Ward environment as assessed by the Ward Atmosphere Scale was the focus of this exploratory study. The Ward Atmosphere scores of 110 patients hospitalized on two units for acute psychiatric care in a state hospital were analyzed for determining differences along the dimensions of population factors, sex and program change. Significant differences in attitude were obtained on certain of the ten scales for each of the three comparisons. The premise of ward atmosphere being a global entity as implied in the literature was not upheld in this population. Sex differences were noted and introduction of an individualized patient management program evoked significant changes in opinions concerning ward atmosphere. A number of interpretations for these results were offered and implication for future research was suggested.

Bakgrund: Tidigare psykologisk forskning har visat på samband mellan hög grad självmedkänsla och välbefinnande samt att låg grad självmedkänsla haft samband med psykopatologi. Lite vårdvetenskaplig forskning har gjorts om självmedkänsla och begreppet anses fortfarande relativt okänt. Syfte: Att beskriva hur vuxna personer med adhd uppfattade begreppet självmedkänsla och samtal utifrån Self-Compassion Scale. Hur såg vuxna med adhd på begreppet självmedkänsla och dess innebörd? Vilka utmaningar och vilken behållning beskrev de i användandet av Self-Compassion Scale? Hur var deras självmedkänsla? Metod: Undersökningen hade en QUAL + quan, mixed method design. Fyra personer deltog i kognitiva intervjuer i den kvalitativa delen och i den kvantitativa delen fyllde 23 personer i Self-Compassion Scale. Intervjuerna genomgick en innehållsanalys medan skattningsskalorna har analyserats numeriskt. Resultat: Intervjuerna redovisar tre kategorier; Självmedkänsla innefattar välbefinnande och relationen till sig själv och andra, Samtal leder till självinsikt och Att utforska problem och lösningar är givande och utmanande. Personerna skattade totalt 2,6 i självmedkänsla, vilket betyder medelnivå (medelnivå = 2,6-3,5 ). Slutsatser: Att samtala om självmedkänsla kan vara utmanande och betydelsefullt för personer med adhd. Att som specialistsjuksköterska inom psykiatri ha kunskap om självmedkänsla kan vara värdefullt för patientens hälsa och återhämtning. / Background: Research has shown correlation between high self-compassion and wellbeing as well as low self-compassion has been correlated with psychopathology. Little research of Self-compassion in nursing science has been done and the concept is still relative unknown. Aim: To describe how adults with adhd percived the concept of self-compassion and conversation  with Self-Compassion Scale as starting point. How did adults with adhd perceive self-compassion and it´s meaning? Which challanges and profits did they describe in the use of Self-Compassion Scale? How was their self-compassion? Method: The study had a QUAL + quan, mixed method design. Four participants performed cognitive interviews in the qualitative part and in the quantitative part 23 participants performed Self-Compassion Scale. The interviews underwent content analysis and the assessment tools has been numerically analyzed. Result: The interviews present three categories; Self-compassion contains wellbeing and the relationship to oneself and others, Conversation leeds to self-awareness and To explore problems and solutions is rewarding and challenging. Persons rate a medium-level self-compassion of 2,6 in total (medium level = 2,6-3,5). Highest scores for the categories isolation and over-identified. Conclusion: To converse about self-compassion can be challenging and important for persons with adhd. For the nurse within psychiatric care to have knowledge of self-compassion can be valuable to patient’s health and recovery.

A reforma psiquiátrica possibilitou transformações na assistência à saúde mental e o acompanhamento terapêutico (AT), como modalidade de assistência e reabilitação psicossocial do portador de transtorno mental, faz parte dessas transformações. Desde então, o acompanhante terapêutico vem ampliando seus conceitos e fundamentando suas bases teóricas, sendo sua prática cada vez mais aceita por diferentes profissionais e valorizada por preencher as lacunas deixadas pelos tratamentos psiquiátricos tradicionais, principalmente depois que as portas dos manicômios, que enclausuravam o referido portador de transtorno mental e as maneiras adequadas de assisti-lo e reabilitá-lo, foram definitivamente abertas. O objetivo do presente estudo foi investigar a contribuição do AT no processo de assistência e reabilitação psicossocial de um portador de transtorno mental assistido em um Centro de Atenção Psicossocial e escolhido com a ajuda de sua equipe multiprofissional. Para isso, foram estabelecidos 16 encontros de AT, os quais foram desenvolvidos em diferentes locais, observados, e seus conteúdos registrados após cada encontro, sintetizados e analisados, segundo o método qualitativo. Os resultados mostraram contribuição muito positiva do AT na assistência e reabilitação psicossocial do portador de transtorno mental, tais como: resgate de sua autoestima; retomada de realização de atividades que fazia anteriormente ao início dos sintomas de seu transtorno mental; motivação para novamente buscar o lazer e conviver de forma mais saudável no seu meio familiar e social; criação de momentos de confronto de seu estado mental com a realidade, possibilitando modificações no comportamento e melhoria da qualidade de vida. Assim sendo, foi possível considerar que o AT constitui-se em mais uma modalidade terapêutica contribuindo para a assistência e reabilitação psicossocial do portador de transtorno mental e pode ser incluído nos planos terapêuticos dos serviços de assistência à saúde mental, pois se trata de modalidade terapêutica não tradicional, totalmente inserida no contexto da reforma psiquiátrica, que tem como princípio básico a mudança no foco da assistência aos portadores de transtornos mentais. / The psychiatric reform made it possible for transformations to take place in mental health care and therapeutic continuity (TC), as a health care modality and psychosocial rehabilitation of individuals with mental disorders. Since then, therapeutic continuity has broadened its concepts and founded its theoretical bases. Hence, its practice has become increasingly acknowledged by different professionals and valued for the fact it fills the gaps that were left from traditional psychiatric treatments, mainly after the doors to asylums, which used to keep mentally ill individuals cloistered, were completely open and appropriate forms of looking after these patients and rehabilitate them were implemented. The purpose of the present study was to investigate the contribution of TC over the health care process and psychosocial rehabilitation of an individual with mental disorders seen at a Psychosocial Care Center, and chosen with the help of its multiprofessional team. To do this, 16 TC appointments were scheduled, which were carried out at different locations. These meetings were observed and their contents were recorded, summarized, and analyzed according to the qualitative method. The results showed that TC has a very positive contribution in the health care and psychosocial rehabilitation of mental disorder patients, with actions such as: recovering selfesteem, going back to activities the patient did before his mental disorder symptoms appeared, motivation to once again become involved in leisure activities and lead a healthier life among his family and social environment, creating moments of confrontation between his mental condition and reality, which made it possible to change his behavior and improve his quality of life. Thus, it is understood that TC is another therapeutic modality that contributes with the psychosocial rehabilitation of patients with mental disorders. Furthermore, it can be included in the therapeutic plans of mental health care services, since it is a untraditional therapeutic modality totally inserted in the context of psychiatric reform, whose main principle is to change the focus of health care services to individuals with mental disorders.

Bakgrund: Vårdkvalitet är ett mångfacetterat begrepp som inte går att beskriva på ett ensidigtsätt. Vårdkvalitet kan ses ur många olika perspektiv, där patientperspektivet är ett. Begreppetdelaktighet framkommer som centralt när vårdkvalitet beskrivs. Patientens delaktighet iutvecklingen av hälso- och sjukvården regleras enligt lag och patienten ses som en naturligdel av utvecklingsarbetet. Tidigare studier visar att patienterna betonade interpersonellprocess som viktigast, för hur vårdkvalitet uppfattades. Syfte: Syftet är att sammanställa forskning ur ett patientperspektiv beträffande vårdkvalitet ipsykiatrisk vård. Metod: En litteraturstudie baserad på 8 granskade kvalitativa artiklar. Analysen genomfördes i enlighet med Evans fyrstegsmetod. Nyckelfynd identifierades och därefter skapades temanoch subteman vilket utgjorde resultatet. Resultat: Vårdkvalitet är enligt patienterna en kombination av flera faktorer. Det mestframträdande är personalen som bryr sig med ett gott bemötande och där patienterna får varadelaktiga. Vårdmiljön är också en viktig faktor för att patienterna ska uppleva vårdkvalitetoch då innefattar det en trygg och estetisk miljö. Resultatet presenteras i två teman, Personalsom bryr sig och En lugn, vacker och trygg miljö med fyra subteman; Bemötande,Delaktighet, Estetik och Trygghet. Slutsats: Personal med en förmåga att skapa ett möte som innefattar delaktighet under tryggaformer i en vacker miljö är en förutsättning för att patienter inom den psykiatriska vården skauppleva vårdkvalitet. Litteraturstudien bidrar med en sammanställning av kunskap om vadpatienter inom psykiatrisk vård upplever är vårdkvalitet, varför den kan användas för attfrämja utveckling, patientens delaktighet samt personalens förmåga att ge patienterna en godvårdkvalitet oavsett vårdkontext. / Background: Quality of care is a multi-faceted concept that cannot be described in a unilateral way. Quality of care can be seen from many different perspectives, where the patient perspective is one. The concept of participation appears as central when the quality of care is described. The patient's involvement in the development of health and medical care is regulated by law and the patient is seen as a natural part of the development work. Previous studies show that patients emphasized interpersonal process as most important, for how care quality was perceived. Purpose: The aim is to compile research from a patient perspective regarding the quality of care in psychiatric care. Methodology: A literature study based on 8 reviewed qualitative articles. The analysis was carried out in accordance with Evans' four-way method. Key concepts were identified and then themes and sub-themes were created that generated the result. Result: The quality of care according to the patients is a combination of several factors. The most prominent are the staff who care about good treatment and where the patients may be involved. The care environment is also an important factor for the patients to experience quality of care and then it includes a safe and aesthetic environment. The result is presented in two themes, Staff who care and A quiet, beautiful and safe environment with four sub- themes; Treatment, Participation, Aesthetics and Security. Conclusion: Staff with an ability to create a meeting that involves participation in safe forms in a beautiful environment is a prerequisite for patients in the psychiatric care to experience quality of care. The literature study contributes with a compilation of knowledge about what patients within psychiatric care experience is quality of care, why it can be used to promote development, patient involvement and the staff's ability to give patients a good quality of careregardless of the health context.

<p>Syftet med studien var att undersöka psykiatrisjuksköterskans självrapporterade utförda arbetsuppgifter och självupplevda kompetens. Studien bygger på individuellt genomförda intervjuer med 19 psykiatrisjuksköterskor verksamma inom den psykiatriska slutenvården. Författarna har använd ett proportionellt stratifierat urval. Resultatet presenteras i fem kategorier; psykiatrisjuksköterskans kompetensområde, specifika arbetsuppgifter i kompetensområdet, arbetsuppgifter utanför kompetensområdet, arbetsuppgifter som psykiatrisjuksköterskan saknar samt rollkonflikter med tillhörande subkategorier. I psykiatrisjuksköterskans kompetensområde ingår arbetsuppgifter som arbetsledare och omvårdnadsansvarig att planera fördela arbetet på avdelningen, vårdplanera, dokumentera samt läkemedelsadministration. Det specifika i kompetensområdet visade sig vara bland annat vara stöd samtal, motiverande samtal och undervisning. Sjuksköterskorna skulle också ha en övergripande helhetssyn samt göra observationer. Arbetsuppgifter utanför kompetensområdet visade att de hjälper doktorerna med olika administrativa uppgifter samt en del kuratorsarbete. Arbetsuppgifter som sjuksköterskorna saknar främst; är mer aktiviteter för patienterna, mer patientkontakt, bättre samarbete med vårdgrannar och anhöriga samt en ökad etisk medvetenhet i omvårdnads och dokumentationsarbetet. Sjuksköterskorna upplevde även rollkonflikter i sitt arbete som mest berodde på olika otydligheter inom arbetsgruppen. Författarna anser att en tydligare arbetsbeskrivning, bättre ansvarsfördelning mellan de olika yrkesgrupperna samt en mer strukturerad vård av patienterna skulle minska otydligheten och osäkerheten för psykiatrisjuksköterskorna.</p><p> </p> / <p>The purpose of the study was to examine self-reported psychiatric nurse performed tasks and self-perceived competence. The study is based on individually conducted interviews with 19 psychiatric nurses working in psychiatric inpatient ward. The authors have used a proportional stratified sample. The results are presented in five categories; psychiatric nurse competence, specific tasks in the areas of competence, work outside the areas of competence, tasks psychiatric nurse lack and role conflicts and related subcategories. In psychiatry nurse competence includes duties as supervisor and nursing manager to plan the work in the department, care planning, documenting, and pharmaceutical administration. The specific competence in the field proved to be, inter alia, support calls, motivational talks and teaching. The nurses would also have a comprehensive approach and make observations. Tasks outside the competence demonstrated that they are helping the doctors with various administrative tasks, and some counselors work. Tasks that nurse do mainly lack; are more activities for patients, more patients, better cooperation with neighbors and family care, and increased ethical awareness in the nursing care and documentation work. The nurses also experienced role conflict in their work as most were due to various ambiguities in the working group. The authors conclude that a better working instruction, better division of responsibilities between the different professions and a more structured care of patients would reduce the lack of clarity and uncertainty of psychiatry nurses.</p><p> </p><p> </p>

<p>SAMMANFATTNING</p><p><strong>Bakgrund</strong>: Patienters upplevelser av att vårdas inom slutenvården med stöd av Lagen om psykiatrisk tvångsvård. Människor med en allvarlig psykisk störning eller ett oundvikligt behov av vård får med stöd av lagen tvångsvårdas. Patienterna fråntas självbestämmandet och blir tvungna att delta i vård och behandling mot sin vilja. När självbestämmandet fråntas patienterna övertar vårdpersonalen ansvaret vilket kan leda till ett lidande för patienterna (1991:1128).</p><p><strong>Syfte</strong>: Syftet var att beskriva patienters upplevelser av tvångsvård inom psykiatrisk slutenvård. </p><p><strong>Metod</strong>: Systematisk litteraturstudie, sex artiklar användes för uppnått resultat.</p><p><strong>Resultat: </strong>Både positiva och negativa upplevelser av tvångsvård påvisades. Patienterna beskrev ett möte med vården kantat av upplevelser kring människovärde, delaktighet i sin egen vård, kommunikation, relationer, synen på våld, hot och straff samt upplevt lidande.</p><p><strong>Slutsats</strong>: Om patienterna bemöttes med respekt, människovärde samt fick tillräcklig information kring vård och behandling blev upplevelserna av tvångsvården mer positiv. Brist på delaktighet i fråga om vård och behandling och kommunikationsbrister var ett problem då patienterna hade lite sjukdomsinskt samt inte hade förståelse för behovet av tvångsvård.</p><p>Vidare forskning med kvalitativa intervjuer om patienters upplevelser av tvångsvård föreslås för att ge utökad förståelse och kunskap.</p>

<p>Forensic psyhiatric care protects the society by giving patients care to diminish risks of serious crimes. In their work the nurses use different care methods to help and support the patient in managing his or her life situation. To clarify how a group of nurses describe the nursing process in forensic psychiatric care. A qualitative study based on interviews. Six nurses were interviewed about their work in four different forensic psychiatric care units. The nursing process in is divided into four categories: evaluation, planning, implementation and assessment. The results are based on the way the interviewed nurses described the essential roles of nurse-patient relationship and structured routines in nursing process. The study also shows some specific difficulties in nursing work, for example the mental dysfunctions of patients, the level of competence among staff and the patients need for social interaction and existence beyond their specific needs.</p>

<p>Enligt Hälso- och sjukvårdslagen har patienten rätt att bli bemött med respekt för sitt självbestämmande och sin integritet. Många patienter blir dåligt bemötta i vården, de känner sig kränkta, utelämnade och maktlösa. Psykiatrisk tvångsvård kan innebära en konflikt mellan att bedriva god vård och utöva tvång. Det är därför av största vikt att undersöka hur tvångsvårdade patienter upplever att de blivit bemötta och vad bra bemötande är vid psykiatrisk tvångsvård. Syftet med denna studie är att undersöka hur patienter upplever att de blivit bemötta vid psykiatrisk tvångsvård. Studien genomfördes som en litteraturstudie med kvalitativ innehållsanalys som metod. Manifest och latent ansats användes. Resultatet baserades på 12 vetenskapliga artiklar och en avhandling. Resultatet i studien presenteras i två huvudteman: Dåligt bemötande vid tvångsvård och bra bemötande vid tvångsvård. Sex underteman framkom: att inte vara delaktig i vården, att bli bemött med makt, att förlora sitt människovärde, att känna sig delaktig i vården, att få god omvårdnad och att känna sig som en människa. Genom att ta reda på patienters upplevelse och behov, kan vården bli individuellt anpassad. Bra bemötande leder till att patienten känner sig respekterad och bekräftad som människa.</p>

<p>It has been suggested that persons with intellectual disabilities (ID) manifest the full range of mental health problems. The main purpose of this thesis is to adapt and evaluate two clinical assessment instruments and to investigate the occurrence of mental health problems as well as psychiatric care utilisation in persons with ID. </p><p>The psychometric properties of a Swedish version of the two instruments [Reiss Screen for Maladaptive Behaviour (RSMB) and the Psychopathology Inventory for Mentally Retarded Adults (PIMRA)] were investigated in a random, institutional and clinical sample of administratively defined (ADDEF) adults with ID (n = 199). The analyses suggest that the RSMB could be used as intended by staff as a primary screening device for the identification of mental health problems in persons with ID, and that the PIMRA had a potential to identify individuals with a specific mental disorder. The psychometric evaluation reveals that the Swedish versions of the RSMB and PIMRA measure a construct related to the diagnostic categories in the DSM-III-R and DSM-IV. This construct could be conceptualised as mental health problems.</p><p>The RSMB and PIMRA results show that the overall occurrence of mental health problems in ADDEF samples of persons with ID (175 men and 148 women) ranged from 34 to 64%.</p><p>The preliminary level of ID was mild (23%), moderate (39%) and severe (38%). The most common mental health problems were aggressive and self-injurious behaviours, depression, anxiety and adjustment disorders. In registered patients receiving out- or in-patient psychiatric care the occurrence of adults with an ICD-10 diagnosis of ID was approximately 1% (70 to 90% had a mild level of ID). </p><p>In contrast to the high frequency of mental health problems reported, psychiatric care was used infrequently. This tendency is particularly evident in persons with moderate and severe ID.</p>

It has been suggested that persons with intellectual disabilities (ID) manifest the full range of mental health problems. The main purpose of this thesis is to adapt and evaluate two clinical assessment instruments and to investigate the occurrence of mental health problems as well as psychiatric care utilisation in persons with ID. The psychometric properties of a Swedish version of the two instruments [Reiss Screen for Maladaptive Behaviour (RSMB) and the Psychopathology Inventory for Mentally Retarded Adults (PIMRA)] were investigated in a random, institutional and clinical sample of administratively defined (ADDEF) adults with ID (n = 199). The analyses suggest that the RSMB could be used as intended by staff as a primary screening device for the identification of mental health problems in persons with ID, and that the PIMRA had a potential to identify individuals with a specific mental disorder. The psychometric evaluation reveals that the Swedish versions of the RSMB and PIMRA measure a construct related to the diagnostic categories in the DSM-III-R and DSM-IV. This construct could be conceptualised as mental health problems. The RSMB and PIMRA results show that the overall occurrence of mental health problems in ADDEF samples of persons with ID (175 men and 148 women) ranged from 34 to 64%. The preliminary level of ID was mild (23%), moderate (39%) and severe (38%). The most common mental health problems were aggressive and self-injurious behaviours, depression, anxiety and adjustment disorders. In registered patients receiving out- or in-patient psychiatric care the occurrence of adults with an ICD-10 diagnosis of ID was approximately 1% (70 to 90% had a mild level of ID). In contrast to the high frequency of mental health problems reported, psychiatric care was used infrequently. This tendency is particularly evident in persons with moderate and severe ID.