Hintergrund: Die Psychotherapierichtlinien ermöglichen erst seit 2011 unter bestimmten Bedingungen eine ambulante psychotherapeutische Behandlung bei Substanzstörungen. Empirische Ergebnisse zu diagnostischen Charakteristika der auf dieser Grundlage behandelten Patienten und zu Erfolgsraten fehlen weitgehend. Methoden: Wir untersuchten N = 59 konsekutive Patienten einer Spezialambulanz, von denen n = 34 eine Behandlung begannen (Intent-to-Treat(ITT)-Stichprobe) und n = 28 sie abschlossen (Completer), mit standardisierten diagnostischen Interviews und ermittelten die Erfolgsraten nach ambulanter Kognitiver Verhaltenstherapie (Einzeltherapie) auf der Basis von Symptomskalen (Brief Symptom Inventory (BSI); Beck Depression Inventory (BDI)) sowie Patienten- und Therapeuten-Ratings, einschließlich einer klinischen Beurteilung der Abstinenz. Ergebnisse: 40% aller anfragenden Patienten nahmen keine Psychotherapie auf. Bei den behandelten Patienten kam es zu signifikanten Veränderungen (ITTAnalysen: d = 0,8 (BSI) bis d = 1,2 (BDI)). Mehr als zwei Drittel der Patienten erreichten eine klinisch relevante Verbesserung der Symptomatik gemäß Patienten- oder Therapeutenbeurteilungen (zwischen 68 und 76%, ITTStichprobe). Alle Completer mit Abhängigkeitssyndrom (n = 11) sowie 86% der diesbezüglichen ITT-Stichprobe erreichten zumindest unter der Behandlung eine Abstinenz. Schlussfolgerungen: Die Erfolgsraten bei Patienten, die die Therapie abschließen, sind gut. Sie sprechen für den Nutzen des ambulanten Settings. / Effectiveness of Outpatient Cognitive-Behavioral Therapy for Substance Use Disorders – Evaluation of a Specialized Outpatient Clinic Background/Aim: Given a number of conditions, the revision of the German psychotherapy guidelines in 2011 facilitates treating substance use disorders in outpatient psychotherapy. Empirical results on the diagnostic characteristics of the patients treated within this setting and about the effectiveness of the treatment are lacking. Material and Methods: We examined N = 59 consecutive patients, diagnosed with standardized diagnostic interviews, of a specialized outpatient clinic for cognitivebehavioral therapy. Of these, n = 34 started the treatment (intent-to-treat (ITT) sample) and n = 28 completed it. The outcome (including clinical judgement of abstinence) was assessed with established symptom scales (Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI)) as well as therapist and patient ratings. Results: About 40% of the patients who contacted the clinic did not start the therapy. In therapy completers, clinically relevant improvement was reached. Based on ITT analyses, effect sizes ranged from d = 0.8 (BSI) to d = 1.2 (BDI). Based on therapist and patient ratings, the percentage of successful therapies was high (between 68 and 76%, ITT analyses). All therapy completers diagnosed with a dependence syndrome reached abstinence at least temporarily. Conclusion: Effectiveness rates are high in completers. These results show that treatment can be efficient in an outpatient setting.

Ziel der im Oktober 2015 in der Tagesklinik für Psychiatrie und Psychotherapie Görlitz durchgeführten prospektive Katamnesestudie war es, den Übergang der Patienten/innen von der Therapie in den Alltag, evtl. Unterstützungsbedarfe sowie mögliche Schnittstellenprobleme zu evaluieren. Dies geschah zum einem vor dem Hintergrund des Entlassungsmanagements als Aufgabe des Sozialdienstes und zum anderen mit Blick auf die sich verändernde Versorgungs- und Finanzierungsstruktur durch den Paradigmenwechsel im deutschen Gesundheitswesen sowie in Psychiatrie und Psychosomatik. Hierfür konnten 37 Studienteilneh-mer/innen, bis zu 21 Monate nach ihrer Behandlung, für die Erhebung gewonnen werden. Die Ergebnisse der Studie liefern Hinweise über die Zufriedenheit mit der Behandlung, zur Bewältigung des Übergangs und filterten darüber hinaus weitere Bedarfe der Patienten/innen. Ein überwiegender Teil der Studienpopulation (71%) war ‚sehr zufrieden’ oder ‚zufrieden’ mit der Behandlung und der Mehrheit der Patienten/innen gelang darüber hinaus der Übergang aus der Therapie zurück in den Alltag ‚gut’ (62,16 %). Obwohl die Mehrzahl der Patienten/innen den Übergang von der Therapie zurück in den Alltag ‚gut’ bewältigt haben, konnten spezifische Prädiktoren des Übergangs aus den Ergebnissen gefiltert werden, welche diesen positiv und negativ beeinflussen. Positive Prädiktoren sind die allgemeine Zufriedenheit mit der Behandlung und im speziellen die Zufriedenheit mit dem Sozialdienst und den Psychologen/innen und Psychiater/innen. Darüber hinaus gelang den Patienten/innen der Übergang gut, welche den Entlassungszeitpunkt als ‚genau richtig’ empfanden. Des Weiteren konnte ein positiver Zusammenhang zwischen der weiteren Einnahme von den in der Tagesklinik verschriebenen Medikamenten und der aktuellen Lebensqualität festgestellt werden. Obwohl viele Patienten/innen (83,78 %) weiter Unterstützungsangebote nach der Entlassung wahrnahmen, wünscht sich ein Großteil (67,57) bereits während der Therapie eine Vermittlung und Begleitung zu anderen, externen Hilfsangeboten oder weitere Beratungsgespräche durch den Sozialdienst (45,95 %). Aus diesem Grund wurden über die Forschung hinaus Optionen einer effektiven und an den Bedürfnissen der Patienten/innen ausgerichteten Entlassungsplanung durch den Sozialdienst diskutiert und spezifische Kooperationsempfehlungen ausgesprochen.

No description available.

Bakgrund: Patienter med psykisk ohälsa har en högre överdödlighet i fysiska sjukdomar jämfört med populationen i stort. Dessa individer drabbas oftare av somatiska problem då denna patientgrupp har en sjukdomsbörda som är förknippad med en större förekomst av primära beteendemässiga risker för kronisk sjukdom förorsakade av levnadsvanor och livsstil. Syfte: Syftet med studien var att belysa specialistsjuksköterskors erfarenheter av att stödja hälsofrämjande livsstilsförändringar hos patienter i psykiatrisk öppenvård. Metod: Kvalitativ metod med induktiv ansats har använts. Datamaterialet har analyserats med kvalitativ innehållsanalys. Psykiatrisjuksköterskor inom vuxenpsykiatrisk öppenvård har intervjuats i Region Skåne. Nio stycken semistrukturerade intervjuer har genomförts. Resultat: Resultaten visar på följande kategorier: vikten av en bärande relation, betydelsen av kompetens och resurser samt nödvändigheten av riktlinjer och verktyg. Slutsats: Genom att bygga en allians och skapa en mellanmänsklig relation med patienten utformas strategier för motivation till livsstilsförändringar där patientens egna resurser främjas. Från sjuksköterskornas sida efterfrågas det ett mer strukturerat arbetssätt för att säkerhetsställa patientens rättighet till likvärdig vård bland annat genom att arbeta fram ett gemensamt verktyg för det hälsofrämjande arbetet gällande livsstilsförändringar. / Background: Patients with mental illness have a higher mortality rate from physical illnesses compared to the general population. These individuals are more likely to suffer from somatic problems as this patient group has a disease burden that is associated with a greater incidence of primary behavioral risks of chronic disease caused by poor lifestyle. Aim: The aim of this study was to shed light the master level mental health nurse's experiences of supporting health-promoting lifestyle changes for patients in psychiatric outpatient services. Method: Qualitative method with inductive approach has been used. The data material has been analyzed with qualitative content analysis. Psychiatric nurses in adult psychiatric outpatient care have been interviewed in Region Skåne. Nine semi-structured interviews were conducted. Results: The results show the following categories: the importance of a core relationship, the importance of skills and resources and the necessity ofguidelines and tools. Conclusion: By building an alliance and creating an interpersonal relationship with the patient shapes strategies for motivation for lifestyle changes where the patient's own resources are promoted. The nurses demand a more structured way of working to ensure the patient's right to equal care, among other things by working out a common tool for the health-promoting work regarding lifestyle changes.

Background: Parents have both a right and an obligation to decide in matters concerning children. At the same time, children have been given a stronger position in healthcare (settings). Research shows low agreement regarding children's and parents' attitudes to children's symptoms and treatment goals. The disagreement has importance for treatment outcomes and prognosis, as well as requiring adaption and strategies from the nurse. Purpose: The aim of the study was to describe nurses experience of nursing in the event of disagreement between children and parents in child and adolescent outpatient mental health care. Method: A qualitative method with an inductive approach was used. Eleven semi-structured interviews were conducted and data was analyzed based on qualitative content analysis. Results: The results are summarized in three categories: Balancing between children and parents 'perspectives, willingness to consider the child's perspective and willingness to consider parents' perspectives. Conclusion: Nurses described that it was a challenge to act so that both children and parents' needs were satisfied. They wanted to take the child's perspective and at the same time wanted to maintain a good relationship with the parents. Depending on the situation, the nurse alternated between acting as a representative for either the parents or children. Lack of strategies to handle disagreement led to feelings of frustration and incompetence. / Bakgrund: Föräldrar har både en rättighet och skyldighet att bestämma i frågor somrör barn. Samtidigt har barn och ungdomar fått en starkare ställning i vården.Forskning visar låg överensstämmelse avseende barns och föräldrars inställning tillbarnens symtom och behandlingsmål. Oenigheten har i sig betydelse förbehandlingsutfall och prognos och kräver anpassning och strategier frånsjuksköterskan. Syfte: Syftet var att belysa sjuksköterskors erfarenheter avomvårdnad vid oenighet mellan barn och vårdnadshavare inom barn- ochungdomspsykiatrisk öppenvård. Metod: Studien genomfördes med kvalitativ metodoch en induktiv ansats. Elva semistrukturerade intervjuer genomfördes och dataanalyserades utifrån kvalitativ innehållsanalys. Resultat: Resultatet sammanfattas itre kategorier: Balansera mellan barn och föräldrars perspektiv, en vilja att beaktabarnets perspektiv samt en vilja att beakta föräldrars perspektiv. Slutsats:Sjuksköterskor beskrev att det var en utmaning att agera så att både barn ochföräldrars behov tillgodosågs då de å ena sidan var måna om att ta barnets perspektivoch samtidigt ville behålla en god relation till föräldrarna. Beroende på situationpendlade sjuksköterskan mellan att agera ombud för antingen föräldrar ochbarn. Avsaknad av strategier att bemöta oenighet gav upphov till känslor avfrustration och maktlöshet.

Background: Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes. Methods: In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female. Results: Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB. Conclusions: Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

The subject of this diploma thesis is the elaboration of project documentation for the construction of a civic amenity building for outpatient care, with associated establishments, namely a pharmacy and a café. The building is designed on a plot of land located in the center of the town of Chotěboř in the Havlíčkův Brod district. The polyclinic is designed as a partially basement, free-standing rectangular building with overhanging entrances to individual establishments. The outpatient department has three floors. Underground vertical structures are designed as reinforced concrete walls, above-ground peripheral and internal load-bearing masonry is made of ceramic blocks, ceiling structures are made of prestressed panels. A double-reinforced concrete monolithic staircase and an elevator are designed in the building. Non-load-bearing internal structures are solved using plasterboard structures and the whole building is covered with a single-skin flat vegetation roof.

No description available.

Bakgrund: Lungemboli är den allvarligaste diagnosen av venös tromboembolism. Poliklinisk behandling istället för traditionell slutenvård kan erbjudas för patienter med LE som inte löper risk för plötslig död och allvarliga komplikationer. Men poliklinisk behandlingsmodell kräver att korrekt medicinsk behandling i hemmet och korrekt medicinsk uppföljning kan säkerställas. Det saknas dock kunskap avseende sjuksköterskor och läkares erfarenheter av polikliniskt omhändertagande av patienter med lungemboli. Syfte: Syftet var att belysa sjuksköterskors och läkares erfarenheter av polikliniskt omhändertagande av patienter med lungemboli Metod: En kvalitativ studie med 12 semistrukturerade intervjuer som analyserades induktivt enligt innehållsanalys.  Resultat: Utifrån analysen av intervjuerna framkom att det strukturerade omhändertagandet ledde till en känsla av kompetens där man kände att man kunde erbjuda denna patientgrupp en god och säker vård. Dessutom var det angeläget att arbeta på ett personcentrerat sätt med hänsyn till de individuella egenskaper och förutsättningar patienter hade och ha förmåga att bemöta deras oro och funderingar med respekt och empati. En viktig del utgjorde även insatser för att främja hos patienter delaktighet i egenvård. Slutsats: Sjuksköterskors och läkares erfarenheter tyder på att en välfungerande poliklinisk struktur skapar förutsättningar för en god och säker vård.  Enligt sjuksköterskor och läkare ligger fokus i möten med polikliniska patienter inte enbart på den medicinska behandlingen utan även på fysiska och psykiska påfrestningar som LE har orsakat. / Background: Pulmonary embolism is the most serious diagnosis of venous thromboembolism. Outpatient treatment instead of traditional inpatient care can be offered for patients with LE who are not at risk of sudden death and serious complications. But the outpatient treatment model requires that proper medical treatment at home and proper medical follow-up can be ensured. However, knowledge regarding nurses’ and physicians’ experiences of outpatient care is lacking of outpatient care for patients with pulmonary embolism.Purpose:The purpose was to illuminate nurses’ and physicians’ experiences of outpatient care of patients with pulmonary embolism.  Method: A qualitative study with 12 semi-structured interviews analysed inductively according to content analysis.  Results: Based on the analyse of the interviews it emerged that the structured outpatient care led to a feeling of competence to be able to offer this patient group good and safe care. In addition, it was important to work in a person-centered way, taking into account the individual characteristics and conditions patients had and to be able to respond to their concerns and questions with respect and empathy. Efforts to promote patients' involvement in self-care also constituted an important part.Conclusion:  The experiences of nurses and physicians indicate that a well-functioning outpatient structure creates the conditions for good and safe care. According to nurses and physicians, the focus in meetings with outpatients is not only on the medical treatment but also on the physical and psychological strains that LE has caused.

Introduction: Family-focused cognitive behavioural therapy (FFCBT) is emphasized as an approach to optimize treatment outcomes for early-onset obsessive-compulsive disorder (OCD). Parental engagement is critical to successful treatment. However, few studies have examined how to promote parental engagement during FFCBT. Additionally, from a parental perspective, there is a limited understanding of factors that influence parental engagement throughout treatment, including the role of nurses. Aims: To determine (i) how parents experience and understand their engagement in FFCBT provided for their child with early-onset OCD in community or outpatient mental health programs, and (ii) how parents describe the role of nurses related to parental engagement during the treatment process. Methods: This study used an interpretive description approach. Semi-structured interviews were completed with parents (n = 17) recruited from community or outpatient children’s mental health programs in the Hamilton Region of Southwestern Ontario. Treatment provider interviews (n = 9) augmented the data collected from parents’ perceptions of their engagement and the role of nurses during FFCBT. Interviews were analyzed using Braun and Clark’s (2006) thematic analysis process. Results: A conceptualized model was constructed to display and communicate the individual, interpersonal, and contextual influences identified by parents and treatment providers. These influences facilitated or inhibited parental engagement during treatment across distinct phases, levels, and stages of engagement. Six distinct nursing roles were identified that promoted parental engagement throughout treatment. / Dissertation / Doctor of Philosophy (PhD) / Without effective treatment, pediatric obsessive-compulsive disorder (OCD) can interfere with childhood development. Early-onset OCD is a unique subtype of the disorder involving pediatric patients with symptoms that present before the age of 10 years. Family-focused cognitive behavioural therapy (FFCBT) emphasizing parental involvement is commonly used to treat pediatric OCD. However, parental engagement during FFCBT, including nurses’ roles, is poorly understood. This study aimed to increase knowledge about parental engagement during FFCBT for children with early-onset OCD receiving treatment in community programs. Data analysis of parent and treatment provider interviews identified various factors and how nurses influenced parental engagement during FFCBT. A model was made to display how these factors helped or hindered parental engagement during treatment and how nurses promoted engagement across three distinct phases. This new knowledge informed recommendations to promote parental engagement for treatment providers, improve service development and delivery, and strengthen nursing education.