Bakgrund: Psykisk ohälsa är ett stigmatiserat men vanligt förekommande problem överallt i världen. Trots att social interaktion är en viktig del av omvårdnadsarbetet så tillbringar vårdpersonalen inom den psykiatriska slutenvården endast en liten del av sin tid med patienterna. Syfte: Att sammanställa vetenskapliga artiklar för att öka kunskapen om den sociala interaktionen mellan patienter och vårdgivare på psykiatriska slutenvårdsavdelningar. Metod: Litteraturstudie. 18 kvalitativa och kvantitativa artiklar granskades. Deras resultat syntetiserades med hjälp av quantitative metasummary. Resultat: Social interaktion kan förbättra patienternas situation på många sätt. Utebliven social interaktion har negativa effekter på deras sjukdomstillstånd. Tidsbrist och ett stigmatiserande klimat är faktorer som påverkar den sociala interaktionen negativt. Slutsats: Stigmatisering och nedsatt social interaktion på psykiatriska slutenvårdsavdelningar kan påverka och orsaka varandra. Detta belyser ytterligare vikten av social interaktion mellan patienter och personal. / Background: Mental illness is a common but still very stigmatized problem that can be seen all over the world. Even though social interaction is an important part of nursing, the staff on psychiatric wards only spend a fraction of their time with the patients. Aim: To compile scientific articles to increase the knowledge of the social interaction between patients and staff on psychiatric wards. Method: Review. 18 qualitative and quantitative articles were reviewed. Their findings were synthesized using qualitative metasummary. Findings: Social interaction can improve the patients’ situation in several ways. Lack of social interaction negatively affects their state of illness. Time constraints and a stigmatizing environment are factors that have a negative effect on the social interaction. Conclusion: Stigmatization can reduce the social interaction on psychiatric wards, and reduced social interaction can cause stigmatization. This illuminates the importance of increasing the social interaction between patients and staff.

O primeiro episódio psicótico (PEP) é um período marcado por uma série de mudanças na dinâmica familiar. A família tem um papel importante no processo de tratamento desses pacientes. As atitudes dos membros familiares acerca do paciente são avaliadas por meio dos níveis de Emoção Expressa (EE) e de sobrecarga familiar. Apesar da importância do papel dos cuidadores, estudos conduzidos para avaliar as relações intrafamiliares de pacientes no PEP são escassos. Este estudo observacional teve como objetivo determinar os fatores relacionados aos níveis de EE e sobrecarga de familiares de pacientes no PEP. Participaram do estudo 100 familiares e 100 pacientes em acompanhamento em um ambulatório de um hospital universitário do interior do Estado de São Paulo, no período de janeiro de 2015 a janeiro de 2016. Para a coleta de dados foram utilizados quatro instrumentos: um formulário contendo dados sociodemográficos e clínicos, o Family Questionnaire - Versão Português do Brasil (FQ-VPB) para avaliar os níveis de EE e de seus domínios Comentários Críticos (CC) e Superenvolvimento Emocional (SEE), o Inventário de Sobrecarga do Cuidador (ISC) para medir os níveis de sobrecarga dos familiares e a Medida de Adesão aos Tratamentos (MAT) para avaliar a adesão ao tratamento. Os dados foram obtidos por meio de entrevista dirigida. Para análise utilizou-se estatística descritiva e regressão logística múltipla. O nível de significância adotado foi de 0,05. Quanto aos resultados, a maioria dos familiares (62%) foi classificada com elevado nível de EE, 63% com baixo nível de CC, 59% com elevado nível de SEE e 43% apresentaram nível moderado de sobrecarga familiar. Em relação à adesão ao tratamento, 84% dos pacientes foram considerados aderentes. Houve associação significante entre os níveis de EE, SEE e o sexo e escolaridade dos familiares, entre o vínculo com o paciente e os níveis de EE, SEE e CC, entre os níveis de sobrecarga e o diagnóstico médico e entre a idade do paciente e os níveis de CC. Além disso, houve associação significante entre os níveis de EE, SEE e CC e os níveis de sobrecarga. A análise do modelo multivariado mostrou que os anos de estudo do familiar foram considerados fatores de proteção para o desenvolvimento de níveis elevados de EE e SEE, enquanto os anos de estudo do paciente foram considerados fatores de proteção para sobrecarga moderada. Outro fator de proteção identificado foi o tipo de vínculo com o paciente, ou seja, ser pai, avós, sobrinhos, primos, tios ou colegas, representa fator de proteção para nível elevado de EE, CC e sobrecarga moderada, moderada a severa e severa. Por outro lado, familiares do sexo feminino apresentaram 4,81 vezes mais chance de apresentar nível elevado de SEE do que familiares do sexo masculino. Além disso, familiares de pacientes com diagnóstico de esquizofrenia tem 4,19 vezes mais chance de apresentar nível elevado de CC do que familiares de pacientes sem diagnóstico. Espera-se que esses resultados possam fornecer informações para elaboração de estratégias de prevenção e promoção em saúde mental que envolvam os pacientes no PEP e seus familiares / The first-episode psychosis (FEP) is a period marked by a series of changes in family dynamics. Family plays an important role in the treatment of these patients. The attitudes of family members about the patient are evaluated by the levels of Expressed Emotion (EE) and family burden. Despite the importance of the role of caregivers, conducted studies to assess the intra-family relationships of patients in the FEP are scarce. This observational study aimed to determine the factors related to EE levels and relatives to FEP patients overwhelmed. The study included 100 families and 100 patients followed up in a clinic of a university hospital in the state of São Paulo, from January 2015 to January 2016. For data collection were used four instruments: a form containing sociodemographic and clinical data; the Family Questionnaire - Brazil\'s Portuguese version (FQ-BPV) to measure the EE levels and its domains of Criticism and emotional overinvolvement (EOI); the Zarit Burden Interview (ZBI) to measure the overload levels of family members and the Measurement of Treatment Adherence (MTA) to evaluate adherence to treatment. The data were obtained by guided interview. For analysis, it was used descriptive statistics and multiple logistic regression. The significance level was 0.05. As the results, most families (62%) were classified with high level of EE, 63% with low criticism, 59% with high level of EOI and 43% had moderate level of family burden. In relation to adherence to treatment, 84% of patients were considered adherent. There was a significant association between EE levels, EOI and the gender and education of family members, between the relationship with the patient and EE levels, EOI and criticism, between the burden levels and the medical diagnosis and between the age of the patient and criticism levels. In addition, there was a significant association between EE levels, EOI and criticism and burden levels. The analysis of the multivariate model showed that the years family study were considered protective factors for the development of high levels of EE and EOI, while the years of patient study were considered protective factors to moderate overwhelm. Another protection factor identified was the type of relationship with the patient. Having another relation with the patient, ie, being a father, grandparents, nephews, cousins, uncles or colleagues, is a protective factor for high level of EE, criticism and moderate overload, moderate to severe and severe. By contrast, female members of the family had 4.81 times more likely to have high level of EOI that those family members who were male. In addition, relatives of patients with schizophrenia has 4.19 times more likely to have high levels of criticism than relatives of patients who do not have diagnosis. It is expected that these results can provide information for developing prevention strategies and promotion on mental health involving patients in the FEP and their families

O uso de tabaco no meio psiquiátrico é um grave problema de saúde pública. Este estudo teve por objetivo estimar a prevalência e identificar o perfil epidemiológico do uso de tabaco da população psiquiátrica dos níveis secundário e terciário de atenção comparados à população geral da rede básica de saúde do município de Marília (SP). Foi realizado um estudo epidemiológico descritivo- analítico, de corte transversal, com três grupos populacionais de Marília/SP: P1 - portadores de transtornos mentais do ambulatório de saúde mental (ASM), P2 - portadores de transtornos mentais das unidades de agudos do hospital psiquiátrico (HP) e P3 - população geral de uma Unidade Básica de Saúde (UBS). Foi selecionada uma amostra probabilística composta por 378 participantes, 126 em cada serviço. As entrevistas foram realizadas entre abril e julho de 2014. Os questionários, avaliados por juízes, foram inseridos no aplicativo TabacoQuest, desenvolvido especialmente para a coleta dos dados deste estudo. Utilizaram-se ferramentas de estatística descritiva, análise bivariada e multivariada (? de 5%). Dentre os 378 participantes, 255 (67,5%) eram mulheres. A idade variou de 15 a 79 anos (em média, 48 anos). Confirmou-se a hipótese de maior prevalência de fumantes entre a população psiquiátrica dos níveis secundário e terciário de atenção do que entre a população geral da rede básica de saúde (ASM= 27% , HP= 60,3%, UBS= 19%). Ademais, a dependência do tabaco foi mais intensa na psiquiátrica (grau muito elevado: ASM= 14,7%, HP= 32,9%, UBS= 4,2%). O perfil pessoal e sociodemográfico dos fumantes foi assim definido: homens; jovens; analfabetos ou com ensino fundamental; solteiros; sem religião; sem ocupação e recebedores de mais de um benefício do governo. Os fumantes com dependência muito elevada também foram representados por pessoas com essas características, porém com maior escolaridade. Houve maior prevalência de fumantes entre os pacientes psiquiátricos graves: diagnóstico de esquizofrenia/transtorno esquizoafetivo; mais tempo de diagnóstico; uso de três ou mais psicofármacos; uso de antipsicóticos de 1ª geração; quatro ou mais internações psiquiátricas e tentativas de suicídio; sintomas psiquiátricos intensos; ansiedade-traço altíssima. O fumo atual esteve independentemente associado aos grupos etários mais jovens, ao catolicismo ou à ausência de religião, aos transtornos mentais graves, aos transtornos ansiosos/outros, ao uso atual e pregresso de álcool e de substâncias ilícitas. Os fatores independentes associados à intensa dependência do tabaco foram sexo masculino, grupo etário, transtornos mentais graves, transtornos ansiosos/outros e risco alto de suicídio. A principal razão que motivava os fumantes a usar tabaco era a redução da tensão/relaxamento. Identificou-se baixo percentual de ex-fumantes no HP (4,8%), o que mostra a dificuldade que os pacientes psiquiátricos graves e crônicos têm em parar de fumar (tentativas de parar no último ano: ASM= 75%, HP= 35,1%, UBS= 62,5%). A população psiquiátrica, especialmente a internada no HP, foi menos favorável à proibição do fumo nos serviços de saúde (ASM= 84,1%, HP= 69,1%, UBS=100%), tendo refletido a cultura do tabagismo dessa instituição. Concluiu-se que a prevalência de fumantes e a dependência do tabaco foram superiores na população psiquiátrica dos níveis secundário e terciário de atenção do que na população geral da rede básica de saúde, especialmente entre os pacientes psiquiátricos graves. Espera-se que esses resultados contribuam para o planejamento de intervenções contra o fumo na população psiquiátrica, fortalecendo a política nacional de controle do tabagismo e o cuidado dos profissionais que atuam nos serviços de saúde mental / The use of tobacco by the psychiatric population is a serious problem in public health. The aim of this study was to estimate the prevalence of smoking and to identify the epidemiological profile of tobacco use in the psychiatric population from secondary and tertiary levels of care compared to the general population from basic health network in the city of Marília (SP). A descriptive analytical cross-sectional epidemiological study was carried out, with three population groups from Marília/SP: P1 - individuals with mental disorders from mental health outpatient (MHO), P2 - individuals with mental disorders from acute unities of the Psychiatric Hospital (PH) and P3 - general population from a Basic Unit of Health (BUH). It was selected a probability sample of 378 participants, 126 in each service. The interviews were conducted in April-July 2014. The questionnaires, assessed by judges, were recorded in TabacoQuest application, which was developed specially to data collection for this study. It were used descriptive statistics tools, bivariate and multivariate analysis (? of 5%). Among the 378 participants, 255 (67.5%) were women. The age ranged between 15 and 78 years (mean, 48 years). It was confirmed the hypothesis of higher smoking prevalence in the psychiatric population from secondary and tertiary levels of care compared to the general population from basic health network (MHO= 27%, PH= 60.3%, BUH= 19%). Moreover, the addiction to tobacco was more intense among psychiatric population (very high level: MHO= 14.7%, PH= 32.9%, BUH= 4.2%). The personal and socio- demographic profile of smokers was well defined: men; youth; illiterate people or with basic education; unmarried; individuals without religion; individuals without occupation and recipients of more than one government benefit. People with those characteristics also represented smokers with high-level dependence, but with higher level of schooling. There was higher prevalence of smokers among the severe psychiatric patients: diagnosis of schizophrenia/schizoaffective disorder; more time of diagnosis; use of three or more psychotropic drugs; use of first generation antipsychotics; four or more psychiatric hospitalizations and suicide attempts; more intense psychiatric symptoms; highest trait anxiety. Current smoking was independently associated to younger age-groups, to Catholicism or absence of religion, to severe mental disorders, to anxiety disorders/others, to current and former use of alcohol and illicit substances. The independent factors associated to intense tobacco dependence were male, age group, severe mental illness, anxiety disorders/others and high risk of suicide. Reduction of tension/relaxing was the main reason for smokers to use tobacco. It was identified low percentage of former smokers in PH (4.8%), showing that severe and chronic psychiatric patients find more difficult quitting smoking (attempts to quit in last year: MHO= 75%, PH= 35.1%, BUH= 62.5%). The psychiatric population, especially those in PH, was less favorable to no-smoking police in health services (ASM= 84.1%, PH= 69.1%, BUH= 100%), reflecting the smoking culture of the institution. It was concluded that the prevalence of smokers and tobacco dependence were higher in the psychiatric population from secondary and tertiary levels of care compared to the general population from basic health network, especially among the severe psychiatric patients. We hope that these results contribute to the planning of interventions against psychiatric population smoking, strengthening the national non-smoking policy and the care of the professionals who work at the mental health care services

Com a transformação da assistência psiquiátrica, torna-se importante verificar como o enfermeiro especialista em enfermagem psiquiátrica e saúde mental se encontra diante de seus papéis, conflitos e gratificações. Assim, trinta e um enfermeiros que se especializaram em enfermagem psiquiátrica e saúde mental responderam um questionário com esse objetivo. Os resultados mostraram que a grande maioria trabalha na área em que se especializaram, e, quanto aos papéis, desenvolvem os administrativos, como: a coordenação e organização do serviço de assistência e participação em conselhos de saúde; os de cuidado direto, como: atuar junto ao paciente e familiar, execução dos cuidados de higiene, medicações e orientações, escuta qualificada, apoio psicológico e controle de crises; específicos do enfermeiro psiquiátrico, como: coordenação/supervisão/orientação da equipe de enfermagem, consulta e pós consulta de enfermagem, exame de estado mental, triagem, acolhimento, visita domiciliar, prevenção na comunidade, escuta terapêutica, avaliação clinica, desenvolvimento de projeto terapêutico individual, profissional de referência, participação em grupos, oficinas e atendimento individual. Possuem conflitos relativos à falta de reconhecimento profissional, como: falta de reconhecimento como enfermeiro especialista, falta de credibilidade no atendimento do enfermeiro especialista e falta de autonomia enquanto enfermeiro; condições de trabalho como: falta de recursos materiais, humanos e de espaço físico, sobrecarga do profissional qualificado, falta de oportunidades de capacitação da equipe, dificuldade de aliar gestão e assistência, dificuldade de associar a teoria com a prática; dificuldades de relacionamento com a equipe, como: profissionais médicos que não conseguem trabalhar em equipe, falta de cooperação entre enfermeiros, desrespeito da equipe pelas decisões tomadas. Como gratificações destacam o reconhecimento profissional, como: agradecimento do paciente pelos serviços prestados, melhora do paciente e reconhecimento da equipe multiprofissional pelo trabalho; reconhecimento pessoal, como: satisfação pessoal, ser reconhecido como enfermeiro psiquiátrico, prazer em trabalhar e paixão pelo que faz; qualificação, como: aplicação dos conhecimentos, postura ética, interesse em buscar mais qualificação e satisfação em conseguir desempenhar o que aprendeu. Assim sendo, pode-se considerar que os enfermeiros pesquisados identificaram o seu papel de especialista na área de enfermagem psiquiátrica e o exercem com propriedade. Seus conflitos relacionaram-se a aspectos de reconhecimento profissional como enfermeiro especializado, estruturais dos serviços e relacionamento, que podem se constituir em agentes complicadores para o desenvolvimento de um bom trabalho, e, suas gratificações, estão ligadas a fatores de reconhecimento profissional, pessoal, qualificação profissional e aplicação de conhecimentos, levando ao entendimento de que o idealismo contido nessas colocações tem grandes chances de serem traduzidos em ações levando a transformações, o que vai de encontro ao que é esperado de um enfermeiro especialista na área de enfermagem psiquiátrica saúde mental. / Due to psychiatric assistance changes, it is important to check how the nurse specialized in psychiatric nursing and mental health deals with his roles, conflicts and rewards. Thus, thirty-one nurses specialized in psychiatric nursing answered a questionnaire for this purpose. Results showed that most of them worked within the area of their specialization and as to roles, they performed administrative ones, such as: coordination and organization of assistance service and participation in health councils; direct care ones, such as: action with patient and relatives, hygiene care performance, medications and guidance, qualified hearing, psychological support and crisis control; psychiatric-nurse specific ones, such as: nursing team coordination/supervision/guidance, nursing appointment and post-appointment, mental state examination, triage, reception, home visit, prevention within the community, clinical evaluation, individual therapeutic project development, reference professional, participation in groups, workshops and individual support. They show conflicts related to the lack of professional recognition, such as: lack of recognition as a specialist nurse, of credibility in specialist nurse assistance and of autonomy as a nurse; work conditions such as: shortage of material and human resources, and physical space, overburden of qualified professional, lack of opportunities for team empowerment, difficulty to ally management and assistance, difficulty to associate theory to practice; difficulty relationship with the team, such as: medical professionals that are not able to work as a team, lack of cooperation among nurses, team\'s disrespect as to decisions made. As rewards they point out professional recognition, as: patient\'s gratitude for services provide, patient\'s improvement and work recognized by the multi-professional team; personal recognition, as: personal satisfaction, recognition as a psychiatric nurse, pleasure to work and passion for the profession; qualification, such as: knowledge application, ethical attitude, interest in looking for a deeper qualification and satisfaction to perform what was learnt. Thus, we may consider that researched nurses have identified their specialized role within psychiatric nursing area and suitably perform it. Their conflicts are related to aspects of professional recognition as a specialized nurse, services structure and relationship, which may become complicating agents for a good work development, and their rewards refer to professional and personal recognition, professional qualifications and knowledge application factors, and we may conclude that idealism contained in these statement has large chances to be translated into actions leading to changes, meeting what is expected from a nurse, who is specialized in psychiatric and mental health nursing area.

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research. / thesis (BPsychology(Hons))--University of South Australia, 2004.

Syftet med denna pilotstudie var att beskriva hur sjuksköterskor som arbetar som Case Managers uppfattar effekterna av denna arbetsmodell avseende medicinsk vård, social situation, missbruk, vård- och omsorgskvalitet samt samordning för patienter med missbruk och samtidig psykisk störning. Metoden var kvantitativ och genomfördes med en webbenkät. Resultatet visade att respondenterna anser att Case Management haft en positiv påverkan på patienternas medicinska vård och sociala situation. Det ledde också till en bättre kontakt med patienten, och förbättrad bedömning av patientens sammansatta situation. Sammantaget framkom en övervägande positiv uppfattning även av vård- och omsorgskvaliteten, samordningen och de arbetsmetoder som använts. Vad gäller missbruket uppgav en del av respondenterna att det påverkades positivt och en del av respondenterna uppgav att det inte påverkades alls. Vid en fullskalig studie hade det varit intressant att göra enkäten mer nyanserad med fler svarsalternativ och även ha med bakgrundsvariabler för att se samband och göra jämförelser. Pilotstudien indikerar att Case Management är en arbetsmodell som kan underlätta omvårdnadsarbetet för patienter med komplex problematik och stort behov av vård och stöd, och även vara en metod för att lättare samordna insatser från olika vårdgivare. Sjuksköterskan kan genom Case Management arbeta hälsofrämjande för att stödja patienter med missbruk och samtidig psykisk störning i olika områden som påverkar hälsan. / The aim of this pilot study was to describe how nurses who work as Case Managers perceive the effect of this approach for medical treatment, social status, substance abuse, quality of health care and coordination for patients with substance abuse and concurrent psychiatric disorder. The method was quantitative and was conducted with a web survey. The results showed that the respondents believe that case management had a positive impact on patients' medical care and social situation. It also led to a better contact with the patient, and improved assessment of the patient's complex situation. Overall, the answers also revealed a generally positive perception of the care quality, the coordination and used methods. As for the abuse, some respondents answered that Case Management had affected the abuse in a positive way, and others that it had not been affected at all. In a full scale study it would have been interesting to make the questionnaire more nuanced with more response options, and also have the background variables to make comparisons. The pilot study indicate that case management is an approach that can facilitate nursing care for patients with complex problems and need of care and support, and also be a method to help to coordinate the efforts of various health care providers. The nurse can through Case Management support patients with substance abuse and mental disorders in different areas of health.

Aggressive or explosive behaviors in children typically occur within the context of a variety of psychiatric diagnoses and pose additional challenges when children present with histories of abuse. These behaviors are often interpreted as deliberate or noncompliant and management of these extreme behaviors often results in locked seclusion in most inpatient psychiatric settings. Locked seclusion remains controversial at best and raises legal and ethical issues regarding its safe and therapeutic use. <br>This retrospective quantitative study evaluated the effectiveness of the Collaborative Problem-Solving (CPS) approach as a less restrictive behavioral intervention on an inpatient child psychiatric unit with children ages 5-12 years that introduced the CPS approach during a nine month performance improvement project from July 1, 2006 - March 31, 2007. This study sought to determine what variables, if any, impacted the use of locked seclusion before, during, and after CPS implementation and whether children with histories of abuse were placed in locked seclusion at a significantly different rate relative to admissions of children who did not have histories of abuse. Erik Erikson's Theory of Psychosocial Development served as the theoretical framework.<br>The closed medical record review involved 197 admissions and 167 children. All data were analyzed in two parts: the entire nine month period of 197 admissions and by time period, based on when the CPS intervention was introduced and implemented on the unit. <br>Length of stay was the only variable statistically significant during the nine month period (n=197) and third time period of January -March 2007 (n=65) when CPS was fully implemented and assessed. This finding suggests that a child's longer length of stay may have had a relationship with being placed in locked seclusion. When length of stay was controlled as an influence with history of abuse, the variable of interest for this study, children with histories of abuse for the nine month period were not significantly more likely of being placed in locked seclusion than children without histories of abuse; for the third time period, they were found to be almost eight times less likely of being placed in locked seclusion with an odds ratio of 7.81.<br>Although these findings suggest a favorable response to the CPS approach and that behaviors associated with traumatized children were normalized to that of their peer group, the results must be considered with caution. There were many limitations to the initial project and any inferred success with abused children and the CPS approach is based on statistical outcomes only. Other variables not measured or controlled must be considered as potential influences that may have impacted these outcomes. As such, future research evaluating CPS effectiveness with traumatized children is recommended. / School of Nursing; / Nursing / PhD; / Dissertation;

Psykiska störningar är tillstånd som kan drabba alla oss människor. Krav om kompetens på hälso- och sjukvården har ställts för att kunna erbjuda patienter med psykisk störning ett effektivt omhändertagande. Syftet med detta examensarbete är att beskriva ambulanssjuksköterskans erfarenheter av att vårda patienter med psykiska störningar. Metoden är av deskriptiv kvalitativ design och semi-strukturerade intervjuer utgör grunden för den kvalitativa innehållsanalysen med manifest utgångspunkt som genomförts. Resultatet omfattar tre huvudkategorier såsom följer, ’svåra möten skapar rädsla och frustration och försvårar interaktion’, ’svårt bedöma tillstånd och lämpliga åtgärder’ och ’vård byggd med autonomi, erfarenhet och uppfinningsrikedom’. Slutsatsen är att interaktionen mellan patienter och sjuksköterskor byggs av omvårdnadsevidens, att det i sjuksköterskornas bedömningar av tillstånd saknas evidens och att den vård som oftast ges strävas att utgöras av evidensbaserad vård men att det saknas direkta sätt att komma i kontakt med en sådan specialistsjukvård. Det har därmed visats att det finns områden att förbättra och utveckla för att kunna erbjuda patienter med psykisk störning ett effektivt omhändertagande. / Psychiatric disorders are conditions which may afflict every one of us humans. Requirements of competence have been set for the healthcare service to be able to offer an effective emergency care to patients with psychiatric disorder. The aim is to describe the ambulance nurse’s experience by caring for patients with psychiatric disorders. The method is of a descriptive qualitative design and semi-structured interviews constitute the material for the qualitative content analysis, which has been carried out with a manifest basis. The result consist of three main categories as follows, ‘difficult encounters create fear and frustration and complicates interaction’, ‘difficult assessing conditions and appropriate measurements’ and ‘care build with autonomy, experience and inventiveness’. The conclusion is how the interaction between patients and nurses is built by evidence-based nursing, how it is in nurses’ assessments of conditions to be a lack of evidence and how the care most often provided is being strived to constitute of evidence-based healthcare while how it is lacking direct ways to come in contact with such a specialised healthcare. Thus has it been shown that it exist areas for amelioration and evolvement to be able to offer an effective emergency care for patients with a psychiatric disorder.

BAKGRUND: Studierna visar att våldet har ökat med åren. Riskfaktorer och riskbeteenden har identifierats och orsakerna kan vara flera till att patienten upplever ohälsa. Forskningen inom detta fält har hittills fokuserat på bakomliggande orsaker till patientens aggressiva beteende och bedrivits under många år. Ökade kunskaper om sjuksköterskans upplevelse av att vårda patienter med aggressivt beteende inom psykiatrisk vård kan bidra till att utveckla omvårdnad anpassad till situationen, i syfte att främja hälsa. SYFTE: Studiens syfte är att utforska sjuksköterskans omvårdnad och upplevelse av att vårda patienter med aggressivt beteende inom psykiatrisk vård. METOD: Litteraturstudie av kvalitativa och kvantitativa studier. RESULTAT: Analysen resulterade i tre huvudkategorier och 12 underkategorier. Huvudteman som uppkom var; sjuksköterskan i interaktion med patienten, organisatoriska faktorer och personliga faktorer samt underkategorier som handlade om; avledning av hotfulla situationer, personligt utrymme, information och bedömning, gränssättning, riskfaktorer kopplade till aggression, bristande support från chefer, bemanning, personalsäkerhet, erfarenhet och kommunikationsfärdigheter, lojalitet gentemot patienten och arbetet, hopplöshet och besvikelse samt coping. SLUTSATS: Resultatet visar att sjuksköterskor upplever vårdandet av patienter med aggressivt beteende inom psykiatrisk vård på olika sätt. Sjuksköterskans upplevelse kan komma att inverka på patientens omvårdnad. För att sjuksköterskan ska kunna arbeta hälsofrämjande behövs verktyg och färdigheter för att kunna hantera aggressionen på ett adekvat sätt. Ökad kompetens upplevs ha en inverkan på vårdkvalitén för patienten och upplevs påverka antalet våldsincidenter. En stödjande ledningsstruktur och god arbetsmiljö upplevs som viktig och kan tänkas bidra till att allt fler sjuksköterskor stannar kvar på sin arbetsplats inom den psykiatriska vården. / BACKGROUND: The studies show that violence has increased over the years. Risk factors and risk behaviors have been identified and the reason for the patient to experience illness can be many. Research in this field has so far focused on the underlying causes of the patient's aggressive behavior and has been conducted for many years. Increased knowledge of the nursing experience of caring for patients with aggressive behavior in psychiatric care can help to develop nursing care adapted to the situation, in order to promote health. AIM: The aim of the study was to explore nursing care and nurse’s perceptions of caring for patients with aggressive behavior in psychiatric care. METHOD: The systematic review was based on both qualitative and quantitative studies. RESULTS: The analysis resulted in three main categories and 12 subcategories. The main themes that emerged were: the nurse in the interaction with the patient, organizational and personal factors as well as subcategories that dealt; diversion of threatening situations, personal space, information and assessment, setting limits, risk factors associated with aggression, lack of support from managers, staffing, personnel security, experience, and communication skills, loyalty towards patient and work, hopelessness and disappointment and coping. CONCLUSION: The results show that nurses experience the care of patients with aggressive behavior in psychiatric care in different ways. The nurse's experience may affect the patient's health. For the nurse to work with health promotion it is required tools and skills to handle aggression in an adequate way. Increased skills are perceived to have an impact on the quality of care for the patient and are experienced to affect the number of violent incidents. A supportive management structure and good working environment is perceived to be important and could contribute to more and more nurses to remain in their workplace in psychiatric care.

Bakgrund: Få studier har gjorts inom psykiatrisk omvårdnad med fokus på patientperspektivet. Detta perspektiv är dock viktigt då det ger en inblick i hur patienterna upplever den vård de erhåller. Syfte: Syftet var att beskriva hur patienter på en psykiatrisk vårdavdelning upplever det bemötande de får av avdelningens sjuksköterskor. Metod: Semistrukturerade intervjuer som sedan analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Vid analys av materialet framkom fyra huvudkategorier som samlade de aspekter på bra och mindre bra bemötande som respondenterna beskrivit: Betydelsen av att bli sedd och bekräftad av personalen, Personalens agerande och attityder gentemot patienterna, Önskemål och förväntningar på personalen samt Hur icke-verbal kommunikation påverkar hur bemötandet upplevs. Slutsats: Den mest framträdande aspekten av gott bemötande beskrevs som förmågan att kunna ta sig tid att lyssna på patienten, och den mest framträdande aspekten av mindre bra bemötande beskrevs som brist på denna förmåga. / Background: There are few studies focusing on the patients’ perspective of psychiatric care. However, this perspective is important, as it offers insight in the care received from the patient’s view point. Aim: The aim of this study was to describe how the patients in a psychiatric ward perceive the caregiving behavior of the ward’s nurses. Method: Semi-structured interviews analyzed through qualitative content analysis. Result: Analysis of the data resulted in four main categories describing aspects of good and less good caregiving behavior as perceived by the patients. The categories were: The importance of being seen and validated by the staff, The staff’s attitudes and behavior towards the patients, Wishes and expectations regarding the staff and How non-verbal communication affects the way the care giving behavior is perceived. Conclusion: The most prominent aspect of good caregiving behavior was described as the nurse’s ability to take the time to listen to the patient, and the most prominent aspect of a less good caregiving behavior was described as insufficiency in this ability.