Despite a growing literature base related to both compassionate care and work-related stress in healthcare settings, there is a lack of empirical studies investigating the relationship between these concepts, particularly in medium secure settings. This mixed methods study explored the relationship between compassion (The Compassion Scale) and work-related stress (The HSE Management Standards Toolkit) from the self-report of 51 members of staff in a medium secure setting, including semi-structured interviews with 12 participants. On the quantitative measures, the relationship between self-reported compassion and work-related stress on the quantitative measures was found to be statistically non-significant. However, elements of compassion were found to significantly predict subscales of work-related stress such that high levels of elements of compassion were found to predict higher levels of subscales of work-related stress. Participants constructed several meanings of compassion and its role in the care of the patients they worked with. Several consequences of occupational demands were cited including an increase in work-related stress and less time to build therapeutic relationships or to develop compassion towards patients. The findings of this study can be used to inform the development of staff interventions. Increased consistency of staff groups, increased debriefing opportunities and a review of paperwork responsibilities within staff teams have also been recommended.

Abstrakt   Bakgrund: Rättspsykiatrin i Sverige vårdar psykiskt sjuka lagöverträdare. Våld är vanligt förekommande och ett stort problem inom den rättspsykiatriska vården. Vårdare som blir utsatta för våld trivs sämre med sitt arbete och har högre sjukfrånvaro. Inom rättspsykiatrisk vård beskrivs en god vårdrelation mellan vårdare och patient som en förutsättning för att kunna vårda.   Syfte: Studiens syfte var att belysa vårdares upplevelse av våldssituationer och hur dessa påverkar vårdrelationen inom rättspsykiatrin.   Metod: Studien har en kvalitativ ansats och utgår från livsvärldsteorin. Studien baseras på intervjuer med tolv vårdare. Intervjuerna har analyserats med hjälp av kvalitativ innehållsanalys.   Resultat: I intervjuerna framkom att våldsamma situationer mellan patienter och vårdare inom rättspsykiatrisk vård kan leda till att en patient flyttas eller att det uppstår en distans mellan vårdare och patient. Våld kan även leda till att vårdare blir sjukskrivna under en period, eller slutar sitt arbete. Erfarna vårdare beskriver att de ständigt har en mental beredskap för att våld plötsligt kan uppstå. De använder även en hård jargong som ett verktyg för att kunna hantera den påfrestande miljön.   Slutsats: Det kan upplevas kontraproduktivt att flytta en patient efter en våldsam situation och därmed omöjliggöra mötet mellan patienten och den vårdare som blev utsatt för våld. Ett undvikande av mötet riskerar att försämra vårdrelationen. Istället kan patienten bjudas in till ett samtal tillsammans med denne vårdare. Vårdare efterfrågar stöd ur ett längre tidsperspektiv efter en våldsam situation. För att skapa förutsättningar för ett stöd på mellanmänsklig nivå efter en våldsam situation behövs ett långsiktigt och strukturerat stöd. Det krävs ytterligare forskning för att bättre förstå den tidvis hårda jargongen och hur den påverkar vårdandet. / Abstract   Background: The forensic psychiatry in Sweden offers care to people who have committed a crime under the influence of a mental disorder. Violence against staff is a common and major problem in the forensic psychiatry. Caregivers who have been exposed to violence feel less satisfied in their work, and are more often staying at home on sick leaves, compared to other caregivers. A good caring relationship between caregivers and patients is described as a prerequisite for giving a good care in the context of forensic psychiatry.   Aim: The aim of the study was to highlight the health professionals' experiences of violent situations and how these affect the caring relationship in forensic psychiatric care.   Method: The study has a qualitative approach based on the lifeworld theory. The study is based on interviews with twelve caregivers. The interviews were analyzed using qualitative content analysis.   Result: The interviews revealed that violent situations between patients and caregivers in forensic psychiatric care can lead to a distance between the caregiver and the patient, or that the patient is being moved. Violence can also lead to sick leave for caregivers or a permanent quit from work. Caregivers with long experience of forensic psychiatry describe that they constantly have a mental preparedness for violence to suddenly arise. They also use a rough jargon as a tool to handle the stressful context.   Conclusion: It may be counterproductive to move a patient after a violent situation, thus making it impossible for the patient and the victim to meet each other after a violent situation. An avoidance of the meeting is likely to worsen the caring relationship. Instead of creating a distance, the patient can be invited to a conversation with this caregiver. Caregivers demand support for a longer period of time after a violent situation. In order to create the conditions for interpersonal support after a violent situation, long-term and structured support is needed. Further research is needed to better understand the occasionally rough jargon and how it affects caring.

This study was conducted within two forensic settings, the high security correctional facility Saltviksanstalten, and the forensic psychiatric institution Karsudden hospital. 66 staff members from Saltvik and 39 from Karsudden participated by answering a questionnaire about threat and physical violence perpetrated towards them by inmates/patients. The aim of the present study was to analyze and compare the prevalence of threat and physical violence and related factors perpetrated by inmates/patient towards staff within these two forensic settings with the objectives to compare and analyse the prevalence, characteristics, situations and consequences of the threat and physical violence. The results showed that a higher percentage of participants were exposed to threats and physical violence within the forensic psychiatric setting. As regards to the intentions behind the threats and physical violence, inmates within high security correctional facilities was to a higher degree instrumental whereas patients within the forensic psychiatry showed a higher degree of reactive intentions. The conclusion is that victimization in the form of threat and physical violence is comprehensive, especially within the forensic psychiatry. Due to that victimization increases both the risk of revictimization, and have a number of negative personal- and societal consequences, this is an issue that needs to be highlighted in order to improve both the work environment and the mental health for the staff. / <p>2017-06-01</p>

No description available.

Studiens syfte var att undersöka arbetsterapeuters erfarenheter av att arbeta med individer som har schizofreni inom rättspsykiatrisk slutenvård. Författarna valde en kvalitativmetod och utförde åtta semistrukturerade intervjuer med arbetsterapeuter som arbetade i södra, mellersta, och norra Sverige inom rättspsykiatrisk slutenvård. Efter intervjuerna transkriberades data som sedan analyserades utefter en kvalitativ innehållsanalys, vilket resulterade i fyra huvudkategorier och fyra underkategorier; Arbetsterapeutisk utredning och bedömning samt användning av bedömningsinstrument med patienter som har schizofreni; Faktorer och riktlinjer som påverkar utredningsarbetet och Bedömning och evidensbaserade bedömningsinstrument inom slutenvården, Styrd av säkerhet och restriktioner i en strukturerad miljö; Restriktionernas inverkan på förskrivning av hjälpmedel  och Möjligheter och utmaningar att arbeta  inom en konstlad miljö, Möjligheter att arbeta med aktivitet och färdigheter med patienter som har schizofreni och Arbetet med motivation, initiativförmågan samt aktivitetsförmåga för att öka delaktighet. Resultatet visade arbetsterapeuters erfarenheter av att arbeta inom en miljö anpassad efter säkerhet och restriktioner med individer som har diagnosen schizofreni. Studien visar betydelsen av arbetsterapeutisk kompetens i arbetet med patienter som har diagnosen schizofreni för att möjliggöra delaktighet samt självständighet trots miljöns inverkan. Det behövs mer forskning om hur arbetsterapeutisk kompetens och bedömningsinstrument bör anpassas utefter en strukturerad och styrd miljö för att möjliggöra en mer kvalitetssäkrad rehabiliterande vård för patienter som har schizofreni inom rättspsykiatrisk slutenvård. / The aim of the study was to explore occupational therapists experience of working with individuals diagnosed with schizophrenia in forensic psychiatric inpatient care. The authors chose a qualitative methodology and conducted eight semi-structured interviews with occupational therapists who worked in forensic psychiatry in south, middle and north of Sweden. The collected data was transcribed and analyzed according to a qualitative analysis method which resulted in four categories and four subcategories;  Occupational evaluation, assessments and the use of assessment instruments with patients with schizophrenia; Impacts of factors and guidelines on evaluation work and Assessments and evidence based assessment instruments in inpatient care, Security and restriction guidelines in a structured environment; Impacts of restriction on prescribing aids and Opportunities and challenges to work in a constrained environment, Opportunities to work with activity and skills with patients with schizophrenia and Work with motivation, initiative and activity to increase participation. The result showed occupational therapists' experience of working in an environment adapted to safety and restrictions with individuals diagnosed with schizophrenia. The study shows the importance of occupational therapy competence in working with patients who have been diagnosed with schizophrenia to enable participation and independence despite the impact of the environment. More research is required on how occupational therapeutic skills and assessment tools should be adapted to a structured and controlled environment to enable more quality-assured rehabilitative care for patients who have schizophrenia in forensic psychiatric care.

Bakgrund: Rättspsykiatrisk slutenvård är en komplex vårdform där dengrundutbildade sjuksköterskans uppgift, förutom att ge god omvårdnad och stöd,är att vakta, förvara och skydda patienter som är överlämnade av domstol enligtsvensk lag. Syfte: Syftet med litteraturstudien är att få en förståelse över hurpatienterna upplever den rättspsykiatriska vården och vilken betydelse relationeroch miljö har för rehabilitering. Metod: Författarparet har gjort en systematisklitteraturstudie där tidigare publicerade studier valts ut, granskats och vars resultatsedan sammanställts och diskuterats. Tretton studier uppfyllde författarparetsinklusionskriterier och dessa genomgick sedan en latent innehållsanalys där trehuvudteman identifierades. Resultat: Resultatet visar att olika delar somrelationer, miljö och trygghet spelar roll för hur patienten upplever denrättspsykiatriska vården, samt delaktighet och autonomi inom den komplexavårdformen. Vidare identifierades underteman gällande bemötande och maktspelfrån vårdpersonalen gentemot patienterna. Avslutning: Utifrån resultatet kan flerabrister identifieras där omvårdnad och rehabiliteringen kan bli lidande, vilketmåste brytas för att tillgodose de rättspsykiatriska patienterna med god omvårdnadoch för att kunna ombesörja deras behov av den grundutbildade sjuksköterskanoch resterande vårdpersonal. / Background: Forensic psychiatric in-patient care is a complex form of care inwhich the registered nurse must, apart from giving good care and support to thepatients, both guard, contain and protect patients who are admitted to forensicpsychiatric care by the Swedish court of law. Aim: The aim of this degree projectis to gain understanding for how forensic psychiatric patients experience their careand the importance of relations’ and milieu’s effect on rehabilitation. Method: Theauthors of this literature review made a systematic literature review wherepreviously published studies were chosen, reviewed and whose results later wereput together and discussed. Thirteen studies met the criteria of inclusion and wereput through a latent content analysis, where three main themes were identified.Result: The results show that different parts, such as relations, environment andsafety matter for how the patient experience the forensic psychiatric care, alongwith participation and autonomy within the complex form of care. Furthermore,subthemes concerning social treatment and powerplay from staff towards thepatients were identified. Conclusion: Given the results, several flaws could beidentified where care and rehabilitation could be suffering and must thereforedispan to ensure that the needs and care of the forensic psychiatric patients aremet by the registered nurse and nursing staff.

Introduction Offenders who suffer from a severe mental illness are sentenced to forensic-psychiatric careinstead of imprisonment. A severe mental illness is a legal term determined by type anddegree of the psychiatric illness. Forensic-psychiatric care ends when signs of severe mentalillness is no longer present. Antisocial behaviors and mental illness due to substance abuse isnot regarded as severe by law but can arguably delay discharge from care. Aim To investigate whether time in treatment for offenders sentenced to compulsory forensicpsychiatriccare is prolonged by a propensity for substance abuse and antisocial behaviors. Methods Extended §7-evaluation dictums from 2017 have been reviewed. Data concerning substanceabuse and antisocial tendencies was assessed to assort offenders in two subgroups with lowestdegree contra highest degree of additional problematic behaviors. The two subgroups andtime in treatment collected through the Swedish National Forensic Psychiatric Register wascombined in a Kaplan-Meier estimator through SPSS. Results Median time in treatment for offenders with highest degree of additional problematic behavioras in substance abuse and or antisocial tendencies was 1048 days (range 1075). Since nodischarge has occurred, median time to discharge could not be estimated. Median time todischarge for offenders with lowest degree of additional problematic behavior was 760 days(range 532). Conclusions The study could not find time in treatment among severe mental ill offenders to be longer foroffenders with additional substance abuse and or antisocial characteristics of crime in relationto offenders without.

Bakgrund: I tidigare forskning framkommer komplexiteten i tvärkulturell vård. Felbedömningar sker kopplat till kulturella uttryck. Ökad kulturkompetens hos vårdaren kan bidra till mer jämlik vård. Kulturkompetens är en ständigt pågående process men måste användas med en ödmjuk inställning till det egna kunnandet. Behov finns av mer studier kring patienters erfarenheter av tvärkulturell vård. Syfte: Att beskriva patienters och sjuksköterskors erfarenheter av tvärkulturella möten i rättspsykiatrisk vård. Metod: 14 semistrukturerade intervjuer genomfördes med patienter och sjuksköterskor på en rättspsykiatrisk klinik. En kvalitativ innehållsanalys med induktiv ansats följt av ett abduktionssprång genomfördes. Resultat: Patienternas erfarenheter redogörs för i Att inte höra till, Att inte bli förstådd, Att känna sig välkomnad, Att skapa relationer och känna samhörighet, Att anpassa sig på gott och ont samt Att sträva mot samförstånd. Sjuksköterskornas erfarenheter presenteras i Att blunda för kulturen, Att uppleva kulturen som hinder, Att försöka skapa relationer och Att utvecklas som person. Ett övergripande tema identifierades som Att sträva efter ömsesidig förståelse. Slutsats: Synen på kultur skiljer mellan patienter och sjuksköterskor. Det finns behov av ökad medvetenhet om kulturens påverkan. Omvårdnaden skulle vinna på att patientens kultur och erfarenheter beaktas. Kulturkompetens behöver uppmärksammas i både verksamhet och utbildning. / Background: Previous research shows the complexity of cross-cultural care. There are misjudgements linked to cultural expressions. Increased cultural competence among caregivers can contribute to a more equal care. Cultural competence is an ongoing process, but it must be used with a humble attitude to one's own knowledge. There is a need for more studies on patients' experiences of cross-cultural care. Aim: To describe patients' and nurses' experiences of cross-cultural encounters in forensic psychiatric care. Method: 14 semi-structured interviews were conducted with patients and nurses at a forensic psychiatric clinic. A qualitative content analysis with an inductive approach and an abductive leap was conducted. Results: The patients' experiences are described as To not belong, To not being understood, To feel welcome, To establish relationships and feel affinity, To adapt for better or worse and To strive for consensus. The nurses' experiences are presented in To wink at culture, To experience culture as an obstacle, To try to establish relationships and To develop as a person. An overarching theme is identified as To strive for mutual understanding. Conclusion: The view on culture differs between patients and nurses. There is a need for increased awareness of the impact of culture. Nursing would benefit from the patients culture and experiences being taken into account. Cultural competence needs attention in both work and education.

Background: Forensic psychiatry is characterised by compulsory care and long hospital stays, where nurses care for patients with severe mental illness, who often have committed crimes. The main objective is to rehabilitate the patient to once again become a part of society by improving mental health and decreasing the risk of criminal relapse. This is mainly achieved through encounters with the patients. Encountering patients in forensic psychiatry means coming face to face with suffering and the duality of caring, doing what is best for the patient and protecting society. Aim: The purpose of the study was to obtain a deeper understanding of encounters with patients with mental illness in forensic inpatient care as experienced by nurses. Method: This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design. A total of 13 nurses working at a forensic psychiatric hospital in Sweden were recruited through a purposive sample to participate in the studies through narrative interviews. Study I was analysed with phenomenological hermeneutics in line with Lindseth and Norbergh (2004) in order to illuminate the lived experience of nurses’ encounters. Study II was a secondary supplementary analysis, which applied hermeneutics in line with Fleming, Gaidys, and Robb (2003) to gain a deeper understanding of nurses’ compassion in forensic psychiatry. The two studies were merged to provide a comprehensive understanding in this licentiate thesis. Findings: Study I illuminated the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care, that is the nurses’ desire to do good despite being confronted with their own emotions as fear, humiliation, and disappointment. Encounters were also occasionally perceived as positive, awakening emotions of compassion, competence, pride, trust, satisfaction, and gratification regarding the patient’s recovery. However, a source of conflict was the struggle between doing what was best for the patient and protecting society. The study comprised of four themes: being frustrated, protecting oneself, being open-minded, and striving for control. Study II aimed to gain a deeper understanding of nurses’ compassion in providing forensic psychiatric inpatient care with three themes: recognising suffering and need for support, responding to patient suffering, and reacting to one’s own vulnerability. Abstracting to a main theme of being compassionate in forensic psychiatry which is described as an emotional journey, an ongoing inner negotiation between own vulnerability and expressions of suffering. This inner negotiation of making sense of patients’ plea and how they were perceived was crucial for determining the development of compassion rather than turning to control and rules as a means to protect oneself. Discussion: A interpretation of the studies (I, II) revealed two topics, being sensitive and responsive and keeping distance, which were reflected upon against the theoretical framework of Kari Martinsen. The studies showed that nurses faced a variety of encounters that forced them to face their own vulnerability and that trust could reduce power imbalances as well as help deal with societal, man-made constructs. The nurses’ encounters with incomprehensible expressions of suffering also show that nurses need to find a way to make room for “expressions of life”– taking a step back and turning their gaze inwards – in order to regulate their own emotions. This may better equip nurses to encounter patients with compassion and kindness rather than turning to norms and rules to protect themselves and guard their own vulnerability. Rather than distancing themselves from the patients, nurses can instead take a step back to come closer to their patients.

Bakgrund: Internationell forskning påvisar att sjuksköterskans genuina omvårdnadsarbete försvåras inom den rättspsykiatriska vården. Kärnan i denna problematik är den tvetydighet som uppstår då sjuksköterskan förväntas bedriva en etiskt grundad omvårdnad gentemot patienter som vårdas mot sin vilja. Forskning, särskilt ur ett kunskapsteoretiskt perspektiv, saknas gällande sjuksköterskors möjlighet att använda sin professionsspecifika kunskap inom den rättspsykiatriska slutenvården. Syfte: Studiens syfte var att beskriva sjuksköterskans möjlighet att tillämpa sin professionella kunskap inom den rättspsykiatriska slutenvården. Metod: Empirisk studie med kvalitativ ansats baserad på tematiskt utarbetade, interaktiva intervjuer med sex sjuksköterskor verksamma vid en rättspsykiatrisk klinik i en svensk storstad. Deduktiv innehållsanalys utifrån Carpers (1975) teori om sjuksköterskors kunskap och dess begrepp. Resultat: Ur analysen utkristalliserades åtta kategorier vilka beskriver sjuksköterskans möjlighet att tillämpa sin professionella kunskap inom den rättspsykiatriska slutenvården: (1) brist på incitament, (2) en ny kunskapsgeneration, (3) tvång utan kränkning, (4) högt och lågt i tak, (5) nödvändig distans, (6) försvårad identifikation, (7) flexibilitet gentemot regler och (8) vårda i motvind. Slutsats: Studiens resultat visar att sjuksköterskans möjlighet att tillämpa sin professionella kunskap inom den rättspsykiatriska slutenvården begränsas av en rad faktorer, både inom och utanför det egna inflytandet. Begränsningar som identifierades var en omvårdnadsfientlig miljö, gamla traditioner, bristande forskningsincitament och en patientgrupp med mångfacetterad problematik. Trots dessa utmaningar lyckas sjuksköterskorna hävda sin profession och därmed bedriva en omvårdnad som de ser som acceptabel, om än med stor förbättringspotential. Klinisk betydelse: Förhoppningen med studien är att inom den rättspsykiatriska slutenvården skapa en medvetenhet om sjuksköterskors unika kunskap så att omvårdnadsvetenskapen får större utrymme i klinisk praxis. / Background: International research indicates that it is difficult for nurses to provide genuine nursing care within the forensic inpatient psychiatry. The dual role taken on by nurses when expected to ethically care for patients subject to involuntary treatment is at the core of this issue. Research, especially from an epistemological point of view, is lacking regarding nurses’ possibility to apply their specific professional knowledge within the forensic inpatient psychiatry. Aim: The aim of this study was to describe nurses' possibility to apply their professional knowledge within the forensic inpatient psychiatry. Method: Empirical study with qualitative approach based on thematic interactive interviews with six nurses employed at a forensic inpatient clinic in one of Sweden's bigger cities. Deductive content analysis based on Carper's (1975) theory of nursing knowledge and its concepts. Results: From the analysis emerged eight categories which describe nurses' possibility to apply their specific professional knowledge in a forensic inpatient psychiatry setting: (1) lack of incentives, (2) a new generation of knowledge, (3) coercion without affront, (4) tolerance in a rigid environment, (5) necessary distance, (6) challenging identification, (7) flexibility towards rules and (8) nursing against a headwind. Conclusion: The findings show that nurses' possibility to apply their professional knowledge within the forensic inpatient psychiatry is limited by factors both in and beyond their power. The identified limitations were a custodial environment, old traditions, a lack of research incentives and a clientele with multifaceted issues. In spite of these challenges, nurses were able to assert their profession and provide nursing care in a way they saw as acceptable, though not without potential for improvement. Implications for practice: Hopefully, this study can raise awareness of nurses’ unique knowledge within the forensic inpatient psychiatry in order to promote nursing science in clinical practice.