<p>The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. </p><p>Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between.</p><p>Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws.</p><p>Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement.</p><p>The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion.</p><p>A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. </p><p>In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.</p>

The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between. Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws. Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement. The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion. A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.

Bakgrund: All hälso- och sjukvård är så långt som möjligt frivillig. Personer som är allvarligt psykiskt sjuka inser dock inte alltid att de är i behov av vård och kan därför vårdas med stöd av tvångslagar. Att vårdas under tvång kan dock upplevas som värdighets- och integritetskränkande och därmed skapa vårdlidande. Det är samtidigt sjuksköterskans, som leder och utför tvångsåtgärder, professionella ansvar att lindra lidande vilket kan ses som ett dilemma. Det finns därför ett behov av ökad kunskap för att bättre förstå tvångsåtgärdernas konsekvenser för att kunna utveckla och förbättra denna vårdåtgärd. Syfte: Syftet var att beskriva sjuksköterskors upplevelse av tvångsåtgärder i psykiatrisk vård. Metod: En litteraturöversikt med systematisk ansats valdes som metod. Femton kvalitativa artiklar inkluderades och analyserades med Thomas och Hardens metod för tematisk analys. Analysen gjordes i tre steg och resulterade i fyra teman, med två tillhörande subteman var. Resultat: Sjuksköterskans upplevelse av tvångsåtgärder präglades av en emotionell stress som grundas i en inre konflikt samtidigt som tvångsåtgärder anses vara ett nödvändigt verktyg för en säker vårdmiljö. Utförandet och utfallet av tvångsåtgärder påverkas av sjuksköterskornas färdigheter och erfarenheter och det finns därför ett behov av omvårdnadshandledning. Slutsats: Den emotionella stressen skapar ett lidande hos sjuksköterskor, som i sin tur kan leda till vårdlidande hos patienterna. Ökad stöttning, omvårdnadshandledning och kunskap om sjuksköterskornas lidande är därmed av essens för att utveckla den psykiatriska vården i riktning mot en god tvångsvård. Nyckelord: Psykiatrisk tvångsvård, sjuksköterskor, upplevelser, tvångsåtgärder, lidande / Background: All health care is as far as possible voluntary. People who are seriously mentally ill do not always realize that they are in need of care and can therefore be cared for with the support of coercive laws. Being cared for under compulsory care can be perceived as a violation of dignity and integrity and thereby create care suffering. At the same time, it’s the nurse's responsibility, who leads and performs coercive measures, to alleviate suffering, which can be seen as a dilemma. There is therefore a need for increased knowledge to better understand the consequences of coercive measures in order to develop and improve this care measure. Aim: The aim was to describe registered nurses' experience of coercive measures in psychiatric care. Method: A literature review with a systematic approach was chosen as the method. Fifteen qualitative articles were included and analyzed using Thomas and Harden's method for thematic analysis. The analysis was done in three steps and resulted in four themes, with two associated sub-themes each. Results: The nurse's experience of coercive measures was characterized by an emotional stress based on an internal conflict, at the same time as coercive measures are considered a necessary tool for a safe care environment. The execution and outcome of coercive measures are affected by the nurses' skills and experiences and there is therefore a need for nursing guidance. Conclusion: The emotional stress creates suffering in nurses, which in turn can lead to care suffering in the patients. Increased support, nursing guidance and knowledge of nurses' suffering are thus of essence for developing psychiatric care in the direction of good compulsory care. Keywords: Compulsory psychiatric care, registered nurses, experiences, coercive measures, suffering

Bakgrund: Sjuksköterskans åtagande är att vårda patienten med hänsyn till dennes autonomi och rätt att vara delaktig. Vid psykisk ohälsa kan situationer uppstå där beslut behöver fattas utan patientens medgivande. Psykiatrisk tvångsvård innebär att patienten vårdas mot sin vilja då hen utgör en fara för sig själv eller andra.  Syfte: Syftet var att beskriva patienters upplevelser av psykiatrisk tvångsvård.  Metod: Den valda metoden var en litteraturöversikt som sammanfattar det aktuella forskningsläget. Denna litteraturöversikt utgår ifrån totalt tio kvalitativa vetenskapliga artiklar som därefter analyserats för att generera gemensamma teman.  Resultat: Patienters upplevelser av psykiatrisk tvångsvård var starkt kopplade till hur de upplevt bemötandet från vårdpersonal. Det var också viktigt för patienterna få information om sin vård och att få känna sig delaktiga i sin behandling.  Slutsats: Patienter som vårdas inom psykiatrisk tvångsvård är i en mycket utsatt situation. För att upplevelsen ska bli så bra som möjligt för patienten är det viktigt att personalen är kunnig, ger ett gott bemötande och adekvat information. / Background: The undertaking of the nurse is to care for the patient with regard to its autonomy and right to participate. In the case of mental illness, situations may arise where decisions need to be made for the patient. Compulsory psychiatric care means that the patient is cared for against his/her will as he/she poses a danger to herself or others.  Aim: The aim was to describe patients' experiences of psychiatric involuntary treatment.  Method: The method used was a literature review which summarizes the current research field. This literature review was based on ten qualitative articles which were analysed to generate common themes.  Results: The patients’ experiences of compulsory psychiatric care were strongly connected to how they had experienced the personal treatment by the care personnel. The patients also valued being informed about their care and involved in their treatment.  Conclusion: Patients in involuntary psychiatric care are in a highly exposed situation. To make their experience as good as possible it is important that care personnel are knowledgeable, gives a good personal treatment and provides the patient with adequate information.

Bakgrund: Patienters delaktighet i sin vård ses idag som en självklarhet i Sverige och personcentrerad vård (PCV) är ett verktyg för att öka delaktigheten. Genom att lyssna till patientens berättelse, sträva efter ett jämbördigt partnerskap och dokumentera det som framkommer får sjuksköterskan möjlighet att med patienten skapa en hållbar och långsiktig effekt av vården. Inom tvångsvården enligt Lagen om psykiatrisk tvångsvård (LPT) ges sjukvården rätten och skyldigheten att vårda patienten mot deras vilja när det anses vara befogat för att skydda patientens liv och hälsa. Enligt LPT är syftet med tvångsvården att förmå patienten till att ta emot vården som erbjuds frivilligt.   Syfte: Syftet med denna studie är att undersöka erfarenheter hos sjuksköterskor i psykiatrisk vård av att arbeta med PCV med patienter som vårdas enligt LPT.  Metod: Studien har genomförts med en kvalitativ semistrukturerad intervju. Detta har sedan analyserats med en kvalitativ innehållsanalys.  Resultat: Studiens resultat uppvisar erfarenheter av att främja patientberättelsen men även hinder för denna. Det framkommer även erfarenheter av partnerskap som bedrivs under LPT. Partnerskapet främjas till stor del av sjuksköterskans bemötande. Till sist framkommer erfarenheter av dokumentationens betydelse för PCV som bedrivs enligt LPT. Slutsats: Utifrån den fakta som läggs fram rörande PCV och LPT i bakgrunden är dessa två begrepp relativt komplicerade att förena. I resultatet av denna studie kan det konstateras att delaktighet kan främjas PVC i vård som bedrivs enligt LPT, som i sin tur främja delaktighet. Förhållandet mellan begreppen PCV och delaktighet blir i det närmsta cirkulärt där de stödjer varandra och skapar uppbyggande symbios Kliniska implikationer: Baserat på resultatet framkommer en tilltro till att PCV kan vara positiv i bemärkelsen att det skapas ökad delaktighet mellan patient och sjuksköterska i vård som bedrivs enligt LPT. / Background: Patients' participation in their care is today seen as a matter of course in Sweden and person-centred care (PCV) is a tool to increase participation. By listening to the patient's story, striving for an equal partnership and documenting what emerges, the nurse has the opportunity to create a sustainable and long-term effect of care with the patient. In coercive care under the Compulsory Psychiatric Care Act (LPT), healthcare is given the right and obligation to care for the patient against their will when this is considered justified to protect the patient's life and health. According to LPT, the purpose of coercive care is to induce the patient to receive the care offered voluntarily.   Aim: The aim of this study is to investigate the experiences of nurses in psychiatric care of working with PCV with patients being cared for according to LPT. Method: The study has been conducted with a qualitative semi-structured interview. This has then been analyzed with a qualitative content analysis. Results: The results of the study show experiences in promoting the patient's story but also obstacles to it. There is also experience of partnerships conducted under LPT. This partnership is largely promoted by the nurse's treatment. Finally, experience of the importance of documentation for PCVs carried out under LPT emerges. Conclusion: Based on the facts presented regarding PCV and LPT in the background, these two concepts are relatively complex to reconcile. In the results of this study, it can be concluded that participation can be promoted PVC in care conducted according to the LPT, which in turn promotes participation. The relationship between the concepts of PCV and participation becomes almost circular where they support each other and create constructive symbiosis. Clinical implications: Based on the results, there is a belief that PCV can be positive in the sense that increased participation between patient and nurse is created in care conducted according to LPT.

Det har sedan början av 2000-talet skett en gradvis ökning av andelen som får vård för psykiatriska tillstånd. Specialistsjuksköterskan med inriktning mot psykiatrisk vård har flera specifika åtaganden, varav ett är att ansvara för att patienten får stöd och insatser för att stärka förmågan till egenvård och återhämtning. När specialistsjuksköterskan aktivt skapar tillitsfulla relationer, arbetar med en etisk medvetenhet, empati och gör patienten delaktig i utformningen av sin vårdplan, kan hon stötta patienten till egenvård och återhämtning. Specialistsjuksköterskan bör etablera god kontakt med anhöriga och ha insikt i att psykisk sjukdom drabbar hela familjen och inte bara den enskilde individen. Sjukvården har ansvar för att fånga upp patienter med svår psykisk sjukdom i ett tidigt skede för att minska lidande och återinsjuknande, men även för att spara på sjukvårdens resurser och ekonomi. Syftet med denna studie var att beskriva specialistsjuksköterskor inom psykiatrisk vårds levda erfarenheter av att vårda patienter enligt lagen om psykiatrisk tvångsvård. Enskilda, kvalitativa intervjuer genomfördes med åtta specialistsjuksköterskor inom psykiatrisk vård för att utforska fenomenet. Analysen av intervjuerna gjordes utifrån ett fenomenologiskt perspektiv med induktiv ansats. Resultatet presenteras i tre huvudkategorier och elva underkategorier. Huvudkategorierna benämns Professionell utveckling, Etiska överväganden och Vårdande förhållningssätt. Professionell utveckling består av underkategorierna Växa över tid, Reflektion, Kompetensutveckling och Självinsikt. Etiska överväganden utgörs av underkategorierna Etisk medvetenhet, Värna patientens Integritet och Intressekonflikter. Vårdande förhållningssätt utgörs av underkategorierna Lyhörd, Patientens delaktighet, Vårdande miljö samt Organisation och resursfördelning. I diskussionen förs resonemang kring studiens resultat utifrån en fenomenologisk livsvärldsteoretisk ansats. / Since the early 2000s, there has been a gradual increase in people receiving care for psychiatric conditions. The specialist nurse in psychiatric care has several specific commitments. The specialist nurse can support the patient in self-care and recovery with trusting relationships, an ethical awareness and involve the patient in the design of their care plan. The specialist nurse should involve relatives in the care and be aware that mental illness affects the whole family and not just the individual. The healthcare system must identify patients with severe mental illness at an early stage to reduce suffering and recurrence, and also to save healthcare resources and finances. The purpose of this study was to describe specialist nurses in psychiatric care's lived experiences of caring for patients according to the law on compulsory psychiatric care. Individual, qualitative interviews were conducted with eight specialist nurses in psychiatric care to explore the phenomenon. The analysis of the interviews was done from a phenomenological perspective with an inductive approach. The results are presented in three main categories and eleven subcategories. The main categories are called Professional Development, Ethical Considerations and Nurturing Approaches. Professional development consists of the subcategories Grow over time, Reflection, Competence development and Self-insight. Ethical considerations consist of the subcategories Ethical awareness, Protecting the patient's integrity and Conflicts of interest. Caring approaches consist of the subcategories Responsive, Patient participation, Caring environment and Organization and resource allocation. In the discussion, the results of the study are discussed based on a phenomenological life-world theoretical approach.