Bakgrund: Ett mångkulturellt samhälle kan vara en utmaning för sjukvårdspraxis. Tillit är viktigt för att kunna bygga en välfungerande relation mellan en patient och vårdgivare. Syfte: Syftet med studien är att beskriva sjuksköterskors erfarenheter av att främja tillit hos invandrarpatienter med psykossjukdomar  Metod: Fem sjuksköterskor intervjuades med hjälp av semistrukturerade intervjuer. Deltagarna jobbar inom psykiatriska vårdenheter i Stockholm. En kvalitativ design användes i denna studie. Resultat: Resultatet diskuteras utifrån de fyra kategorier och två underkategorier som uppkom i studien: Kommunikationens betydelse för tillitsskapande i psykiatrisk vård, med underkategorin värdet av tolksamtal; kroppsspråkets betydelse för tillit; kulturella skillnader gällande psykiska sjukdomar, med underkategorin kulturella skillnader i att beskriva sjukdomssymptom; närståendes betydelse för ett tillitsskapande möte. Resultaten visar att språksvårighet är ett hinder för kommunikation och för främjandet av tillit hos patienter med invandrarbakgrund och tyder på att empati och lyhördhet är grunderna för att främja tillit och skapa förtroende Diskussion: Resultaten visar att där språket inte räcker till blir den icke-verbala kommunikationen viktig. Studien beskriver också brister av kunskap, pedagogik och förhållningssätt i mötet med invandrarpatienter som har psykisk sjukdom och behovet av transkulturell utbildning inom sjukvården. / Background: A multicultural society can be a challenge for. Trust is crucial for building a well functioning relationship between a patient and a caretaker. Aim: The aim of this study was to describe nurses' experiences with promoting trust in immigrant patients with psychosis. Methods: Five nurses were interviewed with the help of semi-structured interviews. The participants work in psychiatric care units in Stockholm. A qualitative design was used for this study. Results: The results are described in four categories and two subcategories that are raised in the study: the importance of communication for creating trust in psychiatric care, with the subcategory interpreted conversation; the importance of body language for trust; cultural differences regarding mental illnesses, with the subcategory cultural differences in describing illnesses; and the signification of relatives in creating at trustful meeting. The results show that language difficulties is a barrier for communication to promote trust in psychiatric patients who are immigrants and suggests that empathy and responsiveness are the foundations for promoting trust. Discussions: The results suggests that non-verbal communication becomes important when language is not enough. The study also describes deficiencies in knowledge, education and approach in the meetings with mentally ill immigrant patients and the need for transcultural training in health care.

Background For patients in need for psychiatric care who refuse treatment, coercive care might be necessary due to The Law of Psychiatric Compulsory Care, LPT. The purpose of this law is to make sure the patient later on will be able to increase autonomy. The most frequent patients in coercive care suffer from psychosis, heavy depression or having high risk of committing suicide. One of the most important tasks in the nurse profession is to increase patients’ autonomy. Therefore having ethical judgment is necessary to know when to use paternalism. To take note of patients’ experiences may increase awareness, making care more patient-centered. Aim To describe patients’ experiences of coercive care and coercive interventions in psychiatric care. Method A literature review has been conducted in order to compile what is currently known about the topic at hand. The result is based on ten scientific articles with findings responding to the aim of this study. The articles have been analyzed by identifying similarities and differences that have synthesized to a new whole.   Result The literature review yielded a profound view of patients’ experiences when being in coercive care. Three main themes were found to cover the phenomenon. Those were Coercive Care - limits and possibilities, The care relationship is fundamental and From abuse to life saving. Discussion The result has been discussed using the theory about Care Suffering, as described by Katie Eriksson. This theory is applicable on the context of interest. The findings has also been discussed using earlier studies concerning coercive care, as well as studies emphasizing the perspective of the nurse’s using coercive restraint. Key words Coercive care, coercive interventions, psychiatric care, patients’ experiences.

Background: A large number of the Swedish population are today living with some kind of mental illness. With an understanding of patient's experiences of continuity, the nurses are able to meet each patient based on their desires. This contributes to an increased opportunity for the patient to achieve health. Aim: The aim of this study was to illuminate patients' experience of continuity of care in psychiatric care. Method: A literature-based study was conducted by analysis of qualitative articles. The articles were found through systematic searches in the databases Cinahl and PsycINFO. A total of eight articles were selected and analysed according to Friberg's five-step model. Results: The result was presented in three main themes which illuminated the patients' perspective. The first theme described the meaning of a care relationship to achieve continuity of care. In the second theme information was presented about how patient participation affects continuity. The third and last theme highlights the organizations effects on continuity. Conclusion: The conclusion is that an increased understanding of patient's own experiences of continuity is needed. It provides an opportunity for patients to achieve health and for health care professionals to meet the patient based on individual conditions in the care relationship. Maintaining continuity in psychiatric care has several positive aspects, both for the individual but also for the health care staff and organization, and should therefore be a priority. / I detta examensarbete var syftet att belysa patienters upplevelser av kontinuitet inom den psykiatriska vården. Psykisk ohälsa är vanligt och förekommer i samhället världen över. Hur patienten upplever den psykiatriska vården påverkas av olika faktorer. Det är av stor betydelse för sjuksköterskan att förstå och lära av dessa faktorer för att möta patienter i olika vårdsammanhang. Patienters upplevelser av kontinuitet var en av dessa faktorer som framkom i detta examensarbete. Efter sökning i två olika databaser kunde åtta kvalitativa vetenskapliga artiklar väljas ut till grund för examensarbetets resultat. Analysen av materialet utgick från Friberg (2017) femstegsmodell som beskrivs i metodavsnittet. Utifrån analysen kunde tre huvudteman och åtta underteman utformas. Det fanns omständigheter i vården som påverkade hälsan negativt. I detta examensarbete framkom det att bristande kontinuitet påverkade patientens utveckling av hälsa. Att upprätthålla kontinuitet visade sig istället leda till att patienten i högre utsträckning fick möjlighet att uppnå hälsa. Resultatet visade att upplevelsen av kontinuitet påverkades av olika faktorer. För att upprätthålla kontinuitet krävdes en fungerande vårdrelation mellan patient och vårdpersonal. Det var även av vikt för patienter att känna sig delaktiga i beslutsfattning. Det gav en motivation till fortsatt vård och behandling. Hur den psykiatriska vårdens organisation var uppbyggd påverkade också patienters upplevelse av kontinuitet. Genom att belysa patienters upplevelser av kontinuitet skapade författarna, i detta examensarbete, förutsättningar för att i framtiden kunna utforma en vård med patienten i fokus.

In my diploma thesis I would like to introduce the readers to the issue of mental health care in the Czech Republic. I will focus on mental health definition, classification of mental illnesses, and also introduce services provided to people with mental illness. Furthermore, I will deal with the systém of mental health care in the Czech Republic, where I will try to point out the greatest positives and also some negatives of this system. The reader will also learn about Czech legislation related to this issue. Finally, I will inform about the psychiatric care reform, which started in 2013 in the Czech Republic - I will mention the main milestones, plan and strategy of this reform, and the benefits of this reform will be demonstrated on particular steps and realized projects. In the research section, I will focus on personal experience of care users, where thanks to the interviews, I can mediate the biggest mental health care problems from users point of view. KEYWORDS mental health, mental illness, psychiatric care system, psychopathology, psychiatric care reform

Background: People with perceived mental illness can experience stigmatization in the somatic care. It has also been shown that staff within the somatic care found it difficult to care for people with psychiatric diagnoses. The perceived mental illness in the society has been observed to increase; hence there is a need to investigate whether specialist nurses in psychiatric care can be used outside the psychiatric context.Aim: The aim of the study was to shed light on the psychiatric nurse's nursing knowledge and work function outside the psychiatric context, within the somatic care.Method: A meta-synthesis with a systematic literature search was done to answer the aim of the study. 15 articles were included and analyzed.Results: Specialist nurses in psychiatric nursing have been shown to fulfill a function outside the psychiatric context. It was shown that the accessibility of care increased, and the quality of care improved. The lack of a clear job description was one of the difficulties described.Conclusion: The results of the study highlight that there is a need for specialist nurses in psychiatric care outside the psychiatric context. / Bakgrund: Personer med upplevd psykisk ohälsa kan uppleva stigmatisering i den somatiska vården. Det har även visat sig att personal inom den somatiska vården upplevt det svårt att vårda personer med psykiatriska diagnoser. Den upplevda psykiska ohälsan i samhället har observerats öka, därav ses ett behov av att undersöka om specialistsjuksköterskor inom psykiatrisk vård (SIPV) kan användas utanför den psykiatriska kontexten.Syfte: Syftet med studien var att belysa psykiatrisjuksköterskans omvårdnadskunskap och arbetsfunktion utanför den psykiatriska kontexten, inom somatisk vård.Metod: En metasyntes med systematisk litteratursökning gjordes för att besvara studiens syfte. 15 artiklar inkluderas och analyserades.Resultat: Specialistsjuksköterska inom psykiatrisk omvårdnad har visat sig fylla en funktion utanför den psykiatriska kontexten. Det ökade tillgängligheten till vård och vårdkvaliteten förbättrades. Avsaknad av tydlig arbetsbeskrivning var en av de svårigheter som beskrevs.Slutsats: Studiens resultat belyser att det finns ett behov av specialistsjuksköterskor inom psykiatriskvård utanför den psykiatriska kontexten.

Bakgrund: Patienter som ofta vårdas inom den psykiatriska slutenvården är patienter med psykotiska störningar, depression och patienter med risk för självmord. Tvångsåtgärder som kan förekomma på en psykiatrisk vårdavdelning kan exempelvis vara bältesläggning, tvångsmedicinering och isolering. För att en sjuksköterska ska kunna vårda dessa patienter behövs såväl kunskap som förståelse. För att axla denna roll behöver sjuksköterskor mer forskning som är fokuserad på patienters erfarenheter. Syfte: Syftet med studien var att beskriva patienters erfarenheter av sluten psykiatrisk tvångsvård samt att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp. Metod: Litteraturstudien genomfördes med en beskrivande design. Studien innefattas av elva stycken kvalitativa vetenskapliga artiklar som svarar på studiens syfte. Resultat: Fem teman var grunden till beskrivningen av denna litteraturstudie: Betydelsen av relationen till vårdpersonalen, Betydelsen av information, Förståelsen av att vårdas mot sin vilja, Erfarenheter av tvångsåtgärder samt Erfarenheter av vårdmiljön. Resultatet avslutas med en beskrivning av artiklarnas urvalsmetod och urvalsgrupp. Slutsats: Patienter beskrev både bra och dåliga erfarenheter av sluten psykiatrisk tvångsvård. Viktiga aspekter som framgick enligt patienterna var: God information, god relation till vårdpersonal, förståelse samt en god vårdmiljö. Det är av stor vikt att sjuksköterskan har god kunskap om patienters erfarenheter för att kunna ge så god omvårdnad som möjligt. / Background: Patient who is treated in a locked psychiatric coercive care unit is patient with psychotic disorders, depression and patients with risk for suicide. Coercive measures that may be present in a psychiatric ward could be, for example medical restraint, forced medication and isolation. For a nurse to be able to care this patients who is in a need for good care it´s important with knowledge and understanding. To handle this role, nurses need more research and focus at the experiences of patients. Purpose: The aim of this study was to describe patient´s experience of a locked psychiatric coercive care unit. Present the selected articles' selection method and study group. Method: This is a literature study with a descriptive design. In this study eleven articles of qualitative approach are included to answer to the purpose of this study. Results: The result is based on five themes: Significance of relationship with health professionals, Significance of information, Understandning of being cared against their own will, Experience of being cared under coercion and Experience of the care environment. The last part om the result descibe the selctions method and the of the study group of the article. Conclusion: Patients described both good and bad experiences of locked psychiatric care. According to the patient important aspects was: Good information, Good Relationships with the health professionals and understanding, God care environment. It´s of great importance that the nurses have good knowledge about patients experience to be able to give such good nursing care as possible.

Denna studie handlar om den rättspsykiatriska personalens erfarenheter av patienternas återhämtningsprocesser. Studien syftar till att försöka belysa de erfarenheter som personalen besitter, med fokus på återhämtning. Studien bygger på en kvalitativ metod och består av intervjuer som gjorts med personal som arbetar inom en av Sveriges rättspsykiatriska vårdkliniker. Resultatet visar att personalen har erfarenheter av att det finns både gynnsamma och hindrande faktorer som påverkar patienternas återhämtning. Resultatet visar även att relationerna mellan personalen och patienten är en viktig förutsättning för patienternas återhämtning. / This study is about the forensic psychiatry staff experiences of patients ' recovery processes. The study aims to highlight the experience staff possesses. The study is based on a qualitative approach and consists of interviews conducted with staff who works in one of the forensic psychiatric care clinics. The study is based on a qualitative approach and consists of interviews conducted with personnel working in one of the forensic psychiatric care clinics. The results show that the staffs have experience of both beneficial and hindering factors that influence patients ' recovery. The result also shows that relations between staff and patient are essential for patients ' recovery.

This thesis focuses mainly on the general ethical considerations of staff and not pre-defined specific ethical problems or dilemmas. The aims of this thesis were: first, to map ethical considerations as described by staff members in their everyday work in child and adolescent psychiatry as well as in adult psychiatry; second, from a normative ethical perspective, examine encounters between staff and patients; and third, to describe staff justification for decisions on coercive care in child and adolescent psychiatry. The material in the three first studies comprised ethical diaries written by staff in 13 inpatient clinics. The fourth study included all the medical records of patients who were admitted to coercive care during one year in child and adolescent psychiatry in Sweden. In a final analysis, combining all the four studies, three staff ideals were identified: being a good carer, respecting the patient’s autonomy and integrity and having good relations with patients and relatives. Staff often felt that the only reasonable way in many situations was to act in a paternalistic way and take responsibility, but they considered it to be problematic. Four main themes were identified as ethical considerations. These were the borders of coercion, the emphasis on order and clarity rather than a more reciprocal relationship with patients, a strong expectation of loyalty within the team, and feelings of powerlessness, mostly in relation to patients. I have identified four challenges for inpatient psychiatry. First, formal and informal coercion in inpatient care raise ethical concerns that also can be emotionally difficult for staff. Second, the professional role and care needs to be redeveloped from providing routinised care to providing more individualised care. Third, staff often worry about how patients manage their life after discharge, indicating that patients need better support. Fourth, staff also need support; they often experience feelings of being alone with their thoughts about ethical difficulties at work. Future research could contribute in the mapping of ethical considerations, in helping to develop, implement and evaluate methods for managing these issues in psychiatric settings, and to develop the normative ethical language so that it is more relevant to the clinic reality.

Bakgrund: Psykossjukdom är ett stort och utbrett hälsoproblem i Sverige, varje år insjuknar cirka 1500- 2000 människor, och medför ett svårt lidande för individen. Religionen har för personer med psykossjukdom visat sig ge upplevelse av hopp, tröst, mening och förklaring. Dock kan psykotiska symptom i form av religiösa vanföreställningar, tendera till att göra det svårt för vårdpersonal att särskilja patologiska föreställningar med religiöst innehåll från friska religiösa tankar. Sjuksköterskans psykiatriska vårdarbete innefattar ett vårdande där man utgår från människan som en helhet och ska se till patientens behov på alla plan. Sannolikheten att möta personer från andra religioner och kulturer är hög relaterat till existerande mångkultur. Det behövs mer forskning för att öka möjligheten till ett vårdande där patienters religiösa behov inkluderas i vårdprocessen. Syfte: att beskriva sjuksköterskors erfarenheter av att möta personer med psykossjukdom och deras religiösa tankar. Metod: Kvalitativ intervjustudie genomfördes med sex sjuksköterskor verksamma inom det psykiatriska vårdfältet. Datamaterialet tolkades genom en kvalitativ innehållsanalys enligt Elo och Kyngäs. Resultat: Studien resulterade i tre teman; Sjuksköterskan i mötet, Vårdandet- att möta behoven samt Sjuksköterskans upplevelse av patienten i mötet. Resultatet visade en rädsla, osäkerhet och låg tilltro till befintlig kunskap hos sjuksköterskor, i hur man möter religiösa tankar och behov. Samt att det föreligger svårigheter i hur man skiljer friska religiösa tankar från religiösa vanföreställningar. Diskussion: Resultatet diskuteras med Katie Eriksson helhetsperspektiv som teoretisk utgångspunkt samt relevanta vetenskapliga artiklar. Faktorer som rädsla, osäkerhet och låg tilltro till befintlig kunskap måste uppmärksammas för att möjliggöra ett vårdande utifrån ett helhetsperspektiv. / Background: Psychosis is a large and widespread health problems in Sweden, each year 1500- 2000 people fall ill, and often causes great suffering for the individual. Religion has for people with psychosis shown to provide experience of hope, meaning, comfort and explanation. However, the patient's psychotic symptoms in the form of religious delusions, tend to make it difficult for health professionals to distinguish pathological beliefs with religious content from healthy religious thoughts. The probability to meet people from other religions and cultures is high in relation to the existing multiculturalism. We need more research to increase the possibility of caring from a holistic perspective where patients' religious thoughts and needs are included in the care process. Aim: To describe nurse’s experiences of meeting individuals with psychosis and their religious thoughts. Methods: Qualitative interviews were conducted with six nurses working in the psychiatric field. The data was interpreted through a qualitative content analysis according to Elo and Kyngäs. Result: The study resulted in three themes; The nurse in the meeting, Caring- to meet the needs and the nurse's experience of the patient in the meeting. The result shows how fear, insecurity and a sense of lack of knowledge of how to meet the religious needs and thoughts, and difficulties in how to distinguish healthy religious thought from religious delusions. Discussion: The results are discussed with Katie Eriksson holistic perspective as a theoretical basis as well as relevant scientific research. Factors such as fear, insecurity and a sense of lack of knowledge must be addressed to enable caring from a holistic perspective.

Background: Several nursing theorists emphasize the importance of establishing the so-called therapeutic relationship between the nurse and the patient in order to facilitate and provide better results of the treatment. Aim: The aim of this study was to investigate how nurses working in out-patient psychiatric care describe the concept of therapeutic relationship and its usage when working with patients. Method: Semi structured interviews were performed and the material was analyzed through qualitative content analyzis. Result: Four main categories that describe the different aspects of the therapeutic relationship emerged. These were: What the nurse does to establish the therapeutic relationship, The functions and definition of the therapeutic relationship, The qualifications of the therapeutic relationship and Challanges in establishing the therapeutic relationship. Conclusion: The therapeutic relationship was described as a tool in working with the patient, and individualized treatment, trust, sufficient time and the use of one's own personality was described as important factors in establishing this relationship.