Bakgrund: I Sverige lider cirka en till två procent av befolkningen av emotionellt instabil personlighetsstörning. Inom den psykiatriska vården är prevalensen mellan 30 och 50 procent. Patientgruppen karaktäriseras av en snabbt skiftande självbild, relationsproblem självskadebeteende, affektlabilitet och nedsatt impulskontroll. Tidigare forskning visar att vårdpersonal anser patientgruppen vara krävande och svårhanterlig, vilket i förlängningen kan leda till en sämre vård. Syfte: Att undersöka patienter med emotionellt instabil personlighetsstörning och deras upplevelser inom öppen- och slutenvård. Metod: En litteraturstudie med kvalitativ ansats genomfördes. Databaserna Cinahl och Psycinfo användes vid sökningen efter vetenskapliga artiklar. Totalt elva vetenskapliga artiklar som samtliga var med kvalitativ ansats och som var relevanta för syftet valdes ut och ligger till grund för litteraturstudiens resultat. Resultat: Studiedeltagarna upplevde att vårdpersonalen hade bristande kunskap om diagnos och behandling vilket bland annat ledde till stigmatisering av patientgruppen. Upplevelser av och rädsla för ensamhet uttrycktes ofta liksom behovet av relationer med andra personer. Stort fokus låg även på behovet och önskan av att kunna känna tillit till personalen. Konklusion: De negativa upplevelser som studiedeltagarna erfor grundande sig ofta i vårdpersonalens brist på kunskap om diagnosen. Fördjupad kunskap i området kan skapa en ökad förståelse för patienternas beteende och behov. Ökad förståelse förenklar mötet och därmed relationen mellan patient och vårdpersonal vilket i förlängningen kan resultera i en bättre vård. / Background: Approximately 1 to 2 percent of the population in Sweden suffer from borderline personality disorder. The prevalence within psychiatric care is higher, between 30 and 50 percent. The diagnosis is characterized by a rapid change in self-image, relationship problems, self-harming behaviour, emotional instability and impaired impulse control. Previous research shows that health care professionals consider the patient group to be demanding and difficult to manage, which can lead to inferior care in the long run. Aim: To explore how patients with borderline personality disorder experience in-patient and outpatient health care. Method: A literature study with a qualitative approach was conducted. The databases Cinahl and Psycinfo were used in the search for scientific articles. A total of eleven articles, all of which were of a qualitative approach, were selected and form the basis for the study's results. Result: The study participants felt that the nursing staff had a lack of knowledge about their diagnosis and the treatment, which among other things led to stigmatization of the patient group. Experiences of and fear of loneliness were often expressed, as was the need for relationships with others. There was also a great focus on the need and desire to be able to trust the staff. Conclusion: The negative experiences of the study participants are often rooted in the nursing staff's lack of knowledge about the diagnosis. In-depth knowledge of the area can create an increased understanding of patients' behavior and needs. Increased understanding simplifies the meeting and thus the relationship between the patient and the care staff, which in the long run can result in better care.

Inledning: Tidigare studier har visat att patienter som är diagnostiserade med emotionell instabil personlighetsstörning (EIPS) framkallar specifika motöverföringsreaktioner till sina terapeuter och omgivningen. Den samtida begreppet motöverföring används av terapeuten för att förstå patientens inre värld.  Syfte: Syftet med denna studie är att undersöka ST-läkares motöverföringsreaktioner vid bedömningen av patienter med emotionellt instabil personlighetsstörning på psykiatrisk akutmottagning.  Metod: Tematisk analys. Semi-strukturerade intervjuer med fem ST-läkare verksamma inom psykiatrin.  Resultat: Studiens resultat visade att motöverföringsreaktionerna kan delas upp i två övergripande teman. Å ena sidan motöverföringsreaktionerna som patienten framkallar hos läkarna under patient-läkarmötet och å andra sidan motöverföringsreaktionerna som är kopplade till läkarens tidigare yrkeslivserfarenheter med patienter som är diagnostiserade med emotionell instabil personlighetsstörning.   Diskussion: Resultatet belyser ST-läkarnas motöveringsreaktioner utifrån flera perspektiv med hänsyn till tidigare forskning och teori. / Introduction: Previous studies have shown that patients diagnosed with emotionally unstable personality disorder (EIPS) evoke specific countertransference reactions in their therapists. The contemporary concept of countertransference is used by therapists to understand the patient's internal world. Aim: The aim of this study is to investigate the residents’ countertransference reactions in the assessment of patients with emotionally unstable personality disorder in psychiatric emergency department.  Method: Thematic analysis. Semi-structured interviews with five residents in psychiatry.  Results: The results of the study showed that the countertransference reactions can be divided into two major categories. First, the countertransference reactions that the patient evokes in the doctors during the patient-doctor meeting and second, the countertransference reactions that are linked to the doctors' previous professional experiences with patients diagnosed with emotionally unstable personality disorder (EIPS).

No description available.

Bakgrund: Proprioception involverar bland annat förmågan att uppfatta var ens kroppsdelar befinner sig utan att behöva titta på dem, detta är en viktig del av handfunktionen. Tidigare studier har jämfört träning på stabilt underlag mot träning på instabilt underlag och vad detta har för effekt på fotledens proprioception. Effekten av hur de olika träningstyperna påverkar handleden är mindre studerat. I denna pilotstudie undersöks två olika träningsmetoder för handen, en stabil träningsform (Powergrip**) och en instabil träningsform (Powerball). Syfte: Undersöka effekten på proprioception och greppstyrka av träning med Powergrip respektive Powerball. Metodansats: Fjorton friska personer, 18 år eller äldre, delades in i två grupper, gruppindelningen skedde delvis slumpmässigt. Före och efter träningsperioden utfördes positionsinnestest för handledsproprioception och styrketest med handdynamometer för greppstyrka. Träningsperioden pågick fyra veckor och innehöll totalt 12 träningstillfällen, endast den dominanta handen tränades. Resultat: Inga stora skillnader framkom mellan grupperna i positionsinnestestet och styrketestet. Tendenser indikerar att positionssinnestestet och greppstyrketestet förbättrades för den tränade handen, men inte den icke-tränade handen för både Powerball och Powergrip. Powergripgruppen fick jämfört med powerballgruppen något större förbättring i styrketestet för tränade handen. Konklusion: Denna pilotstudie indikerar tendenser till förbättrad proprioception och styrkeökning för tränade handen, men inga eller små skillnader mellan grupperna. Framtida studier med fler deltagare behövs för att statistiskt kunna analysera eventuella skillnader inom och mellan grupperna. Framtida studier bör även inkludera personer med nedsatt handfunktion för att utvärdera träningseffekter vid rehabilitering.

Personer med diagnosen emotionell instabil personlighetsstörning är högkonsumenter av psykiatrisk akutvård. Diagnosen kännetecknas av ett ihållande mönster av instabilitet vad gäller självbild, känslor och relationer med andra, samt en hög grad av impulsivitet. Vidare förekommer ofta självskadebeteende och suicidala handlingar som ett sätt att reglera affekter. Symtombilden kan göra mötet mellan patient och vårdpersonal svårt. Syftet med denna studie var att utifrån lidandeperspektiv belysa hur personer med diagnosen Emotionellt instabilt personlighetssyndrom upplever och erfar personalens bemötande när de söker akut vård. Metoden som användes var en kvalitativ intervjustudie med fenomenologisk ansats.  Huvudresultatet visade att fenomenets centrala teman är att respekteras som människa med symtom, att inte bli tagen på allvar och att bli stigmatiserad. Varje tema kunde kopplas till ett lidandeperspektiv; sjukdomslidande lindras av att respekteras som människa med symtom, men att inte bli tagen på allvar orsakade vårdlidande och att bli stigmatiserad orsakade ett livslidande. Samtidigt gick lidandeformerna in i varandra, på så vis att vårdlidande lades till den levda erfarenhet som är livslidandet, och livslidandet hade betydelse för hur sjukdomslidandet hanterades och upplevdes. Slutsatsen är att personer med EIPS som söker akut psykiatrisk vård upplever vårdpersonalens bemötande som att de antingen respekteras som människa med symtom och får sitt sjukdomslidande lindrat, eller inte tas på allvar och stigmatiseras med vård- respektive livslidande, som ökar på symtombördan, som följd. / People with Borderline Personality Disorder [BPD] are among the consumers of psychiatric emergency care. BPD is characterized by a persistent pattern of impulsivity and instability with regard to self-image, emotions and relationships with others. Furthermore, self-harm and suicidal behaviour often occur as a way to regulate emotions. The symptoms can make interaction between patients and healthcare professionals difficult. The aim of this study was to gain insight into how, from a perspective of suffering, people with BPD who seek psychiatric emergency care experience and sense the approach. The method used was a qualitative interview study with a descriptive phenomenological approach. The main results consisted of three central themes: to be respected as a human being with symptoms, to not be taken seriously, and to be stigmatized. Each theme was linked to a perspective of suffering; being respected as a human being with symptoms alleviated suffering from symptoms, while not being taken seriously caused suffering related to care, and getting stigmatized added to the existential suffering. The different dimensions of suffering interacted; suffering related to care was added to the existential suffering, which in turn had implications for the ability to deal with suffering from symptoms. The conclusion is that individuals with BPD experience either a treatment with respect for being a human being with symptoms, and thus having those symptoms alleviated, or experience not being taken seriously and being stigmatized, with the consequences of suffering related to care and existential suffering, both which add on to the symptom burden.

A prestação dos serviços no Sistema Único de Saúde (SUS) no país deve ser desenvolvida em um conjunto de estabelecimentos assistenciais de saúde, organizados em uma rede hierarquizada e regionalizada de atenção à saúde, em níveis de complexidade crescente. A rede de saúde no Estado do Rio Grande do Sul está dividida em sete macrorregiões e dezenove microrregiões, em um sistema hierarquizado que vai da atenção básica ao serviço de alta complexidade. A presente pesquisa tem como objetivo analisar a distribuição regional dos serviços de saúde de alta complexidade, considerando suas relações com as características do quadro de desigualdades socioespaciais no Estado. A metodologia utilizada foi levantamento documental referente à bibliografia especializada, abordando-se casos no Brasil. A seguir, em fase dedicada ao estudo de caso, examinaram-se os documentos do SUS, pertinentes ao tema, nas dezenove microrregiões que compreendem as coordenadorias de saúde no Rio Grande do Sul. Os dados coletados foram descritos conforme os serviços disponíveis por especialidade de alta complexidade e da população de cada região, criando-se indicadores de oferta, e das características das desigualdades socioespaciais. Para analisar os dados, aplicou-se procedimento que consistiu em confrontar, em cruzamento, os indicadores de oferta e de características socioeconômicas, visando-se examinar a adequação da oferta segundo critério que leva em conta a desigualdade social. O instrumento de análise revelou-se importante ao qualificar situações que a análise quantitativa, tipo correlação, não explicita adequadamente. Por fim, concluiu-se que a distribuição espacial dos serviços de saúde do SUS, no RS, estão inadequados, o que comprova a hipótese da pesquisa. / The provision of services in the Public Health System (SUS) in the country should be developed in a set of health care establishments, organized in a hierarchical and regionalized health care network, in level of increasing complexity. The health care network in the State of Rio Grande do Sul is divided into seven macro and nineteen micro regions, in a tiered system that goes from basic attention, up to the high complexity service. The aim of this research is to analyze the regional distribution of health care services of high complexity, considering their relation to the characteristics of the social spatial inequalities situation in the State of Rio Grande do Sul. The methodology used was to create a documentary survey based in specialized bibliographies, covering cases in Brazil, then, in order dedicated to the case study, relevant documents from SUS were examined in nineteen micro regions that include the health coordinating organs in Rio Grande do Sul. The collected data were described according to the services available for specialty of high complexity and the population of each region, thus creating indicators of offer, and the characteristics of spatial inequalities. To analyze the data a procedure was used, to match the indicators of offer and social economic characteristics, in order to examine the appropriateness of the offer according to the criterion that include the social inequality. The instrument of analysis proved to be important to qualify situations that the quantitative analysis type correlation does not specify adequately. Lastly, it was concluded that the spatial distribution of health services of SUS in Rio Grande do Sul is inadequate, proving the hypothesis of the research.

A prestação dos serviços no Sistema Único de Saúde (SUS) no país deve ser desenvolvida em um conjunto de estabelecimentos assistenciais de saúde, organizados em uma rede hierarquizada e regionalizada de atenção à saúde, em níveis de complexidade crescente. A rede de saúde no Estado do Rio Grande do Sul está dividida em sete macrorregiões e dezenove microrregiões, em um sistema hierarquizado que vai da atenção básica ao serviço de alta complexidade. A presente pesquisa tem como objetivo analisar a distribuição regional dos serviços de saúde de alta complexidade, considerando suas relações com as características do quadro de desigualdades socioespaciais no Estado. A metodologia utilizada foi levantamento documental referente à bibliografia especializada, abordando-se casos no Brasil. A seguir, em fase dedicada ao estudo de caso, examinaram-se os documentos do SUS, pertinentes ao tema, nas dezenove microrregiões que compreendem as coordenadorias de saúde no Rio Grande do Sul. Os dados coletados foram descritos conforme os serviços disponíveis por especialidade de alta complexidade e da população de cada região, criando-se indicadores de oferta, e das características das desigualdades socioespaciais. Para analisar os dados, aplicou-se procedimento que consistiu em confrontar, em cruzamento, os indicadores de oferta e de características socioeconômicas, visando-se examinar a adequação da oferta segundo critério que leva em conta a desigualdade social. O instrumento de análise revelou-se importante ao qualificar situações que a análise quantitativa, tipo correlação, não explicita adequadamente. Por fim, concluiu-se que a distribuição espacial dos serviços de saúde do SUS, no RS, estão inadequados, o que comprova a hipótese da pesquisa. / The provision of services in the Public Health System (SUS) in the country should be developed in a set of health care establishments, organized in a hierarchical and regionalized health care network, in level of increasing complexity. The health care network in the State of Rio Grande do Sul is divided into seven macro and nineteen micro regions, in a tiered system that goes from basic attention, up to the high complexity service. The aim of this research is to analyze the regional distribution of health care services of high complexity, considering their relation to the characteristics of the social spatial inequalities situation in the State of Rio Grande do Sul. The methodology used was to create a documentary survey based in specialized bibliographies, covering cases in Brazil, then, in order dedicated to the case study, relevant documents from SUS were examined in nineteen micro regions that include the health coordinating organs in Rio Grande do Sul. The collected data were described according to the services available for specialty of high complexity and the population of each region, thus creating indicators of offer, and the characteristics of spatial inequalities. To analyze the data a procedure was used, to match the indicators of offer and social economic characteristics, in order to examine the appropriateness of the offer according to the criterion that include the social inequality. The instrument of analysis proved to be important to qualify situations that the quantitative analysis type correlation does not specify adequately. Lastly, it was concluded that the spatial distribution of health services of SUS in Rio Grande do Sul is inadequate, proving the hypothesis of the research.

A prestação dos serviços no Sistema Único de Saúde (SUS) no país deve ser desenvolvida em um conjunto de estabelecimentos assistenciais de saúde, organizados em uma rede hierarquizada e regionalizada de atenção à saúde, em níveis de complexidade crescente. A rede de saúde no Estado do Rio Grande do Sul está dividida em sete macrorregiões e dezenove microrregiões, em um sistema hierarquizado que vai da atenção básica ao serviço de alta complexidade. A presente pesquisa tem como objetivo analisar a distribuição regional dos serviços de saúde de alta complexidade, considerando suas relações com as características do quadro de desigualdades socioespaciais no Estado. A metodologia utilizada foi levantamento documental referente à bibliografia especializada, abordando-se casos no Brasil. A seguir, em fase dedicada ao estudo de caso, examinaram-se os documentos do SUS, pertinentes ao tema, nas dezenove microrregiões que compreendem as coordenadorias de saúde no Rio Grande do Sul. Os dados coletados foram descritos conforme os serviços disponíveis por especialidade de alta complexidade e da população de cada região, criando-se indicadores de oferta, e das características das desigualdades socioespaciais. Para analisar os dados, aplicou-se procedimento que consistiu em confrontar, em cruzamento, os indicadores de oferta e de características socioeconômicas, visando-se examinar a adequação da oferta segundo critério que leva em conta a desigualdade social. O instrumento de análise revelou-se importante ao qualificar situações que a análise quantitativa, tipo correlação, não explicita adequadamente. Por fim, concluiu-se que a distribuição espacial dos serviços de saúde do SUS, no RS, estão inadequados, o que comprova a hipótese da pesquisa. / The provision of services in the Public Health System (SUS) in the country should be developed in a set of health care establishments, organized in a hierarchical and regionalized health care network, in level of increasing complexity. The health care network in the State of Rio Grande do Sul is divided into seven macro and nineteen micro regions, in a tiered system that goes from basic attention, up to the high complexity service. The aim of this research is to analyze the regional distribution of health care services of high complexity, considering their relation to the characteristics of the social spatial inequalities situation in the State of Rio Grande do Sul. The methodology used was to create a documentary survey based in specialized bibliographies, covering cases in Brazil, then, in order dedicated to the case study, relevant documents from SUS were examined in nineteen micro regions that include the health coordinating organs in Rio Grande do Sul. The collected data were described according to the services available for specialty of high complexity and the population of each region, thus creating indicators of offer, and the characteristics of spatial inequalities. To analyze the data a procedure was used, to match the indicators of offer and social economic characteristics, in order to examine the appropriateness of the offer according to the criterion that include the social inequality. The instrument of analysis proved to be important to qualify situations that the quantitative analysis type correlation does not specify adequately. Lastly, it was concluded that the spatial distribution of health services of SUS in Rio Grande do Sul is inadequate, proving the hypothesis of the research.

Bakgrund: Kvinnor med självskadebeteende skadar sig inte för att de vill ta livet av sig, utan för att lindra den psykiska smärtan och för att få kontroll över ångesten. Det är viktigt att vårdpersonalen ser hela människan och inte bara beteendet, kvinnor med självskadebeteende vill bli sedda och behandlade som alla andra patienter.  Syfte: Syftet var att beskriva kvinnors upplevelse av vården vid självskadebeteende. Metod: En kvalitativ studie gjordes utifrån en innebördsanalys. Fem självbiografier analyserades och bildade resultatet. Resultat: De fyra teman som återfinns i resultatet; att uppleva betydelsen av mötet mellan personal och kvinnor, att uppleva behandlingen som vårdande eller skadande, att uppleva betydelsen av att få bekräftelse vid vårdandet och att uppleva betydelsen av olika känslor vid vårdandet. Dessa teman visar att kvinnor med självskadebeteende vill bli sedda samt kunna känna en tillit till sjuksköterskor och annan vårdpersonal. Tid för samtal upplevs vara viktigt för att kvinnor ska få en bra vård. Slutsats: Kvinnors upplevelser är både positiva och negativa. Delaktighet och förklaringar kring självskadebeteendet och vårdandet upplevs vara viktigt för att få en god hälsa och en god vårdtid. / Background: Women with self-harm don’t cut themselves because they want to die, they do it to ease the psychic pain, and they get control over their angst. It is important that the nurses see the big picture in the person behind the self-harming behavior. Women with this behavior wants to be seen and treated like the other patients. Aim: Women’s experiences of health care in regards to self-harm. Methods: The study, was made with a qualitative meaning analysis. Five self-biographies where analyzed and became the results. Results: The four themes in the results; to experience the significance of the meeting between staff and women, to experience treatment as caring or damaged, to experience the importance of getting confirmation by caring and to experience the role of emotions in caring. These themes shows that the women wants to be seen and feel trust to the nurses and other professionals. Time and places for conversations are the women`s needs for having good treatment and care. Conclusion: Women’s experiences is positive and negative. Participation and explanation about their disease and treatment experience the woman as an important part of being able to feel good and to health care should be a good experience.

Personer som lider av emotionellt instabil personlighetsstörning (IPS) upplever mångfacetterad aktivitetsobalans i sin vardag. Arbetsterapeuter strävar till att stödja aktivitetsbalans och öka upplevelsen av tillfredsställelse men kunskapen om hur man kan stödja dessa personers upplevelse av balans är bristfällig. Syftet med denna studie var att beskriva hur arbetsterapeuter resonerar kring att stödja aktivitetsbalans hos personer som lider av IPS. Sju arbetsterapeuter intervjuades för ändamålet. Materialet analyserades enligt kvalitativ innehållsanalys. Resultatet framhävde som resonemangets grunddrag att variera mellan teoribaser samt mellan att arbeta med synliga aktivitetsmönster och upplevd balans. Det reflekterar att arbetsterapeuters metoder och resonemang kan bidra till att skapa aktivitetsbalans. Nya insatser som mångsidigare inbegriper det sociala sammanhanget behövs Vidare forsnkning behövs om de arbetsterapeutiska insatsernas effekter för att stärka deras evidens. / People suffering from emotionally unstable personality disorder face various forms of occupational imbalance in their daily life. Occupational therapists strive to suppport occupational balance and thus increase the experience of satisfaction. Knowledge of how to support the experience of balance is yet insufficient. The aim of this study was to describe the reasoning of occupational therapists when working with people suffering from emotionally unstable personality disorder and supporting occupational balance. Seven occupational therapists were interviewed. Analyses were conducted using qualitative content analysis. Results emphasise that the reasoning is based upon combining different theoretical perspectives and varying between working with visible occupational patterns and individually experienced balance. This accentuates that the reasoning and methods of occupational therapists may contribute to create occupational balance. Broader methods considering also the social context are needed. Also, further studies evaluating the effects of already existing methods used in occupational therapy is needed to strengthen the evidence.