Syftet med studien var att beskriva sjuksköterskors upplevelser av att utföra tvångsåtgärder inom psykiatrisk slutenvård. Studien hade en deskriptiv design. Ett bekvämlighetsurval tillämpades som urvalsmetod och sex sjuksköterskor från en psykiatrisk slutenvårdsavdelning i Mellansverige deltog i studien. Data samlades in via ostrukturerade intervjuer och analyserades utifrån kvalitativ innehållsanalys. Resultatet visade att sjuksköterskorna upplevde positiva känslor i samband med utförandet av tvångsåtgärder. De upplevde att det var tur att tvångsåtgärderna finns som en möjlighet för patientens bästa. Ibland kunde tvångsåtgärder leda till att relationer skapades till patienten, då sjuksköterskan och patienten tillsammans upplevt en jobbig situation. Sjuksköterskorna upplevde att tvång var lättare att utföra när de kände patienten och i vissa tydliga situationer. Sjuksköterskorna upplevde även negativa känslor i samband med utförandet av tvångsåtgärder, att det inte var något de kände någon glädje över att utföra. Tvångsåtgärder uttrycktes i känslor av hämnd, dåligt samvete, rädsla och att det är jobbigt. De uttryckte att tvångsåtgärderna innebar en kränkning av patienten, och att det ibland kan kännas som att de begår övergrepp mot patienten. Sjuksköterskorna berättade även om situationer då tvång kändes svårare att utföra och att situationer där tvång utfördes kunde framkalla känslor av kluvenhet hos sjuksköterskorna. Sjuksköterskorna berättade även om hur hot om tvång ibland används mot patienten. Slutsatsen med föreliggande studie är att den psykiatriska vården är och förblir ett etiskt dilemma, då sjuksköterskorna kan ställas inför handlingar som kan skapa konflikt med hennes professionella, rättsliga, etiska och personliga ansvar för att hjälpa dessa patienter. / The aim of this study was to describe nurses' experiences of carrying out coercive measures in psychiatric inpatient care. The study had a descriptive design. A convenience sample was applied as sampling method, and six nurses from a psychiatric inpatient ward in central Sweden participated in the study. Data were collected through unstructured interviews and analyzed according to qualitative content analysis. The results revealed that nurses experienced positive feelings associated with using of coercive measures. They felt that it was good that the coercive measures were available as an option for the patient's best interests. Sometimes coercion led to development of therapeutic relationships between the nurse and the patient, because of the fact that they experienced a difficult situation together. The nurses felt that compulsion was easier to perform when they knew the patient and also in some obvious situations. The nurses also experienced negative feelings associated with the use of coercive measures, as it was not something that they felt any joy to perform. Coercive measures were expressed in feelings of revenge, remorse, fear, and that it was a burdensome issue. They expressed that coercive measures was a violation of the patient, and that it could sometimes feel like they were assaulting the patient. The nurses also told about situations where coercion felt more difficult to perform and situations where coercion was carried out could cause mixed feelings among the nurses. The nurses also told about how they sometimes used threat of coercion against patients. The conclusion of this study is that mental health care remains an ethical dilemma, since nurses may face options which may create conflict with her professional, legal, ethical and personal responsibility to help these patients.

Avsikten med denna uppsats var att granska hur bedömningen av psykiatrisk tvångsvård av barn och ungdomar i Sverige, motiverades under året 2002-07-01 - 2003-06-30. Genom en kvalitativ ansats har en textinnehållsanalys av journaler genomförts, i syftet att bidra till att ge en överblickbar beskrivning av materialet. Uppsatsen grundar sig på journaler som tidigare insamlats från chefsöverläkare vid samtliga barn- och ungdomspsykiatrikliniker i Sverige, vilket resulterade i 142 patienter och 159 vårdtillfällen som journalfördes. Patienterna utgjordes av barn och ungdomar i åldrarna 10-18 år. Motiveringarna till tvångsvården analyserades därefter utifrån sex stycken, redan befintliga etiska kategorier. Resultaten av uppsatsen visar att motiveringen av psykiatrisk tvångsvården oftast förekommer i form av multimotiveringar och att det är sällan som det förekommer motargumentationer i bedömningen till beslut. Vanligt förekommande är istället att så kallade övertalningsargument används, i syftet att klargöra att det inte finns någon alternativ vård till den psykiatriska tvångsvården. / The purpose of this paper was to review how the assessment of compulsory psychiatric treatment of children and adolescents in Sweden, was motivated by the year 2002-07-01 - 2003-06-30. Through a qualitative approach, a content analysis of records was made with the purpose to help provide a transparent description of the material. The essay is based on records that were previously collected from all child- and adolescent psychiatry clinics in Sweden, which resulted in 142 patients aged 10-18 years and 159 records. The results from this paper, was then analyzed based on six ethical categories that justified the compulsory psychiatric treatment. The results shows that the justification of compulsory psychiatric care is usually evidenced by multi-justifications and that it’s seldom that there is arguments against the compulsory psychiatric treatment in the assessment decision. Persuasive arguments are used to clarify that there is no alternative care then compulsory psychiatric treatment.

<p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p><strong>Objective:</strong> When caring for a patient with Anorexia Nervosa (AN) it is difficult for the registered nurses to develop a good nurse-patient relationship due to a lack of understanding for the illness.  It is important for the nurse to understand the suffering that the AN patients experience, and what makes them feel better, to be able to improve the patient-nurse relationship. This study aims to explore what makes patients with AN feel better during the illness and the process of recovery.</p><p><strong>Method: </strong>A qualitative scientific approach was used. Eight autobiographies were selected as data for this study. Both English and Swedish books were used. The data was analyzed using a qualitative method of data analysis.</p><p><strong>Results:</strong> The ways patients with AN could feel better are presented in seven themes: being seen as a whole individual behind the illness, being able to trust and find security, taking responsibility for recovery, finding motivation to keep fighting towards recovery, when one's suffering is noticed, filling a void, and the strengthening of the relationship between care giver and patient. This study may help registered nurses understand the needs of the patient recovering from AN and help them meet these needs in a better way.</p> / <p><strong>Avsikt:</strong> För sjuksköterskor är det svårt att utveckla en bra sjuksköterske-patient relation när de vårdar patienter med anorexia nervosa (AN), eftersom det finns brister i deras förståelse för sjukdomen. För att kunna stärka relationen mellan sjuksköterskor och patienter är det viktigt för sjuksköterskan att förstå det lidandet som patienter med AN upplever och vad som kan lindra det.  Syftet med denna studie är att utforska vad som får patienter med AN att må bättre under sjukdomens lopp och tillfrisknandet.</p><p><strong>Metod: </strong>En kvalitativ metod valdes för att utföra studien. Sex självbiografier valdes som data till studien. Böcker skrivna på svenska och engelska användes. En kvalitativ dataanalys, enligt Dahlberg, användes för att tolka data.<strong></strong></p><p><strong>Resultat: </strong>Resultatet presenteras i sju teman: att bli sedd som en individ bakom sjukdomen, att kunna känna tillit och hitta trygghet, att ta eget ansvar för tillfrisknandet, att hitta motivation för att fortsätta kämpa mot tillfrisknandet, att ens lidande uppmärksammas, att fylla ett tomrum efter sjukdomen och att stärka relationen mellan vårdare och patient. Denna studie kan hjälpa allmänna sjuksköterskor att förstå de behov patienter med AN har och hjälpa dem att bemöta deras behov på ett bra sätt.</p>

<p>Anorexia Nervosa är en komplex sjukdom som kräver en individualiserad vård. Då patienter med anorexi ofta kännetecknas av att vara ambivalenta angående att tillfriskna, behövs ett gott samarbete och en god relation med sjuksköterskorna. Syftet med studien är att undersöka vad god omvårdnad innebär för patienten och sjuksköterskan vid vård och behandling av Anorexia Nervosa. Arbetet är utformat till en litteraturstudie grundad på tio vetenskapliga artiklar. I resultatet, som är tvådelat, framkommer sju teman vilka är <em>självständighet</em>, <em>socialt stöd</em>, <em>isolering</em>, <em>en utmaning</em>, <em>relationen, omtanke och respekt </em>samt<em> tillit</em>. I resultatet framkom det att patienter prioriterade ett gott stöd från sjuksköterskorna genom att finnas tillhands, visa omtänksamhet samt vara icke-dömande. Sjuksköterskorna ansåg att vägen till god omvårdnad var; empati, tillit, acceptans samt ömsesidig respekt. Slutsatsen blev att en god relation mellan patienten och sjuksköterskan var av stor betydelse för att nå framgång i behandlingen av Anorexia Nervosa. Förhoppningen med denna studie är att sjuksköterskor ska kunna få en inblick och ta lärdom av det presenterade materialet, för att på så sätt förbättra omvårdnaden av flickor med diagnosen Anorexia Nervosa.</p> / <p>Anorexia Nervosa is a complex disease that requires an individual treatment. Patients with Anorexia are known to be ambivalent when it comes to making a recovery and therefore need strong teamwork and a good relationship with the nurse. The aim of this study is to examine what good care means for the patient and the nurse when it comes to treating Anorexia Nervosa. The essay is a literature review based on ten scientific articles. In the result, which is divided in two parts, seven themes arise and these are: <em>independence, social support,</em> <em>isolation</em>, <em>a challenge</em>, <em>the relationship, caring and respect </em>and<em> trust</em>. In the result it was revealed that the patients prioritize support from the nurses, showing that they care and don’t judge the patients. The nurses describe compassion, trust, acceptance and mutual respect as important parts in the given care. The conclusion is that a good relationship between the nurse and patient means a great deal to achieve success when treating Anorexia Nervosa. Hopefully this study gives nurses an ability to learn from the presented material, and be able to improve the care of girls suffering from Anorexia Nervosa.</p>

<p>Forskning visar att personer med samtidig missbruks- och psykisk problematik är hårt utsatta, eftersom det finns stora svårigheter med att upptäcka, behandla och samverka kring problematiken. Arbetet är i Sverige idag generellt uppdelat mellan organisationerna kommun och landsting. De två organisationerna delar ansvaret och uppmanas därför att samverka. Syftet med examensarbetet är att förstå socialtjänstens och psykiatrins arbete med och samverkan kring personer med samtidig missbruks- och psykisk problematik. För att nå syftet har en kvalitativ metod använts i form av intervjuer med yrkesverksamma. Vår studie visar att den samtidiga problematiken uppfattas som vanlig. Studien visar även, i likhet med tidigare forskning, att det finns stora svårigheter i verksamheterna framför allt när det gäller upptäckt, utformning av behandling och ansvarsfördelning. Många gånger sker en överlämpning av klienter/patienter mellan de olika verksamheterna. För att arbetet och samverkan ska fungera bättre menar respondenterna att det är viktigt med geografisk närhet, etablerade kontakter samt gemensam ledning och ekonomi. Resultatet har analyserats med hjälp av kategorisering och nyinstitutionell organisationsteori. Med kategorisering har verksamheternas inkludering och exkludering av klienter/patienter analyserats. Den nyinstitutionella organisationsteorin har använts för att analysera och förstå samverkan mellan verksamheterna.</p>

Denna uppsats undersöker hur uppfattningar om pedofili artikuleras och omformas under perioden 1950—1980. Två delundersökningar genomförs. Den ena studerar uppfattningar och förhållningssätt kring barns sexualitet, sexuella avvikelser och sexualupplysning bland några av de professioner som verkade inom områdena, som exempelvis psykiatriker, pedagoger och läkare. Den andra delundersökningen fokuserar på några av de radikala idéströmningar som artikuleras inom den sexuella frigörelserörelse som växer fram under 1960- och 1970- talen. En grundpelare inom de sexliberala idéströmningar som nu formas är idén om allas rätt till sexuell tillfredsställese där en frigörelse från vad som uppfattades som gammal förlegad moralism och där en mer tillåtande inställning till sexualiteten eftersträvades. Även pedofilen som kategori undersöks i denna uppsats närmare, hur det talas om denne och hur diskursen förändrats över tid. Under den undersökta perioden råder det delade meningar om huruvida sexuella avvikelser ska betraktas som psykopatologiska störningar eller bara ett mindre vanligt beteende som tabubelagts. I uppsatsen drivs tesen att att den vetenskapliga diskursen  gav viss legitimitet åt och möjliggjorde den mer radikala argumentationen under 1960- och 1970-talen.

Syftet med denna studie var att undersöka grundutbildade sjuksköterskors upplevelser av sin kunskap för att bemöta och vårda patienter med borderline personlighetsstörning samt undersöka vilka kunskaper de önskade att grundutbildningen skulle ge. Sju legitimerade sjuksköterskor utan specialisering inom psykiatri som arbetar i Mellansverige deltog i studien. Studien hade en deskriptiv design med kvalitativ ansats. Det insamlade materialet analyserades med kvalitativ innehållsanalys. Studiens huvudresultat visade att sjuksköterskorna tyckte att psykiatriutbildningen gav en bra teoretisk grund men att den inte alltid överensstämmer med praktiken. De saknade fördjupning och några av dem uttryckte att kursen kändes föråldrad. Det fanns en önskan från sjuksköterskorna att förlänga psykiatrikursen samt möjlighet att fördjupa sig inom vissa områden. De upplevde att psykiatrikursen inte förberett dem tillräckligt för att bemöta och vårda patienter med borderline personlighetsstörning och då patienter med personlighetsstörning utgör en stor patientgrupp är det viktigt att de finns med i utbildningen. Sjuksköterskorna tyckte att det borde vara obligatoriskt att ha verksamhetsförlagd utbildning i sjuksköterskeutbildningen då det var den som förberett dem bäst inför att arbeta med psykiskt sjuka. Slutsatsen av denna studie var att den nuvarande psykiatrikursen inte är tillräcklig vid bemötandet av patienter med borderline personlighetsstörning. / The aim of this study was to investigate the basic trained nurses’ perceptions of their knowledge to respond to and care for patients with borderline personality disorder and explore what skills they wanted the undergraduate education to provide. Seven registered nurses without specialization in psychiatry and working in central Sweden participated in the study. The study had a descriptive design with qualitative approach. The collected material was analyzed by qualitative content analysis. The main result of the study revealed that the nurses felt that psychiatric training provided a good theoretical basis but that it does not always match reality. It lacked depth and some of them expressed that the course was outdated. There was a desire from the nurses to extend the psychiatry course and the opportunity to immerse themselves in certain areas. They felt that the psychiatry course did not prepare them adequately to face and care for patients with borderline personality disorder and because patients with personality disorders are a large patient population, it is important that they are represented in the education. The nurses thought there should be mandatory to have clinical training in nursing as it was the one who prepared them better for working with the mentally ill. The conclusion of this study was that the psychiatry course is not sufficient for treatment of patients with borderline personality disorder.

A severe burn is one of the most traumatic injuries a person can experience. Posttraumatic stress disorder (PTSD) is relatively common after burns, and can be devastating for the individual’s possibilities for recovery. The principal aims were to gain knowledge regarding posttraumatic stress symptoms and cognitive processes after burn and to evaluate methods for assessing symptoms of PTSD up to one year after burn. The psychometric properties of a Swedish version of the Impact of Event Scale-Revised (IES-R) were examined. The results indicate that the IES-R is a valid screening instrument for measuring PTSD symptoms in patients with burns and it can be used during hospitalisation to identify resilient individuals. The pattern of PTSD symptoms over time was also investigated. Four distinct trajectories of PTSD symptoms were identified, i.e. four groups of patients with significantly different onsets and courses. The trajectories differed in the expected direction regarding several risk factors associated with PTSD symptoms. Several previously known risk factors for PTSD symptoms were also identified including burn severity, psychiatric history, previous life events, early psychological symptoms, neuroticism-related personality traits, avoidant coping and low social support. The risk factors correspond well with those reported in the international trauma literature, which strengthens the findings in this thesis. Finally, using the emotional Stroop task at one year post burn it was found that burn-specific attentional bias was common and associated with more previous life events, more perceived life threat, larger burns and higher levels of PTSD symptoms. In summary, there are individual differences in the development and course of PTSD symptoms after burn and attentional bias is a common cognitive phenomenon related to these symptoms. The findings also support the use of the IES-R as a screening instrument for PTSD symptoms in patients with burns.

It has been known for many years that the children of parents with mental illness run a high risk of developing psychiatric and other problems both during their childhood and later in adulthood. Meeting and providing support for the patients’ children has, however, been a neglected area in adult psychiatry until today. Recent supplementary legislation in the Nordic countries obligates the professionals in health services to take account of the needs for information and support of the children and their families when a parent suffers from a serious illness. Beardslee’s preventive family intervention (FI) is the first family-based and structured method used in psychiatric services in Sweden. The method has some evidence of positive long-term effects for the children and families with parental depression. The purpose of this thesis was to investigate the FIs safety and feasibility in Sweden (paper I), its’ perceived impact for the families (papers I, III and IV) and also to examine the process of the FI from the perspective of the ill parent, the other parent and the children (papers II, III and IV). The studies were conducted in naturalistic settings. The data in paper I was collected by using a questionnaire to parents and children (117 parents and 89 children responded) one month after an FI. Paper II comprises interviews with ten parents, suffering from depression, about their decision process for participation in an FI. In papers III and IV the data from 25 interviews with parents and 14 interviews with children about the experiences of the FI is presented. Seventy five professionals from 29 psychiatric units had conducted the FIs for the families that participated in the studies. The data was analyzed by descriptive statistics and chi2 (I), Grounded theory (II and III) and Qualitative content analysis (IV). The results in paper I showed that the overall satisfaction with the FI was high for both parents and children. Ninety three percent of the answers from parents to questions concerning the satisfaction with the FI were positive, and 71 % of the answers from the children. The reported perceived impact of the FI was also predominantly positive. Feelings of guilt decreased for 89 % of the children who had had feelings of guilt towards the parent prior to the FI. Knowledge about the parent’s illness was perceived to increase for 74 % of the children. There were a few negative answers about the impact of FI from the children; five children experienced increased concerns about the parent and three children reported a lower level of well-being after the FI. In paper II the interviews with the depressed parents revealed ambivalence in the decision to participate in an FI. The parents longed for knowing how their children were feeling, how they thought about the illness and if it had harmed them. On the other hand, the parents were anxious about hearing the answers to their questions, as feelings of shame and guilt were associated with these. Exposure to outside opinion was also both relieving and scaring. The examination of the parents’ experiences continued in paper III. The process of opening up the dialogue about the illness with the children was demanding. To listen to the children’s experiences, to find the words to speak about the illness to the children and finally to be able to start to talk about it in the family session required a solid base of confidence and security in the professionals and in the method. The FI as a method seemed to provide favorable conditions for an establishment of an alliance with the parents. The children’s experiences of the FI are presented in paper IV. Most of the children described a sense of relief because of better knowledge about the parent’s illness and increased communication in the family and thus they also felt released from some worry for the parent. They could spend more time with their friends and did not need to take so much responsibility at home. Parents and children in the same families described the changes in similar ways, indicating mutual understanding in the families. The parents experienced themselves as stronger in their roles as parents and less ashamed. In summary, the families are satisfied with their participation in FI, they report a positive impact and the number of perceived negative effects is low. The children describe a sense of relief from concerns about the parent’s illness.

Background: Several studies have reported socioeconomic, socio-demographic factors, including violence against women to be associated with depression among women, but knowledge in the area among women living under extreme poverty in developing countries remains scarce. Relationship between intimate partner violence and women’s literacy in societies where violence is normative is complex, there are only limited data describing this difference in the distribution of violence exposure by residency and literacy. Few studies have addressed consequences of maternal depression and experiencing violence among women on children’s survival. Objective: The aim of this thesis is to determine prevalence of depressive episode and examine its association with violence by intimate partner and socioeconomic status It also assesses contribution of residency and literacy of women on vulnerability to physical violence by intimate partner, and independent effect of intimate partner violence and maternal depression on the risk of child death in rural Ethiopia. Methods: A community-based cross-sectional study was undertaken among 3016 randomly selected women in the age group between 15-49 years conducted from January to December 2002. A cohort study was done through following up women who gave birth to a live child within a year of the survey, in rural Ethiopia. Analysis was made using all the 3016 women, 1994 of the married women and 561 of women who gave birth within a year of the data collection time. Cases of depression were identified using the Amharic version of the Composite International Diagnostic Interview, experience of physical, sexual and emotional violence by intimate partner was made using the WHO multi-country study on women’s life events, and child death was measured by continuous demographic surveillance data from the Butajira Rural Health Program. Result: The twelve-month prevalence of depression was estimated to be 4.4%. In the analyses being currently married, divorced and widowed women, living in rural villages, having frequent khat chewing habit, having seasonal job and living in extreme poverty were factors independently associated with depression. Similarly, among the married women, experiencing physical violence, childhood sexual abuse, emotional violence and spousal control were factors independently associated with depressive episode. Women in the overall study area had beliefs and norms permissive towards violence against women. Violence against women was more prevalent in rural communities, in particular, among rural literate women and rural women who married a literate spouse. In this study, maternal depression was associated with under five child death. Although no association was seen between experiencing violence and child death, the risk of child death increases when maternal depression is combined with physical and emotional violence. Conclusion: Prevalence of depression among women was still in the lower range as compared to studies from high-income countries. Though depression is associated with socio-demographic factors and extreme poverty, the association is complex. The high prevalence of violence against women could be a contributing factor for preponderance of depression among women than in men. Urbanization and literacy are thought to promote changes in attitudes and norms against intimate partner violence. However, literacy within rural community might expose women to the higher risk of violence. Improving awareness of clinicians and public health workers on the devastating consequences of violence against women and depression is essential in order to identify and take measure when violence and maternal depression co-occurred.