Bakgrund: All vård och behandling bör tillämpas med respekt för patientens autonomi och integritet. Patienter med en allvarlig psykisk störning tvångsvårdas efter stöd av lagen om psykiatrisk tvångsvård. Tvångsvård kan begränsa patienters delaktighet och självbestämmande då de inte längre kan vara lika självständiga. Detta kan då leda till en maktposition och ett stort ansvar för vårdpersonalen. Tvångsvård kan även skapa ett lidande för patienterna. Syfte: Syftet med litteraturöversikten var att beskriva patienters upplevelser av tvångsvård. Metod: Litteraturöversikt enligt Friberg innebär att relevanta artiklar har sökts och hittats. De sökorden som valts är: coercive treatment, coercive care, coercive measures, compulsory treatment, psychiatric care, involuntary treatment, experiences, qualitative, forensic care, coercion och patient. Nio artiklar har använts. Artiklarna hämtades från databaserna CINAHL Complete, PubMed och PsycINFO. Resultat: Patienterna upplevde tvångsvård som både positivt och negativt. Patienterna beskrev att upplevelsen av tvångsvård berodde på vårdpersonalens bemötande mot patienterna. Patienterna upplevde att tvångsvården var som att förlora autonomin och integriteten, att det var brist på information, att de blev/inte blev värdigt bemötta och att det var brist på respekt från vårdpersonalen. Diskussion: I diskussionen lyfts Phil Barkers teori om tidvattenmodellen då den användes som teoretisk utgångspunkt. Barkers beskriver att sjuksköterskans uppgift är att öka patientens delaktighet och återhämtning samt förbereda de till att bli självständiga individer i samhället. Resultatet till litteraturöversikten visade att patienterna upplevde tvångsvård som en kränkning mot deras autonomi. Detta stämmer överens med Barkers teori där det är viktigt att respektera patienters behov och önskningar för att förstärka autonomin. / Background: All care and treatment should be applied in accordance with the patient's autonomy and integrity. Patients with a serious mental disorder are forced to receive compulsion under the law on psychiatric care. Involuntary treatment can limit patients' involvement and autonomy as they can no longer be as independent. This can then lead to a position of power and a major responsibility for healthcare professionals. Involuntary treatment can also lead to suffering for patients. Aim: The aim of this study was to describe patients’ experiences of involuntary treatment. Method: Literature review according to Friberg which means that relevant articles have been sought and found. The keywords chosen are: coercive treatment, coercive care, coercive measures, compulsory treatment, psychiatric care, involuntary treatment, experiences, qualitative, forensic care, coercion and patient. Nine qualitative studies have been used. The studies retrieved from databases as CINAHL Complete, PubMed and PsycINFO. Results: Patients experienced compulsive care as both positive and negative. Patients described that the perception of compulsive care was due to the care staff's response to patients. Patients felt that involuntary treatment was like losing their own autonomy and integrity, it was lack of information and they experienced not being enough dignified. Patients also experienced lack of respect from the healthcare professionals. Discussion: Phil Barker's theory about the tidal model was used as a theoretical frame of reference. Barker describes that nurse's task is to increase patient participation and recovery and prepare them to become independent individuals in society. The result of the literature review showed that some patients experienced involuntary treatment as a violation of their autonomy. This is in line with Barker's theory where it is important to respect the needs and desires of patients to increase their autonomy.

A reforma psiquiátrica possibilitou transformações na assistência à saúde mental e o acompanhamento terapêutico (AT), como modalidade de assistência e reabilitação psicossocial do portador de transtorno mental, faz parte dessas transformações. Desde então, o acompanhante terapêutico vem ampliando seus conceitos e fundamentando suas bases teóricas, sendo sua prática cada vez mais aceita por diferentes profissionais e valorizada por preencher as lacunas deixadas pelos tratamentos psiquiátricos tradicionais, principalmente depois que as portas dos manicômios, que enclausuravam o referido portador de transtorno mental e as maneiras adequadas de assisti-lo e reabilitá-lo, foram definitivamente abertas. O objetivo do presente estudo foi investigar a contribuição do AT no processo de assistência e reabilitação psicossocial de um portador de transtorno mental assistido em um Centro de Atenção Psicossocial e escolhido com a ajuda de sua equipe multiprofissional. Para isso, foram estabelecidos 16 encontros de AT, os quais foram desenvolvidos em diferentes locais, observados, e seus conteúdos registrados após cada encontro, sintetizados e analisados, segundo o método qualitativo. Os resultados mostraram contribuição muito positiva do AT na assistência e reabilitação psicossocial do portador de transtorno mental, tais como: resgate de sua autoestima; retomada de realização de atividades que fazia anteriormente ao início dos sintomas de seu transtorno mental; motivação para novamente buscar o lazer e conviver de forma mais saudável no seu meio familiar e social; criação de momentos de confronto de seu estado mental com a realidade, possibilitando modificações no comportamento e melhoria da qualidade de vida. Assim sendo, foi possível considerar que o AT constitui-se em mais uma modalidade terapêutica contribuindo para a assistência e reabilitação psicossocial do portador de transtorno mental e pode ser incluído nos planos terapêuticos dos serviços de assistência à saúde mental, pois se trata de modalidade terapêutica não tradicional, totalmente inserida no contexto da reforma psiquiátrica, que tem como princípio básico a mudança no foco da assistência aos portadores de transtornos mentais. / The psychiatric reform made it possible for transformations to take place in mental health care and therapeutic continuity (TC), as a health care modality and psychosocial rehabilitation of individuals with mental disorders. Since then, therapeutic continuity has broadened its concepts and founded its theoretical bases. Hence, its practice has become increasingly acknowledged by different professionals and valued for the fact it fills the gaps that were left from traditional psychiatric treatments, mainly after the doors to asylums, which used to keep mentally ill individuals cloistered, were completely open and appropriate forms of looking after these patients and rehabilitate them were implemented. The purpose of the present study was to investigate the contribution of TC over the health care process and psychosocial rehabilitation of an individual with mental disorders seen at a Psychosocial Care Center, and chosen with the help of its multiprofessional team. To do this, 16 TC appointments were scheduled, which were carried out at different locations. These meetings were observed and their contents were recorded, summarized, and analyzed according to the qualitative method. The results showed that TC has a very positive contribution in the health care and psychosocial rehabilitation of mental disorder patients, with actions such as: recovering selfesteem, going back to activities the patient did before his mental disorder symptoms appeared, motivation to once again become involved in leisure activities and lead a healthier life among his family and social environment, creating moments of confrontation between his mental condition and reality, which made it possible to change his behavior and improve his quality of life. Thus, it is understood that TC is another therapeutic modality that contributes with the psychosocial rehabilitation of patients with mental disorders. Furthermore, it can be included in the therapeutic plans of mental health care services, since it is a untraditional therapeutic modality totally inserted in the context of psychiatric reform, whose main principle is to change the focus of health care services to individuals with mental disorders.

Bakgrund: Flera tusen personer vårdas varje år enligt lagen om psykiatrisk tvångsvård (LPT). Tvångsvård får endast utföras om patienten lider av allvarligpsykisk störning, motsätter sig vård och har ett oundvikligt behov av vårdsom endast kan tillgodoses på en sluten psykiatrisk avdelning. Patientersom lider av allvarliga psykotiska tillstånd, depressioner med suicidtankareller har andra allvarliga psykiska funktionsnedsättningar kan vara i behov av tvångsvård. Syfte: Att beskriva vuxna patienters upplevelser av psykiatrisk tvångsvård. Metod: Litteraturöversikt av 12 kvalitativa studier publicerade mellan år 2001–2015 är hämtade från databaserna CINAHL Complete, PubMed och psycINFO. Artiklarna analyserades sedan i enlighet med Fribergsmetodbeskrivning (2012) för att identifiera likheter och skillnader och kategoriserades slutligen i fem teman vilka var; Att bli informerad, Att varadelaktig, Att bli sedd och respekterad som människa, Att behålla integritetoch autonomi, Den egna synen på tvångsvård som behandling. Resultat: Patienter upplevde brist på information och delaktighet i sin vård.Upplevelser av vårdpersonal som utnyttjade sin maktposition, var ignorantoch visade en brist på kompetens. Patienterna uppgav en viss ambivalensgällande om tvångsvården hade varit nödvändig eller inte. Diskussion: Metoddiskussionen koncentreras runt styrkor och svagheter i urvalet avartiklar samt till tematiseringsprocessen. I resultatdiskussion så diskuteraspatienternas upplevelser av sjuksköterskans omvårdnad och bemötande.Vidare diskuteras vad som kan påverka dessa variabler och på vilket sätt dessa påverkar patienten. Detta anknyts till Erikssons (1994) teori omlidande. / Background: Several thousands of people are treated each year in accordance to the Swedish law regarding compulsory psychiatric care, lag om psykiatrisktvångsvård (LPT). Compulsory psychiatric care can only be applied if thepatient is suffering from a severe psychiatric condition, is opposing careand has an unavoidable need of care that only can be given in a lockedpsychiatric ward. Patients’ suffering from severe psychotic conditions,depressions with suicidal thoughts or other severe psychiatric disabilitiesmay be in need of coercive care. Aim: To describe adult patients’ experiences of compulsory psychiatric care. Method: Literature review of 12 qualitative studies published between the years of2001–2015 and was gathered from databases CINAHL Complete, PubMed and psycINFO. The studies were analyzed in accordance with Friberg’s description of method (2012) to identify similarities anddifferences and the data was then categorized into five different themeswhich were; To be informed, To be participating, To be seen andrespected as a human being, To keep ones integrity and autonomy, Theown view on compulsory psychiatric care as treatment. Results: Patients experienced a lack of information and a lack of involvement intheir own care. Experiences of staff abusing their position of powertowards the patients, acting ignorant and showing a lack of competence.Patients were ambivalent towards the necessity of coercive care. Discussion: The strengths and weaknesses of the method is discussed and thediscussion is mainly centred around the sampling of articles and the thematization process. The patients' experiences of nursing activities andtreatment are discussed. Furthermore, what could have an impact ontheese variables and what impact theese variables might have on thepatients is discussed. This is discussed in relation to Eriksson’s (1994) theory on suffering from care.

Bakgrund: Inom psykiatrisk vård är det viktigt att respektera patientens personliga förväntningar och mål för att uppnå goda behandlingsresultat och för att patienterna ska känna sig tillfreds med den vård de erhåller. Sjuksköterskan bör underlätta för patienter att kommunicera om sina besvär, stödja patienten att analysera destruktivt beteende, stödja patienten att skapa en normal daglig livsföring samt främja patientens integritet och egenvård. Trots detta upplever inte patienterna att detta uppfylls alla gånger. Syfte: Syftet med denna litteraturöversikt var att undersöka patienter med psykisk ohälsa med fokus på deras upplevelser av vården på psykiatriska vårdavdelningar.  Metod: I denna litteraturöversikt har författarna använt tio vetenskapliga artiklar för att besvara syftet. Dessa har granskats för att förstå skillnader och likheter och sedan delats in i teman. Resultat: Tre teman och tre underteman påvisades i denna litteraturöversikt. Ett tema var patienters upplevelser av att bli eller inte bli behandlad med respekt med undertemana patienters upplevelser av stigmatisering samt patienters upplevelser av vårdande miljö. Det andra temat var upplevelser av personalens förhållningssätt med undertemat patienters upplevelser av vårdande relationer. Det tredje och sista temat var patienters upplevelser av trygghet. Diskussion: I diskussionen diskuterar författarna patienters upplevelser på psykiatriska vårdavdelningar samt hur dessa påverkar dem. Författarna kom fram till fyra områden; patienters upplevelser av maktlöshet vid stigmatisering, vårdandets och miljöns påverkan på känslor av trygghet, självbestämmandets betydelse samt betydelsen av delaktighet. Dessa områden diskuterades och jämfördes med befintlig forskning och knöts an till Phil Barkers tidvattenmodell. / Background: In psychiatric care, it is important to respect the patients’ personal expectations and goals in order to achieve good treatment outcomes and to make patients feel satisfied with the care. The nurse should help patients to communicate about their inconveniences, support the patient to analyze destructive behaviors, support the patient to create a normal daily life routine and promote patients’ integrity and self-care. However, patients do not experience this in psychiatric care. Aim: The aim of this literature review was to explore patients with mental illness focusing on their experiences of care in psychiatric care units. Method: In this literature review the authors used ten scientific papers to answer the aim of the review. These articles have been examined to understand differences and similarities and then the authors performed a thematic analysis. Results: Three themes and three subthemes were identified in this literature review. The first theme was patients’ experiences of being or not being treated with respect with the associated subthemes patients’ experiences of stigmatization and patients’ experiences of the health care environment. The second theme was the experience of the staff's attitude with the associated subtheme patients’ experiences of caring relationship. The third and last theme was patients’ experiences of safety. Discussion: The authors discussed patients' experiences in psychiatric care units and how these experiences affect the patients. The discussion emphasized four areas; patients experiences of powerlessness in stigmatization, the healthcare’s and the environment's impact on feelings of safety, the importance of self-determination and the importance of participation. These areas were discussed and compared to existing research and also linked to Phil Barker's tidal model.

M.Cur. (Psychiatric Mental Health Nursing) / Die doel van hierdie studie is om te bepaal of ondersteuningsgroepe aan ouers met verstandelik vertraagde kinders 'n positiewe uitwerking het op die ouers se funksionering binne die gesin. 'n Eksperimentele ondersoek is gedoen met tien gesinne wat voldoen het aan kriteria vir seleksie. Hierdie tien gesinne het bestaan uit vier enkelouergesinne en ses twee-ouergesinne. Hierdie proefpersone moes ten minste een verstandelik vertraagde kind op skool he, met ander woorde, hy/sy moes opleibaar wees; hulle moes binne die Potchefstroomse woongebied en/of distrik woonagtig wees en hulle moes skriftelik toestemming gee tot vrywillige bywoning van die ondersteuningsgroepe wat aangebied is. Alle proefpersone is deur middel van gestratifiseerde steekproefneming ewekansig getrek en in 'n eksperimentele groep van agt ouers, en 'n kontrolegroep van agt ouers, geplaas. Die eksperimentele groep het agt sessies ondersteuningsgroepe ontvang waar doelstellings en verwagtings deur die ouers met verstandelik vertraagde kinders, opgestel is met leiding deur die groepsleier. Die sessies het tweemaal per week vir vier weke lank geskied. Die kontrolegroep het 'n inligtingstuk oor ondersteuning ontvang wat self deurgewerk moes word oor ~ tydperk van vier weke om die Hawthorne-effek te minimiseer. Onverstaanbare terminologie is deur die navorser verduidelik.

Thesis (M. Cur.) --University of Limpopo, 2015 / Background: Re-admission is a common problem encountered in psychiatric care. Re-admissions are often, but not always, related to a problem inadequately resolved in the prior hospitalization. A better understanding of factors leading multiple psychiatric admissions is needed. Such knowledge can help planners to set priorities and to make appropriate services and resources available to mental health care users and their families after hospital discharge. Objective: The purpose of this study was to explore the factors leading to re-admission of mental health care users at the Thabamoopo Psychiatric Hospital, Limpopo Province. Methodology: A qualitative phenomenological research approach was used to explore the factors leading to readmission of mental health care users. Purposive sampling was used to select participants of the study at the Thabamoopo Hospital. Twelve one-on-one semi-structured interviews were conducted. Ethical clearance was granted by the Medunsa Research Ethics Committee and permission to collect data was granted by the Limpopo Department of Health. The data were analysed through Tesch’s method of analysis. Results: The research findings indicate that the use of substances, non-adherence to psychiatric medication, the nature of the illness and social problems contributes to readmission of mental health care users. Conclusion and recommendations: In order to deal with factors related to re-admission of mental health care users, the mental health care practitioners, mental health care users and their families must be involved and work together.

Bakgrund: Självskadebeteende är ett vida utbrett problem världen över och år 2016 vårdades omkring 6900 personer i Sverige för självskadebeteende. Orsakerna till självskadebeteende kan skilja sig åt mellan olika personer och kan bland annat bero på trauma, depression, ångest eller misshandel. Vårdpersonalen kommer ofta i kontakt med patienter som skadar sig själva, där vårdpersonalens föreställningar och attityder skulle kunna inverka på bemötandet och vården av dessa patienter.  Syfte: Belysa vårdpersonalens erfarenheter av att vårda patienter med självskadebeteende inom den psykiatriska vården. Metod: Litteraturstudie med integrativ ansats. Tolv studier inkluderades med antingen en kvantitativ eller kvalitativ ansats, som ligger till grund för resultatet. Analysen genomfördes med stöd av Whittemore och Knafl (2005) i fem steg. Resultat: Analysen genererade fyra kategorier: känslomässigt utmanande, svårigheter att vara professionell och tillämpning av olika interventioner, samt, förutsättningar för ett professionellt förhållningssätt. Slutsats: Föreliggande studie belyste att vården var känslomässigt umanande och visade på brister i bemötande, kunskaper, vård och behandling gällande patienter med självskadebeteende. Bristerna skapade missförstånd och konfliker som påverkade vården negativt, samt ökade patientens självskadebeteende. Genom föreliggande studie kan det antas att en utveckling av vården kring patienter med självskadebeteende kan resultera i ett gott bemötande, samt en gynsam vård och behandling genom utbildning av vårdpersonalen, införande av en alliansbaserad eller lösningsfokuserad vård, samt upprättande av vårdplaner med återinläggning vid försämrat mående. / Background: Self-harm is a worldwide problem and the year 2016 6900 people were admitted to hospital care in Sweden because of their self-harm. The reasons to self-harm vary between people and the cause can be trauma, depression, anxiety or abuse. Healthcare professionals are regularly exposed to patients who self-harm, where the professionals beliefs and attitudes can impact on the care and treatment the patient get. Aim: Highlight the healthcare professionals experience in caring for patients with self-harm in psychiatric care. Method: Literature review with integrative design. Including twelve studies with qualitative or quantitative design, for the foundation of the results. Analysis where conducted in support of Whittemore and Knafl (2005) in five steps. Results: The analysis generated four categories, Emotionally unmanageable, Difficulties in being professional, Application of various interventions, and Presumption for a professional approach Conclusion: The present study highlighted that the care was emotionally unmanageable and showed deficiencies in attending, knowledge, care and treatment regarding patients with self-harm. The deficiencies created misunderstandings and conflicts that negatively affected the care, and increased the patient's self-harm. By the present study, it can be assumed that a development of care around patients with self-harm can result in a good response, as well as favorable care and treatment through training of the healthcare staff, the introduction of an alliance-based or solution-focused care, and the establishment of care plans with re-admission in the event of deterioration.

Bakgrund: Vårdrelationen är ett fackbegrepp som används för att betona patientperspektivet i vårdvetenskapen. Sjuksköterskan har en hjälpande roll och är delaktig i skapandet av vårdrelationen. Patienten bör uppfatta sjuksköterskan som genuint vårdande med relevanta färdigheter samt ha en professionell klokhet. Vårdrelationen förutsätter en respekt för patientens livsvärld och en öppenhet för patienten som levd och subjektiv varelse. Det är i mötet människor bidrar till varandras livshistoria och förståelsen av sig själva och världen de lever i. Vårdrelationen är till sin natur asymmetrisk och sjuksköterskan bör ha vårdandets etiska värdegrund samt idén om värnandet av patientens värdighet som utgångspunkt. Syfte: Syftet var att undersöka psykiatrisjuksköterskans erfarenheter av vårdrelationen. Metod: En litteraturstudie valdes som metod och data analyserades med kvalitativ innehållsanalys. Artikelsökningen genomfördes i databaserna Cinahl och PubMed. Resultatet baserades på åtta artiklar med kvalitativ ansats. Resultat: Ur resultatet framkom två teman och fem subteman. Teman var Personliga förutsättningar samt I praktiken med tillhörande subteman tillit, tidsaspekter, allians samt i mötet och utförande. Diskussion: Diskussionen delas upp i metod samt resultatdiskussion. I metoddiskussionen diskuteras styrkor och svagheter med metoden. I resultatdiskussionen diskuteras resultatet utifrån Hildegaard Peplaus teori samt nya vetenskapliga artiklar. / Background: The nurse-patient relationship is a professional term used to emphasize the patient perspective in health care science. The nurse has a helping role and is involved in creating the relationship. The patient should perceive the nurse as genuinely caring with relevant skills as well as having a professional wisdom. The relationship requires a respect for the patient's lifeworld and openness for the patient as a lived and subjective being. It is in the meeting that people contribute to each other's life history and the understanding of themselves and the world in which they live. The relationship is by nature asymmetrical and the nurse should have the ethical value of care as well as the idea of safeguarding the patient's dignity as a starting point. Aim: The aim was to investigate the psychiatric nurse's experiences of the nurse-patient relationship. Method: A literature study with qualitative content analysis has been applied. The article search was conducted in the databases Cinahl and PubMed. The result is based on eight articles with a qualitative approach. Results: The result shows two themes and five sub themes. Personal prerequisites and In practice with subthemes trust, time aspects, alliance as well as in the meeting and execution. Discussion: The discussion is divided into method and result discussion. In the method discussion, strengths and weaknesses are discussed with the method. In the results discussion, the results are discussed based on Hildegaard Peplau's theory and new scientific articles.

Background: Forensic psychiatric care is a non-voluntary care form for people with severe mental disorders and criminal backgrounds. These patients have a restricted autonomy based on predetermined guidelines regulating this careform. The legislation governing forensic psychiatry confines the patient's power to influence the decision making concerning their treatment plan. Enabling patient involvement in this non-voluntary careform can be challenging for healthcare staff. Aim:To identify how patient involvement can be encouraged within forensic psychiatry. Method: A literature overview proceeding from eleven scientific qualitative articles that were analysed using thematic analysis method. Result: The patients stated that they wanted a greater influence over their care form. Furthermore, they lifted the importance of being informed about their treatment plan and medications by the caregivers to increase their involvement. Patients and healthcare staff relations are characterized by honesty and constitute a central role in patient involvement encouragement. Conclusion: Based on the literature study’s result the authors identified two key factors that affect the patients' experience of their involvement negatively, these factors were lack of information and exclusion from treatment conferences. Further research through qualitative studies should be carried out focusing on the working and non-working methods regarding the promotion of forensic psychiatric patients' involvement. / Bakgrund: Rättspsykiatrisk vård är en ofrivillig vårdform som personer med en allvarlig psykiatrisk störning som begår ett brott kan dömas till. Patienter inom rättspsykiatrisk vård har en begränsad autonomi vilket grundar sig i förutbestämda riktlinjer som styr denna vårdform. Att möjliggöra patientens delaktighet inom rättspsykiatrisk vård kan vara en utmaning för vårdpersonalen då vården inte utgår från samtycke. Syfte: Att identifiera hur patienters delaktighet kan främjas inom den rättspsykiatriska vården. Metod: En litteraturöversikt som utgick från elva vetenskapliga artiklar med kvalitativ ansats. Artiklarna som inkluderades analyserades med tematisk innehållsanalys. Resultat: Patienterna uppgav att de ville ha större inflytande över den vård de erhöll. Vidare lyfte de vikten av att vårdpersonal gav dem information kring deras behandling och medicinering för att främja deras delaktighet i vården. Vårdrelationen mellan patienter och vårdpersonal präglas av ärlighet och utgör en central roll vid främjande av patienters delaktighet. Slutsats: Utifrån litteraturstudiens resultat identifierade författarparet att två nyckelfaktorer som visades påverka patienternas upplevelse av delaktighet negativt var brist på information och exkludering från behandlingskonferenser. Fortsatt forskning genom kvalitativa studier bör utföras med fokus på de arbetsmetoder som fungerat och inte fungerat gällande främjandet av rättspsykiatriska patienters delaktighet.

Background: Threats and violence are a major problem in healthcare that negatively affects both staff and patients. Acute Psychiatric wards are one of the most affected workplaces in healthcare and where work on threat and violence prevention is highly relevant. Violent preventive theories and concepts exist as developed research like the Bergenmodel, Deescalation and low-impact arousal. Aim: The aim is to describe the nurse's experience of the working group's application of threat and violence prevention measures in emergency psychiatric care. Method: The study is a qualitative interview study with a descriptive approach. Results: Three themes were identified - Prophylaxis measures, avert escalation and preserve knowledge. Crucial to the violence prevention work in emergency psychiatric care was to seek for respectful tone in encounters with patients to avoid escalating a suspected threatening situation. Knowledge, experience and training together with good cooperation inthe working group can lead to reduced situations of violence as staff is given the opportunity to experience safety and security. Conclusion: Adequate care with a focus on communication and professional encounter together with solid training is important for the working group's ability to work with violence prevention.