SAMMANFATTNING Bakgrund: Patienters upplevelser av att vårdas inom slutenvården med stöd av Lagen om psykiatrisk tvångsvård. Människor med en allvarlig psykisk störning eller ett oundvikligt behov av vård får med stöd av lagen tvångsvårdas. Patienterna fråntas självbestämmandet och blir tvungna att delta i vård och behandling mot sin vilja. När självbestämmandet fråntas patienterna övertar vårdpersonalen ansvaret vilket kan leda till ett lidande för patienterna (1991:1128). Syfte: Syftet var att beskriva patienters upplevelser av tvångsvård inom psykiatrisk slutenvård.  Metod: Systematisk litteraturstudie, sex artiklar användes för uppnått resultat. Resultat: Både positiva och negativa upplevelser av tvångsvård påvisades. Patienterna beskrev ett möte med vården kantat av upplevelser kring människovärde, delaktighet i sin egen vård, kommunikation, relationer, synen på våld, hot och straff samt upplevt lidande. Slutsats: Om patienterna bemöttes med respekt, människovärde samt fick tillräcklig information kring vård och behandling blev upplevelserna av tvångsvården mer positiv. Brist på delaktighet i fråga om vård och behandling och kommunikationsbrister var ett problem då patienterna hade lite sjukdomsinskt samt inte hade förståelse för behovet av tvångsvård. Vidare forskning med kvalitativa intervjuer om patienters upplevelser av tvångsvård föreslås för att ge utökad förståelse och kunskap.

This thesis analyzes the culture of coercive voluntarism in Georgia during the First World War using studies of legislation and vigilance, the press, and the Georgia Council of Defense. Each of the themes studied demonstrates how organizations attempted to coerce support of the US war effort in Georgia. The study focuses on Georgia as a single state rather than simply as part of the South, as most other studies have done. The purpose is to challenge studies that have emphasized resistance only, which presents an incomplete picture of Georgia’s domestic scene during the war. In fact, many elements within Georgia—at the state, local, and citizen level—actively supported the war, often with the same level of intention, if not the same results, as did other areas of the country. Georgia attempted to comply with federal imperatives while preserving its rights as a state.

The effect of gender-neutral language in a survey designed to measure unwanted sexual experiences was examined. Methodological issues pertaining to survey design and significant variability in prevalence estimates of sexual violence demonstrate that further refinement of self-report instruments is necessary. As a variety of macrolevel forces influence individual behavior, the current study contends that coercive tactics used to obtain sex in mixed-gender interactions are normalized by the traditional heterosex script and conveyed through gender-specific language. Reference to respondents’ sexual partners in gender-neutral, as opposed to gender-specific terms, was hypothesized to result in more disclosure of sexually coercive victimization and perpetration experiences. Logistic regression analyses revealed no statistically significant differences in disclosure between language conditions. Null findings are interpreted with reference to the broader gender-neutral language literature and implications for future research are suggested.

Bakgrund: Att vara inskriven enligt lagen om psykiatrisk tvångsvård, LPT, innebär att självbestämmandet tas ifrån en. Eftersom den nya lagen skapades för att skydda patienters integritet undersöker detta arbetet patienternas upplevelser av tvångsvård. Syfte: Syftet var att beskriva patienters erfarenheter av tvång med fokus på tvångsvård inom den psykiatriska vårdenheten. Metod: En litteraturstudie där sju vetenskapliga artiklar ingick. Systematisk granskning av artiklarna genomfördes. Resultat: Resultatet utgörs av tre kategorier: de som uppfattar tvång i störst utsträckning vilket var främst vita, högutbildade och kvinnor. Negativa erfarenheter av tvångsvård vilket inkluderade att ingen lyssnade eller tog en på allvar. Slutligen positiva erfarenheter av tvångsvård vilket bland annat innebar att ha någon att prata med och få viss kontroll över sin vård. Diskussion: Självbestämmande och kommunikation är viktiga faktorer som spelar en stor roll när det kommer till upplevelser av tvångsvård. Slutsats: Många faktorer spelar in vid upplevelser av tvångsvård och tvång. Både negativa och positiva upplevelser kom fram. Många problem hade kunnat undvikas om personalen hade pratat med patienterna och visat empati. Fler studier i ämnet behövs för att personalen ska kunna förstå patienterna och i slutändan ge en bättre vård. / Background: To be admitted according to the law of coercive measures in psychiatric care, LPT, one is stripped of one’s self-determination. Since the new law was created to protect patients' integrities, the aim of this study was to determine how patients' experienced coercive measures. Purpose: The aim was to describe patient´s experience of coercive measures with focus on psychiatric coercive care within a psychiatric care unit. Method: A literature review in which seven scientific articles were included. Systematic review of the articles was used. Results: Three categories were found: Those who experience coercive measure the most which was mainly white people, women and those with a high education. Negative experience of coercive measures which included not being listened to and taken serious. Finally positive experience which included having someone to talk to and being given some control over one’s own care. Discussion: Self determination and communication are key factors when it comes to experiences of coercive measures in psychiatric health care. Conclusion: There are many factors that correlated with experience of coercive measures and coercion. Both negative and positive experiences were mentioned. Many problems could have been avoided if only the staff had talked to the patients and showed empathy. More studies are needed to make the staff understand patients and ultimately give them better care.

Syftet med studien var att beskriva sjuksköterskors upplevelser av att utföra tvångsåtgärder inom psykiatrisk slutenvård. Studien hade en deskriptiv design. Ett bekvämlighetsurval tillämpades som urvalsmetod och sex sjuksköterskor från en psykiatrisk slutenvårdsavdelning i Mellansverige deltog i studien. Data samlades in via ostrukturerade intervjuer och analyserades utifrån kvalitativ innehållsanalys. Resultatet visade att sjuksköterskorna upplevde positiva känslor i samband med utförandet av tvångsåtgärder. De upplevde att det var tur att tvångsåtgärderna finns som en möjlighet för patientens bästa. Ibland kunde tvångsåtgärder leda till att relationer skapades till patienten, då sjuksköterskan och patienten tillsammans upplevt en jobbig situation. Sjuksköterskorna upplevde att tvång var lättare att utföra när de kände patienten och i vissa tydliga situationer. Sjuksköterskorna upplevde även negativa känslor i samband med utförandet av tvångsåtgärder, att det inte var något de kände någon glädje över att utföra. Tvångsåtgärder uttrycktes i känslor av hämnd, dåligt samvete, rädsla och att det är jobbigt. De uttryckte att tvångsåtgärderna innebar en kränkning av patienten, och att det ibland kan kännas som att de begår övergrepp mot patienten. Sjuksköterskorna berättade även om situationer då tvång kändes svårare att utföra och att situationer där tvång utfördes kunde framkalla känslor av kluvenhet hos sjuksköterskorna. Sjuksköterskorna berättade även om hur hot om tvång ibland används mot patienten. Slutsatsen med föreliggande studie är att den psykiatriska vården är och förblir ett etiskt dilemma, då sjuksköterskorna kan ställas inför handlingar som kan skapa konflikt med hennes professionella, rättsliga, etiska och personliga ansvar för att hjälpa dessa patienter. / The aim of this study was to describe nurses' experiences of carrying out coercive measures in psychiatric inpatient care. The study had a descriptive design. A convenience sample was applied as sampling method, and six nurses from a psychiatric inpatient ward in central Sweden participated in the study. Data were collected through unstructured interviews and analyzed according to qualitative content analysis. The results revealed that nurses experienced positive feelings associated with using of coercive measures. They felt that it was good that the coercive measures were available as an option for the patient's best interests. Sometimes coercion led to development of therapeutic relationships between the nurse and the patient, because of the fact that they experienced a difficult situation together. The nurses felt that compulsion was easier to perform when they knew the patient and also in some obvious situations. The nurses also experienced negative feelings associated with the use of coercive measures, as it was not something that they felt any joy to perform. Coercive measures were expressed in feelings of revenge, remorse, fear, and that it was a burdensome issue. They expressed that coercive measures was a violation of the patient, and that it could sometimes feel like they were assaulting the patient. The nurses also told about situations where coercion felt more difficult to perform and situations where coercion was carried out could cause mixed feelings among the nurses. The nurses also told about how they sometimes used threat of coercion against patients. The conclusion of this study is that mental health care remains an ethical dilemma, since nurses may face options which may create conflict with her professional, legal, ethical and personal responsibility to help these patients.

Coercion within parent/child relationships can have lasting effects on the behavior of children. The Family Safety/Applied Behavior Analysis Initiative at the University of South Florida is part of a statewide project designed to serve foster parents and the children in the foster care system, has developed a training program entitled .Parenting Tools for Positive Behavior Change.. To date, the effectiveness of the parenting course has been evaluated in two ways. First, parents have been tested in role-play situations before and after training, and have shown improvements in their use of positive parenting skills. Second, frequency of foster home placement disruptions has been evaluated. The Preliminary results suggest that the parenting course was successful in decreasing the costs associated with placement disruptions, as well as reducing the number decreasing the costs associated with placement disruptions, as well as reducing the number of restrictive placements. Despite the promising results thus far, research has not been conducted to determine whether the parenting course reduces coercion in interactions between parents and children. The present study sought to demonstrate the effectiveness of .Parenting Tools for Positive Behavior Change. training course on the use of positive parenting tools within the context of authentic environments (i.e., within home settings) using parents and biological children. Although all parent participants. appropriate responding improved during the course of the study, results appeared more dramatic for some parents over others. In general, the parent participants seemed to do better in decreasing coercive responses with their child.s appropriate behaviors than their child.s inappropriate behaviors. Overall, affect on the parent.s coercive responses to their children.s behaviors was not as dramatic as the affect on their increase in responding appropriately to their child.s appropriate behaviors. It seems that the increase in more appropriate responses does not necessarily mean that this will also result in dramatic reductions in coercive responses by the parents.

Tvång är en realitet i psykiatrisk slutenvård och påverkan på individens autonomi utgör en viktig kunskapskälla för omvårdnadspersonal. Under 1990-talet genomfördes betydande förändringar inom psykiatrins område med uppkomst av Psykiatrireformen, Lag om psykiatrisk tvångsvård och Lag om rättspsykiatrisk vård, i syfte att förbättra vård och behandling av individer med psykiatriska åkommor. Tvångsåtgärder som förekommer inom den psykiatriska vården utgörs av bältning, isolering, kvarhållande på en sluten psykiatrisk vårdenhet och dylika frihetsberövande åtgärder. Syftet var att beskriva upplevelser och erfarenheter hos individer som genomgått psykiatrisk tvångsvård inom slutenvården. Metoden var en litteraturstudie av kvalitativ design med induktiv ansats. Resultatets fyra bärande teman är: Individen och autonomi, Individen, tvångets skepnad och omgivningen, Individen och relationer samt Individen under tvång. Litteraturstudiens slutsatser består till en del utav informationens betydelse. Därutöver är en omvårdande relation utav yttersta vikt samt att innehållet i vad som upplevs som tvång differentierar. Tvång är alltid närvarande i omvårdnadssituationer där hot om detta föreligger. Implikationen för grundutbildningen till sjuksköterska är att öka sjuksköterskestudenternas förståelse för individens upplevelser och erfarenheter av tvångsvård samt tillhandahålla verktyg för bemötande. Framtida forskning bör koncentrera sig på individens upplevelser och erfarenheter av tvång inom psykiatrisk slutenvård, i syfte att höja kvalitéten på den omvårdnad som tillhandahålls. / Coercion is a reality in psychiatric inpatient care and how it affects the individual’s autonomy is an important source of knowledge for nursing staff. During the 1990´s, important changes were conducted within the area of psychiatry with creation of “Psykiatrireformen”, “Lag om psykiatrisk tvångsvård” and “Lag om rättspsykiatrisk vård”, aiming to improve care and treatment of individual´s with psychiatric diseases. Coercive measures that occurs within psychiatric care consists of mechanical restraint, seclusion, detention in a psychiatric unit and similar confinement measures. The aim was to describe the experiences of individuals who have undergone coercion within psychiatric inpatient care. The method was a literature study of qualitative design with an inductive approach.  The result’s four carrying themes are: The individual and autonomy, The Individual, the semblance of coercion and surroundings, The individual and relationships and The individual during coercion. Conclusions of this literature study consist to a part of the importance of information. In addition, a caring relationship is of the most importance and the content in the experience of coercion is differentiating.  Coercion is alwayspresent in nursing situations where the threat of this exists. Implication for thenurse basic education consists in providing greater understanding for the individual’sexperiences of psychiatric inpatient coercion and providing tools inencountering. Future research should concentrate at the individual’sexperiences of coercion in psychiatric inpatient care, aiming to increase thequality of the care that is provided.

Šio tyrimo tikslas nustatyti moksleivių su sveikata susijusio elgesio ir mokykloje patiriamos prievartos bei stresogeninių situacijų įveikimo strategijų sąsajas. Buvo tirta 200 Vilniaus miesto Petro Vileišio ir Varėnos „Ąžuolo“ vidurinių mokyklų moksleivių. Tyrimas vyko 2008 m. kovo - balandžio mėn. Įveikimo strategijoms ir būdams ištirti panaudotas COPE klausimynas (Autoriai - C. Carver, M. Scheier, J. Weinbtraub. Į lietuvių kalbą išvertė E. Kavaliauskaitė.); L Reederio įtampos skalė, pagrįsta kiekvieno žmogaus nuomone apie save, savo vidinių būsenų įvertinimu; paauglių prievartos skalė, skirta tiesioginei ir netiesioginei prievartai. (Autoriai - Y. Mynard, S. Joseph, 2000.) Jos pagrindu I. A. Furmanovas (И. А. Фурманов) sukūrė klausimyną. (Į lietuvių kalbą išvertė A.Vienažindys). Tyrimo nustatyta, kad didesnę įtampą patiriantys moksleiviai mažiau naudojo į emocijas nukreiptą įveikimo strategiją (įveikos strategija – pozityvi interpretacija), mažesnę įtampą - į problemą nukreiptą įveikimo strategiją (įveikos strategija – aktyvus įveikimas ir planavimas). Merginų grupėje buvo nustatyta, kad didesnę įtampą patiriančios merginos taip pat mažiau naudojo į emocijas nukreiptą įveikimo strategiją. Jų įveikos strategija – humoras. Tai juokavimas iš situacijos. Vertinant sveikatos įveikos strategijas buvo nustatyta, kad prastai ir vidutiniškai sveikatą vertinančios merginos daugiau naudojo į emocijas nukreiptą streso įveikimo strategiją (neigimą bei susikoncentravimą į emocijų... [toliau žr. visą tekstą] / The goal of the thesis was to determine the correlations of strategies of coping with stressogenic situations with pupils’ health related behaviour and coercion experienced at school. The object and methods of research: 200 secondary school pupils of the cities of Vilnius (Petro Vileišio secondary school) and Varena (Ąžuolo secondary school). The survey was conducted in March-April 2008. Research methods: COPE questionnaire was used for investigating the strategies and methods for coping with stress. Authors C.Carver M.Scheier, J.Weinbtraub, translated into Lithuanian by E.Kavaliauskaitė. L.Reeder’s scale of psycho-social stress, based on every person’s opinion about himself, assessment of one’s own inner conditions. C.D.Spilberger – Chanin’s questionnaire (1976, 1978). The scale of teenagers’ coercion devoted to direct and indirect coercion (Authors Y.Mynard, S.Joseph,2000). On its basis I.A. Furmanovas (И.А.Фурманов) created a questionnaire that was translated into Lithuanian by A.Vienažindys. Results of the study: It was determined that pupils experiencing bigger tension used the emotions-focused strategy of coping with stress less seldom (positive interpretation). Pupils who experienced lesser tension used the problem-focused strategy of coping with stress (active overcoming and planning). Ladies experiencing bigger tension also used the emotions-focused strategy of coping with stress less seldom. They used humour as an overcoming strategy. It’s laughing at a situation... [to full text]

The use of coercion to induce entry to addiction treatment is controversial and a large body of research has accumulated considering ethical issues, benefits, and repercussions. However, development of evidence-based policy and practices is hampered by limitations of existing literature. Theoretical and empirical work on self-determination suggests that perceptions of coercion have negative implications for motivation, behaviour change, and psychological well-being; however, these insights have not generally informed research on coerced treatment. The present work seeks to further understandings of the meaning and effectiveness of coerced addiction treatment through a theory-based, prospective study of coercion and treatment processes. The sample includes 276 adults admitted to an outpatient counseling program for alcohol- and drug-related problems. At admission, participants completed questionnaires on motivation, perceived coercion, and pressures to enter treatment. Two months later, a second questionnaire assessed engagement in treatment and substance problem severity (follow-up rate = 74.3%). Retention was determined via self-report and agency records. Analysis was guided by a conceptual model based on Self-Determination Theory. Perceived coercion at admission was associated with greater pressures from legal and informal sources, and lower substance problem severity. Fewer than half (45.7%) of participants were still attending treatment at 2-month follow-up. Clients who reported greater coercion were more likely to leave treatment within the first 2 months, and to qualify that decision by statements indicating a lack of perceived need for continued treatment. Greater autonomous motivation was associated with higher client confidence in treatment, and lower perceived coercion and greater informal pressure were associated with greater resolution of substance problems in the weeks following admission. This work contributes empirical evidence to ongoing debates over the legitimacy of coerced addiction treatment by reframing relevant concepts in terms of client perspectives and evaluating the impact on treatment processes. Results raise questions about previous conclusions of the effectiveness of coerced treatment and suggest many future avenues for research. In particular, research is needed to evaluate the longer-term implications of coercion and the changing nature of perceptions and motivation during treatment.

The use of coercion to induce entry to addiction treatment is controversial and a large body of research has accumulated considering ethical issues, benefits, and repercussions. However, development of evidence-based policy and practices is hampered by limitations of existing literature. Theoretical and empirical work on self-determination suggests that perceptions of coercion have negative implications for motivation, behaviour change, and psychological well-being; however, these insights have not generally informed research on coerced treatment. The present work seeks to further understandings of the meaning and effectiveness of coerced addiction treatment through a theory-based, prospective study of coercion and treatment processes. The sample includes 276 adults admitted to an outpatient counseling program for alcohol- and drug-related problems. At admission, participants completed questionnaires on motivation, perceived coercion, and pressures to enter treatment. Two months later, a second questionnaire assessed engagement in treatment and substance problem severity (follow-up rate = 74.3%). Retention was determined via self-report and agency records. Analysis was guided by a conceptual model based on Self-Determination Theory. Perceived coercion at admission was associated with greater pressures from legal and informal sources, and lower substance problem severity. Fewer than half (45.7%) of participants were still attending treatment at 2-month follow-up. Clients who reported greater coercion were more likely to leave treatment within the first 2 months, and to qualify that decision by statements indicating a lack of perceived need for continued treatment. Greater autonomous motivation was associated with higher client confidence in treatment, and lower perceived coercion and greater informal pressure were associated with greater resolution of substance problems in the weeks following admission. This work contributes empirical evidence to ongoing debates over the legitimacy of coerced addiction treatment by reframing relevant concepts in terms of client perspectives and evaluating the impact on treatment processes. Results raise questions about previous conclusions of the effectiveness of coerced treatment and suggest many future avenues for research. In particular, research is needed to evaluate the longer-term implications of coercion and the changing nature of perceptions and motivation during treatment.