<p>Telefonrådgivning via en sjuksköterska har funnits ända sedan 1930-talet men det är först de senaste åren som denna kompetens har erkänts som en egen specialitet. Inom vården sker allt fler möten mellan vårdgivare och vårdsökande via telefonen vilket leder till att allt högre krav ställs på sjuksköterskans yrkeskunnighet. Studiens syfte var att beskriva vad sjuksköterskor upplever vid telefonrådgivning till personer med psykiska problem. Metoden som använts i denna litteraturstudie var kvalitativ innehållsanalys med manifest och latent ansats. Resultatet baseras på 10 vetenskapliga artiklar där fyra kategorier framkom: trygghet, utsatthet, ett känsligt öra samt meningsfullhet. I resultatet framkom att kunskap och klinisk erfarenhet är faktorer som har stor betydelse för yrkesrollen inom telefonrådgivning. Som rådgivningssjuksköterska inom psykiatrisk vård upplevde många en hög stressnivå vad gäller den komplexa yrkesrollen. Att inte se patienten med sina egna ögon upplevdes som att delvis arbeta i blindo. Detta ledde till att rådgivningssjuksköterskorna lyssnade aktivt för att försöka förstå vad som uttrycktes mellan raderna i samtalet med den vårdsökande. Ett etiskt dilemma som rådgivningssjuksköterskor beskriver är upplevelse av svårigheter att hantera andrahandsinformation vid telefonrådgivning. Dessa svårigheter uppkommer då rådgivningssjuksköterskan ej har möjlighet att tala direkt till den person som telefonråden gäller. För övrigt gavs uttryck för att arbetet som rådgivningssjuksköterska är stimulerande och utmanande</p>

<p> </p><p> </p><p> </p><p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p></p><p><p><strong><p>Abstract</p><strong><p>Aims:</p></strong><p> </p><p>To explore whether and in that case how nurses question women in the psychiatric care about violence in close relationships and how nurses respond to women who have been exposed to domestic violence.</p><strong><strong><p>Method:</p></strong><p> </p><p>A qualitative descriptive interview study with twelve nurses from four psychiatric wards was carried out in Uppsala. Informants were chosen from a convenient selection. The interviews with semi-structured interview questions were recorded on tape, transcribed and analyzed with content analysis.</p><strong><strong><p>Results:</p></strong><p> </p><p>There is no routine to ask all female patients if they are victims of violence. It happens only in cases where the suspicion arises or is confirmed. It is individually whether and how the nurse asks the woman if she is subjected to violence in a close relationship, depending on patient and nurse. Nurse handles the violence exposed woman by supporting her to share their experiences. Then consult and discuss with their nurse colleagues and other professionals for further follow-up and approach.</p><strong><strong><p>Conclusions:</p></strong><p> </p><p>The study has in accordance with previous research further highlighted the need for more education for nurses on how to handle women who are victims of violence in close relationships. More research should be done in Sweden to develop and implement standardized questionnaire for nurses in all health care.</p></strong></strong></strong></strong></p></p>

The aim of this thesis was to carry out an epidemiological study on mental health related issues in the Kurdish population of Iran. This part of Iran suffered directly during the Iran-Iraq war 1980-1988. Iran is an Islamic republic with strict adherence to Islamic traditions, which has implications for the way of life and gender issues. Suicide is prohibited according to Islamic teaching, but still there is a rather high suicide incidence especially among young women, who burn themselves to death. This thesis deals with mental health in general, the prevalence of post traumatic stress disorder and issues related to suicide. In a cross- sectional study in Sanandaj, the capital of the province of Iranian Kurdistan, 1000 households were approached. One member of each household was asked to respond to the following internationally well-known questionnaires; General Health Questionnaire (GHQ12), Posttraumatic Stress Disorder Checklist (PCL), Life Events Check List (LEC), Beck Depression Inventory (BDI-II) and Attitude Toward Suicide (ATTS). PCL and LEC were translated to Farsi and their psychometric properties were studied. The other instruments have already been translated and used by other researchers in Iran. About 27% of the subjects were found to suffer from mental distress according to GHQ-12. No gender differences were found. Unmarried and unemployed belong to the most afflicted. The participants in the investigation reported, not surprisingly, a low level of personal experiences of suicidal behaviour in their family. Females were more prone to believe that suicide is preventable compared to males. A low number reported suicide attempts during the last year. Being married seemed to have a protective effect against suicide attempts for males but not for females. Suicide behaviour was not substantially related to PTSD, but to severe depression. The idea that there is a continuity of suicidal behaviour from suicidal thoughts to suicide attempts was supported. Younger individuals more often reported thoughts of life weariness and those who reported suicide attempts were younger than individuals with no suicidal attempts. Females reported more death wishes than males during the last year and married women more often reported suicide attempts than men. The prevalence of posttraumatic stress disorder was 10, 9% which is higher than reported in other countries, but still lower than expected. Women suffered significantly more often from PTSD than men. Women reported also more often re-experiencing and more arousal symptoms than men. The finding supported a good construct validity of PCL. One major limitation of these studies is the fact that the sample was drawn from the population of the capital city of the province. So the finding cannot probably be generalized to Iranian Kurds from rural areas. The sample also had a rather high educational level compared to the population of Sanandaj. To this should be added the fact that the instruments used are developed in the western culture, which might influence the way questions are perceived. So, the result should be interpreted with some caution. The results, however, give indications that there are mental health problems of a magnitude that should be taken seriously.

The present study focuses on the phenomenology of the violent encounter, and is to be understood as the study of the violent encounter as a phenomenon, i.e. as experienced. The overall aim is to elucidate, analyse and describe violent encounters within psychiatric care as experienced by carers and patients. Moreover, the study aims at promoting the development of a phenomenological research approach in caring science in general and elucidating tacit caring knowledge in particular. The thesis includes three empirical studies and one methodological study. The research is guided by a phenomenological and lifeworld theoretical approach. Research data consist of narratives and qualitative interviews, as well as reenactment interviews with carers and patients. Data are analysed for meaning. The analysis and synthesis of meaning are aimed at openness and meaning sensitivity through a reflective attitude characterised by the intent to bridle the process of understanding. The goal of the analysis is to describe the general structure of the phenomenon and its meaning constituents. The result shows that violence and threat do not evolve in “naked” caring, characterised by encounters where carers are able to touch their patients at the same time as being touched, speaking both literally and figuratively. It is through “naked” caring and caring touch that the carers are able to reach the patients and to give undisguised invitations to genuine presence. The possibilities of touch rely on the carers’ capacity to be authentic and to genuinely wish well. Violence is on the contrary nourished by touch without caring intention, or non-touch, i.e. caring where the reciprocity of touching and being touched is missing between patients and caregivers. In the discussion, the different meanings of the violent encounter are related to the philosophy of Merleau-Ponty and Lévinas. The philosophical dimensions of touch are investigated and it is discussed how the “naked” encounter can be understood from a phenomenological ethical standpoint. The discussion focuses on the caregivers’ vulnerability and the high demands they are subjected to. It is also argued that a foundation of caring science is needed in caring practice in order to make possible a development of a caring attitude that prevents violence.

Telefonrådgivning via en sjuksköterska har funnits ända sedan 1930-talet men det är först de senaste åren som denna kompetens har erkänts som en egen specialitet. Inom vården sker allt fler möten mellan vårdgivare och vårdsökande via telefonen vilket leder till att allt högre krav ställs på sjuksköterskans yrkeskunnighet. Studiens syfte var att beskriva vad sjuksköterskor upplever vid telefonrådgivning till personer med psykiska problem. Metoden som använts i denna litteraturstudie var kvalitativ innehållsanalys med manifest och latent ansats. Resultatet baseras på 10 vetenskapliga artiklar där fyra kategorier framkom: trygghet, utsatthet, ett känsligt öra samt meningsfullhet. I resultatet framkom att kunskap och klinisk erfarenhet är faktorer som har stor betydelse för yrkesrollen inom telefonrådgivning. Som rådgivningssjuksköterska inom psykiatrisk vård upplevde många en hög stressnivå vad gäller den komplexa yrkesrollen. Att inte se patienten med sina egna ögon upplevdes som att delvis arbeta i blindo. Detta ledde till att rådgivningssjuksköterskorna lyssnade aktivt för att försöka förstå vad som uttrycktes mellan raderna i samtalet med den vårdsökande. Ett etiskt dilemma som rådgivningssjuksköterskor beskriver är upplevelse av svårigheter att hantera andrahandsinformation vid telefonrådgivning. Dessa svårigheter uppkommer då rådgivningssjuksköterskan ej har möjlighet att tala direkt till den person som telefonråden gäller. För övrigt gavs uttryck för att arbetet som rådgivningssjuksköterska är stimulerande och utmanande

Abstract Aims:   To explore whether and in that case how nurses question women in the psychiatric care about violence in close relationships and how nurses respond to women who have been exposed to domestic violence. Method:   A qualitative descriptive interview study with twelve nurses from four psychiatric wards was carried out in Uppsala. Informants were chosen from a convenient selection. The interviews with semi-structured interview questions were recorded on tape, transcribed and analyzed with content analysis. Results:   There is no routine to ask all female patients if they are victims of violence. It happens only in cases where the suspicion arises or is confirmed. It is individually whether and how the nurse asks the woman if she is subjected to violence in a close relationship, depending on patient and nurse. Nurse handles the violence exposed woman by supporting her to share their experiences. Then consult and discuss with their nurse colleagues and other professionals for further follow-up and approach. Conclusions:   The study has in accordance with previous research further highlighted the need for more education for nurses on how to handle women who are victims of violence in close relationships. More research should be done in Sweden to develop and implement standardized questionnaire for nurses in all health care.

Background: The need for structured practice has in recent years appeared in connection with the request for a more evidence-based nursing. In psychiatric care with its complex disabilities, it is important to have methods to identify these. Research has demonstrated the importance of patient participation in nursing that has been shown to affect their mental health. It is essential to get to know how patients with mental illness are capable of involvement in their life situation. The ICF emerged as a useful theoretical framework for development of questionnaires of patient participation. Aim: The aim of the present pilotstudy was to develop and test a questionnaire for participation, based on ICF. Method: This pilotstudy had a quantitative approach and was based on a draft for the purpose described. For the development process two expertgroups were used, one consisted of nurses with experience of ICF and one by former patients recruited from psychiatric patient organizations to discuss participation and item selection. The final questionnaire was answered by 29 nurses, who also could comment on the content in three open questions used for face validity. Cronbach´s alpha was used to calculate internal consistency. The final goal is to develop a concept of two questionnaires for participation. One that will be answered by nurses and another part based on patients self-assessment. During this pilotstudy, the nurse`s part was focused. Result: The result indicated good internal consistency both in the whole Assessment of Participation in Psychiatric care (APP) (0.900) and for each item (0.892-0.904). We also found indication for good face validity.  The result of this pilot study can be useful for further research and development.

Introduktion: Att någon gång drabbas av psykisk ohälsa blir allt vanligare, därför är betydelsen av forskning inom området stor. Sjuksköterskor med sin specifika omvårdnadskompetens utgör den största personalgruppen inom psykiatrisk öppenvård men sjuksköterskans roll inom psykiatrisk öppenvård är begränsat beskriven i vetenskaplig litteratur. Detta innefattar aspekter kring sjuksköterskans egen roll samt i relation till andra yrkesgrupper inom psykiatrisk öppenvård. Syfte: Att beskriva sjuksköterskans upplevelse av sin egen roll inom psykiatrisk öppenvård samt upplevelsen av interaktionen med andra yrkesgrupper i sitt arbete. Metod: Studien var en deskriptiv intervjustudie med kvalitativ ansats. Sju sjuksköterskor arbetandes i psykiatrisk öppenvård inkluderades i studien. Data insamlades genom semistrukturerade intervjuer och analyserades sedan med kvalitativ innehållsanalys. Resultat: Sammanlagt skapades 25 kategorier: positiva respektive negativa aspekter i arbetet som sjuksköterska inom öppenpsykiatri, samarbete mellan de olika yrkeskategorierna i teamet, bemötande och uppskattning för sjuksköterskans kompetens samt sjuksköterskans bidragande kompetens i vården av patienten. Slutsats: Sjuksköterskans upplevelse inom psykiatrisk öppenvård är komplex och visar bland annat på känslor av hög arbetsbelastning, en odefinierad roll i interprofessionellt samarbete samt både undervärdering och uppskattning för sin kompetens. Uttryck för ett bidragande omvårdnadsperspektiv samt en bredare syn på patienten i vården visar dock på tydliga uppfattningar om sin kompetens som sjuksköterska. Allt detta är relaterat till flera faktorer såsom organisation, arbetskollegor samt den egna uppfattningen om sin yrkesroll i arbetet. / Introduction: At some point suffer from mental illness is becoming more common, therefore, research in the field is of great importance. Nurses with their specific nursing skills form the largest staff group in psychiatric outpatient care, but the nurse's role in psychiatric outpatient care is limited as described in scientific literature. This includes aspects of the nurse's own role and in relation to other professions in psychiatric outpatient care. Aim: To describe the nurse's perception of their role in psychiatric outpatient care, and the experience of interaction with other professionals in their work. Method: The study was a qualitative, descriptive interview study. Seven nurses working in psychiatric outpatient care were enrolled in the study. Data were collected through semi-structured interviews and analyzed with qualitative content analysis. Results: A total of 25 categories concerning positive and negative aspects of work as a nurse in outpatient psychiatric care, collaboration between the professions in the team, treatment and appreciation to the nurse's competence and nurses contributory expertise in caring of the patient were created. Conclusion: Nurse's experiences in psychiatric outpatient care are complex and show feelings of heavy workload, an undefined role in inter-professional collaboration and both under-valuation and appreciation of their skills. Though, expression of a contributory caring perspective and a broader view of the patient show views oft the nurse's competence. All this can be related to several factors such as organization, work colleagues and their own perception of their professional role in their work.

Det saknas studier hur handledarna upplever handledning på avancerad nivå inom psykiatrisk omvårdnad. Rollen handledarna har är komplex, de ska både fungera som en mentor och som den som bedömer studenternas prestationer samt ge god vård åt patienten. Syftet med denna studie är att belysa hur handledning upplevs av den handledande sjuksköterskan under Verksamhetsförlagd utbildning (VFU) för specialistsjuksköterskor i psykiatri. Att få kunskapen studien genererar skapar förutsättningar för organisationen och universitetet att anpassa utbildning och återkoppling som gynnar handledarna och studenternas utveckling samt höjer vårdkvaliteten för patienterna. En explorativ kvalitativ ansats enligt fokusgruppsintervjuer har ansetts lämplig för studien då målet är att fånga vidden och komplexiteten i handledning. När deltagarna dras med i diskussionen skapas ett reflekterade klimat som på ett omfattande sätt belyser individens upplevelser, tankar och känslor. Studien kommer att utföras inom psykiatriska kliniken på Länssjukhuset Ryhov efter tillstånd från etisk kommitté.

The prevalence of psychiatric symptoms in next-of-kin (NOK) of intensive care unit (ICU) patients has been reported at higher than 70% when screening is performed using the Hospital Anxiety and Depression Scale (HADS). The primary purpose of this study was to assess the ability of the HADS to predict psychiatric illness, diagnosed with the aide of a validated tool, the Structured Clinical Interview for DSM-IV (SCID). In addition, we asked NOK to rate aspects of the ICU experience to determine possible associations with psychiatric diagnosis. Thirty-four NOK were enrolled in this study from July 2006 to November 2006. Subjects were interviewed to gather demographic information, their perception of the ICU experience, and to administer the SCID and the HADS. At least 6 months later, subjects were contacted by telephone to determine presence of psychiatric morbidity after the ICU experience. Fifty-six percent of all NOK experienced symptoms of either anxiety or depression during the ICU admission and 24% had psychiatric illness. The HADS had 100% sensitivity and 58% specificity when used as a screening tool for psychiatric diagnosis. Those with any SCID diagnosis were more likely to be a spouse (50% vs. 9%, p = 0.013) or a primary caregiver (60% vs. 8%, p = 0.003). Most NOK identified the healthcare team as supportive, though a subgroup of NOK who slept in the ICU reported that they found the healthcare team less supportive. This small study suggests the HADS is able to predict psychiatric illness in NOK of ICU patients. The ability to implement this tool as part of clinical practice to better meet the needs of families in the ICU warrants further investigation.