The purpose of this paper is to provide an overview of how cooperation functions between the health services and social services within Sollentuna County Municipal area regarding clients and simultaneous or double diagnoses. Focusing more specifically; the paper also aims to provide additionally, an inquiry as to how the implementation of the Gemensam Individuell Vårdplan (GIVP) (The Integrated Individual Service Care Programme or (GIVP) functions within the Sollentuna Municipal County Area. The questions asked in the paper are: How do the Municipal and County Council personnel experience how the (GIVP) system functions in Sollentuna? How do the Municipal Council and County Council personnel respectively describe their own and their cooperative sister services rolls in terms of the implementation of the GIVP system in practice? The projection activates a hypothesis and tries to explain how the cooperation functions and provides an assessment as to how it functions or not as may be the case in practise. The authors attempt to achieve this using a combination of methodologies. Partly through data based collection and collation through the use of a vignette-focus-study and partly through the use of a questionnaire. A combination of methods has been used to collate both quantitative and qualitative data. The analysis and interpretation of the data is managed through the use of Bengt Berggren’s (1982) cooperative model, incorporating both cognitive theory as well as meta-cognitive theory. The purpose and application of the theories is designed both to individually and collectively nuance interpretations of the relevant data. The investigations primary results show the existence of a strong willingness to cooperate. It shows that cooperation is widely regarded as being important, and that in addition, GIVP is regarded as a useful system for an improved integrated service. It additionally suggests that cooperation can be improved amongst the relevant services to an even greater extent.

Vorliegende Arbeit untersucht – nach intensiver Datenanalyse und -klärung – die ersten eineinhalb Jahrzehnte Transition in Ostdeutschland ökonometrisch. Im Mittelpunkt stehen dabei die Interaktionen zwischen der allgemeinen Wirtschaft und den Krankenhäusern sowie – auf Basis der Hauptdiagnose – den in Krankenhäusern behandelten Krankheiten. Verschiedene, in den politischen Diskussionen zur Effizienz der Krankenhäuser übliche Indikatoren werden verglichen und auf ihre Eignung zur adäquaten Beschreibung von Krankenhauskosten und -leistungen geprüft. Durch Einbeziehen der Daten aus Rheinland-Pfalz wird herausgearbeitet, welche der Veränderungen in Ostdeutschland transitionsbezogen sind und ob und wie sich die transitionsbezogenen von eher transitionsunabhängigen Veränderungen trennen lassen. Dazu werden den Daten – jährlich erhobenen Angaben zu einem jeden Krankenhaus bzw. jedem Kreis des Untersuchungsgebietes – Paneldatenmodelle angepasst. Ergänzt um deskriptive Statistiken, Graphen und Choroplethenkarten sind diese Modelle Grundlage einer wirtschaftswissenschaftlichen Interpretation der Veränderungen zwischen 1992 und 2005. Größten Einfluss auf die Krankenhäuser in Ost- wie in Westdeutschland haben die sich verändernden Rahmenbedingungen, zuvörderst die etappenweise Ablösung einer budgetbasierten Krankenhausfinanzierung durch eine, die auf Fallpauschalen für die verschieden schweren Krankenhausfälle (per diagnose related groups – DRG) basiert. Bereits die um das Jahr 2000 unter den Ärzten und Krankenhausmanagern beginnende Diskussion um die Fallpauschalen führt zu erheblichen Veränderungen bei der ärztlichen Diagnosestellung (bzw. -kodierung), diese Veränderungen werden diskutiert. Vor allem den Besonderheiten der Finanzierung des deutschen Gesundheitswesens ist es geschuldet, dass die Transition für die ostdeutschen Krankenhäuser sehr schnell zu einem den westlichen Krankenhäusern ähnlichen Leistungs- und Kostenniveau führt und dass mikroökonomische Unterschiede in Wirtschafts- und Sozialparametern kaum Einfluss auf die Krankenhäuser haben. / This research investigates the first 15 years of East Germany’s transition from an econometric perspective. Primary interest of the investigations lies with the potential interactions between the overall economic situation and the hospitals as well all the hospital treated patients. Economic and legislative discussions of hospital efficiency are heavily based on economic indicators. Common indicators are compared for their usefulness in describing hospital efforts and costs. By incorporating data of one of the West German federal states – Rhineland-Palatinate – distinctions can be made between transition and non-transition related changes. Panel data regression models are applied to yearly hospital and district economic data. Their interpretation is supported by descriptive statistics, graphs and choropleth maps. The hospitals of both East and West Germany are heavily influenced by the changes of the political and economic environment – most particularly by the transition from the budget-based financing to the lump compensation (DRG) based reimbursement. The data reveals that the year 2000 marks both the beginning of hospital physicians’ and managers’ discussion of the upcoming DRG system as well as the beginning of major changes in diagnosing (or diagnose coding) – these changes are discussed. Above all other it is the financing particularities of the German health care system that East Germany’s hospitals minimized the gap to their West German counterparts quite quickly with regard to performance and costs; microeconomic differences between districts have only minor influence on the hospitals.

This thesis investigates ‘the doing’ of the Swedish social insurance program Activity Compensation (AC). AC is an example of disability policies in Western welfare states. These policies have two goals: to ensure financial security and to promote social participation. In 2003 AC replaced Early Retirement Pension for persons aged 19 to 29 years and who, for medical reasons, have reduced work capacity. Three features characterize AC. Young adults are differentiated in a separate system. For them, benefits are time-limited. Benefits include an established right to participate in activities. Doing AC is studied bottom-up. Interviews with two actor groups have provided the empirical base: 1) persons accorded AC and medically certified to have an anxiety and/or a depression diagnosis and 2) the respective administrator(s) at the Swedish Social Insurance Agency. National legislative preparatory texts and legal documents complete the data. The conclusions of this study are three-fold addressing goal displacement and non-contact. Firstly, a discursive change in respect to the denotation of social participation within the politics of principle has appeared throughout OECD countries over the last decennium. This goal displacement obscures the goal of economic security emphasizing the profitability of work. AC explicitly manifests this change in establishing a right to activity participation for beneficiaries. This displacement is without full impact in the politics of practice when actors’ experience of doing AC is examined. Financial security remains the foremost goal in the local politics of practice mirroring the initial function of safeguard for those with reduced work capacity due to certified illness. Relating to this lexical displacement, the study concludes that social participation is revealed as a goal to be realized in a specific form, salaried employment, within a distinct arena, the labor market. Values such as life-quality are neglected as regulatory efforts to get persons on the track to work have been underscored. Finally, the prescribed contact between the insured young adults and their administrator(s) is not consistently present. This contact is a necessary condition for the intended planning of activities to take place. When non-contact prevails, the established regulatory right to participate in activities can not materialize.

The present work aims at developing a model of an organizational diagnosis which evaluates the organization, before the execution of the organizational strategic plan-ning. For achieving the objective, the research used an exploratory study, of a qualit-ative nature with the use of a bibliography research, it was developed a detailed route of evaluation that will be incorporated in a harmonic way into the Model of Stra-tegic Administration of Estrada (2007). The Model of Organizational Diagnosis here developed is segmented with seven perspectives: Structure, Marketing, Production and Operations, People, Finances, Knowledge, and Society. The development of the Organization Diagnosis Model contributes with the literature of the area presenting an effective and practical instrument of data collection in the sense of assisting con-sultants and administrators on the global evaluation of companies, allowing also ana-lyzing the readiness of the company before the execution of the strategic planning. / O presente trabalho tem como propósito desenvolver um modelo de diagnós-tico organizacional que avalie a organização, antes da execução do Planejamento estratégico organizacional. Para atingir este objetivo a pesquisa utilizou-se de um estudo exploratório, de natureza qualitativa com a utilização de pesquisa bibliográfi-ca, foi desenvolvido um roteiro detalhado de avaliação que será incorporado de ma-neira harmônica ao Modelo de Gestão Estratégica de Estrada (2007). O Modelo de Diagnóstico Organizacional aqui desenvolvido está segmentado em sete perspecti-vas: Estrutura, Marketing, Produção e Operações, Pessoas, Finanças, Conhecimen-to e Sociedade. O desenvolvimento do Modelo de Diagnóstico organizacional contri-bui com a literatura da área apresentando um instrumento de coleta de dados ope-rante e prático no sentido de auxiliar consultores e administradores na avaliação global de empresas, permitindo também analisar a prontidão da empresa antes da execução do planejamento estratégico.

Made available in DSpace on 2015-05-08T14:47:43Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1750252 bytes, checksum: 70aa02b8b820043f921b68e2737352f4 (MD5) Previous issue date: 2014-02-26 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introduction: The child's hospitalization is characterized by an extremely stressful which could lead to negative consequences in their development, such as the anxiety of hospitalization in children. Objective: To analyze the concept of anxiety of hospitalization in children, identifying their attributes, antecedents and consequences, with a view to building a nursing diagnosis. Method: It was taken based on the model conceptual analysis proposed by Walker and Avant, which aims to clarify the meanings of terms, being composed of eight stages: concept selection, choice of targets, aims and objectives of conceptual analysis, identification of possible uses of the concept, determining critical attributes, defining or essential, construction of model cases, development of other cases, identification of antecedents and consequences of the concept and definition of empirical referents. The data collection was made possible through close reading of the literary corpus consists of 46 papers that focused on the theme, published in the languages Portuguese, English and Spanish in the period 2006-2013. For its operation, we proceeded with the extraction of the phenomena that were related to the attributes, antecedents and consequences of the concept under study. Results: As a result, it was possible to identify the attributes, classified as biological needs (changes in appetite, dyspnea and respiratory sensation of constriction, sympathetic stimulation, arousal and tachycardia, insomnia and Increased alertness, and psychological needs (apprehension, wow, conflict, restlessness of mind, lack of concentration and inattention, hyperactivity, impulsivity, agitation and restlessness, irritability and anger, fear, dread and anxiety, nervousness, loss of self-confidence, insecurity, impotence and loss of autonomy, concern, sense of abandonment, loneliness and helplessness, feeling guilt and punishment, injury or assault, stress, tremors and sadness) for the background, we selected the clearance in the familiar context, lack of procedures, experiences submission to invasive procedures, hospitalizations previous/ experience of pain/ suffering, insert unknown environment (hospital), deprivation of recreational and superficial relations with healthcare professionals. already as consequences of the concept, identified the depression, manic episode, phobias, angst, suicide attempt disorder, separation anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, mood disorder, panic/ panic disorder, social anxiety disorder and obsessive compulsive disorder. Conclusions: based on the conceptual analysis of the elaborated up a proposal for a nursing diagnosis, meeting the criteria for inclusion in ICNP®, which needs to be tested in the practice of nursing as a way to connect up the knowledge to professional practice. Diagnosis Anxiety hospitalization was defined as an Anxiety with the following specific characteristics: changes in appetite, dyspnea, respiratory sensation of constriction, sympathetic stimulation - cardiovascular excitation, superficial vasoconstriction, pupil dilation, excitement, tachycardia, insomnia, increased alertness and trembling; seizure; chore; conflict; uneasiness of mind, lack of concentration, inattention, hyperactivity, impulsivity, agitation, restlessness, irritability, anger, fear, anxiety, nervousness, loss of self-confidence, insecurity, impotence, loss of autonomy; concern; sensation of abandonment, loneliness, helplessness, feeling guilt and punishment, bodily injury or assault; voltage, and sadness. / Introdução: A hospitalização da criança caracteriza-se por um período extremamente estressante que pode repercutir em consequências nocivas ao seu desenvolvimento, tais como a Ansiedade da hospitalização em crianças. Objetivo: Analisar o conceito de Ansiedade da hospitalização em crianças, identificando seus atributos, antecedentes e consequências, tendo em vista a construção de um diagnóstico de enfermagem. Método: Tomou-se como base o modelo de análise conceitual proposto por Walker e Avant, que objetiva o esclarecimento de significados dos termos, sendo compostas por oito etapas: seleção do conceito; determinação dos alvos, finalidades e objetivos da análise conceitual; identificação dos possíveis usos do conceito; determinação de atributos críticos, definidores ou essenciais; construção de casos modelo; desenvolvimento de outros casos; identificação de antecedentes e consequências do conceito e definição de referentes empíricos. O levantamento de dados foi viabilizado mediante leitura minuciosa do corpus literário composto por 46 trabalhos que versavam acerca da temática, publicados nas línguas português, inglês e espanhol no período de 2006 a 2013. Para sua operacionalização, procedeu-se com a extração dos fenômenos que estivessem relacionados com os atributos, antecedentes e consequências do conceito em estudo. Resultados: Como resultado, foram possível à identificação dos atributos, classificados em Necessidades biológicas (alterações do apetite, dispneia e sensação de constrição respiratória, estimulação simpática, excitação e taquicardia, insônia e aumento do estado de vigilância); e necessidades psicológicas (apreensão, choro, conflitos, desassossego da mente, falta de concentração e desatenção, hiperatividade, impulsividade, agitação e inquietação, irritabilidade e raiva, medo, temor e angústia, nervosismo, perda de confiança em si mesmo, insegurança, impotência e perda da autonomia, preocupação, sensação de abandono, solidão e desamparo, sensação de castigo e culpa, dano corporal ou agressão, tensão, tremor e tristeza). Para os antecedentes, foram selecionados o afastamento do contexto familiar, desconhecimento dos procedimentos, experiências de submissão a procedimentos invasivos, hospitalizações anteriores/experiência de dor/sofrimento, inserção em ambiente desconhecido (hospital), privação de atividades recreativas e relações superficiais com profissionais de saúde. Já como consequências do conceito, identificou-se a depressão, episódio maníaco, fobias, revolta, tentativa de suicídio, transtorno de ansiedade de separação, transtorno de ansiedade generalizada, transtorno de estresse pós-traumático, transtorno de humor, transtorno do pânico/pânico, transtorno da ansiedade social e transtorno obsessivo compulsivo. Conclusão: Tomando como base a análise conceitual do fenômeno, elaborou-se uma proposta de diagnóstico de enfermagem, atendendo aos critérios para a inclusão na CIPE®, que precisa ser testado na prática de enfermagem como forma de conectar o conhecimento levantado com a prática profissional. O diagnóstico Ansiedade da hospitalização foi definido como sendo uma Ansiedade com as seguintes caraterísticas específicas: alterações do apetite; dispneia; sensação de constrição respiratória; estimulação simpática - excitação cardiovascular, vasoconstricção superficial, dilatação da pupila; excitação; taquicardia; insônia; aumento do estado de vigilância e tremor; apreensão; choro; conflitos; desassossego da mente; falta de concentração, desatenção; hiperatividade, impulsividade, agitação, inquietação; irritabilidade, raiva; medo, temor, angústia; nervosismo; perda de confiança em si mesmo,insegurança, impotência, perda da autonomia; preocupação; sensação de abandono, solidão, desamparo; sensação de castigo e culpa, dano corporal ou agressão; tensão; e tristeza.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O objetivo do estudo foi realizar a revisÃo e validaÃÃo do diagnÃstico de enfermagem Falta de AdesÃo em pessoas com hipertensÃo arterial, fundamentando-se na hipÃtese de que ao promover a validaÃÃo de um diagnÃstico de enfermagem, o enfermeiro terà dados concretos para ajudar o indivÃduo a dar um seguimento adequado à terapÃutica instituÃda. No momento, o diagnÃstico Falta de AdesÃo apresenta seis caracterÃsticas definidoras e 28 fatores relacionados, divididos em individuais, relacionados ao plano de assistÃncia à saÃde, à rede e ao sistema de saÃde. ApÃs revisÃo integrativa da literatura, desenvolvida a partir das bases de dados CINAHL, LILACS, PUBMED, Biblioteca Cochrane e o Banco de Teses da CAPES, com utilizaÃÃo dos descritores âdiagnÃstico de enfermagemâ, âcooperaÃÃo do pacienteâ e ârecusa do paciente ao tratamentoâ e seus respectivos correspondentes na lÃngua inglesa e espanhola, alÃm dos descritores nÃo controlados adesÃo terapÃutica e adesÃo ao tratamento, utilizados somente no Banco de Teses da CAPES, os elementos do diagnÃstico foram revisados e tiveram suas definiÃÃes constitutivas/operacionais desenvolvidas (etapa A). A seguir, essas definiÃÃes foram avaliadas por 29 enfermeiros especialistas em terminologias de enfermagem e/ou adesÃo terapÃutica (etapa B - fase 1), utilizando-se o procedimento metodolÃgico do modelo de validaÃÃo de conteÃdo diagnÃstico de Ferhing (1987) e a adequaÃÃo dessas definiÃÃes tambÃm foi avaliada (etapa B â fase 2), por 26 especialistas. A validaÃÃo nesta etapa conduziu aos seguintes resultados: modificaÃÃo da definiÃÃo do diagnÃstico, de algumas caracterÃsticas definidoras e fatores relacionados; exclusÃo de alguns desses elementos e criaÃÃo de novos componentes do diagnÃstico. Posteriormente, esta nova proposta de diagnÃstico, caracterÃsticas definidoras e fatores relacionados, foram validados clinicamente junto a 128 pacientes com hipertensÃo arterial atendidos pela AtenÃÃo PrimÃria de saÃde do municÃpio do Crato (etapa C). Para esta etapa, os dados foram coletados pela pesquisadora e submetidos a duas especialistas com experiÃncia clÃnica e em diagnÃsticos de enfermagem. ApÃs a validaÃÃo clÃnica, o diagnÃstico Falta de AdesÃo passou a contar com seis caracterÃsticas (Manejo inadequado do tratamento nÃo medicamentoso; Comportamento indicativo de falha na adesÃo; Dificuldade em cumprir decisÃes acordadas com a equipe de saÃde; Manejo inadequado do tratamento medicamentoso; EvidÃncia de exacerbaÃÃo da hipertensÃo e EvidÃncia do desenvolvimento de complicaÃÃes) e doze fatores relacionados (PrejuÃzo nas capacidades pessoais; Conhecimento deficiente para o seguimento do regime terapÃutico medicamentoso e nÃo medicamentoso; CrenÃas e valores do indivÃduo relacionados ao processo saÃde/doenÃa; InfluÃncias culturais; Falta de apoio de pessoas significativas; Complexidade do regime terapÃutico medicamentoso; Custo financeiro do tratamento; DuraÃÃo permanente do tratamento; Efeitos adversos do tratamento; Falha na cobertura do sistema de saÃde; Habilidade de ensino insuficiente dos profissionais de saÃde; Relacionamento paciente-equipe de saÃde prejudicado). Considera-se que o presente estudo forneceu direÃÃo para a eficiÃncia do uso dos indicadores clÃnicos avaliados, contribuindo com o aprimoramento do diagnÃstico de enfermagem Falta de AdesÃo e seus elementos constituintes. A enfermagem deve se apropriar de suas tecnologias, buscando incrementar e amplificar sua utilizaÃÃo, contribuindo com a melhoria da assistÃncia prestada. / The aim of this study was to review and to validate the nursing diagnosis Noncompliance in people with hypertension, basing on the assumption that when promoting the validation of a nursing diagnosis, the nurse will have concrete data to help the individual adequate follow up therapy. Currently, the diagnosis Noncompliance features six defining characteristics and 28 related factors, divided into individual, related to care plan health, the network and the health system. After an integrative literature review, developed from the databases CINAHL, LILACS, PubMed, Cochrane Library and the CAPES Thesis Database, using the descriptors "nursing diagnosis", "patient compliance" and "treatment refusal" and their corresponding in Portuguese and Spanish, in addition to descriptors uncontrolled "therapeutic adherence" and "adherence to treatmentâ, the elements of diagnosis were reviewed and had their constituent/operational definitions developed (stage A). Subsequently, these definitions were evaluated for 29 experts in nursing terminology and/or therapeutic adherence (stage B-phase 1), using the methodological procedure of Ferhingâs Validation Model (1987) and the adequacy of these definitions was also evaluated (stage B-phase 2) by 26 experts. The validation at this stage produced the following results: change in the diagnosis definition of some defining characteristics and related factors, exclusion of some those elements and creating new components of the diagnosis. Thereafter, the proposed new diagnosis features and factors have been clinically validated on 128 patients with hypertension treated by Primary Health of the County of Crato (stage C). For this stage, the data were collected by the researcher and submitted to two experts with clinical and nursing diagnosis experience. After clinical validation, diagnosis Noncompliance now has six defining characteristics: Two main characteristics (Inadequate management of non-medication treatment and Behavior indicative of failure in adhesion); No secondary feature; Four characteristics of little relevance (Difficulty in meeting decisions agreed with the health staff, Inadequate management of drug treatment, Evidence of exacerbation of hypertension and Evidence of development of complications). The factors listed were all rated as very relevant in clinical practice, although the content validation have listed all of them as principal. The factors were distributed as follows: Individual (Loss in personal skills, Insufficient knowledge to the sequence of drug treatment regimen and non-medication treatment, Individual values and beliefs related to health/disease process, Cultural influences); Related to the support network (Lack of support from significant persons); Relating to the treatment (Drug treatment regimen complexity, Financial cost of treatment, Duration of continuous treatment, Adverse effects of treatment) and related system and team of health (Failed coverage of the health system; Ability insufficient education of health professionals, Patient-health staff relationship impaired). It was considered that this study provided direction for the efficient use of clinical indicators evaluated, contributing to the improvement of nursing diagnosis Noncompliance and yours constituents. Itâs concluded that the Nursing must take ownership of their technology, aiming to develop and broaden their use, contributing to the improvement of care.

Redes probabilísticas são modelos muito versáteis, com aplicabilidade crescente em diversas áreas. Esses modelos são capazes de estruturar e mensurar a interação entre variáveis, permitindo que sejam realizados vários tipos de análises, desde diagnósticos de causas para algum fenômeno até previsões sobre algum evento, além de permitirem a construção de modelos de tomadas de decisões automatizadas. Neste trabalho são apresentadas as etapas para a construção dessas redes e alguns métodos usados para tal, dando maior ênfase para as chamadas redes bayesianas, uma subclasse de modelos de redes probabilísticas. A modelagem de uma rede bayesiana pode ser dividida em três etapas: seleção de variáveis, construção da estrutura da rede e estimação de probabilidades. A etapa de seleção de variáveis é usualmente feita com base nos conhecimentos subjetivos sobre o assunto estudado. A construção da estrutura pode ser realizada manualmente, levando em conta relações de causalidade entre as variáveis selecionadas, ou semi-automaticamente, através do uso de algoritmos. A última etapa, de estimação de probabilidades, pode ser feita seguindo duas abordagens principais: uma frequentista, em que os parâmetros são considerados fixos, e outra bayesiana, na qual os parâmetros são tratados como variáveis aleatórias. Além da teoria contida no trabalho, mostrando as relações entre a teoria de grafos e a construção probabilística das redes, também são apresentadas algumas aplicações desses modelos, dando destaque a problemas nas áreas de marketing e finanças. / Probabilistic networks are very versatile models, with growing applicability in many areas. These models are capable of structuring and measuring the interaction among variables, making possible various types of analyses, such as diagnoses of causes for a phenomenon and predictions about some event, besides allowing the construction of automated decision-making models. This work presents the necessary steps to construct those networks and methods used to doing so, emphasizing the so called Bayesian networks, a subclass of probabilistic networks. The Bayesian network modeling is divided in three steps: variables selection, structure learning and estimation of probabilities. The variables selection step is usually based on subjective knowledge about the studied topic. The structure learning can be performed manually, taking into account the causal relations among variables, or semi-automatically, through the use of algorithms. The last step, of probabilities estimation, can be treated following two main approaches: by the frequentist approach, where parameters are considered fixed, and by the Bayesian approach, in which parameters are treated as random variables. Besides the theory contained in this work, showing the relations between graph theory and the construction of probabilistic networks, applications of these models are presented, highlighting problems in marketing and finance.

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Sexmissbruk eller diagnosmissbruk? – En diskursanalys av begreppet sexmissbruk Jakobsson, R.Key words: diagnoses, hypersexuality, medicalization, nymphomania, sexual addiction, sexual behavior, sexual compulsivity, sexual deviation, shame, social construction.Background: Sexual addiction has been given a dominant discoursive power in Sweden which (re)inforces the idea that sexuality is essentially a dangerous and lethal force.Methods: The thesis consists of two sub studies. Firstly, a critical discourse analysis is conducted over scientifical articles of sexual addiction and sexual compulsivity. Secondly, a critical discourse analysis of the concept of sexual addiction in newspapers in Sweden’s largest newspaper, DN, and an evening paper, Aftonbladet. These two sub studies are reflected towards each other to examine the construction and discourses surrounding sexual addiction.Results: The first sub study shows that sexual addiction is a term and concept that lacks empirical data. However, research still speculates that a sex addict can be someone who compulsively consumes any sexual behaviors that deviates from marital sex. The second sub study shows that sexual addiction is a vague concept that could be applied to most people in society; it may include people who masturbate, are unfaithfull, are rapists, perform incest, consume pornography, have difficulties with intimacy and/or have multiple sexual partners.Conclusion: Sexual addiction is a moral concept, which pathologizes people who deviate from erotic normalcy. The media articles presented a vague image of a sex addict that includes a series of sexual behaviors, ranging from masturbation to sex offending. Although research has been conducted for over 30 years, there is no empirical data about what constitutes sexual addiction and what the potential consequences for the individual and society are. In sum, both science and popular discourses presents a potential addiction to diagnoses.Suggested Citation: "Jakobsson. R. (2013): Sexmissbruk eller Diagnosmissbruk? – En Diskursanalys av Begreppet Sexmissbruk. Master Thesis at Malmo University, Sexology.”

Background: The prevalence of psychiatric diagnoses is increasing in society and nurses in somatic care frequently encounter patients with psychiatric diagnoses in their work. Psychiatric- and somatic multimorbidity is common and the nurse is expected to care with aperson-centered and holistic approach for patients in accordance with established documents and laws. Previous research indicates a stigmatization of these patients in society and by the nurses themselves. Aim: The aim of this study was to illustrate nurses’ experiences of caring for patients with psychiatric diagnoses in somatic care. Method: A qualitative literature-based study with eight scientific articles were included and analyzed with Friberg´s description of the five-step model. Results: Three main themes were identified with seven additional subthemes. The nurse’s personal challenges: nurses felt fear and anxiety when caring for patients with psychiatric diagnoses with psychiatric and somatic multimorbidity in a somatic care setting because of the lack of knowledge and trust for the patients. Organizational Barriers: inadequate teamwork and collaboration on and between the units made it difficult. Perceptions of patients: stigmatization and preconceptions by the nurses influenced the care of the patients. Conclusion: It indicates that nurses experience uncertainty in caring for patients with psychiatric diagnoses in somatic care. There is a substantial knowledge gap in the field, and further research is needed for nurses to feel more confident working with patients with psychiatric diagnoses in somatic care. / Personer med psykiatriska sjukdomar är ett ökande folkhälsoproblem. I takt med utvecklingen blir det vanligare att patienter med psykiatriska diagnoser även blir somatiskt sjuka. Sjuksköterskor i den somatiska vården möter därmed ofta patienter med psykiatriska diagnoser i deras arbete. Sjuksköterskan ska bemöta, vårda och behandla patienter enligt de styrdokument och lagar som finns, vilket innebär bland annat att vårda patienten utifrån ett personcentrerat och holistiskt perspektiv. Tidigare forskning visar att sjuksköterskor brister i omvårdnaden av patienter med psykiatrisk och somatisk samsjuklighet, vilket kan bero på kunskapsbrist, rädsla och organisatoriska barriärer. Syftet med examensarbetet är att belysa sjuksköterskors erfarenheter av att vårda patienter med psykiatriska diagnoser inom somatisk vård. En litteraturbaserad studie med kvalitativ metod där åtta vetenskapliga artiklar inkluderades och analyserades utifrån Fribergs femstegsmodell för att undersöka sjuksköterskors subjektiva erfarenheter, känslor och tankar. Resultatet delas upp i tre teman: Sjuksköterskans personliga utmaningar, organisatoriska barriärer och stigmatisering. Samtliga teman går hand i hand och påverkar varandra. Sjuksköterskans personliga utmaningar innefattar rädsla, oro, kunskapsbrist och bristande förtroende för patienter med psykiatriska diagnoser. Rädslan visar sig främst då sjuksköterskan känner att de inte har kontroll över situationen. Detta går hand i hand med den kunskapsbrist som sjuksköterskorna vittnar om. Organisatoriska barriärer i form av otillräcklig teamsamverkan är också bidragande faktorer till svårigheter vid vårdande av somatisk och psykiatrisk samsjuklighet. Den stigmatiserande bild som finns i samhället av personer med psykiatriska diagnoser påverkar patientens möte med vården negativt då förutfattade meningar från sjuksköterskan existerar.  Slutsatsen indikerar på att sjuksköterskor upplever stor osäkerhet vid vårdande av patienter med psykiatriska diagnoser inom somatisk vård. Kunskapsluckan inom området är stor och ytterligare forskning behövs för att sjuksköterskor ska bli trygga i att arbeta utifrån problemområdet.