background: Anorexia nervosa (AN) is one of the most common mental disorders in children and adolescents. Disturbances in the way in which one´s body shape is experienced lead to a severe self-inflicted weight loss. Majority of patients need to be treated in hospital at least once in a lifetime. Cortisol is an essential adrenal cortical hormone, which enables human organism to cope with long-lasting stress. However, perseverative stress can cause abnormalities in metabolism, growth, reproduction and the immune system. Cortisol and its metabolites are excreted renal predominantly. Therefore, analyzing urinary cortisol concentration (UCC) is part of good clinical practice and proved of value in research. Recently, the assessment of long-term cortisol concentration via hair samples has been shown to be a sensitive cortisol parameter too. According to the multicompartment model diffusion of cortisol from blood capillaries into the growing hair cells of the follicle represents the main pathway of cortisol incorporation into the hair. Hair cortisol concentrations (HCC) offer a retrospective view that is easily accessible. Numerous studies have used hair cortisol successfully to examine changes in long-term cortisol levels in a number of psychiatric diseases. Underweight patients with AN are known to have increased cortisol levels (hypercortisolism). Cortisol levels were found to correlate with both physical and mental symptoms in a complex interplay. Most studies reported a urinary hypercortisolism in AN and a significant decrease in cortisol levels during weight gain. So far, the only other study that examined HCC in AN found lower HCC compared to healthy controls, which is contradictory to the existing literature. Aim: The aim of this study was to investigate whether HCC in acutely ill AN patients reflects a well-established classic cortisol measure (UCC) using a longitudinal study design over the course of inpatient weight-restoration treatment. Methods: Therefore, after admission every patient provided a weekly 24-h-urine sample. The corresponding body weight was measured on each day of collection. After the last urine collection, a hair sample was taken for analyzing a monthly HCC. Additionally, eating disorder symptoms were measured by EDI-2. Hair samples were analyzed by a LC-MS/MS-based method. The determination of cortisol concentration in urine was performed by using a competitive immuneenzymatic colorimetric method. As urinary cortisol was measured weekly while hair cortisol values were reflecting cortisol levels over one month, we calculated the median urinary cortisol corresponding to each monthly hair cortisol value individually. In sum, we matched three pairs of median UCC and HCC for each patient, representing the beginning, middle and end of the therapy. Results: The cohort in our longitudinal analysis consisted of a total of 33 patients who participated for 13 weeks on average. A subsample of 16 patients provided a hair sample after inpatient treatment. UCC was increased and revealed the expected decrease during weight gain while HCC showed no significant change. Tested for associations between HCC and UCC there was a trend effect for UCC on HCC. Separate correlation analyses per time-period showed a significant correlation between UCC and HCC for the third time period at the end of the therapy. Disaffection with the own body correlated with UCC, but not with HCC at the beginning and end of inpatient therapy. Hair treatment had no effect on HCC. Discussion: In summary UCC proved to be a reliable cortisol measure in our sample. Despite reduction, UCC remained increased after weight-restoration and correlated with eating disorder symptoms. This confirms the supposed complex interplay of hypercortisolism with physical and mental symptoms. Compared to cortisol levels of previously reported healthy females HCC was normal in AN and did not decline significantly during weight-restoration. Overall HCC did not reflect UCC, particularly with regard to the phase of acute starvation and incipient weight gain. However, association of HCC and UCC seemed to approximate healthy conditions after weight restoration. One possible explanation for lack of correlation might be trophic disturbances of hair in AN. Studies reported that scalp hair in AN show a higher percentage of hair in the telogen (resting) phase, which implies no further hair follicle activity, consequently less hair growth, and less storage of hormones like cortisol in hair. Furthermore, disturbances of the activity of 11-β-HSD-enzymes, converting cortisol in cortisone and vice versa, might influence the incorporation of cortisol in hair too. Altogether we suggest that incorporation of cortisol into the hair might be impaired due to factors associated with underweight and undernutrition in AN. Our data demonstrate that HCC does not reflect hypercortisolism in individuals suffering from acute AN, while after some weight gain it may proof to be a useful measurement of long-term cortisol levels.

Background: Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes. Methods: In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female. Results: Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB. Conclusions: Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

Bakgrund: Patienter med psykisk ohälsa har ofta flera sjukdomstillstånd samtidigt och har en ökad risk att drabbas av somatisk samsjuklighet. All hälso- och sjukvård avser att medicinskt förebygga, utreda och behandla sjukdomar. Sjuksköterskor bör därför arbeta för god omvårdnad och ha ett helhetsperspektiv. Den somatiska vården för patienter med psykisk ohälsa och samtidig somatisk samsjuklighet är bristfällig och kan leda till att patienterna får en sämre vård och hälsa. Sjuksköterskor saknar ofta kunskap när det gäller att vårda dessa patienter och det saknas ofta etablerade arbetsprocesser inom den psykiatriska heldygnsvården.  Syfte: Syftet var att beskriva sjuksköterskors upplevelse av att vårda patienter med somatisk samsjuklighet inom psykiatrisk heldygnsvård. Metod: Studien var en intervjustudie med kvalitativ ansats. Tretton sjuksköterskor intervjuades med hjälp av semistrukturerade intervjuer. Intervjuerna analyserades med en kvalitativ innehållsanalys på latent nivå.  Resultat: Det framkom fyra teman; Ett åtagande i en miljö som inte är rustad, En avancerad men utmanande uppgift, Ett ansvarsfullt men utsatt uppdrag, Ett pålitligt och fullständigt vårdande genom erfarenhet och samarbete. Till dessa anknöts det vidare åtta sub-teman. Slutsats: Vårdandet av patienter med somatisk samsjuklighet inom den psykiatriska heldygnsvården är komplext. Resurser och en tydlig ansvarsfördelning för patientens samlade vårdbehov saknas, vilket påverkar patientens möjlighet till adekvat vård. Sjuksköterskan bär ett tungt professionellt och etiskt ansvar för såväl den somatiska som den psykiatriska vården och känner sig utsatt och ensam. Införande av reflektion på arbetsplatsen ses som en möjlighet i att förebygga sjuksköterskors ohälsa. Ledningen anses även behöva utveckla tydliga strukturer kring ansvarsfördelning för vårdpersonalens arbete, för att göra sjuksköterskans roll i den psykiatriska heldygnsvården mer synlig och på så sätt förhindra utsatthet. Den psykiatriska slutenvården anses vara i behov av att rustas upp resursmässigt, dels med kunskap, material och logistiska resurser för att ha förutsättningar att kunna bedriva en god vård för patienter med somatisk samsjuklighet. / Background: Patients with mental illness often have several medical conditions at the same time and have an increased risk of developing somatic comorbidity. All health care intends to medically prevent, investigate and treat diseases, and nurses should therefore thrive towards good nursing and have a holistic perspective. The somatic care for patients with mental illness with comorbid somatic diseases is deficient and can lead to patients not receiving adequate care and in the long run, poorer health. Nurses often lack the knowledge to care for these patients and work processes regarding this issue needs to be established.  Aim: The aim was to describe nurses experience of caring for patients with somatic comorbidity in psychiatric inpatient care.  Method: The study was an interview study with a qualitative approach. Thirteen nurses were interviewed using semi-structured interviews. The interviews were analyzed with a qualitative content analysis at a latent level. Results: Four themes emerged; A commitment in an environment that is not equipped, An advanced but challenging task, A responsible but exposed assignment, A reliable and complete care through experience and cooperation. To these, eight sub- themes were attached. Conclusion: The care of patients with somatic comorbidity in psychiatric inpatient care is complex. Both resources and a clear distribution of responsibilities for the patients overall care needs are lacking, which affects the patients’ possibility for adequate care. The nurse has a substantial professional and ethical responsibility for both somatic and psychiatric care and feels vulnerable and alone. The introduction of reflection in the workplace is seen as an opportunity in preventing nurses’ illness. The management is in need to develop clear structures regarding the distribution of responsibilities for the care staffs work, in order to make the nurses role in psychiatric inpatient care more visible and thus prevent vulnerability. Inpatient psychiatric care is considered to be in need of increased resources, consisting of knowledge, materials, and logistical resources in order to be able to provide good care for patients with somatic comorbidity.

Bakgrund: Det är väl känt att fysisk aktivitet har positiva effekter på människans mentala hälsa. Hälsofrämjande arbete kan med fördel påbörjas i den psykiatriska heldygnsvården. Samtidigt är motivationsbrist vanligt förekommande för personer med psykisk ohälsa och då behövs stöd och motivation för att öka patientens möjligheter att främja sin hälsa. Således har sjuksköterskan inom psykiatrisk vård en viktig roll i det hälsofrämjande arbetet. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att främja fysisk aktivitet inom psykiatrisk heldygnsvård. Metod: En kvalitativ intervjustudie användes som metod. Det insamlade materialet utgår från åtta semistrukturerade intervjuer med sjuksköterskor som var yrkesverksamma inom psykiatrisk heldygnsvård i Region Skåne. Efter transkribering analyserades intervjuerna med manifest innehållsanalys enligt Burnard (1996). Resultat: Resultatet presenterades i tre kategorier enligt följande: Inverkan på patientens återhämtning, Sjuksköterskans behov för att arbeta med fysisk aktivitet och Organisatoriska hinder. Slutsats: Studien visar att främjandet av fysisk aktivitet inom psykiatrisk heldygnsvård kan bidra till återhämtning för patienter men möjligheten att arbeta med fysisk aktivitet var begränsad för sjuksköterskor. Studien pekar på vikten av att arbetet med fysisk aktivitet implementeras från organisationen. Stöd från organisationen skulle kunna bidra till att sjuksköterskan får en tydligare roll i det hälsofrämjande arbetet med fysisk aktivitet inom psykiatrisk heldygnsvård. / Background: It is well known that physical activity has positive effects on a person’s mental health. Health promotion work can advantageously start in at the psychiatric ward. At the same time, a lack of motivation is common for people with mental illness, and support and motivation are then beneficial to promote their health through physical activity. Thus, the nurse in psychiatric care has an important role in the health promotion work. Aim: The aim of the study was to illuminate nurses’ experiences of promoting physical activity in psychiatric inpatient care. Method: A qualitative interview study was used as a method. The collected material was based on eight semi-structured interviews with nurses working at psychiatric wards in Skåne county. After transcription, the interviews were analysed using manifest content analysis according to Burnard (1996). Result: The results were presented in three categories as follows: Impact on the patient’s recovery, The nurse’s need to work with physical activity and Organizational barriers. Conclusion: The study shows that the promotion of physical activity in psychiatric wards can contributing to recovery for patients but the opportunity to work with physical activity is limited. The study indicates that there is a need for promotion of physical activity from the organization. Organizational support could contribute to strengthen the nurse’s role in their work of promoting physical activity within psychiatric inpatient care.

Current empirical evidence suggests that true recovery from eating disorders is not possible without a corresponding improvement in body image and self-esteem. Ten studies in current literature evaluate this relationship between self-esteem and clinical eating disorders during inpatient treatment or during follow-up studies but do not provide both pre- (baseline) and post-treatment self-esteem scores. As a result, many questions about the nature of the relationship between eating disorders and self-esteem remain unanswered. The purpose of this study was to empirically investigate whether a comprehensive measure of self-esteem, given to women at the beginning of inpatient treatment for eating disorders, reliably predicted treatment outcome. Specific and global levels of self-esteem were determined by the Multidimensional Self-Esteem Inventory (MSEI). Pearson Product Moment Correlations run on SPSS 10 were used to determine significant results. Participants in this study included 246 women experiencing anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified who received inpatient treatment at the Center for Change (CFC), in Orem, Utah, during the years 1996 to 2003. For the purposes of this study, outcome was measured upon termination of treatment at the Center for Change. CFC discharge was based on clinical judgment of progression through the treatment program, medical stability, reduction of purging behaviors, body weight, as well as attainment of additional treatment goals designed by the therapist. The results of the current study replicate earlier research that reports that positive treatment outcome is nearly always associated with high self-esteem at discharge. These findings extend earlier research by suggesting that high levels of self-esteem at admission are associated with positive treatment outcome. This investigation, which is the first to examine self-esteem change scores between admission and discharge, found that women who experience the greatest decrease in eating disorder symptomatology are those who presented at admission with low self-esteem. Further, a significant association was found between improvements in self-esteem and decreases in eating disorder symptomatology. These findings suggest that the women who report high self-esteem at admission, or women who have low self-esteem but make dramatic improvements by discharge, are likely to experience significant reductions in disordered eating behaviors.

[pt] A área da saúde desponta como um terreno fértil para a pesquisa científica em Tecnologia da Informação. As atividades de pesquisa na área permitem abordar diversas questões para promover o desenvolvimento tecnológico. Além disso, em relação aos aplicativos para dispositivos móveis, as principais lojas de aplicativos registraram um crescimento significativo no número de aplicativos de saúde disponíveis. Esses crescimentos encontram uma de suas causas na realidade pandêmica que enfrentamos desde o início de 2020. Para lidar com os diferentes desafios de saúde apresentados atualmente, o uso de sistemas multiagentes tem sido considerado uma boa abordagem para lidar, por exemplo, com distribuição, pró-atividade e autonomia dos sistemas. Embora várias plataformas conhecidas utilizem agentes de software, algumas delas não oferecem suporte adequado para o desenvolvimento de agentes, como a plataforma iOS. Assim, nesta dissertação propusemos um framework BDI para iOS que visa apoiar o desenvolvimento de aplicativos móveis de saúde com agentes de software. Esse framework é chamado de Swift Agent Development framework for health (SADE4Health) e usa recursos nativos do iOS, como o Healthkit, que é um repositório central de dados de saúde e condicionamento físico para acessar e compartilhar dados, mantendo a privacidade e o controle do usuário. Para mostrar como o framework suporta o desenvolvimento de novos aplicativos iOS com agentes de software, são explicados os passos mínimos necessários para criar um agente usando os recursos de saúde oferecidos pelo iOS, assim como um cenário de uso modelado a partir deles. Além disso, é apresentado um cenário de uso relacionado ao monitoramento remoto de sinais vitais de pacientes, ilustrando como desenvolver uma instância do framework proposto. Por fim, uma avaliação empírica com desenvolvedores iOS para medir a usabilidade do framework trouxe importantes achados. / [en] The healthcare area is emerging as a fertile ground for scientific research in Information Technology. Research activities in this field allow us to address several issues to promote technological development. In addition, regarding mobile device apps, the leading app stores registered significant growth in the number of available eHealth apps. One of the causes of this growth derives from the pandemic reality we have faced since the beginning of 2020. In order to confront the different health challenges presented currently, the use of multi-agent systems has been considered a good approach, dealing with, for example, distribution, pro-activity and autonomy of systems. Although several known platforms that use software agents, some of them do not offer appropriate support to develop agents, such as the iOS platform. Thus, in this dissertation we have proposed a BDI framework for iOS that aims to support the development of health mobile apps with software agents. This is known as Swift Agent Development Framework for Health (SADE4Health) and it uses native iOS resources, such as Healthkit, comprising a central repository for health and fitness data to access and share data while maintaining the user s privacy and control. To show how the framework supports the development of new iOS apps with software agents, the minimum necessary steps to create an agent using health features offered by iOS are explained, as well as a modeled use scenario based on it. Furthermore, a use scenario related to remote monitoring of patients vital signs that illustrates how to develop an instance of the proposed framework is presented. Finally, an empirical evaluation with iOS developers to measure the framework usability brought important findings.

Bakgrund: Psykiatrisjuksköterskan behöver ta hänsyn till olika aspekter i sitt värv, alltifrån Sveriges lagar till rådande normer på avdelningen. Informellt tvång som enligt tidigare forskning är ett kulturellt fenomen i psykiatri då personal med påtryckningar försöker få patienten att följa vårdarnas upplägg - inte sällan mot sin vilja. Bärande begrepp: Första begreppet är makt, vilket ger vidare förståelse för mekanismerna bakom vårdens etik. Det andra bärande begreppet är vårdrelation. Syfte: Belysa före detta patienters upplevelse av informellt tvång i psykiatrisk heldygnsvård och dess påverkan på vårdrelationen. Metod: Fallstudie med semistrukturerad intervjuguide utfördes med tre informanter. Intervjuerna transkriberades och pseudonymiserades. Narrativ analys utfördes på intervjuerna. Resultat: Informanternas upplevelser sätts i ett narrativ som börjar vid ankomst till vårdavdelningen och intrycket av att hamna i en onaturlig värld. Vidare skildras händelserna kring vårdens innehåll där känsla av vanmakt dominerar. I slutet reflekterar informanterna kring känslan, förväntningar inför framtida vård och vårdrelationen. Slutsats: Genom att analysera informellt tvång ur ett maktperspektiv kan etiken bakom fenomenet synliggöras. Med psykiatrisjuksköterskans interpersonella kompetens kan hen i det kliniska arbetet med den terapeutiska relationen verka för att minska informellt tvång och därmed maktobalansen och således möjliggöra den goda vården. / Background: The psychiatric nurse has to consider many different aspects while working, from Swedish laws to existing norms in the ward. Informal coercion is according to research a cultural phenomenon in psychiatric inpatient care where nursing staff use pressure techniques to get the patient to comply, often against the patient’s will. Key concepts: Key concepts are used within this paper. The first key concept is power, where we can gain more understanding of the mechanisms of caring ethics. The caring relationship is the other key concept in this paper. Aim: To enlighten former inpatients’ experience of informal coercion and its impact on the caring relationship. Method: A case study using a semi-structured interview guide was performed with three interviewees. The interviews were transcribed and pseudonymized. Narrative analysis was performed on the interviews. Results: The informants' experiences are put in a narrative and start with arrival at the ward and the feeling of entering an unnatural setting. Later the depictions revolve around the content of the given care which evoked feelings of powerlessness. At the end of the narrative the informants describe feelings, expectations of future care and the caring relationship. Conclusion: By viewing informal coercion as a form of excursion of power one can unravel the ethics behind the phenomena. Using the psychiatric nurse's interpersonal competence, she can in the clinical work with the therapeutic relationship strive to reduce informal coercion and thus the imbalance of power and thereby enable the good care.

RATIONALE & OBJECTIVE: Patients receiving maintenance dialysis have higher mortality after primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a benefit to patients receiving dialysis that is similar to that which occurs in lower-risk groups remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for ST-elevation myocardial infarction (STEMI) and receiving maintenance dialysis with the effect among patients hospitalized for STEMI but not receiving dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We used the National Inpatient Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. PREDICTORS: Primary exposure was PCI. Confounders included dialysis status, demographics, insurance, household income, comorbidities, and the elective nature of the admission. OUTCOME: In-hospital mortality, stroke, acute kidney injury, new dialysis requirement, vascular complications, gastrointestinal bleeding, blood transfusion, mechanical ventilation, palliative care, and discharge destination. ANALYTICAL APPROACH: The average treatment effect (ATE) of pPCI was estimated using propensity score matching independently within the group receiving dialysis and the group not receiving dialysis to explore whether the effect is modified by dialysis status. Additionally, the average marginal effect (AME) was calculated accounting for the clustering within hospitals. RESULTS: Among hospitalizations, 4,220 (1.07%) out of 413,500 were for patients receiving dialysis. The dialysis cohort was older (65.2 ± 12.2 vs 63.4 ± 13.1, P < 0.001), had a higher proportion of women (42.4% vs 30.6%, P < 0.001) and more comorbidities, and had a lower proportion of White patients (41.1% vs 71.7%, P < 0.001). Patients receiving dialysis were less likely to undergo angiography (73.1% vs 85.4%, P < 0.001) or pPCI (57.5% vs 79.8%, P < 0.001). Primary PCI was associated with lower mortality in patients receiving dialysis (15.7% vs 27.1%, P < 0.001) as well as in those who were not (5.0% vs 17.4%, P < 0.001). The ATE on mortality did not differ significantly (P interaction = 0.9) between patients receiving dialysis (-8.6% [95% CI, -15.6% to -1.6%], P = 0.02) and those who were not (-8.2% [95% CI, -8.8% to -7.5%], P < 0.001). The AME method showed similar results among patients receiving dialysis (-9.4% [95% CI, -14.8% to -4.0%], P < 0.001) and those who were not (-7.9% [95% CI, -8.5% to -7.4%], P < 0.001) (P interaction = 0.6). Both the ATE and AME were comparable for other in-hospital outcomes in both groups. LIMITATIONS: Administrative data, lack of pharmacotherapy and long-term outcome data, and residual confounding. CONCLUSIONS: Compared with conservative management, pPCI for STEMI was associated with comparable reductions in short-term mortality among patients irrespective of their receipt of maintenance dialysis.

Bakgrund: Tydlig information vid utskrivning från slutenvården har stor betydelse för patienten. I samband med utskrivning från slutenvården finns behov av tydlig och anpassad information om behandling och vård som givits under vårdtiden. Sjuksköterskan som ger information bör försäkra sig om att patienten har förstått både betydelsen och innehållet i den information som lämnats. En god kommunikation i patientmötet är nödvändig för att öka patientens delaktighet och förbättra patientsäkerheten. Syfte: Syftet med litteraturöversikten var att belysa patienters erfarenheter av information i samband med utskrivning från slutenvården. Metod: En strukturerad litteraturstudie baserad på 18 vetenskapliga artiklar med inslag av den metodologi som används vid systematiska översikter. Databaserna som användes var CINAHL och PubMed, artiklarna som användes var publicerade mellan år 2013 och 2022. Resultat: I resultatet identifierades tre huvudkategorier som påverkade patienters erfarenheter av information i samband med utskrivning från slutenvården: Mötet i samband med utskrivning, brist på information och anpassad information. Slutsats: Litteraturöversikten visar att patienter upplever bristande information vid utskrivning från slutenvård. Att tillgodose patientens behov av information och delaktighet vid utskrivning visar sig vara en utmaning för vårdpersonal. Genom att arbeta personcentrerat och fokusera på den enskilda individens behov samt inkludera och informera, ökar delaktighet på ett patientsäkert sätt. / Background: Clear deliver of information through the discharge process is important for the patient. Iti s also important with adapted and person-centered information about the patient treatment plan and the care provided during the period of time at the hospital. The nurse who is providing the information should ensure that the patient has understood the content of the information and the meaning of it. Good communication is necessary to increase patient participation and improve patient safety. Aim: The aim of this literature review was to highlight inpatients experiences of information associated with discharge from hospital. Method: A structured literature review has been made based on 18 scientific articles with elements of the methodology used in systematic reviews. The databases used were CINAHL and PubMed, the articles used were published between 2013 and 2022. Results: The result identified three categories that affected patients experiences of information associated with discharge from hospital: Meeting associated at discharge, lack of information and customized information. Conclusions: The literature review shows that patients experience lack of information when discharge from hospital. Meeting the patient's need for information and participation at discharge turns out to be a challenge for healthcare professionals. By working personcentered and focusing on the individual's needs as well as including and informing, participation increases in a patient-safe manner.

Introduktion: Personcentrerad vård (PCV) kan beskrivas som en vård som strävar efter att synliggöra och tillgodose hela personens fysiska och psykiska behov. Det pågår mycket arbete med att utveckla personcentrerade arbetssätt för att stärka patientens ställning. Många studier visar att PCV är bra för patienterna, men få studier beskriver upplevelser kring personcentrerade arbetssätt ur sjukvårdspersonalens perspektiv. Syfte: Att beskriva sjuksköterskors upplevelse av att arbeta utifrån ett personcentrerat arbetssätt på en geriatrisk slutenvårdsavdelning. Metod: En kvalitativ intervjustudie genomfördes med tio, kliniskt verksamma, sjuksköterskor på en akutvårdsavdelning från ett sjukhus i mellansverige. Data samlades in med hjälp av en halvstrukturerad intervjuguide och dataanalysen utfördes med ett beskrivande fenomenologiskt förhållningssätt genom Colaizzis (1978) analysmodell. Resultat: De sex teman som identifierades var: Känsla av delaktighet hos alla, Behov av avsatt tid, Kontinuitet i teamsamarbete, Ledarskapets betydelse, Positiv påverkan på arbetsmiljön och Sjuksköterskans professionella utveckling främjas. Informanterna uttryckte ökad grad av arbetstillfredsställelse, bättre psykosocial arbetsmiljö och mindre stress i jämförelse mot hur de upplevde sin arbetssituation innan arbetssättet infördes. Slutsats: Resultatet visar vilka förutsättningar som krävs för att ett strukturerat arbetssätt ska lyckas. Alla som är involverade i den äldres vård behöver samarbeta och ett personcentrerat arbetssätt behöver vara multiprofessionellt och teambaserat med en gemensam målbild och vårdfilosofi. / Introduction: Person-centered care (PCC) can be described as care that strives to make visible and meet the entire person's physical and mental needs. There is a lot of work going on to develop person-centered working methods to strengthen the patient's position. Many studies show that PCC is good for patients, but few studies describe perceptions of person-centered working methods from the perspective of healthcare professionals. Aim: To describe nurses' experience of working based on a person-centered working methods in a geriatric inpatient ward. Method: A qualitative study with a descriptive phenomenological approach was conducted. Ten clinically active nurses at a geriatric medicine ward, from a hospital in central Sweden, participated in the survey. Data were collected using a semi-structured interview guide and analyzed using Colaizzi's (1978) phenomenological analysis model. Results: The six themes identified were: A feeling of participation among all, A need for time set aside, A continuity in teamwork, The importance of leadership, Positive impact on the work environment, and The nurse's professional development was promoted. The informants expressed an increased degree of job satisfaction, a better psychosocial work environment and less stress in comparison to how they experienced their work situation before the work method was introduced. Conclusion: The result shows the conditions required to successfully establish and maintain a structured person-centered working method. Everyone involved in the elderly person's care need to collaborate and a person-centered approach needs to be multi-professional and team-based with a common goal picture and care philosophy.