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Bakgrund: Tidigare forskning visar att patienter som kommer i kontakt med psykiatrin eftersuicidförsök ofta upplever känslor av skam och rädsla. Det första mötet med sjuksköterskan är ofta avgörande för hur vårdtiden av patienten utvecklas. Upplever patienten sig inte tagen på allvar, sedd eller hörd kan detta leda till flyktkänslor eller att man drar sig undan. Syfte: Syftet med studien är att utifrån vetenskaplig litteratur beskriva patienter och sjuksköterskors upplevelser av att få samt ge vård efter ett suicidförsök. Metod: Kvalitativ forskningsöversikt inkluderat åtta vetenskapliga studier från databaserna CINAHL och PsychINFO. Data har analyserats med stöd av Evans fyrstegsanalys. Resultat: Resultatet visar att patienter har ett behov att känna sig tagna på allvar för att lindra lidande. Resultatet visar även att sjuksköterskan upplever svårigheter i mötet med den suicidala patienten. Sjuksköterskans bemötande och engagemang i patienten har en central roll för patientens möte med psykiatrisk vård efter ett suicidförsök. Diskussion: Mötet mellan patienten och sjuksköterskan avspeglar sig i sjuksköterskans bemötande och engagemang i patienten, genom att ta patienten på allvar kan lidande lindras och patientens välbefinnande kan ökas. Genom engagemang stöttas patienten och genom eliminering av negativa upplevda känslor kan sjuksköterskan nå patienten på ett sätt som gör att patienten kan inspireras att förändra sin livssituation. / Background: Previous researches shows patients who come in contact with a psychiatric ward after suicide attempt often experience feelings of shame and fear. The first meeting is determined by how the time at the ward develops. If a patient experience not being taken seriously or heard it usually leads to feelings of escaping or withdrawing. Aim: The purpose of the study is based on scientific literature describing patients and nurses' experiences in receiving and providing care after a suicide attempt. Method: Qualitative research review included eight scientific studies from the databases CINAHL and PsychINFO. Data were analyzed with the aid of Evans four steps analysis. Results: The results show that patients have a need to feel that they are being taken seriously in order to alleviate suffering. The result also shows that nurses are experiencing difficulties in meeting with the suicidal patient. The nurse's attitude and commitment to the patient has a central role in the patient's encounter with psychiatric care after a suicide attempt. Discussion: The meeting between the patient and the nurse is reflected in the nurse's attitude and commitment to the patient, by taking the patient seriously suffering can be alleviated and the patient's well being can be increased. Through dedication supported the patient and by the elimination of negative emotions experienced nurse can reach the patient in a way that allows a patient to be inspired to change their lives.

Background Suicidal behavior is an important global health problem affecting also significant others. Both genetic and environmental influences play an important role in the development of suicidal behavior. There is a need of interventions for family and friends after a suicide attempt. The aim of this thesis was to assess the impact of family history of suicide (FHS) and early life adversity (ELA) on severity of suicidal behavior and on level of interpersonal problems in suicide attempters. Furthermore it aimed to evaluate a DBT-based skills training program, Family Connections (FC), for relatives and friends of suicide attempters. Methods Studies I and II included 181 suicide attempters. FHS was assessed with the Karolinska Self-Harm History Interview or in patient records. ELA was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to interpersonal violence in childhood. Suicide intent was measured with the Freeman scale. Interpersonal problems were assessed with the Inventory of Interpersonal Problems (IIP). Study III, a pilot study evaluating the effect of FC for family members of suicide attempters, included 13 participants who completed the program with pre- and post-questionnaires. The experience of burden was assessed with the Burden Assessment Scale (BAS), general wellbeing with Brief Symptom Inventory (BSI) and level of depression was assessed with Beck Depression Inventory (BDI). The Swedish scale Questions About Family Members (QAFM) was used to explore the quality of the participants’ relationship with the patient and the Quality of Life Inventory (QOLI) was used to measure satisfaction with life situation. Study IV included 132 family members, and investigated the feasibility and preliminary efficacy of FC in psychiatric care. Participants were assessed pre- and post-intervention with the following self-report questionnaires: BAS, QAFM and Five Facet Mindfulness Questionnaire. Results Male suicide attempters with FHS made more serious and well planned suicide attempts and had higher suicide risk. FHS and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters. Regarding interpersonal problems, suicide attempters with FHS had significantly more often an intrusive personal style, indicating that they might have an impaired ability to create stable, long-lasting relationships. In the pilot study the participants reported a significant reduction in burden, an improved psychic health and an improvement in the relationship with the patient after completing FC. In the fourth study, FC showed to be feasible and effectively implemented in a psychiatric outpatient services clinic. Regarding burden, results were in line with the pilot study, with a significant reduction in all subscales in BAS. Conclusions High-risk patients call for a consideration of both ELA and FHS in clinical suicide risk assessment. In suicide attempters at biological risk, suicide might be prevented with the early recognition of environmental risks. Further, the interpersonal problems associated with FHS may cause difficulties for suicide attempters to accept or benefit from treatment, and caregivers should take into account the characteristics of the suicide attempter´s interpersonal functioning. The results from the pilot study provide support for the need and importance of an educational program addressed specifically to family members of suicide attempters. Preliminary results support the feasibility and potential value of an implementation of FC in psychiatric open care clinics.

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maîtrise en droit des affaires" / Il nous appartiendra au fin de ce mémoire, d'observer comment les autorités de la concurrence communautaires, américaines et canadiennes assurent la régulation des pratiques anticoncurrentielles prenant leur source ou produisant leur effets au sein de leur marché. Il conviendra donc à cet égard de se pencher sur les spécificités de chacun de ces régimes juridiques, afin d'étudier les similitudes et différences existantes quant à la définition de la notion de marché du marché pertinent, la qualification juridique des différentes infractions (ententes ou cartels - abus de position dominantes ou monopolisation concentration d'entreprise ou fusionnement ou même mergers) ainsi que la procédure permettant à ces différentes autorités d'autoriser, d'amender ou d'interdire ces différentes pratiques. Il conviendra par la suite de démontrer comment et sur quel fondement chacun de ces systèmes peuvent avoir une interaction entre eux en élargissant notamment leur champ de compétence respectif par le recours à une application extraterritoriale de leurs lois antitrust. Ce mémoire aura également pour objectif de se pencher sur les tentatives des différents législations étudiées pour arriver à une harmonisation de leurs normes et pour favoriser une plus ample coopération internationale. Pour conclure il conviendra de faire le point sur les travaux visant à la mise en place d'un droit antitrust international qui pourrait selon les cas reposer soit sur un traité international, soit un code multilatérale ayant trait aux pratiques restrictives à la concurrence. / The purpose of this memoir is to observe how the antitrust authorities of the European Union, the United States of America and the Canada are controlling and enforcing cartels, monopolizations or attempts of monopolizations and mergers and acquisitions which have sometimes the effect of restricting the competition in a specifie market. In order to do so, the differences and similarities between this three different antitrust legislation will be highlight especially those concerning the definition of the relevant market, the qualification and the nature of aIl this practices and the process by which, each authority permit, amend or fordid the supposed infringement. In a second time this memoir will have to demonstrate the basis of the extraterritorial application of their nationallegislation by national antitrust authorities, on foreign market or foreign company. Finally the last goal of this memoir is to take stock on evolution of an international antitrust legislation inspired by a treaty or a multilateral guide, which be bounding for each actor of the economic process.

Abstrakt Bakgrund:Med termen suicidförsök avses ett beteende som är livshotande och där en individ med uppsåt skadat sig men inte avlidit. Antalet suicidförsök per år i Sverige är en uppskattning då mörkertalet anses vara stort. Registrerade fall 2008 var 9643 personer (över 15 år), minst det dubbla antalet förmodas om alla oregistrerade och oupptäckta fall skulle tillkomma. Det första mötet med patienten som gjort ett suicidförsök sker inom akut somatisk sjukvård innan patienten flyttas över till psykiatrisk vård eller skrivs ut. Syftet: Att belysa hur sjuksköterskor på akut- och intensivvårdsavdelningar upplever att möta och vårda patienter efter ett suicidförsök. Metod: En narrativ metod där tolv sjuksköterskor berättar om sina upplevelser i djupintervjuer. En kvalitativ innehållsanalys valdes som analysmetod. Resultat: Sjuksköterskors upplevelser visade sig vara främst kopplade till frustration på olika plan, nämligen, frustration gällande patienten, gällande anhöriga, gällande samhället, samt gällande sjukhus-verksamheten. Dock synliggjordes även upplevelser av tillfredsställelse. Resultatet presenteras genom två teman: frustration och tillfredsställelse. Slutsats: Det finns behov för sjuksköterskor på akut- och intensivvårdsavdelningar att få utbildning i suicidologi som skulle kunna ge bättre verktyg för att vårda och möta patienter som gjort ett suicidförsök. Det finns även behov av handledning för att bearbeta och orka med sitt arbete. Vidare finns det behov av ett bättre samarbete mellan somatik och psykiatri. Sättet som verksamheten och organisationen är strukturerad innebär ibland svårigheter att i praktiken att ge en holistisk och patientcentrerad vård. Prioriteringar och det oförutsägbara med arbetet gör det svårt att tillgodose patientens alla behov. / Abstract Bakgrund: The term suicide attempt refers to life-threatening self inflicted injury by which an individual seeks to commit suicide but survives. The number of suicide attempts in Sweden per year is merely a rough estimate and the number of unregistered cases is considered as high. Registered cases in 2008 amounted to 9643 people (over the age of 15), at least double the number is presumed if all unregistered and undetected cases were to be included. The nurses’ first meetings with patients after attempted suicide often occurs within emergency and intensive care wards, before the patient is transferred to a psychiatric care unit or is discharged from hospital. Aim: This study aims to illustrate how nurses within somatic emergency and intensive care wards experience situations when meeting and caring for patients after a suicide attempt. Method: A narrative method whereby twelve nurses talked about their experiences in depth interviews. A qualitative content analysis was chosen as the method for analysis. Result: Nurses' experiences proved to be mainly linked to frustration regarding the patient, the patient’s family members, current society, and current hospital establishment. However, the results also revealed experiences of satisfaction. The results were presented by two themes: frustration and satisfaction. Conclusion: There is a need for nurses in emergency and intensive care units to receive training in suicidology which could provide better tools to care for patients after a suicide attempt. There is also a need for councelling to help nurses to cope with their work and encounters with suicidal patients. Furthermore, there is need for better cooperation between somatic and psychiatric wards when it comes to providing healthcare for suicidal patients. The manner in which work within emergency and intensive care wards is structured sometimes makes it difficult to meet all patient needs as well as offer a holistic and patient-centered care.

Introdução: Ideação suicida e tentativas de suicídio são geralmente complicações dos transtornos psiquiátricos. O estudo da freqüência e fatores associados podem contribuir para uma abordagem mais adequada por profissionais de saúde mental. Objetivos: Estimar a prevalência de tentativas e pensamentos suicidas, em pessoas com transtornos mentais graves (TMG) e as associações com características sócio-demograficas, diagnóstico, ajustamento social, sintomas psiquiátricos, uso de substâncias psicoativas, envolvimento familiar e tratamentos realizados. Método: Foram entrevistados e avaliados 192 pessoas que apresentavam TMG, com idade entre 18 e 65 anos e que tiveram contato com os serviços de saúde mental de três regiões definidas do município de São Paulo em período determinado. Utilizou-se anamneses estruturadas com questionários padronizados e escalas psicométricas. As entrevistas foram realizadas no domicílio do paciente. Realizou-se análise descritiva, análise univariada e análise multivariada. Resultados: Da amostra estudada predominaram as pessoas do sexo masculino (53,1%), solteiras (57,3%), com diagnóstico de esquizofrenia (58,3%). Poucas pessoas apresentavam abuso ou dependência de álcool (7,3%) e apenas três pessoas (1,6%) não utilizaram medicações psiquiátricas no período de um ano anterior à entrevista. Cento e nove (57,7%) entrevistados apresentaram pensamentos suicidas ao longo da vida e nos 12 meses anteriores a entrevista, trinta e oito (20,1%) tiveram tais pensamentos. Cinqüenta e nove (30,9%) pessoas já haviam tentado suicídio durante a vida e oito (4,2%) apresentaram tentativas nos 12 meses anteriores à entrevista. Para todas as variáveis de desfecho, apresentaram associação estatística, a presença de sentimentos de culpa e sintomas depressivos. Na análise multivariada, o uso de neurolépticos apresentou associação com pensamentos e tentativas de suicídio ao longo da vida. Conclusão: Ideação e tentativas de suicídio foram bastante prevalentes na população estudada devendo sempre ser investigadas pelos profissionais de saúde mental, para que se possa tomar as devidas condutas, como o manejo dos sentimentos de culpa e depressão, além do ajuste correto da medicação para o transtorno mental. / Introduction: Suicidal ideation and suicidal attempts are usually complications of psychiatric disorders. The study of the frequency and associated factors may contribute for the mental health professionals to have a more appropriate approach. Aims: Estimate the prevalence of attempts and suicidal thoughts, in people who have serious mental disorder (SMD) and the association with social-demographic characteristics, diagnosis, social adjustment, psychiatric symptoms, use of psychoactive substances, family involvement and treatments they have gone though. Method: One hundred ninety two subjects, age 18 - 65, showing SMD and having been in touch with mental health services in three defined zones in the city of Sao Paulo, in the determined period, were evaluated and interviewed. The researchers used structured anamnesis with standardized questionnaires and psychometric scales, the subjects were interviewed at home and a descriptive analysis, a univariate analysis and a multivariate analysis were used. Results: From the sample we studied we’ve found a predominance of men (53,1%), single people (57,3%), having a diagnose of schizophrenia (58,3%). Few people presented abuse or dependence of alcohol (7,3%) and only three people (1,6%) hadn’t used psychiatric medications within one year before the interview. One hundred nine (57,7%) people who where interviewed showed suicidal thoughts during their lives and during 12 months prior to the research, thirty eight (20,1%) had that kind of thoughts. Fifty nine (30,9%) people had tried to commit suicide during their lives and eight (4,2%) showed attempts to it within 12 months before the interview. The presence of guilt feelings and depressive symptoms showed statistics association to all dependant variables. The multivariate analyses showed statistics association to attempts and suicidal thoughts during the patients’ lives to the occasional use of neuroleptics. Conclusion: The presence of suicidal ideation and attempts to suicide were prevalent in the studied population and they should always be investigated by the health mental professionals in order for them manage the prosper procedures, such as the handling of guilt feelings and depression and be able to stablish the proper medication, for the mental disorder.

A queimadura pode ser considerada como um dos traumatismos mais destrutivos que o ser humano pode sofrer. Sua relevância decorre não só da frequência com que acontece, mas também, pelas sequelas funcionais, estéticas e emocionais que a queimadura provoca. A autoagressão é um dos motivos preocupantes e de difícil manejo tanto para a equipe de saúde como para toda a sociedade, visto que é uma situação que relaciona tanto aspectos subjetivos e culturais, como também religiosos e de saúde pública. Os objetivos desta pesquisa são: caracterizar os pacientes que sofreram queimadura térmica por líquido inflamável na tentativa de suicídio, após a alta hospitalar de uma Unidade de Queimados de um Hospital Universitário entre os anos de 2006 e 2009; investigar a vida ocupacional do paciente em suas atividades de vida diária e prática, atividades produtivas e de trabalho e as atividades de lazer após a alta hospitalar e identificar quais são os recursos que contam para prosseguir sua vida. Trata-se de um estudo qualitativo, em que a história oral foi utilizada como método de investigação na modalidade história oral temática. Para a análise dos dados, seguiram-se os passos da técnica de Análise Indutiva de Conteúdo. A coleta de dados foi realizada no período de agosto a outubro de 2010. As entrevistas foram realizadas com oito pacientes queimados por autoagressão que forneceram subsídios para a construção de três núcleos de sentidos: \"Morrer ou viver: a busca pelo atendimento de urgência/emergência\"; \"Os desafios enfrentados pelo paciente no retorno para casa\" e \" Recursos e projetos futuros após a sobrevivência\". A partir da análise e discussão destas categorias, fica evidente a importância de conhecer estes pacientes em seu retorno para casa e saber por meio de suas experiências as principais dificuldades, avanços e desafios, bem como os recursos com que contam para enfrentar suas vidas, com um olhar atento para suas queixas relacionadas a ideias ou pensamentos de morte, a fim de atentar-se principalmente a possíveis reincidivas que certamente poderão ser letais; necessitando dos profissionais de saúde de urgência e emergência e dos familiares a capacidade, quando possível, de identificar um pedido de socorro ou ajuda com tomadas de ações mais efetivas e de acompanhamento a esses pacientes, mesmo com a falta de adesão ao tratamento. Para isso, é preciso conhecer a realidade e as necessidades dos serviços a partir das experiências das pessoas que recebem assistência nos mesmos e dos profissionais de saúde que as assistem. / The burn can be considered as one of the most destructive traumas that humans can suffer. Its relevance stems not only on how often it happens, but also by functional sequelae, both aesthetic and emotional cause. Self-harm is one reason for concern and difficult to manage both for the health care team for the whole society, since it is a situation that relates both subjective and cultural aspects, as well as religious and public health. The objectives of this research are: characterizer of patients who suffered thermal burns of flammable liquid in a suicide attempt, after discharge from a burn unit of a university hospital between the years 2006 to 2009; investigate the occupational life of the patient in their activities of daily living and practical, productive activities and work and leisure activities after discharge and identify what resources they have to continue your life. This is a qualitative study in which oral history was used as a method of research in oral history form. For data analysis, followed the steps of the technique of Inductive Content Analysis. Data collection was conducted between August to October 2010. The interviews were conducted with eight patients burned by self-harm which provided subsidies for the construction of three groups of meaning: \"To die or live: the search for urgent care / emergency,\" \"The challenges faced by the patient upon returning home\" and \"Resources and future projects after survival.\" From the analysis and discussion of these categories, it is evident the importance of knowing these patients on their return home and learn from their experiences major difficulties, progress and challenges, as well as the resources that have to face their lives with a look attentive to their complaints related to ideas or thoughts of death, to pay attention mainly to relapsed possible that certainly could be lethal for health professionals needing urgent and emergency capacity and family whenever possible to identify a distress or help with more effective actions taken and follow-up of these patients despite the lack of adherence to treatment. For this, one must know the reality and needs of services from the experiences of people who receive the same assistance and health professionals who care for them.

Suicidal behaviors are common and problematic among young populations, and attitudes held towards such behavior likely impact the frequency of its occurrence. The present study was conducted to gain insight into the attitudes held towards suicide attempt victims amongst a traditional college population. Undergraduate students (n = 360) were administered a survey to assess demographics, suicide ideation levels, and perceptions formed after reading a short suicide attempt report. Results indicated that ideation levels had the most impact on perceptions, with ideators being significantly more likely than non-ideators to view suicide attempters as more intelligent, more justified in their actions, more likable, more trusting, and more likely to be a personal friend. These findings signify that acceptance of suicidal behavior is positively correlated with one’s own level of suicidal ideation. The understanding of these attitudes is an essential aspect to address when developing prevention programs for suicidal behaviors in the future.

INTRODUCTION: Attempted suicide is very common. Those who arrive to a hospital by reason of attempted suicide need a nurse with qualifications in the care of suicidal patients. OBJECTIVE: The aim of this study was to compile and elucidate research which describes how patients in care for their attempted suicide experience the care that is received. METHOD: A literature review was chosen for this study. Scientific articles sought in the database CINAHL. RESULT: The result consist of 11 scientific articles published between 1999-2009. The result gave three head themes; communication, self esteem, follow-up - safety and three subthemes; understanding, empathy and confirmation - acceptance. It emerged in the result that verbal communication with health professionals is seen as fundamental to feel better and to find a meaning of life and finding the will to live. Nurses have an excellent starting point to support and help patients to regain self-esteem. Patients feeling of safety grows by knowing that they can contact the ward after being discharged. DISCUSSION: Many patients are negative to the care they receive. Lack of qualifications and shortage of time are a few things that could have effect on the care that is applied from the health professionals to suicidal patients. / INTRODUKTION: Suicidförsök är mycket vanligt. De som inkommer till sjukhus på grund av suicidförsök är i behov av kompetens hos sjuksköterskan inom vård av suicidnära patienter. SYFTE: Syftet med studien var att sammanställa och belysa forskning som beskriver hur patienter som vårdas för suicidförsök upplever omvårdnaden. METOD: En litteraturöversikt har genomförts. Vetenskapliga artiklar söktes i databasen CINAHL. RESULTAT: Resultatet består av 11 vetenskapliga artiklar publicerade mellan 1999-2009. Resultatet gav tre huvudteman; kommunikation, självkänsla och uppföljning - säkerhet samt tre subteman; förståelse, empati och bekräftelse - acceptans. I resultatet framkommer det att verbal kommunikation med hälso- och sjukvårdspersonal ses som grundläggande för välmående och för att finna mening med livet och viljan att leva vidare. Sjuksköterskor har en utmärkt utgångspunkt för att stötta och återskapa självkänsla hos patienter. Patienters känsla av säkerhet ökar genom att veta att de kan kontakta avdelningen efter utskrivning. DISKUSSION: Många av patienterna är negativa till omvårdnaden som ges. Bristande kompetens och tidsbrist hos hälso- och sjukvårdspersonal kan ha påverkan på omvårdnaden som ges till suicidnära patienter.