Bakgrund: Suicid är ett folkhälsoproblem som har nått epidemiska mått globalt. Suicidala tankar kan kopplas till känslor av hopplöshet och ambivalens, ensamhet, brist på självvärde och otillräcklig förmåga att hantera sitt liv. Specialistsjuksköterskan utför suicidriskbedömningar för att förebygga och förhindra suicid i den psykiatriska öppenvården. Utförandet av suicidriskbedömningar är en komplex uppgift för specialistsjuksköterskan och det är viktigt att det finns möjlighet att kunna reglera känslor och balansera engagemang. Syfte: Syftet med studien var att beskriva specialistsjuksköterskors erfarenheter av att genomföra suicidriskbedömningar i psykiatrisk öppenvård. Metod: Induktiv ansats användes och materialet analyserades med kvalitativ innehållsanalys. Specialistsjuksköterskor inom vuxenpsykiatrisk öppenvård i Region Skåne intervjuades. Tio semistrukturerade intervjuer genomfördes. Resultat: I resultatet framkom tre kategorier: betydelsen av tillit till egen intuition, vikten av tilltro till organisationens stödjande struktur och värdet av förtroende i kommunikationen med patienten. Slutsats: Genom att ha insikt om vad arbetets utmaningar innebär för specialistsjuksköterskan, genom lyhördhet, god kommunikation, fungerande rutiner och kollegial samverkan optimeras förutsättningarna för att utföra en trygg suicidriskbedömning.Resultatet kan användas i utbildningssyfte och som diskussionsunderlag i klinisk verksamhet för att öka kunskap, kompetens och självmedvetenhet vid suicidriskbedömningar. Vidare forskning om suicidpreventivt arbeteutifrån patientens perspektiv skulle vara till nytta. / Background: Suicide is a public health problem that has reached epidemic proportions globally. Suicidal thoughts can be linked to feelings of hopelessness and ambivalence, loneliness, lack of self-worth, and insufficient ability to manage one's life. The specialist nurse performs suicide risk assessments to prevent suicide in psychiatric outpatient care.Carrying out suicide risk assessments is a complex task for the specialist nurse, and it is important that there is an opportunity to regulate emotions and balance commitment. Aim: The aim of the study was to describe specialist nurses' experiences of carrying out suicide risk assessments in psychiatric outpatient care. Method: An inductive approach was used, and the material was analyzed with qualitative content analysis. Specialist nurses in adult psychiatric outpatient care in Region Skåne were interviewed. Ten semi-structured interviews were conducted. Results: The results revealed three categories: The importance of trust in one's own intuition, The importance of trust in the supportive structure of the organization and the Value of trust in communication with the patient.Conclusion: By having insight into what the challenges of the work mean for the specialist nurse, through responsiveness and good communication, functioning routines and collegial collaboration, the conditions for performing a suicide risk assessment safely are optimized. The result can be used for educational purposes and as a basis for discussion in clinical practice to increase knowledge, competence and self-awareness in suicide risk assessments. Further research on suicide risk prevention from the patient´s perspective would be beneficial.

Alla människor har rätt till en lika vård men studier visar att personer med substansbrukssyndrom befinner sig i en utsatt position i mötet med vården. Substansbruk definieras enligt världsorganisationen WHO som ett sjukdomstillstånd. 275 miljoner människor beskrivs ha ett substansbruk, varav 36 miljoner av dessa människor har ett substansbrukssyndrom. Syftet med denna studie var att sammanställa kunskap om hur personer med substansbrukssyndrom upplever bemötandet och stigmatisering i vården. Metoden som valdes var en systematisk litteraturöversikt av studier med kvalitativ metod med metasyntes som analysmetod. Databaserna PubMed och PsycInfo användes. Efter kvalitetsgranskning inkluderades 16 artiklar. Resultatet av metasyntesen resulterade i tre slutteman:  Att bli särbehandlad och dömd. Att bli ignorerad och misstrodd. Att bli behandlad som en människa och uppleva att man får den vård man är i behov av. Resultatet visade att personer med substansbrukssyndrom upplever både ett negativt och ett positivt bemötande av vården. I resultatet framkom det en upplevd stigmatisering och en känsla av att bli misstrodd av vården, medan andra delar av resultatet visade att patientgruppen erhöll ett tillitsfullt bemötande och blev sedd som en människa bakom sin diagnos. Slutsatserna tyder på vikten av en personcentrerad vård och att ett individuellt bemötande kan vara grunden för att skapa en god vårdrelation för att förbättra vården för patienter med substansbrukssyndrom. Denna studie kan bidra till en ökad förståelse och kunskap om hur personer med substansbrukssyndrom upplever att de blir bemötta av vården. Studien kan få en betydelse för vårdpersonal, men också för patienter och anhöriga, genom att vården kan uppnå ett förbättrat förhållningssätt till denna patientgrupp.

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

When students learn caring during clinical practice, the usual point of departure is thatcaring and learning coexist, as separate and parallel phenomena. There is, however, a needto study how caring and learning relate to one another, as well as when and how theyconverge. The aim of this dissertation is to describe how caring and learning converge inthe encounters between students and patients, in a dedicated educational unit withinpsychiatric care, as experienced by students, patients, and supervisors. Describing howsupervisory support can facilitate this is another aim. A reflective lifeworld approach basedon phenomenological philosophy has been applied. Data were collected through interviews,participant observations with follow-up interviews, and narrative diaries.The result shows that caring and learning converge in those encounters between studentsand patients which are characterized by reciprocity, wherein the patient’s narrative is thepoint of departure, complemented by the student’s listening and inquiring attitude. It ishere, that the desire for and pursuit of health and understanding, give the reciprocalinteraction power. The common desire of those involved to know, to become accustomedto the new and unfamiliar, as well as the presence of a feeling of responsibility for oneanother, create questions which in turn create opportunities wherein students and patientsare available to one another.The dissertation shows that learning in a caring context can be complex. Despite theirbeing prerequisites for one another, competition and conflicts can occur when the caringand learning perspectives are not equally attended to. When they are placed counter to oneanother, there is a risk that reciprocal interaction is hindered, which can cause loneliness forall involved. For convergence to occur most propitiously, those involved must exist in acaring and learning togetherness. Responsible and present supervisors are needed, whocreate possibilities for the perspectives to converge through maintenance and monitoring, sothat caring and learning receive equal space.A didactic concept has been developed based on the dissertation’s result, focusing on themeaning of creating forums where students’, patients’, and supervisors’ caringconsiderations and reflections can intertwine.

Bakgrund: Stressrelaterad ohälsa inklusive utmattningssyndrom (UMS) ökar kraftigt. UMS innebär ett mänskligt lidande för de drabbade och en belastning för vårt samhälle. Det finns ännu ingen evidens för hur personer med UMS ska behandlas. Syfte: Att undersöka hur vårdpersonal kan stödja personer med UMS. Metod: Semistrukturerade intervjuer genomfördes. Urvalet bestod av sju vårdgivare som alla arbetade med personer med UMS. Data analyserades utifrån en kvalitativ innehållsanalys och med en induktiv ansats. Resultat: Det informanterna beskrev som stödjande för personer med UMS var att ge en vård utifrån personens behov, att arbeta för att stärka patientens egna förmågor, att ge möjlighet till en medveten närvaro, att skapa balans mellan aktivitet och vila samt att ge patienten och dennes närstående en ökad kunskap. Slutsats: Vårdpersonal kan stödja personer med UMS genom att ge en vård utifrån personens förutsättningar och sjukdomsfas. De stödjande insatserna ska vara personcentrerade och ha som syfte att ge kunskap och verktyg om hur personen kan hantera sin sjukdom. Samarbete mellan professioner är viktigt. Att inkludera psykiatrisjuksköterskan och/eller distriktssköterskan i vården för dessa personer skulle vara gynnsamt eftersom omvårdnad är en faktor som saknas i många fall. / Background: Stress-related ill-health including exhaustion syndrome is increasing sharply. Exhaustion syndrome means a human suffering for the affected and a burden for our society. There is no scientific evidence yet for how people with exhaustion syndrome should be treated. Aim: To investigate how healthcare professionals can support people with exhaustion syndrome. Method: Semi-structured interviews were conducted. The selection consisted of seven healthcare providers who all worked with people with exhaustion syndrome. The data was analyzed with a qualitative content analysis with an inductive approach. Result: What the informants described as support for people with exhaustion syndrome was to provide a care based on the person's needs, to work to strengthen the patient's own abilities, to provide the opportunity for a conscious presence, to create a balance between activity and rest and to give the patient knowledge. Conclusion: Healthcare professionals can support people with exhaustion syndrome by providing a care based on the person's conditions and disease phase. The supportive efforts must be person-centered and have the purpose of providing knowledge and tools on how the person can handle their illness. Cooperation between professions is important. To include the psychiatric nurse and / or the district nurse in the care of these persons would be beneficial as in many cases nursing is a missing factor.

Bakgrund: Suicid är idag den vanligaste yttre dödsorsaken i Sverige. Den enskilt största risken att avlida i suicid är tidigare suicidförsök. Det är en frekvent förekommande anledning till akut vård, vilket innebär att sjuksköterskor utanför den psykiatriska vården möter dessa patienter. Patienter som utfört suicidförsök beskriver både positiva och negativa erfarenheter av vården. I sjuksköterskans ansvar ingår att utföra bedömningar och att tillsammans med patienten komma överens om omvårdnadsåtgärder. Syfte: Syftet var att beskriva sjuksköterskans erfarenheter av att vårda suicidnära patienter inom somatisk vård. Metod: En litteraturöversikt har genomförts där tio kvalitativa artiklar inhämtades från databaserna CINAHL Complete och PubMed. Färgkodning användes för att identifiera likheter och skillnader i artiklarnas resultat. Dessa tematiserades sedan under tre rubriker. Resultat: I resultatet framkom det att sjuksköterskor upplevde att de inte hade den utbildning och kunskap eller de erfarenheter och färdigheter som behövdes för att vårda dessa patienter. Det framkom även att hög arbetsbelastning och tidsbrist påverkade mötet negativt. Vidare beskrevs att vården som gavs främst var inriktad på de fysiska behoven. I mötet väcktes känslor som medlidande, ilska, rädsla och lidande.    Diskussion: Resultatet har diskuterats utifrån Joyce Travelbees teori om den mellanmänskliga relationen. Författarna har kommit fram till att etableringen av den mellanmänskliga relationen kan hindras på grund av osäkerhet, tidsbrist, hög arbetsbelastning, kommunikationssvårigheter eller om fokus läggs på observation av symtom och tecken snarare än att lära känna personen bakom dessa. Den kan även hindras om sjuksköterskan och patienten ser varandra på ett stereotypt sätt. Vidare diskuteras om sjuksköterskornas beskrivna sympati är gynnsam eller hämmande i vården av suicidnära patienter. / Background: Suicide is today the most common external cause of death in Sweden. The single greatest risk to die in suicide is a previously performed suicide attempt. This is a frequently occurring reason for acute care which means that nurses outside psychiatric care is meeting these patients. Patients that has attempted suicide describes both positive and negative experiences of the care provided. In the nurses’ responsibilities includes performing assessments and to reach agreement in which nursing measures to apply. Aim: The aim was to describe the nurses’ experiences of encountering suicidal patients in somatic care. Method: A litterature review has been performed. Ten qualitative articles were retrieved from CINAHL Complete and PubMed. Color coding was used to identify similarities and differences in the results of the articles. These were then themed under three headlines. Results: The results showed that the nurses experienced that they did not have the education, knowledge, experiences or skills needed to care for these patients. It also emerged that high workload and lack of time affected the encounter negatively. Furthermore, it was described that the care provided was mainly focused on the physical needs. Feelings that were evoked in the encounter were primarily compassion, anger and fear. Discussion: The result has been discussed based on Joyce Travelbee’s theory of the interpersonal relationship. The authors has come to the conclusion that the establishment of the interpersonal relationship can be hindered because of uncertainty, communication difficulties, or if focus is placed on observing symptoms and signs, rather than getting to know the person behind them. It can also be hindered if the nurse and the patient see each other in a stereotypical way. Furthermore, it is discussed whether the described sympathy is beneficial of inhibitory in the care of suicidal patients.

<p>Det är sjuksköterskans ansvar att etablera en vårdrelation där patienten känner sig trygg, därför var det viktigt att belysa patientens egen uppfattning om vårdrelationens innebörd och vad det kan ha för betydelse för omvårdnaden. Syftet med studien var att undersöka vårdrelationens innebörd för vuxna patienter inom psykiatrisk tvångsvård. Studien är litteraturstudie med kvalitativ och deskriptiv design. Det gjordes en artikelsökning i Cinahl och PubMed med sökorden psychiatric care, caring relationship, coercion samt patients experiences. Artiklarna som valdes ut kvalitetsgranskades och sedan gjordes en manifest innehållsanalys. Den resulterade i sex kategorier: att känna sig åsidosatt, förlorat människovärde, maktlöshet, att bli tagen på allvar, medmänsklighet samt delaktighet. Därefter gjordes en tolkning av det manifesta innehållet, dvs. en latent innehållsanalys, där urskiljdes två teman: ensidighet och ömsesidighet. Patienterna beskrev antingen att de upplevde en distans från vårdarna eller att vårdarna bemötte dem på ett jämlikt plan. Eftersom patienterna är i en beroendeställning inom psykiatrisk tvångsvård blir relationen ojämn (asymmetrisk). En ömsesidig vårdrelation kan ses som en moralisk norm som banar väg för upprättandet av en vårdgemenskap.</p> / <p>It is the nurse's responsibility to establish a caring relationship in which the patient feels safe, therefore it was important to highlight the patient's own perception of the caring relationship and what it means to caring. The aim of this study was to investigate the meaning of the caring relationship for adult patients in compulsory psychiatric treatment. The study was a literature review with qualitative and descriptive design. The search for scientific articles was done by the databases in Cinahl and PubMed with the keywords psychiatric care, caring relationship, coercion, and patient experiences. The selected articles were quality reviewed and then a content analysis of the manifest content was made which resulted in six categories: to feel disregarded loss of dignity, powerlessness, to be taken seriously, humanity and participation. Thereafter, an interpretation of the manifest content, i.e. a latent content analysis was made. Two themes were discerned: one-sidedness and mutuality. Patients described either that they experienced a distance from the health personal or that they responded to them on an equal plane. Since patients are in a dependent position in compulsory psychiatric treatment relationship becomes uneven (asymmetrical). A mutual caring relationship can be seen as a moral standard that paves the way for the establishment of a community.</p>

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

Det är sjuksköterskans ansvar att etablera en vårdrelation där patienten känner sig trygg, därför var det viktigt att belysa patientens egen uppfattning om vårdrelationens innebörd och vad det kan ha för betydelse för omvårdnaden. Syftet med studien var att undersöka vårdrelationens innebörd för vuxna patienter inom psykiatrisk tvångsvård. Studien är litteraturstudie med kvalitativ och deskriptiv design. Det gjordes en artikelsökning i Cinahl och PubMed med sökorden psychiatric care, caring relationship, coercion samt patients experiences. Artiklarna som valdes ut kvalitetsgranskades och sedan gjordes en manifest innehållsanalys. Den resulterade i sex kategorier: att känna sig åsidosatt, förlorat människovärde, maktlöshet, att bli tagen på allvar, medmänsklighet samt delaktighet. Därefter gjordes en tolkning av det manifesta innehållet, dvs. en latent innehållsanalys, där urskiljdes två teman: ensidighet och ömsesidighet. Patienterna beskrev antingen att de upplevde en distans från vårdarna eller att vårdarna bemötte dem på ett jämlikt plan. Eftersom patienterna är i en beroendeställning inom psykiatrisk tvångsvård blir relationen ojämn (asymmetrisk). En ömsesidig vårdrelation kan ses som en moralisk norm som banar väg för upprättandet av en vårdgemenskap. / It is the nurse's responsibility to establish a caring relationship in which the patient feels safe, therefore it was important to highlight the patient's own perception of the caring relationship and what it means to caring. The aim of this study was to investigate the meaning of the caring relationship for adult patients in compulsory psychiatric treatment. The study was a literature review with qualitative and descriptive design. The search for scientific articles was done by the databases in Cinahl and PubMed with the keywords psychiatric care, caring relationship, coercion, and patient experiences. The selected articles were quality reviewed and then a content analysis of the manifest content was made which resulted in six categories: to feel disregarded loss of dignity, powerlessness, to be taken seriously, humanity and participation. Thereafter, an interpretation of the manifest content, i.e. a latent content analysis was made. Two themes were discerned: one-sidedness and mutuality. Patients described either that they experienced a distance from the health personal or that they responded to them on an equal plane. Since patients are in a dependent position in compulsory psychiatric treatment relationship becomes uneven (asymmetrical). A mutual caring relationship can be seen as a moral standard that paves the way for the establishment of a community.

The overall aim of this thesis was to describe quality of care from different perspectives in the psychiatric setting, to develop an instrument for measuring quality of care from the in-patient perspective and to use this instrument empirically. A qualitative descriptive design involving a phenomenographic analysis was used in Studies I, III and IV, and a descriptive and comparative design with statistical analysis in Study II. In Study I, 20 patients were interviewed. The results showed that quality of care was perceived as a positive, normative concept namely as good quality of care. Five descriptive categories emerged: the patient’s Dignity is respected; the patient’s sense of Security with regard to care; the patient’s Participation in care; the patient’s Recovery; and the patient’s care Environment. In addition, two conceptions that had not explicitly emerged in previous studies on quality of care were identified: Being helped to reduce the shame and Being looked upon as like anyone else. In Study II a definition of quality of care from a patient perspective was formulated on the basis of the results in Study I. A two-part instrument the Quality in Psychiatric Care (QPC) was developed for measuring the patients’ expectations regarding quality of care (QPC-1) and their subsequent experience of it (QPC-2). One hundred and sixteen patients answered both parts of the instrument. Overall, the quality of care was rated high in both parts. However, experienced quality of care was significantly lower than the patient’s expectations in all the dimensions of the instrument: Total dimension, Dignity, Security, Participation, Recovery and Environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health also experienced this, but had in addition significantly higher levels of Participation. This new instrument exhibited too high Cronbach’s alpha values (QPC-1 0.87–0.98, QPC-2 0.85–0.98), which means the instrument needs to be further tested in order to improve its psychometric properties. Twelve next of kin were interviewed in Study III. The next of kin described quality of care mainly from their own perspective, but also to a large extent from the patient’s perspective as well. They described it in both positive and negative terms. Five descriptive categories resulted: Dignity, Security, Participation, Recovery and Health-promoting surroundings. Good relations and communication between staff, patients and next of kin emerged as the central factors regarding the quality of care. The next of kin asked for information about mental illnesses and wanted to co-operate and participate in the patient’s care. They avoided telling others about their family member’s psychiatric illness because of a feeling of shame and guilt. In Study IV, 20 care staff and care associates were interviewed. They described quality of care both from the patient’s perspective and from a professional perspective. They perceived the concept as a positive one and as being of great importance for the patient’s health and life situation. Four descriptive categories resulted: the patient’s Dignity is respected; the patient’s Participation in the care; the patient’s Recovery; and the patient’s care Environment plays an important role. The main contribution of this thesis with regard to the concept of quality of care in the psychiatric setting is its emphasis on the significance of the different perspectives described above, as such knowledge is vital when planning and implementing and evaluating quality of psychiatric care. In addition, the descriptive categories that emerged in this thesis clearly highlight the importance of interpersonal relationships in the care situation. The new instrument (QPC) needs psychometric testing before it routinely can be used as a self-rating instrument for the purpose of improving psychiatric inpatient care and help guide the proper allocation of care resources.