<p>The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. </p><p>Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between.</p><p>Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws.</p><p>Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement.</p><p>The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion.</p><p>A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. </p><p>In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.</p>

The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between. Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws. Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement. The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion. A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.

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Bakgrund: Lagen om psykiatrisk tvångsvård och Lagen om rättspsykiatrisk vård ger rätt att vårda patienter mot deras vilja. I psykiatrisk vård förekommer specifika omvårdnadsåtgärder som bältesläggning, tvångsmedicinering och avskiljning. Dessa väcker många känslor och kräver att sjuksköterskan arbetar med hänsyn och respekt. Relationen är en central del inom psykiatrisk omvårdnad och ska baseras på tillit och empati. Syfte: Att belysa sjuksköterskors uppfattning om tvångsåtgärders inverkan på omvårdnadsrelationen. Metod: Semi-strukturerade intervjuer med hjälp av en intervjuguide genomfördes med yrkesverksamma sjuksköterskor på en psykiatrisk klinik. Data bearbetades med en kvalitativ manifest innehållsanalys. Resultat: Studien resulterade i sex kategorier; professionellt förhållningssätt, vårdande samtal, tillitsfull relation, tvång som maktmedel, sjuksköterskans uppfattning av patientens känslor och sjuksköterskans känslor. Slutsats: Tvångsåtgärder väckte flera känslor hos sjuksköterskan. Med hjälp av ett professionellt förhållningssätt och vårdande samtal skapades en tillitsfull relation med patienten. Detta medförde att tvångsåtgärderna inte hade en negativ inverkan på omvårdnadsrelationen. / Background: The Compulsory Psychiatric Care Act and the Forensic Psychiatric Care Act gives the right to treat patients involuntarily. Specific nursing interventions in the form of restraint, coerced medication and seclusion occur in psychiatric care. These evoke a lot of emotions and require that the nurse work with consideration and respect. The nurse-patient relationship is an essential part within psychiatric nursing and should be based on trust and empathy. Aim: To illuminate nurses perception of coercive measures impact on the nurse-patient relationship. Method: Semi-structured interviews with the help of a topic guide were conducted with nurses on a psychiatric clinic. The data were processed through a qualitative manifest content analysis. Results: The study resulted in six categories; professional approach, caring dialogue, trusting relationship, coercion as an instrument of power, the nurse´s perception of patients emotions and the nurse´s emotions. Conclusion: Coercive measures raised several emotions within the nurse. With the use of a professional approach and a caring dialogue a trusting relationship was created with the patient. This meant that coercive measures didn't have a negative impact on the nurse-patient relationship.

Bakgrund: Inom psykiatrisk tvångsvård förkommer tvångsåtgärder som exempelvis kan vara att administrera läkemedel utan patientens samtycke, att isolera patienten eller att spänna fast patienten i en säng. Tvångsåtgärder görs som en sista utväg för att ge patienten nödvändig vård eller för att skydda patienten eller andra. Författarna anser att det är viktigt att belysa hur sjuksköterskor upplever att utföra dessa tvångsåtgärder för att ge en ökad förståelse och kunskap för komplexiteten i att tvinga någon till vård. Förhoppningen är att en ökad förståelse ska leda till bättre rustade sjuksköterskor som därmed kan ge patienterna inom den psykiatriska slutenvården en bättre omvårdnad.Syfte: Syftet med litteraturstudien är att belysa sjuksköterskors upplevelser av att utföra tvångsåtgärder inom vuxenpsykiatrin.Metod: En litteraturstudie med kvalitativ ansats. Databassökning genomförd i PubMed, CINAHL samt PsychINFO och begränsningar har applicerats med följande inklusionskriterier: kvalitativa studier, sjuksköterskor, psykiatrisk vård av vuxna, tvångsåtgärder inom psykiatrisk vård, artiklar skrivna på svenska eller engelska som blivit peer reviewed, artiklar skrivna efter 1992/01/01, tillgängliga i fulltext via Malmö universitet. Sökträffar har genomlästs och elva artiklar inkluderades. Dessa har sedan genomgått en syntesprocess enligt Howell Major och Savin-Baden.Resultat: Att utföra tvångsåtgärder väckte starka känslor hos sjuksköterskor, framför allt av negativ karaktär. De teman som framkom utgår från studiens frågeställning var; obehag, rädsla och osäkerhet, behov av rättfärdigande, terapeutisk relation, maktlöshet, skuld och skam, avtrubbad samt makt. Konklusion: Sjuksköterskorna ansåg att tvångsåtgärder var ett nödvändigt ont för att kunna skydda och behandla svårt sjuka patienter. De ville egentligen inte utföra tvångsåtgärder men ansåg sig oftast inte ha några alternativ. Sjuksköterskorna strävade efter att bedriva personcentrerad vård vilket gjorde att de kunde förebygga tvångsåtgärder. / Background: In psychiatric compulsive care, coercive measures are imposed, for example, to administer medication without the patient’s consent, to seclude the patient or to mechanically restrain the patient. Coercive measures are a last resort to provide the patient with the necessary care or to protect the patient or others. The authors consider it important to highlight how nurses experience these coercive measures to provide increased understanding and knowledge of the complexity of using coercion in health care. The hope is that increased understanding will lead to better equipped nurses, thus giving patients in psychiatric compulsory care better treatment.Aim: The aim of the literature study is to highlight the nurses' experiences of using coercive measures in adult psychiatric care.Method: A literature study with a qualitative approach. Databases that have been searched are PubMed, CINAHL and PsychINFO. Applied limitations were the following inclusion criteria: qualitative studies, nurses, adult psychiatric care, coercive measures in psychiatric care, articles written in Swedish or English that have been peer reviewed, articles written after 1992/01/01, available in full text via Malmö University. Search results have been read and eleven articles were included. These articles have undergone a process of synthesis according to Howell Major and Savin-Baden.Result: To perform coercive measures induced strong emotions for nurses, especially of a negative nature. The themes that emerged are based on the study's aim was; discomfort, fear and insecurity, need for justification, therapeutic relationship, powerlessness, guilt and shame, compassion fatigue and power. Conclusion: Nurses considered that coercive measures were a necessary evil to protect and treat severely ill patients. They did not really want to carry out coercive measures but usually experienced no options. Nurses strived to pursue person centred care, which meant that they could prevent coercive measures.

Bakgrund: All hälso- och sjukvård är så långt som möjligt frivillig. Personer som är allvarligt psykiskt sjuka inser dock inte alltid att de är i behov av vård och kan därför vårdas med stöd av tvångslagar. Att vårdas under tvång kan dock upplevas som värdighets- och integritetskränkande och därmed skapa vårdlidande. Det är samtidigt sjuksköterskans, som leder och utför tvångsåtgärder, professionella ansvar att lindra lidande vilket kan ses som ett dilemma. Det finns därför ett behov av ökad kunskap för att bättre förstå tvångsåtgärdernas konsekvenser för att kunna utveckla och förbättra denna vårdåtgärd. Syfte: Syftet var att beskriva sjuksköterskors upplevelse av tvångsåtgärder i psykiatrisk vård. Metod: En litteraturöversikt med systematisk ansats valdes som metod. Femton kvalitativa artiklar inkluderades och analyserades med Thomas och Hardens metod för tematisk analys. Analysen gjordes i tre steg och resulterade i fyra teman, med två tillhörande subteman var. Resultat: Sjuksköterskans upplevelse av tvångsåtgärder präglades av en emotionell stress som grundas i en inre konflikt samtidigt som tvångsåtgärder anses vara ett nödvändigt verktyg för en säker vårdmiljö. Utförandet och utfallet av tvångsåtgärder påverkas av sjuksköterskornas färdigheter och erfarenheter och det finns därför ett behov av omvårdnadshandledning. Slutsats: Den emotionella stressen skapar ett lidande hos sjuksköterskor, som i sin tur kan leda till vårdlidande hos patienterna. Ökad stöttning, omvårdnadshandledning och kunskap om sjuksköterskornas lidande är därmed av essens för att utveckla den psykiatriska vården i riktning mot en god tvångsvård. Nyckelord: Psykiatrisk tvångsvård, sjuksköterskor, upplevelser, tvångsåtgärder, lidande / Background: All health care is as far as possible voluntary. People who are seriously mentally ill do not always realize that they are in need of care and can therefore be cared for with the support of coercive laws. Being cared for under compulsory care can be perceived as a violation of dignity and integrity and thereby create care suffering. At the same time, it’s the nurse's responsibility, who leads and performs coercive measures, to alleviate suffering, which can be seen as a dilemma. There is therefore a need for increased knowledge to better understand the consequences of coercive measures in order to develop and improve this care measure. Aim: The aim was to describe registered nurses' experience of coercive measures in psychiatric care. Method: A literature review with a systematic approach was chosen as the method. Fifteen qualitative articles were included and analyzed using Thomas and Harden's method for thematic analysis. The analysis was done in three steps and resulted in four themes, with two associated sub-themes each. Results: The nurse's experience of coercive measures was characterized by an emotional stress based on an internal conflict, at the same time as coercive measures are considered a necessary tool for a safe care environment. The execution and outcome of coercive measures are affected by the nurses' skills and experiences and there is therefore a need for nursing guidance. Conclusion: The emotional stress creates suffering in nurses, which in turn can lead to care suffering in the patients. Increased support, nursing guidance and knowledge of nurses' suffering are thus of essence for developing psychiatric care in the direction of good compulsory care. Keywords: Compulsory psychiatric care, registered nurses, experiences, coercive measures, suffering

This essay aims to find out how the five values of liberalism view the law on secret room wiretapping and the law on secret wiretapping of electronic communications. The method used to achieve the purpose of the study is an idea analysis in descriptive and explanatory form. When processing the material, two dimensions have been formulated in the form of analysis tools: integrity and legitimacy. The study's questions are as follows: How do the five values of liberalism view the laws regarding secret interception of electronic communications and secret room interception, and are the laws considered to be or not accepted by liberalism. The conclusion could be drawn that all five values believe that the laws can be applied as their purpose is to protect citizens, society, and the state from those who are not considered law-abiding. Despite their freedom and integrity being curtailed, the laws must be used to ensure that the majority´s safety, integrity, freedom, and rights are protected.

Background Every day in Sweden approximately 3,000 people are in care with support from the Compulsory Mental Care Act ("LPT") or the Forensic Mental Care Act ("LRV") within inpatient care. Coercive measures are used as a last resort when no other treatment works and the patient poses a danger to themselves or their surroundings. Forced medication is the most common coercive measure and is most often used in combination with medical restraint. Aim: The aim was to highlight nurses' experiences of caring for patients under coercion in psychiatric inpatient care. Method: Qualitative approach with semi-structured interviews of two focus groups was used. The transcribed texts were analyzed using qualitative content analysis. Results: The analysis resulted in three main categories: Strategies to avoid coercive measures, when coercive measures are used as last resort and conditions for a reflective and ethical approach, with associated subcategories. The result reflected that the exercise of coercive measures was a complex area and they were always used as a last resort and with the patient's best interest in mind. It was important for nurses to have the opportunity for reflection and ethical consideration after executed coercive measures. Conclusion: Getting the opportunity to reflect after a performed coercive measure is essential for nurses to be developed and improved in their exercise of coercive measures. To reflect on what happened, how it happened and what they could have done differently contributes to increased preparedness for future enforcement action and gives greater security for these situations. Also receive training in the field and to practice their skills is requested by the nurses. / Bakgrund: Inom den psykiatriska slutenvården i Sverige tvångsvårdas ca 3000 människor varje dag med stöd av Lagen om psykiatrisk tvångsvård (LPT) eller Lagen om rättspsykiatrisk vård (LRV). Tvångsåtgärder används som en sista utväg när ingen annan behandling fungerar och patienten utgör en fara för sig själv eller sin omgivning. Tvångsmedicinering är den vanligaste tvångsåtgärden och den används ofta ihop med bältesläggning. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att vårda patienter under tvång inom psykiatrisk slutenvård. Metod: Kvalitativ metod med semistrukturerade intervjuer av två fokusgrupper användes. Den transkriberade texten analyserades utifrån kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier: Strategier för att undvika tvångsåtgärder, att använda tvångsåtgärder som en sista utväg, samt förutsättningar för ett reflekterande och etiskt förhållningssätt, med tillhörande underkategorier. Resultatet visade att tvångsåtgärder var ett komplext område och att de alltid användes som en sista utväg med patientens bästa i fokus. Det var viktigt för sjuksköterskorna att de fick möjlighet till reflektion och etisk eftertanke efter en utförd tvångsåtgärd. Konklusion: Att få möjlighet till reflektion efter en utförd tvångsåtgärd är centralt för sjuksköterskorna för att kunna utveckla och förbättra sina färdigheter gällande tvångsåtgärder. Genom att få reflektera över vad som föranledde tvångsåtgärden, hur den utfördes och om något kunde gjorts annorlunda bidrar till en ökad handlingsberedskap för sjuksköterskorna inför kommande tvångsåtgärder och skapar trygghet i dessa situationer. Sjuksköterskorna efterfrågar även praktisk träning så de kan träna på de färdigheter som behövs för att utföra tvångsåtgärder.

Bakgrund: Psykisk ohälsa är ett växande problem och drabbar de flesta under sin livstid. Patienter under lagen om psykiatrisk tvångsvård vårdas mot sin vilja och får sin autonomi och integritet fråntagen. Tvångsåtgärder kan ge konsekvenser för patientens fysiska och psykiska hälsa. Personcentrerad vård är en central del av omvårdnaden i psykiatrisk kontext, vilket inkluderar kommunikation och delaktighet. Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser av tvångsåtgärder inom psykiatrisk heldygnsvård. Metod: Denna kvalitativa litteraturstudie grundades på tolv studier inhämtade från databaserna PubMed, PsycInfo och CINAHL och analyserades med Popenoe m.fl. analysmetod. Resultat: Patienternas upplevelse presenterades i tre kategorier – Förlust av autonomi och integritet, Psykiskt och fysiskt lidande samt Upplevelse av tacksamhet och acceptans. Konklusion: Resultatet visar att patienterna övergripande hade negativa upplevelser av tvångsåtgärder och att deras autonomi och integritet fråntagits dem. Personalens beteende påverkade både upplevelsen negativt och positivt. Litteraturstudien visade att det finns behov av förbättringar i bemötandet av patienter som behöver tvångsvård och vikten av att arbeta personcentrerat. / Background: Mental illness is a growing problem and can affect anyone during their lifetime. Patients under the Compulsory Psychiatric Care Act are cared for against their will and have their autonomy and integrity taken away. Coercive measures can have consequences for the patient's physical and mental health. Person-centered care is a central part of nursing in the psychiatric context, which includes communication and active participation. Aim: The purpose of the literature study was to shed light on patients' experiences of coercive measures within psychiatric inpatient care. Method: This qualitative literature study was based on twelve studies obtained from the databases PubMed, PsycInfo and CINAHL and analyzed with Popenoe et al. analysis method. Results: The patients' experience was presented in three categories - Loss of autonomy and integrity, Mental and physical suffering and Experience of gratitude and acceptance. Conclusion: The results show that the patient's overall had negative experiences of coercive measures and that their autonomy and integrity were taken away from them. The staff's behavior affected the experience both negatively and positively. The literature study showed that there is a need for improvements in the treatment of patients who need compulsory care and the importance of person-centered care.

O objetivo desta dissertação é analisar a efetividade das decisões judiciais proferidas na Comarca da cidade de Palmas/TO, que buscam garantir o acesso à saúde pública. O método quanti-qualitativo se mostrou o mais adequado aos objetivos propostos, a saber a medida executiva mais eficaz para se garantir o cumprimento da decisão judicial que efetiva o direito constitucional à saúde. A coleta de dados foi realizada por meio da análise dos processos judiciais, em trâmite na Primeira Vara das Fazendas e Registros Públicos, cujas decisões tenham sido deferidas de forma antecipada ou com exame aprofundado, bem como tenham ocorrido entre os dias 01 de janeiro de 2016 a 20 de novembro de 2017, sempre através da base de dados da Justiça Estadual tocantinense (E-proc). Foram excluídos da análise os processos em que o provimento pleiteado fora indeferido, demandas coletivas, bem como os processos que tramitam ou tramitaram em segredo de justiça, limitando-se aos feitos abertos à consulta pública. Além do resultado obtido com a aplicação do instrumento de coleta de dados, foi utilizado variado material bibliográfico que se deu por meio de consultas a livros, artigos científicos, legislação, julgados de Tribunais Superiores e páginas da internet. Os resultados indicam que, para cada provimento que se busca, quer seja acesso a um medicamento, quer seja procedimento cirúrgico, internações ou outras modalidades de intervenções, há uma medida executiva mais adequada, sendo ela coercitiva ou sub-rogatória. Sempre primando pela proporcionalidade entre o direito constitucional que se garante e aquele que se relega, mas acima de tudo na efetividade de um direito à saúde digna. / The purpose of this dissertation is to analyze the efficacy of the judicial decisions pronounced in the comarca of the city Palmas/TO, they seek to garantee the access public health. The quantitative-qualitative method showed to the more adequate to the intending objetive, that is, the executive measure more efficacius for to garante the execution of the judicial decision that effective the constitutional right to health. The data collection was done through the analysis of judicial processes in course in the First Judicial Area of the Treasury and Public Registers of the City Palmas, whose decisions were granted of form anticipate or in-depth examination and which occurred between January 1, 2016 and November 20, 2017, always through the database of the State Court of Tocantins (E-proc). Were excluded from the analysis the cases in which the pleadings had been reject, collective demands, as well as the processes that be in course or process that was in curso in secrecy of justice, being limited to the facts open to the public consultation. In addition to the result obtained with the application of the data collection instrument, a varied bibliographic material which occurred through consultations on books, scientific articles, legislation, judgments of High Courts and websites. The results indicate that, for each provision sought, either by access to a medicinal product or by surgical procedure, hospitalizations or other forms of intervention , there is a more appropriate executive measure, being coercive or subrogation. Always striving for proportionality between constitutional law, but above all, on the effectiveness of a decent health right.