Bakgrund: Patientens delaktighet är reglerat i flertalet lagar och är en rättighet för alla patienter inom svensk hälso- och sjukvård. Inom tvångsvården har tidigare forskning visat att delaktigheten begränsas då det finns vårigheter i att få en patient som vårdas under tvång att känna sig delaktig. För att öka förståelsen för hur arbetet kring patientdelaktighet inom den rättspsykiatriska kontexten går till valde författarna att undersöka detta. Syfte: Syftet var att beskriva sjuksköterskors erfarenhet av att arbeta med patientdelaktighet inom rättspsykiatrisk vård. Metod: En kvalitativ studie med semistrukturerade intervjuer som analyserades enligt kvalitativ innehållsanalys med induktiv ansats. Sex sjuksköterskor med minst två års erfarenhet av att arbeta inom rättspsykiatrisk vård intervjuades. Resultat: Resultatet presenterades i tre olika teman. Vikten av kommunikation beskriver betydelsen av tydlig kommunikation och att patienten får den information som krävs för att kunna vara delaktig. Patientens engagemang i sin vård tar upp sjuksköterskornas syn på delaktighet, deras erfarenhet av att motivera till delaktighet samt att alla patienter har olika nivåer av förmåga och insikt. Förutsättningar för patientdelaktighet beskriver de utmaningar sjuksköterskan möter i arbetet kring delaktighet och vad det finns för resurser som främjar delaktighet. Slutsats: Denna studie undersökte sjuksköterskors erfarenheter av att arbeta med patientdelaktighet inom rättspsykiatrisk vård. Resultaten visade att patientens vårdplan och kommunikation var centrala för att främja delaktighet. Anpassning, motivation och kompetens var viktiga faktorer. Trots utmaningar har patientdelaktighet utvecklats positivt över tid.

Syftet med föreliggande studie var att undersöka relationen mellannätverk, samverkan, ej fungerande samverkan och vårdtid förpatienter som vårdats på rättspsykiatriska kliniker i Sverige.Rättspsykiatriska vården syftar till rehabilitering och minskning avrisken för återfall i brott. Tidigare forskning har visat att nätverk ochsamverkan kan påverka vårdtidens längd. I analysen ingick 316patienter som registrerats mellan år 2014-2015 för rättspsykiatriskvård. Data från kvalitetsregistret RättspsyK genererade fyra variablerför studien att analysera; vårdtid, nätverk, samverkan och ejfungerande samverkan. Studiepopulationen delades in i grupper omkort och lång vårdtid. Vårdtiden baseras på medianvårdtiden pårättspsykiatrin. Fishers exakta test visade emellertid att resultatetsaknade statistisk signifikans och går inte i linje med tidigareforskning. Trots att sociala kontakter enligt tidigare forskning ärbetydelsefull för återhämtningsprocessen finns det anledning att fråndenna studies resultat anta att relationen mellan nätverk, samverkanoch vårdtid är mer komplext än vad studier tidigare visat. / The aim of the present study was to examine the relationship betweennetwork, cooperation, non-functioning cooperation and length of stayfor patients treated in forensic psychiatry in Sweden. Forensicpsychiatric care aims to rehabilitate and reduce the risk ofreoffending. Previous research has shown that network andcooperation can affect the length of care. The analysis included 316patients registered between 2014-2015 for forensic psychiatric care.Data from the quality registry RättspsyK generated four variables;length of care, network, cooperation and non-functioning cooperation.The study population was divided into short and long care time groupsbased on the median length of care in forensic psychiatry. Fisher'sexact test showed that the result lacked statistical significance and isnot in line with previous research. There is reason to assume from thisstudy's findings that the relationship between networks, cooperationand length of care is more complex than previous studies have shown.

Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two different mandates: criminal justice (public protection) and health care (public good). Nurses’ involvement at one of the systems’ points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and health care professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCRMD) represent significant threats to the safety of the public, and orders conditions aimed at keeping the community safe. The aim of this research project was to explore how psychiatric and public safety discourses construct the identity of persons UST or NCRMD during RB hearings, and nurses’ contribution to such identity construction. Critical ethnography methodology was employed, mobilizing three data sources: interviews with forensic psychiatric nurses, observations of RB hearings, and RB documentary artifacts. A poststructuralist lens was used to discern how RB culture produces truths about persons UST or NCRMD that sustain the hegemony of public safety and psychiatric discourses. The main finding was that the forensic psychiatric structure leverages therapeutic nursing interventions and documentation as evidence of deviancy, so that persons UST or NCRMD can be objectified and produced as dangerous, prior to socially rehabilitating them. Discursive structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering it coercive and punitive. Thus, a care-and-custody dichotomy is insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for research, practice, and education in forensic psychiatric nursing, nursing ethics, and other nursing specialties on the medico-legal borderland.

The purpose of this study was to develop a medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe. The study used the grounded theory approach utilising a mixed sequential dominant status design. Purposive sampling of key stakeholders was the primary method and theoretical sampling became necessary as the study evolved in the qualitative phase. A confirmatory retrospective document review of 119 files of patients was done in the quantitative phase. Pierre Bourdieu’s conceptual canon of field, habitus and capital was utilised as the theoretical point of departure for the study. Findings and results showed dislocation and dissonance between and within the habitus of social fields the judiciary, health (medical) and the prison systems with an ensuing hysteretic effect that negatively affected the outcome of forensic psychiatric rehabilitation in special institutions in Zimbabwe. Forensic psychiatric patients were caught up in a double bind situation of aligning to both of the contradictory functions of the medical and the prison systems. The result of this hysteretic scenario seemed to breed some kind of rehabilitative schizophrenia. The developed medico-judicial framework is projected to transform the libido dominandi of the present into a widened scope of therapeutic jurisprudence. The medico-judicial framework is forwarding the forensic psychiatric practitioner to a new address since it has changed its residence from the special institution to the forensic psychiatric hospital. It is inviting the person involved with forensic psychiatric rehabilitation to begin again, inciting him or her to be open to the possibilities of mapping a path through the tangled growth of current realities into an increased width and depth of comprehensive forensic psychiatric practice that follows an empowering legislative prescript / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to develop a medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe. The study used the grounded theory approach utilising a mixed sequential dominant status design. Purposive sampling of key stakeholders was the primary method and theoretical sampling became necessary as the study evolved in the qualitative phase. A confirmatory retrospective document review of 119 files of patients was done in the quantitative phase. Pierre Bourdieu’s conceptual canon of field, habitus and capital was utilised as the theoretical point of departure for the study. Findings and results showed dislocation and dissonance between and within the habitus of social fields the judiciary, health (medical) and the prison systems with an ensuing hysteretic effect that negatively affected the outcome of forensic psychiatric rehabilitation in special institutions in Zimbabwe. Forensic psychiatric patients were caught up in a double bind situation of aligning to both of the contradictory functions of the medical and the prison systems. The result of this hysteretic scenario seemed to breed some kind of rehabilitative schizophrenia. The developed medico-judicial framework is projected to transform the libido dominandi of the present into a widened scope of therapeutic jurisprudence. The medico-judicial framework is forwarding the forensic psychiatric practitioner to a new address since it has changed its residence from the special institution to the forensic psychiatric hospital. It is inviting the person involved with forensic psychiatric rehabilitation to begin again, inciting him or her to be open to the possibilities of mapping a path through the tangled growth of current realities into an increased width and depth of comprehensive forensic psychiatric practice that follows an empowering legislative prescript / Health Studies / D. Litt. et Phil. (Health Studies)

Bakgrund Målet med den rättspsykiatriska vården är att patienterna skall kunna återvända till ett gott liv utanför vården utan återfall i kriminalitet. Socialstyrelsen har klargjort att patienter inom den specialiserade psykiatriska vården ska riskbedömas. Den strukturerade professionella bedömningen, som HCR-20, är en vetenskapligt framtagen checklista och har visat sig ha både hög validitet och reliabilitet. Arbetet med bedömning av och förståelse för risk för våld och eller återfall i brottslighet är något av det säregna i arbetet för sjuksköterskor inom den rättspsykiatriska vården Syfte Belysa hur den kunskap som framkommer genom riskbedömningsformuläret HCR-20 omsätts i omvårdnadsarbetet vid rättspsykiatrisk vård. Metod Datainsamlingen gjordes med åtta intervjuer som sedan analyserades genom en kvalitativ innehållsanalys. Resultatet I resultatet har två kategorier framträtt som är att Synliggör risker och Underlag till planering. Under dessa två kategorier finns ett antal underkategorier. Personalen ser i stort inga uppenbara brister med HCR-20 utan anser att det är ett bra system som fyller sin funktion. Vid HCR-20 bedömning förs dialog om vad man som personal kan lägga fokus på och vilka risker som kan minskas. Det upplevs intressant att se när risker minskas samt att man tolkar den förändring som skattningsinstrumentet visar som framsteg i arbetet. Diskussion Författarna menar att resultatet belyser något om hur arbetet runt HCR-20 och riskhantering vid rättspsykiatrisk vård uppfattas av omvårdnadspersonal samt att utvecklingsmöjligheter har identifierats. / Background The purpose of forensic psychiatric care is that patients are able to return to a good life outside care without criminal recidivism . Swedish law has clarified that the patients in specialist mental health services should be risk assessed . The structured professional risk assessment, like the HCR- 20, is a scientifically formulated checklist and have been shown to have both high validity and reliability. Work on the assessment and understanding of the risk of violence and recidivism is one of the peculiarity of the work of nurses in forensic psychiatry Aim Highlighting how the knowledge obtained from the risk assessment form, HCR- 20 is put into the nursing work in forensic nursing. Methods The data was collected with eight interviews then analyzed by qualitative content analysis. Results The result has two categories emerged as Visualize risks and Basis for planning. Within these two categories there are a number of subcategories. The staff looks basically no obvious flaws with the HCR- 20, and believe it is a good system that fulfills its function. At HCR- 20 assessment dialogue is conducted on what personnel can focus on and what risks that can be reduced. It felt interesting to see when the risks are reduced and that we interpret the change that estimate the instrument as progress in working with the patients. Discussion The authors believe that the results illustrate how the work around the HCR- 20 and risk management in forensic nursing is perceived by the nursing staff as well as development opportunities have been identified.

A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.

<p>Syftet med studien är att undersöka hur samverkan ser ut mellan kommun och landsting vad</p><p>avser personer som vårdas enligt lag (1991:1129) om rättspsykiatrisk vård (LRV) och skall</p><p>permitteras till hemkommunen. Studiens frågeställningar är: (1) Hur sker samverkan mellan</p><p>kommun och landsting innan permissionen verkställs?</p><p>(2) Hur sker samverkan mellan kommun och landsting under tiden en person är permitterad?</p><p>(3) Vilka möjligheter och hinder finns vad avser samverkan mellan kommun och landsting gällande personer som permitterats?</p><p>Metodvalet är kvalitativt och författarna har genomfört fem intervjuer med nyckelpersoner</p><p>inom landsting och samverkande kommuner. Den teoretiska utgångspunkten är Danermarks</p><p>tre primära samverkansbegrepp: organisation, kunskap och regelverk. Resultatet visar att</p><p>landstinget har ansvar för vård och behandling och att kommunen har ansvar för boende och</p><p>sysselsättning. Respondenterna inom landstinget upplever att deras samverkan fungerar bra</p><p>och uttrycker att det är vikigt med en god kommunikation samt att personkännedom</p><p>underlättar samverkan. I dagsläget saknas det skriftliga samverkansavtal som är förankrade i</p><p>verksamheterna, det saknas även en klar målsättning för samverkan. Detta är något som</p><p>studiens tidigare forskning rekommenderar för en förbättrad samverkan. Respondenterna i en</p><p>av kommunerna upplever att de får för lite bakgrundshistorik om brukarna och anser att viss</p><p>rädsla kan finnas på grund av detta. De anser även att den handledning de idag får ifrån</p><p>landstingets personal inte är tillräcklig. En respondent ifrån landstinget tycker dock att de ger</p><p>lagom mycket information och att rädslan skulle kunna öka bland kommunens personal om de</p><p>gav mer information.</p> / <p>The aim of this study is to research how the collaboration between municipality and county</p><p>council works, about persons who are in forensic psychiatric care and are going on</p><p>community leave. The studied issues are: (1) How does the collaboration work, between the</p><p>municipality and county council, before the community leave is carried out? (2) How does the</p><p>collaboration work, between the municipality and county council, during the community</p><p>leave? (3) Witch possibilities and obstacles can be found in the collaboration between the</p><p>municipality and county council, about persons who are on community leave?</p><p>The method in the study is qualitative and the authors have accomplished five interviews with</p><p>key figures within county council and collaborating municipalities. The theoretical starting</p><p>point is Danermarks three collaboration concepts: organization, knowledge and rules. The</p><p>result shows that the county council has the responsibility of medical care and treatment and</p><p>that the municipality has the responsibility of the housing and occupation. The county council</p><p>respondents experience that the collaboration is good and they also express that it is important</p><p>to have an open communication, and that good knowledge of the persons involved facilitates</p><p>the collaboration. Today there is a lack of written collaboration agreements that have gained</p><p>approval within the organizations. Also, there is no common aim with the collaboration. A</p><p>written agreement with a clear aim for the collaboration is something that is recommended by</p><p>earlier research to improve the collaboration. The respondents in one municipality would like</p><p>to get more background history about the persons who are on community leave, the lack of</p><p>information could cause fear among the employees. They would also like some more</p><p>guidance from the county council staff. One county council employee thinks that more</p><p>information would cause more fear amongst the municipality staff.</p>

The present study focuses on the caring of patients who have sexually abused children. To do research in a field that has been considered taboo has not been without problems. The conclusive factor for the decision to carry out the research was the fascinating and interesting paradox that, in spite of the caregivers having a mandate from the judicial system to do care for these patients, they do not understand how this care is to be given. The understanding of what caring for these patients can entail is based on the perspectives of the lifeworld of both the patients and the caregivers. The theoretical perspective in this dissertation is that of the caring sciences while the epistemological framework is phenomenology. Research data consist of qualitative interviews. The aim of the first study is to describe the patients’ suffering, and the aim of the second study is to describe the caregivers’ experiences of caring for these patients. The essential meaning of the suffering felt by the patients is described in terms of the patients’ acknowledgement and then betrayal of their yearning to be part of a close human fellowship. The meaning structure of “caring”, can be understood as being lost in an obscure and unknown landscape. It challenges the caregivers and occasionally arouses strongly unpleasant but also strongly threatening feelings. However when the caregivers gain clarity on how to care they are able to find their caring courage and hope, even for these patients. The findings thus show that caring for patients who themselves do not see any opportunity of taking a place among other adults is a great challenge. The study also shows that the support that is needed to be successful in caring for these patients is a caring culture that can permeate both patients and caregivers. These patients, whose criminal acts appear to be bizarre and strange, need to learn to be able to bear their suffering without losing their humanity. The philosophical intermediate chapter shows that it is the body image of the patients that prevents them from becoming whole, i.e. existing fully, by it playing the existential drama that leads to sexual abuse. It appears from this dissertation that in order for caring to be able to relieve the suffering felt by these patients, and thus prevent them from further abuse of children, then it is important as a caregiver to be able to allow the patients just to “be”. The research also shows that in order for caregivers to be able to understand what they receive from the patients they need support from both caring science and existential reflections. Such methods can help to clarify caring and to give possibilities for a freer and more creative thinking. Encountering and understanding different lifeworlds is necessary in order to give care based on a caring perspective. The patient group in the present study have been able to demonstrate this in a clearer way than has previously been done.

Syftet med studien är att undersöka hur samverkan ser ut mellan kommun och landsting vad avser personer som vårdas enligt lag (1991:1129) om rättspsykiatrisk vård (LRV) och skall permitteras till hemkommunen. Studiens frågeställningar är: (1) Hur sker samverkan mellan kommun och landsting innan permissionen verkställs? (2) Hur sker samverkan mellan kommun och landsting under tiden en person är permitterad? (3) Vilka möjligheter och hinder finns vad avser samverkan mellan kommun och landsting gällande personer som permitterats? Metodvalet är kvalitativt och författarna har genomfört fem intervjuer med nyckelpersoner inom landsting och samverkande kommuner. Den teoretiska utgångspunkten är Danermarks tre primära samverkansbegrepp: organisation, kunskap och regelverk. Resultatet visar att landstinget har ansvar för vård och behandling och att kommunen har ansvar för boende och sysselsättning. Respondenterna inom landstinget upplever att deras samverkan fungerar bra och uttrycker att det är vikigt med en god kommunikation samt att personkännedom underlättar samverkan. I dagsläget saknas det skriftliga samverkansavtal som är förankrade i verksamheterna, det saknas även en klar målsättning för samverkan. Detta är något som studiens tidigare forskning rekommenderar för en förbättrad samverkan. Respondenterna i en av kommunerna upplever att de får för lite bakgrundshistorik om brukarna och anser att viss rädsla kan finnas på grund av detta. De anser även att den handledning de idag får ifrån landstingets personal inte är tillräcklig. En respondent ifrån landstinget tycker dock att de ger lagom mycket information och att rädslan skulle kunna öka bland kommunens personal om de gav mer information. / The aim of this study is to research how the collaboration between municipality and county council works, about persons who are in forensic psychiatric care and are going on community leave. The studied issues are: (1) How does the collaboration work, between the municipality and county council, before the community leave is carried out? (2) How does the collaboration work, between the municipality and county council, during the community leave? (3) Witch possibilities and obstacles can be found in the collaboration between the municipality and county council, about persons who are on community leave? The method in the study is qualitative and the authors have accomplished five interviews with key figures within county council and collaborating municipalities. The theoretical starting point is Danermarks three collaboration concepts: organization, knowledge and rules. The result shows that the county council has the responsibility of medical care and treatment and that the municipality has the responsibility of the housing and occupation. The county council respondents experience that the collaboration is good and they also express that it is important to have an open communication, and that good knowledge of the persons involved facilitates the collaboration. Today there is a lack of written collaboration agreements that have gained approval within the organizations. Also, there is no common aim with the collaboration. A written agreement with a clear aim for the collaboration is something that is recommended by earlier research to improve the collaboration. The respondents in one municipality would like to get more background history about the persons who are on community leave, the lack of information could cause fear among the employees. They would also like some more guidance from the county council staff. One county council employee thinks that more information would cause more fear amongst the municipality staff.