Bakgrund:Personer med allvarlig och kronisk psykisk sjukdom (SPMI), är en sårbar grupp med hög sjuklighet och dödlighet över genomsnittet. Trots detta är lite känt om dessa personers erfarenheter och behov av palliativ vård. Syfte:Syftet med uppsatsen var att belysa vårdande av psykiskt sjuka patienter med somatisk sjukdom i palliativt skede. Metod:Uppsatsen är en litteraturöversikt. Den huvudsakliga metoden har utgjorts av litteratursökning och analys av relevanta vårdvetenskapliga artiklar. Datainsamlingen har skett genom en inledande och en egentlig litteratursökning Resultat:Resultatavsnittet har tre teman. Det första temat, aspekter av vårdande, belyser palliativ vård av psykiskt sjuka patienter, symtom på livshotande sjukdom hos patientgruppen, förstärkning av den psykiatriska symtom vid livshotande somatisk sjukdom, upplevelser av smärta samt palliativ psykiatri. Det andra temat behandlar den psykiskt sjuka patientens beslutsförmåga och självbestämmande. Det tredje temat, tillit och kommunikation, handlar om relationen mellan sjuksköterskan och den psykiskt sjuka patienten. Diskussion:Människors omvårdnadsbehov i ett palliativt skede är sannolikt likartade, men alla patientgrupper får inte sina behov tillgodosedda. När det gäller personer med SPMI, får patientgruppen dels otillräcklig vård och dels tillgodoses inte omvårdnadsbehoven. En ökad kunskap om dessa personers ökade risk att dö av somatisk sjukdom och större kännedom om patientgruppens symtom på allvarlig somatisk sjukdom, skulle kunna leda till förebyggande vård och tidigare upptäckt av livshotande sjukdom. / Background: Persons with severe and persistent mental illness (SPMI), is a vulnerable group with high morbidity and mortality above average. Despite this, little is known about these people's experiences and needs of palliative care. Aim: The aim of this paper was to highlight the caring of mentally ill patients with somatic illness in palliative phase. Method: This paper is a literature review. The method consisted of a literature search and analysis of relevant healhtcare scientific papers. Data collection was conducted through an initial and an actual literature search. Results: This section consists of three themes. The first theme, aspects of care, highlights the palliative care of mentally ill patients, symptoms of life-threatening disease, increase of psychotic symptoms, experiences of pain and palliative psychiatry. The second theme consider mentally ill patient's decision-making ability and self-determination. The third theme, trust and communication, discusses the relationship between the nurse and the mentally ill patient. Discussion: Human needs in palliative care is probably similar, but all patient groups do not get their needs fulfilled. Persons with SPMI as a group receive partly inadequate care. A better knowledge of these persons increased risk of death from somatic diseases and better knowledge of symptoms of serious somatic illness, could lead to preventive care and early detection of life-threatening disease.

Bakgrund: 2014 anlände drygt 80.000 flyktingar till Sverige. Dessa individer kan ha varit med om traumatiska händelser vilket i sin tur kan ha bidragit till sämre psykisk hälsa i form av depression, posttraumatisk stressyndrom och psykos. Sjuksköterskor som möter flyktingar med psykisk ohälsa upplever olika svårigheter vid omvårdnad av flyktingar. För att sjuksköterskorna ska kunna optimera vården behövs större förståelse för deras upplevelser av denna patientgrupp med psykisk ohälsa. Syfte: Syftet med studien är att beskriva sjuksköterskors upplevelser att vårda flyktingar med psykisk ohälsa. Metod: En studie med empirisk ansats i form av kvalitativa intervjuer med fem sjuksköterskor inom en psykiatrisk verksamhet. All data analyserades med hjälp av en innehållsanalys. Resultat: Det var flertalet olika upplevelser som synliggjordes i resultatet, vilka utmynnade i fem teman: "upplevelser att tillgodose flyktingars behov", "upplevelser av kompetensutveckling", "upplevelser av kulturkrock", "upplevelser av maktlöshet" samt "upplevelser av medlidande för flyktingen". Slutsats: Två av de fem dimensionerna av sjuksköterskors upplevelser är nya i förhållande till tidigare studiers fynd. Dessa upplevelser är maktlöshet och medlidande som är viktiga att beaktas i sjuksköterskors arbete inom psykiatrisk vård. Medlidandet hos sjuksköterskorna i studien bidrog till en ökad påfrestande belastning, både under och utanför arbetstid. Professionell handledning och utbildning är väsentliga för att underlätta sjuksköterskans vård av flyktingar med psykisk ohälsa. Fortsatt forskning: För att minimera upplevelse av exempelvis maktlöshet måste vidare forskning på nationell och internationell nivå på detta område utvecklas. Detta genom att undersöka på djupet vilka situationer som orsakar upplevelse av maktslöshet och medlidande hos sjuksköterskor inom psykiatrisk vård. / Background: In 2014 about 80,000 refugees arrived to Sweden. Most of these individuals have experienced traumatic events, which contributed to mental illness, example of these diagnosis are depression, PTSD and psychosis. Registrered nurses who take care of this group of patients facing some difficulties in their caring. To optimize the caring there is a essential need of comprehensive for the nurse´s experiences of refugees with mental illness. Aim: The aim of the study is to describe the experiences of registred nurses to care of refugees with mental illness. Method: A study with a empirical approach, qualitative interviews with five registrered nurses in a psychiatric clinic. All data were analysed through a content analysis. Results: The results demonstrated five different experiences of the nurses: "experiences of caring of the refugees, "experiences of the need of skills development", "experiences of culture clash", "experiences of powerless" and "experiences of compassion". Conclusion: Two of five dimensions of experiences are new compare to earlier studies´ approaches: experience of powerlessness and experiences of compassion among the nurses in psychiatric care. Compassion of the nurses contributed to a tension in their own mental health. A professional supervision by the employer is necessary to facilitate the nurses´ care of the refugees. Further research: To minimize the experiences, for example powerlessness, the research should exspand on national and international basis.

Employees who stay home from work because of mental illness are an increasing number in Sweden. One of the reasons may be the increasing demands on the employees. The purpose of this essay is to investigate the legal context about the employers responsibility with regard to rehabilitation, and also to investigate what happens, mentally and economically, with the employee on a sick leave. The responsibility is wide and the consequences are many. To fulfill the purpose the legal method have been used.   If an employee becomes ill, the employer is responsible to start a rehabilitation. If  the employee is unable to go back to the same work tasks as before, the employer must investigate whether the employee can be of any other use to the employer or not. To let an employee go due to his/her mental illness should only be done as a last resort.   The sick leave may have negative influences for the employee, one example is that the mental illness can be even worse. A sick leave can also involve an economic insecurity, therefore many employees work even if they are ill. / <p>1381</p>

The area of mental health distress is one that crosses many disciplines including; psychiatry, critical psychiatry, psychology, critical psychology, history, politics, economics, philosophy, sociology, culture and human geographies (Thrift, 2006). Consequently, there are a complex set of issues to consider when discussing the experiences of being a mental health service user. Notwithstanding this diversity, such representations of mental health have a tendency to position service users as a fairly homogenous and static group of bodies – in other words, they are the stable ‘other’ (Conradson, 2005; Parr, 2000). As a way of exploring the complexity, this thesis sets out to explore the multiplex constituents and heterogeneous ways in which daily service user life is played out within everyday mental health spatial contexts. These spaces incorporate the psychiatric institution, the mental health day centre and the home. Using interviews, ethnography, poetry and visual ethnographies, service users’ experiences are analysed by exploring the relational aspects of the discursive and the non-discursive, such as receiving a diagnostic label and subsequent treatments and the ways in which these practices permeate the embodied and spatial experiences of every day service user life. This corpus of research data suggests that rather than the experiences of mental health distress operating as a stratified set of factors awaiting analysis, there were divergent accounts incorporating positivity, negativity and ambivalence in the ways which service users made meanings of their daily lives (Brown & Tucker, 2010). Consequently, this thesis is framed around the ontological realms of creativity, potentiality and of becoming within and through space (Deleuze & Guattari, 2004; Massumi, 2002). Finally, some implications of the current political changes and how these may impact upon daily service user life are discussed to highlight that mental health service users’ are always on the move.

Bakgrund: Hundterapi är ett relativt outforskat område, i dagsläget finns det en begränsad mängd med evidensbaserad forskning rörande vårdhundens effekter. Vårdhunden har många olika användningsområden inom sjukvården. Sjukdomar som demens och psykisk ohälsa är vida utbrett i världen och det syns en ökning av personer som drabbas av demens vilket kan kopplas till en ökad medellivslängd. Syfte: Syftet med denna litteraturstudie var att beskriva vårdhundens effekter på välbefinnandet hos personer med kognitiv nedsättning samt att som metodologisk aspekt beskriva på vilket sätt hunden använts som oberoende variabel i studiernas interventioner. Metod: En deskriptiv litteraturstudie där tio kvantitativa experimentella studier har granskats och sammanställts. Huvudresultat: Sammanställningen av studierna gav tre olika utfall, förbättrad effekt, försämrad effekt samt oförändrat utfall. Flera av studierna visade på att vårdhunden hade minskat deltagarnas depressiva symtom och deras nedstämdhet. Samtidigt syntes en ökad emotionell stabilitet samt en minskad ångest och aggressivitet hos deltagarna. De ingående studierna visade även en försämrad effekt av välbefinnandet och en ökning av dementa symptom vilket yttrade sig genom att deltagarna blev mindre adekvata och mer verbalt aggressiva, huruvida denna effekt berodde på vårdhunden framkom inte. Utifrån den metodologiska frågeställningen framkom det ur studierna att deltagarna fått klappa, leka, utfodra, promenera samt fått välja själva hur de spendera tiden med hunden. Slutsatser: Ur litteraturstudien framkom det förbättrade effekter på välbefinnandet hos deltagarna med kognitiva nedsättningar efter hundterapin, vilket framhåller hundens hälsofrämjande egenskaper. Vidare saknade stora delar av de ingående studierna statistisk signifikans och blev därför inte tillförlitliga. Det behövs därför mer evidensbaserad forskning för att kunna fastställa vårdhundens effekter inom området. / Background: Dog therapy is an unexplored area within the field of nursing, to date there´s a lack of evidence based research regarding the therapeutic effects of the dog in health-care. The therapy dog has a variety of areas in the healthcare which it can be used. Dementia and mental illness is a widely spread over the world and there is an increase in people diagnosed with the disorder, it´s thought to be related to increased average life expectancy. Aim: The aim of this literature-review was to describe the effects of the therapy dog on the wellbeing on patients with cognitive dysfunctions and as methodological aspect describe in which way the dog has been used as an independent variable in the interventions of the studies. Method: A descriptive literature-review where ten quantitative experimental studies has been reviewed and complied. Main result: The result of the included studies were summarized under three different outcomes, improved effect, degraded effect and unchanged effect. Several of the studies showed a decrease in the participant’s depressive symptoms, it was thought to be due to the effects of the dog. The participants showed an increased emotional stability and a reduced grade of anxiety as well as decreased aggressive behavior. The outcome of the included studies also showed a decreased tendency in the participant’s self-experience quality of life and an increased frequency of dementia symptoms, which were revealed as les adequateness and more verbally aggressive. Based on the methodological question the studies showed that the activities the participants did during the intervention were; pet the dog, play with the dog, feed it, take walks with the dog and they could choose individually what they wanted to do. Conclusion: The literature- review revealed that the therapy dog had a improved impact on the participants wellbeing after the intervention, compared to before the intervention. This emphasizes the dog´s health-promoting characteristics. Furthermore, the outcome of the literature- review shows that the result from the included studies lack statistical significance, therefore these results were not counted as reliable. The present review underlines the need for further evidence- based research regarding the health-promoting effects of the therapy dog.

Working in health care professions involves many emotional and interpersonal job stressors. Difficulties in handing such stressors commonly lead to a distinctive combination of emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (RPA), a syndrome known as burnout. Although most helping professionals contend with similar demands, mental health workers are faced with many unique pressures. The problem addressed by the proposed research was burnout of mental health providers. More specifically, the current study sought to identify organizational and individual factors that may lead to less--or more--burnout in providers who report having a majority of clients with long-term mental illness and/or substance use disorders (LTMI). Several hypotheses were tested. It was proposed that each of the organizational and personality characteristics would be significantly associated with all three dimensions of burnout and that the majority of the assessed variables would significantly contribute to the prediction of burnout. Exploratory moderation analyses were also conducted. Participants were recruited from regional community mental health centers, social service agencies, and chemical dependency programs. Participants included direct care staff who reported that the majority of work performed was face-to-face with clients diagnosed with LTMI. Demographic information was assessed in addition to three self-report measures. Results of this investigation demonstrated that, contrary to a priori hypotheses, levels of burnout in social services workers serving mostly LTMI clients were generally low. Most of the occupational and personality variables did not account for as much variance of each burnout dimension as expected. However, the full sets of chosen demographic, organizational, and personality variables significantly predicted each dimension of burnout. Psychological demands were most predictive of EE, job insecurity and agreeableness accounted for a significant portion of variance of DP, and none of the organizational or personality variables uniquely contributed to the prediction of RPA. The lack of significance of the proposed predictors may be attributed to several factors, especially the uniqueness of the current sample, nonrandom selection, and potential socially desirable responding. Additional empirical research including a burnout intervention for larger samples of social services workers who work with LTMI is indicated. Practical implications are discussed.

The purpose of this research is to examine the barriers to food security for single adults with mental illness and/or problematic substance use living in supported housing on Vancouver Island. The objectives are: (a) to examine the difference in the level of food security for tenants of supported housing neighbourhoods located in urban versus a rural community; (b) to examine the barriers to food access experienced by the tenants; and (c) to examine which barriers have the greatest effect on the tenants. Using an explanatory case study design, I employ a community-based research method with a social justice perspective as the framework. I have used an explanatory matrix to illustrate the tenant identified barriers to food security and the social structures that affect these barriers. As well, I have made recommendations for integrating food security services and programs into supported housing projects. I have argued that food security is a matter of public health and an integrative approach is needed. I am suggesting a shift on a larger policy scale, to promote the health and well-being of tenants in supported housing. An adequate holistic perspective with an integrated, long-term strategy linking all the determinants of health would result in health-in-all policies. This strategy could reduce the existing health inequities that the tenants in supported housing experience. / Graduate / judy@nahs.ca

Patienter ur normavvikande grupper blir drabbade av sjuksköterskors negativa attityder som ett resultat av bristande kunskap och fördomar från samhället. Syftet med litteraturstudien var att belysa vilka faktorer som påverkar attityder sjuksköterskor har i mötet med patienter ur normavvikande grupper. Föreliggande litteraturstudies resultat speglar övergripande betydelsen av kunskap och vikten av utbildning, arbetsmiljön samt könstillhörighet hos sjuksköterskor och baseras på 15 vetenskapliga artiklar utförda i olika länder. Artiklarna består av 12 med kvantitativ ansats, två från kvalitativ ansats och en av mixad metod. Resultatet är analyserat i olika steg där teman skapades och en djupare förståelse nåddes genom att sammanfatta och sammanställa resultatartiklarna i artikelöversikter. Sjuksköterskors negativa attityder kan medföra en sämre omvårdnad och ett dåligt bemötande vilket kan reduceras genom mer utbildning och genom att studera de bidragande faktorer för sjuksköterskors attityder kan det skapa en större förståelse och acceptans. Ytterligare forskning krävs för att kunna påverka de faktorer som leder till negativa attityder. / Patients who deviate from the norms of society will be affected by nurses' negative attitudes as a result of lack of knowledge and prejudice from society. The purpose of this study was to elucidate the factors that influence attitudes nurses have in meeting with patients from the norm deviant groups. This literature studies results reflect the overall importance of knowledge and the importance of education, work environment and gender of nurses and is based on 15 scientific articles conducted in different countries. Articles consisting of 12 from quantitative approach, two from qualitative approach and one from mixed method. The results are analyzed in different stages where themes were created and a deeper understanding reached by summarizing and compiling results in article overviews. Nurses’ negative attitudes can result in poorer care and a bad attitude, which can be reduced through more education and to find out the contributing factors for nurses' attitudes may create a greater understanding and acceptance. Further research is needed to influence the factors that lead to negative attitudes.

A literature review examines how mental health difficulties may differ for people with learning disabilities (PwLD) and the general population; with respect to their vulnerability to mental ill-health and the definition, presentation and treatment of mental health problems. Factors which have been found to positively impact on the mental health of PwLD are then explored. The review considers methodological limitations and gaps in our understanding, highlighting a need for further research focusing on mental health recovery for individuals with learning disabilities. Section B presents a study exploring what recovery means for people with learning disabilities and mental health difficulties. Interviews were conducted with nine individuals and Interpretative Phenomenological Analysis used. A model was developed which described participants’ entry to the therapeutic service and their progression towards recovery. The model firstly describes how participants felt entering the service, their Mental Health/Therapy Experience, and explains how these experiences were validated and the recovery process enabled through the therapeutic alliance. Once enabled, the second dimension of the model is detailed, that of the Client Recovery Experience which extends across three phases of recovery. The first phase, Feeling Better describes elements perceived as integral to improved mental health. The second phase, Recovery Ongoing identifies that more input is required. Thirdly, Attainability?: Reality, Ideals and Fantasy, reveals PwLD’s perceptions of recovery and the techniques used in striving to achieve this. Salient features of recovery specific to PwLD are recognised as important to clinical practice, and results suggest there is a need to openly discuss LD identity, and address idealisations surrounding a non-LD one. This would involve setting realistic goals and managing expectations accordingly and focussing on social integration as a way of enabling ongoing recovery.

Criticism of NHS acute psychiatric care has been high within patient experience research, compounded by critical press coverage of inpatient wards. Government policy requires staff to deliver compassionate, personalised care, but there is little research considering staff’s perspectives and experiences of the work. This study aimed to construct a grounded theory of acute psychiatric staff’s experiences, with particular attention to what might facilitate or block compassionate patient care. Semi-structured interviews were conducted with ten ward staff (three men, seven women) across a range of disciplines. Data were analysed using constructivist grounded theory. The model constructed captures the dynamic interactions between eleven categories: Being in a chaotic environment, Feeling limited, Struggling to improve without support, Building patient relationships, Enjoying the work, Staying vigilant, Taking an emotional toll, Putting up a barrier, Supporting each other, Seeing tensions and differences, and Acting as one team. The study concluded that staff described feeling motivated to engage with patients but restricted by practical and emotional demands. While support was provided by colleagues and formal structures, staff could not always make full use of them. Suggestions for future research and clinical practice include changes to practical demands on staff, as well as attitudes towards reflective practice.