Bakgrund: Asylsökande patienter drabbas ofta av psykisk ohälsa relaterat till stress i samband med flykt och svåra levnadsförhållanden. Som omvårdnadsansvarig ansvarar sjuksköterskan bland annat för att hjälpa människor med det som de själva hade utfört om de hade kraften. På grund av språkförbistringar och kulturbetingade förväntningar kan ibland vårdandet försvåras. För att kunna arbeta effektivt med asylsökande patienter behövs fördjupade kunskaper i hur sjuksköterskor beskriver sitt arbete med asylsökande patienter. Syfte: Syftet med uppsatsen är att beskriva sjuksköterskors erfarenheter av att vårda asylsökande patienter i psykiatrisk vård. Metod: Studien är en kvalitativ studie med induktiv ansats där semistrukturerade intervjuer genomfördes med fem sjuksköterskor verksamma inom psykiatrisk vård. Det insamlade datamaterialet analyserades enligt kvalitativ innehållsanalys. Resultat: Dataanalysen resulterade i två kategorier med fem respektive två subkategorier vardera. Den första kategorin beskriver sjuksköterskors erfarenheter av hinder och möjligheter i relation till vårdandet av asylsökande patienter med underkategorier: kulturella skillnader, egenpåverkan och behovet av handledning, behov av information, förhållningssätt samt patientens nätverk. Den andra kategorin beskriver sjuksköterskors erfarenheter av hinder och möjligheter i relation till externa instanser, med underkategorier; tolk och asylsökningsprocessen. Diskussion: Resultatet diskuteras utifrån Leiningers Soluppgångsmodell samt annan relevant forskning. Soluppgångsmodellen ger stöd för sjuksköterskor i mötet med patienter med en annan kulturell bakgrund, vilket kan vara viktigt för att arbeta holistiskt. / Background: Asylum seeking patients often suffer from mental health problems related to stress during flight and harsh living conditions. Being responsible for the care, nurses are responsible to help people with what they themselves have difficulties performing or are unable to do themselves. Due to language difficulties and cultural conditional expectations the caring of patients within this group can sometimes be suffering. In order to work effectively with asylum seeking patients in psychiatric care, it is required to possess a thorough knowledge of how nurses describe their work with asylum seeking patients. Aim: The purpose of this paper is to describe nurses' experiences of caring for asylum seeking patients in psychiatric care. Method: The study is a qualitative study with the inductive approach in which semi-structured interviews were conducted with five nurses working in psychiatric care. The collected data were analyzed according to qualitative content analysis. Results: Data analysis resulted in two categories with five and two subcategories each. The first category describes the nurses' descriptions of the obstacles and opportunities in relation to asylum seekers patients with subcategories: cultural differences, personal impact and the need for guidance, the need of information, approaches, and patient social networks. The second category describes nurses' descriptions of the obstacles and opportunities in relation to external instances, with subcategories; interpreter and asylum process. Discussions: The results are discussed from Leininger’s Sunrise Model and other relevant research. Sunrise model provides support for nurses in the meeting with patients with a different cultural background, which can be important to work holistically.

The aim of this study was to reach an understanding of how young adults with permanent residence permit, who came to Sweden as unaccompanied asylum seeking minors, experience their confrontation with the Swedish society. Another purpose was to understand how these young adults view Sweden and its inhabitants, as well as the experience of starting a new life in Sweden. In order to investigate these questions, a qualitative method consisting of five interviews with five young men was conducted. The results showed that the respondents feared the meeting with the immigration board and that they feel that school is divided in two groups, Swedes and immigrants. People with nonethnic Swedish background who have lived in Sweden for a long time are seen as Swedes, and in that meaning assimilated. One important conclusion we made was that the division between Swedes and immigrants have a negative influence on the immigrants´ integration in the society. Another conclusion is that school has to take more responsibility to give the children a more meaningful life.

No description available.

The aim of this study was to examine how social workers relate to unaccompanied asylum-seeking children, regarding their cultural background and potential social issues. In order to achieve a more profound and comprehensive view of the social workers views regarding the separated children, we selected to execute semi structured interviews with social workers. These interviews were aimed at those social workers who performed assessments and investigations concerning unaccompanied children. We completed nine interviews which we recorded and transcribed in a strict manor. When we analyzed the empirical material, certain themes where identified as more protuberant and thus we our selection was based on what we regarded as the most relevant topics, in accordance to the aim of the study. Furthermore, our focus was set upon the social workers views regarding cultural differences between unaccompanied asylum-seeking children and Swedish children. We also decided to focus on which views these social workers portrayed, regarding the unaccompanied asylum-seeking child’s cultural background and how social issues could affect the social workers frame, their assets and formulation of their interventions, concerning separated children. We learned during our study that the social workers are enduring a heavy workload, especially since the numbers of arriving separated children are rapidly increasing. Furthermore, the economical recourses, in forms of personnel, are not increasing the same pace. In recent years, societal attitudes have altered and more negative and separative views regarding separated children are apparent. However, the social workers have applied a more universalistic approach towards the children to show the resemblances rather than differences between unaccompanied asylum-seeking children and Swedish children. Our study makes evident, that underneath this universalistic policy, culturalization of the children took form and this development also affected how the interventions were framed. Conclusively, this study displays how culturalization of the interventions affected the care of the children negatively and resulted in a declining standard of care, as well as differentiation of care.

Ensamkommande är en utsatt grupp där posttraumatiskt stressyndrom (PTSD) är vanligt förekommande. Den hälso- och sjukvård som ges är bristfällig och evidensbaserade interventioner för målgruppen på första linjen saknas. Studiens syfte var att belysa hur ensamkommande flyktingbarn i åldern 13-18 år, som screenat positivt för PTSD, upplever sitt deltagande i Teaching recovery techniques (TrT) grupperna. Material har inhämtats genom kvalitativa intervjuer, från sju grupper, totalt 22 ungdomar cirka tre månader efter avslutad intervention. Resultatet visar hur känslor, tankar och reaktioner normaliserades i gruppen. Den sociala gemenskapen och stödet från jämnåriga har framstått som en viktig komponent i ungdomarnas livssituation. Deltagarna har återfått kontrollen för att kunna strukturera upp sina känslor och reaktioner. Slutligen kände deltagarna att de med hjälp av de tekniker och verktyg som de lärt sig kunde klara av aktuella utmaningar och framtida kriser. Behovet av en traumafokuserad intervention som denna verkar finnas hos målgruppen. / Unaccompanied refugee minors (URM) is an exposed group in which post-traumatic stress disorder (PTSD) is common. The care provided is inadequate and there are few evidence-based interventions on the target group of URMs. The aim of this study was to examine URMs, aged 13-18, who screened positive for PTSD and their experiences of the Teaching Recovery Techniques-program. Qualitative interviews were conducted with 22 youth from seven groups, three months after the completion of the intervention’s final session. The results show that participants felt that sharing their stories helped them normalize their experiences. Feelings of fellowship and support have seemed as an important component of the youth's life. The program helped them feel more in control of their own body and reactions. Finally, the participants felt that, with the help of the techniques and tools they learned, they could cope with current challenges and future crises. Trauma-focused interventions like this appears be needed in this target group.

Denna studie syftar till att undersöka hur personer som sökt asyl tillsammans med sina familjer har upplevt sin livssituation i väntan på uppehållstillstånd, där fokuset läggs på barnfamiljer. Studien bygger på en kvalitativ forskningsmetod och resultatet analyseras med hjälp av en innehållsanalys. Empirin är framtagen genom semistrukturerade intervjuer med män och kvinnor som sökte asyl i Sverige under den så kallade flyktingkrisen. Studiens teoretiska ramverk utgörs av teorin om känsla av sammanhang samt utgår från teoretiska begreppen liminalitet och resiliens. Resultatet visar att personer som söker asyl tillsammans med barn i familjen kan stå inför en rad olika påfrestningar under vänteperioden; nämligen ekonomiska svårigheter, otrygga boendeförhållanden, ovisshet inför framtiden och en dubbel orosbörda. Den ovissa framtiden gör det svårare att uppleva nuet som begripligt och hanterbart när man inte vet om man kommer få stanna i landet eller inte. Oron om barnets framtid och tankar om hur ett avslag kan påverka barnets liv präglar tillvaron i väntan. Men samtidigt är det barnen och familjen som ökar motivationen att fortsätta hålla ut. Studien lyfter också på vilket sätt det var möjligt för asylsökande att hantera sin situation. Resultatet visar att intervjupersoner har använt sig av olika resiliensstrategier och resurser för att känna sammanhang i sin tillvaro. Studien kommer slutligen fram till att en lång asylprocess påverkar asylsökande barnfamiljer på flera olika plan och för att individer i dessa familjer ska känna sig kunna hantera sin situation bör man satsa på att förstärka deras känsla av sammanhang.

The thesis examines accompanied asylum-seeking children’s position in Swedish asylum reception management and in the determination of their claims. The three articles of the thesis focus on children’s own experiences of seeking asylum, on the experiences and practices of the civil servants at the Migration Board, as well as those of the legal representatives that assist asylum-seekers in the application process. The thesis builds on ethnographic fieldwork carried out between 2008 and 2010 in southwest Sweden. Theoretical inspiration has been sought in the new sociology of childhood as well as in practice theory. The first article in the thesis concerns children’s caseworkers who are responsible for safeguarding children’s interests in the Migration Board’s daily work with reception. The study highlights a range of dilemmas caseworkers have to deal with in their role as frontline bureaucrats. The study shows that the children’s caseworkers often perceive their discretion as limited, but also that they themselves contribute to limiting it, for example due to their hesitation in challenging existing norms and collegiality.    The second article examines the ways in which legal representatives, who act on behalf of families in asylum determinations, in their practice perceive and relate to the concept of children’s best interests and children’s right to participate. The study shows that children in families can become invisible in the legal representatives’ daily rounds. This invisibility is due to practical limitations in the representatives’ work as well as a general view that children rarely have their own grounds for asylum, as separate claimants to their parents. The third paper of the thesis explores the ways in which children experience and seek to influence circumstances that signify their time spent as asylum-seekers. The study shows how the children developed a range of tactics to deal with their particular situations, which varied with their housing and schooling, and the family’s financial resources. The conclusion is that the children themselves are the primary representatives of the child perspective in the asylum-seeking process, not least through their struggle to belong and create a life like that of ’ordinary’ children.  In line with previous research in the field, the thesis points to the contradiction between the principle of regulated migration and the child perspective in the asylum-seeking process. Together with practical circumstances, such as lack of resources, this contradiction results in a more limited implementation of the child perspective than rules and regulations actually stipulate. Finally, the thesis points to the active role asylum-seeking children take in their efforts to create an everyday life that is as similar as possible to that of  the ’ordinary’ children (e.g. non asylum-seeker and permanently settled children) around them. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Submitted.</p>

Introduction Not all children seeking asylum without parents or other relatives are entitled to residence permits. In the last few years, more than one in four unaccompanied asylum-seeking refugee children have been forced to repatriate, either to their home country or to a transit country. Mostly the children refuse to leave the country voluntarily, and it becomes a forced repatriation. Five actors collaborate in the Swedish child forced repatriation process: social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. When a child is forced to repatriate, the Swedish workers involved must consider two different demands. The first demand requires dignified repatriation, which is incorporated from the European Union’s (EU’s) Return Directive into Swedish Aliens Act. The second demand requires that the repatriation process be conducted efficiently, which means that a higher number of repatriation cases must be processed. The fact that the same professionals have different and seemingly contradictory requirements places high demands on the involved collaborators. Two professionals have a legal responsibility for the children until the last minute before they leave Sweden: social workers and police officers. That makes them key actors in forced repatriation, as they carry most of the responsibility in the process. Further, they often work with children who are afraid what will happen when they return to their home country and often express their fear through powerful emotions. Being responsible and obliged to carry out the government’s decision, despite forcing children to leave a safe country, may evoke negative emotional and mental stress for the professionals involved in forced repatriation. Aim The overall aim of this study is to explore and analyse forced repatriation workers’ collaboration and perceived mental health, with special focus on social workers and police officers in the Swedish context. Materials and methods The study combines a qualitative and quantitative research design in order to shed light at both a deep and general level on forced repatriation. In qualitative substudy I, a qualitative case study methodology was used in one municipality in a middle-sized city in Sweden. The municipality had a contract regarding the reception of unaccompanied asylum-seeking refugee children iv with the Swedish Migration Board. The municipality in focus has a population of more than 100,000 inhabitants. The city in which the data were collected has developed a refugee reception system where unaccompanied asylumseeking refugee children are resettled and await a final decision regarding their permit applications. This situation made it possible to recruit participants who had worked with unaccompanied refugee children without a permit. Semi-structured interviews were conducted with a total of 20 social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. A thematic approach was used to analyse the data. In quantitative substudies II, III and IV, a national survey of social workers (n = 380) and police officers (n = 714), with and without experience of forced repatriation, was conducted. The questionnaires included sociodemographic characteristics, the Swedish Demand-Control Questionnaire, Interview Schedule for Social Interaction, Ways of Coping Questionnaire and the 12- item General Mental Health Questionnaire. Factor analysis, correlational analysis, and univariate and multivariable regression models were used to analyse the data. Results The qualitative results in substudy I showed low levels of collaboration among the actors (social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians) and the use of different strategies to manage their work tasks. Some of them used a teamwork pattern, showing an understanding of the different roles in forced repatriation, and were willing to compromise for the sake of collaboration. Others tended to isolate themselves from interaction and acted on the basis of personal preference, and some tended to behave sensitively, withdraw and become passive observers rather than active partners in the forced repatriation. The quantitative results in substudy II showed that poorer mental health was associated with working with unaccompanied asylum-seeking refugee children among social workers but not among police officers. Psychological job demand was a significant predictor for mental health among social workers, while psychological job demand, decision latitude and marital status were predictors among police officers. Substudy III showed that both social workers and police officers reported relatively high access to social support. Furthermore, police officers working in forced repatriation with low levels of satisfaction with social interaction and close emotional support increased the odds of psychological disturbances. In substudy IV, social workers used more escape avoidance, distancing and positive-reappraisal coping, whereas police officers used more planful problem solving and self-controlling coping. Additionally, social workers with experience in forced repatriation used more planful problem solving than those without experience. Conclusions In order to create the most dignified forced repatriation, based on human dignity, for unaccompanied asylum-seeking refugee children and with healthy actors, a forced repatriation system needs: overall statutory national guidance, interagency collaboration, actors working within a teamworking pattern, forced repatriation workers with reasonable job demands and decision latitude, with a high level of social support and adaptive coping strategies. The point of departure for an interagency model is that it is impossible to change the circumstances of the asylum process, but it is possible to make the system more functional and better adapted to both the children’s needs and those of the professionals who are set to handle the children. A centre for unaccompanied asylum-seeking refugee children, consisting of all actors involved in the children’s asylum process sitting under the same roof, at the governmental level (Swedish Migration Board, the police authority) and municipality level (social services, board of legal guardians), can meet all requirements.

Introduction: Policing is a public health issue. The police often encounter vulnerable populations. Police officers have wide discretionary powers, which could impact on how they support vulnerable populations. In encountering vulnerable populations the police officers are required to be professional; maintaining mental health in the face of challenges is part of professionalism. Their encounters with vulnerable populations might influence their mental health which in turn might influence the way they use their discretion when making decisions. Background/context: Sweden receives more unaccompanied, asylum-seeking refugee children than any other country in Europe. The number of asylum applications for such children increased from 400 in 2004 to 7000 in 2014 to over 35,000 in 2015. These children come to Sweden and apply for asylum without being under the care of their parents or other legal guardian. Some are denied asylum. If they do not return to their country of origin voluntarily the police are responsible for their deportation. The Swedish government wants an increasing number of deportations and wants them carried out with dignity. This thesis is about the police officers’ perceptions of how to interpret the seemingly contradictory demands for more deportations, that is, efficiency; and concerns for human rights during the deportation process, that is, dignity. This is conceptualized using three theoretical frameworks: a) street-level bureaucracy, b) job demand-control-social support model and c) coping. These theoretical frameworks indicate the complexity of the issue and function as constructions by means of which understanding can be brought to the police officers’ perceptions of deportation work involving unaccompanied, asylum-seeking refugee children and how such work is associated to their mental health. Aim: The current research aims to investigate and analyse Swedish police officers’ mental health in the context of deportations of unaccompanied, asylum-seeking refugee children. Methods: This thesis uses both qualitative and quantitative methodology. The qualitative approach comprised interviews conducted to achieve a deeper understanding of the phenomenon of police officers’ perceptions of deportations of unaccompanied, asylum-seeking refugee children. The quantitative method involved the use of validated questionnaires to investigate the association between police officers’ mental health and psychosocial job characteristics and coping. This approach made it possible to study a complex issue in a complex environment and to present relevant recommendations. A total of 14 border police officers were interviewed and 714 police officers responded to a survey. Results: The police officers utilize their wide discretionary powers and perceive that they are doing what is best in the situation, trying to listen to the child and to be aware of the child’s needs. Police officers with experience of deportations of unaccompanied, asylum-seeking refugee children were not found to have poorer mental health than police officers with no such experience. Furthermore, high job demand, low decision latitude, low levels of work-related social support, shift work and being single are associated with poor mental health. Coping moderates the association between mental health and the experience of carrying out deportations of unaccompanied, asylum-seeking, refugee children, and the police officers seem to utilize both emotional and problem-solving coping during the same complex deportation process. Implications / conclusions: The general conclusion reached in this thesis is that if police officers are subject to reasonable demands, have high decision latitude, access to work-related social support, and utilize adaptable coping, the deportation work does not seem to affect their mental health. When police officers meet vulnerable people, they utilize their discretionary powers to deal with seemingly contradictory demands, that is, efficiency and dignity. The executive role in the deportations of unaccompanied, asylum-seeking refugee children and the awareness of dealing with a child threatened with deportation might give rise to activation of a sense of protection, safety and security. Discretion might make it possible to act on this sense of protection, safety and security and to combine efficiency and dignity. Further studies, which integrate cognitive and emotional discretion with coping, need to be undertaken. / Introduktion: Polisarbete är i mångt och mycket en folkhälsofråga, något som inte minst blir tydligt i polisers möte med utsatta människor. Poliser har ett stort handlingsutrymme, vilket kan påverka hur de bemöter utsatta människor. I mötet med dessa människor behöver poliserna vara professionella; att ta hand om sin psykiska hälsa när man möts av utmaningar är en del av professionalismen. Att möta utsatta människor kan påverka polisernas psykiska hälsa, som i sin tur kan påverka hur de använder sitt handlingsutrymme när de fattar beslut. Bakgrund: Sverige tar emot fler ensamkommande asylsökande flyktingbarn än något annat land i Europa. Antalet asylansökningar för sådana barn ökade från 400 år 2004 till 7000 år 2014 till över 35 000 år 2015. Dessa barn kommer till Sverige och ansöker om asyl utan sina föräldrar eller annan vårdnadshavare. Somliga av dem nekas asyl. Om de inte återvänder till sitt ursprungsland frivilligt är polisen ansvariga för utvisningen. Den svenska regeringen kräver ett ökande antal verkställigheter av av- och utvisningar samt fastlår att verkställigheterna ska genomföras med respekt för människors värdighet. Denna avhandling handlar om polisers uppfattningar och tolkningar av de till synes motsägelsefulla kraven på att verkställa fler av- och utvisningar, det vill säga effektivitet; och hur man hanterar de mänskliga rättigheterna under utvisningsprocessen, det vill säga värdighet. Detta beskrivs och analyseras med hjälp av tre teoretiska ramverk: a) gräsrotsbyråkrati, b) jobb-krav-kontroll-socialt stödmodellen och c) coping. Dessa teoretiska ramverk visar på arbetsuppgiftens komplexitet och fungerar som utgångspunkt för att skapa förståelse för polisernas uppfattningar av arbetet med att verkställa av- och utvisningar av ensamkommande asylsökande flyktingbarn och hur sådant arbete är associerat med polisernas psykiska hälsa. Syfte: Denna avhandling syftar till att undersöka och analysera svenska polisers psykiska hälsa i relation till av- och utvisningar av ensamkommande asylsökande flyktingbarn. Metod: Både kvalitativ och kvantitativ metod användes i denna avhandling. Det kvalitativa tillvägagångssättet innefattade intervjuer för att uppnå en djupare förståelse för hur poliser uppfattar av- och utvisningar av ensamkommande asylsökande flyktingbarn. Den kvantitativa metoden innebar tillämpning av validerade frågeformulär för att undersöka sambandet mellan polisernas psykiska hälsa och psykosociala jobbkarakteristika samt coping. Detta tillvägagångssätt gjorde det möjligt att studera en komplex fråga i en komplex miljö och att presentera relevanta rekommendationer. Totalt intervjuades 14 gränspoliser och 714 poliser svarade på en enkätundersökning. Resultat: Resultatet visar att poliserna utnyttjar sitt stora handlingsutrymme och uppfattar att de gör det som är bäst i situationen, att de försöker lyssna på barnet och vara medvetna om barnets behov. Poliser med erfarenhet av av- och utvisningar av ensamkommande asylsökande flyktingbarn har inte visat sig ha en sämre psykisk hälsa än poliser utan sådan erfarenhet. Vidare är höga krav och lågt beslutsutrymme på arbetet, låga nivåer av arbetsrelaterat socialt stöd, skiftarbete och singelliv associerat med dålig psykisk hälsa. Coping mildrar effekten på den psykiska hälsan hos de som har erfarenhet av att utföra av- och utvisningar av ensamkommande asylsökande flyktingbarn. Poliserna verkar utnyttja både emotionell och problemlösande coping under en och samma komplexa utvisningsprocess. Slutsats: Den viktigaste slutsatsen i denna avhandling är att om poliser utsätts för rimliga krav, har stort beslutsutrymme, tillgång till arbetsrelaterat socialt stöd och använder sig av anpassningsbar coping, verkar det som att arbetet med av- och utvisningar inte påverkar deras psykiska hälsa. När poliser möter utsatta människor utnyttjar de sitt handlingsutrymme för att hantera de till synes motsägelsefulla kraven, det vill säga effektivitet och värdighet. Den verkställande rollen i av- och utvisningar av ensamkommande asylsökande flyktingbarn och medvetenheten om att hantera ett barn som hotas av utvisning kan ge upphov till en aktivering av känslan att ge skydd, trygghet och säkerhet. Handlingsutrymmet kan göra det möjligt att agera på denna känsla av skydd, trygghet och säkerhet samt att kunna kombinera effektivitet och värdighet. Ytterligare studier, som integrerar kognitivt och känslomässigt handlingsutrymme med coping, behöver emellertid genomföras.

This study explores the challenges that unaccompanied minors face in accessing healthcare, especially mental health services, in Sweden. It uses a qualitative approach with five partici-pants aged 18–25, who were previously unaccompanied minors. Through interviews, the study identifies themes and patterns related to the theoretical framework, incorporating the KASAM theory and transcultural psychiatry, which emphasize self-reflection and cultural factors. The results reveal difficulties such as fear of impacting the asylum process, language barriers, anda lack of knowledge within the healthcare system. The study aims to contribute to understanding and improvements within the healthcare system. Limitations include a focus on Swedish conditions and the age group of 18–25. Suggestions for future research involve exploring wait times for psychiatric care and effectively communicating knowledge about mental health to these children to identify areas for improvement in healthcare. Overall, the study underscores the need to overcome barriers, customize healthcare to individual needs, and enhance understanding of this vulnerable group.