O emprego da psicoterapia de grupo no atendimento em saúde mental, sobretudo em contextos institucionais, tem se expandido em ritmo acelerado em nossa realidade, não havendo uma expansão correlata de pesquisas na área, conforme aponta a literatura especializada. Esse estudo visa contribuir com o conhecimento sobre essa prática, estudando um grupo de apoio com pacientes psiquiátricos ambulatoriais (16 sessões), em condições naturais, em um serviço de saúde mental de Ribeirão Preto. Objetivou-se compreender as possibilidades e limites dessa intervenção descrevendo o desenvolvimento do grupo através das formas de manejo do coordenador e investigando os fatores terapêuticos presentes no grupo segundo a perspectiva de seus participantes. O grupo foi composto por dez pacientes de ambos os sexos, de 29 a 65 anos, predominantemente casados e com escolaridade de 1o grau incompleto. Com diagnósticos psiquiátricos diversos, tinham indicação prevalente de uso de medicação ansiolítica e/ou antidepressiva. Observação e registro audio-gravado do grupo e Questionário do Incidente Crítico (QIC) constituíram as principais fontes de dados. Consultas aos prontuários dos pacientes e notas de campo também foram realizadas durante o período de coleta de dados. Os dados foram analisados por procedimentos qualitativos e quantitativos. Efetuou-se, com base na transcrição e nos registros de observação das sessões, a descrição da temática e da dinâmica das mesmas. A análise do manejo do grupo foi realizada por procedimentos de análise categorial de conteúdo das intervenções do coordenador (N=1904). A análise das respostas dos pacientes ao QIC (N=112), foi realizada por procedimentos de análise categorial de conteúdo, tendo como base um sistema descritivo dos fatores terapêuticos proposto na literatura. Os dados dos prontuários e as anotações de diário de campo foram utilizados na contextualização dos dados derivados da análise das outras fontes. Os resultados da análise do manejo do grupo nos remetem a oito categorias de intervenção: reiteração (48%); investigação (16%); elucidação (13%); confrontação (11%); enquadre (7%); avaliação (2%); orientação (1%) e fala interrompida (2%). O sistema a priori de categorias de análise do QIC não se mostrou suficiente para a classificação de todas as respostas, levando à criação de novas categorias. Nossos resultados apontam para a presença de dez categorias derivadas da percepção dos pacientes sobre o grupo: universalidade (23%); aprendizagem vicária (22%); distanciamento (13%); desesperança (9%); instilação de esperança (7%); altruísmo (6%); aceitação (5%); auto revelação (4%); orientação (4%) e catarse (3%). Apenas 5% das respostas ao QIC foram não classificáveis. Estes resultados remetem à presença de fatores terapêuticos e não terapêuticos no grupo, tal como vivenciado pelos pacientes. Assim, este estudo possibilita uma compreensão sobre o modo como os pacientes vivenciaram o processo deste grupo – tendo em vista os sentidos que produziram a partir de sua participação neste – e, em conjunção com seus quadros clínicos e com o entendimento sobre o funcionamento do grupo através da descrição de seu manejo, situa algumas possibilidades e limites deste tipo de tratamento, considerando o contexto em que ocorre e a clientela que usualmente o integra. (FAPESP) / The use of group psychotherapy in mental health attendance, specially in institutional contexts, it has been expanding in a accelerated rhythm in our reality, with no correlate expansion of researches in this area, according to the specialized literature. This study aims to contribute with the knowledge about this practice, by studying in natural conditions, a support group with psychiatric outpatients (16 sessions) in a mental health center of Ribeirão Preto. It was objectified to understand the limits and the possibilites of this type of treatment, by describing group’s development through the cordinator’s handling and investigating the therapeutic factors existing on this group according to the participants’perspective. The group was composed by ten patients of both sexes, aging 29 to 65 years old, mainly married and having not complete junior hight school. With several psychiatric diagnoses, they pointed out the principal use of anxiolytics and antidepressant medication. Observation and audio-recorded tapes of the group, and the Critical Incident Questionaire (CIQ) constituted the main sources of data. Consultations to the patients'' files and field notes were also accomplished during the period of data collection. The data were analyzed by qualitative and quantitative procedures. Based on sessions’ transcription it was made the thematic and dynamic description of all the group’meetings. The analysis of the group’s handling was accomplished by procedures of categorial content analysis of the coordinator''s interventions (N=1904). The analysis of the patients’answers to the CIQ (N=112) was also accomplished by procedures of categorial content analysis, based on a descriptive system of the therapeutic factors proposed in the literature. The data origineted from the files and the fields notes were used on the comprehension of the data derived from the analysis of the other sources. The analysis of the cordinator’s handling of the group resulted in eight categories of intervention: reiteration (48%); investigation (16%); elucidation (13%); confrontation (11%); setting rules (7%); evaluation (2%); guideness (1%) and interrupted speach (2%). The descriptive system of the therapeutic factores used on the initial analysis of QIC was not sufficient for classification all the answers, driving us to new categories. Our results point for the presence of ten categories derived from the patients'' perception of the group: universality (23%); vicarious learning (22%); distant (13%); hopeless (9%); instilation of hope (7%); altruism (6%); acceptance (5%); self disclosure (4%); guideness (4%) and catharsis (3%). Just 5% of CIQ‘s answers were not classify. These results show us the presence of therapeutic and non therapeutic factors in the group, according to the patients’perspective. Thus, this study contribute to an understanding about the way patients lived the process of this group according to the meanings produced by them after the group’sessions and, in conjunction with their clinical condition and with the understanding of the group development through the description of the cordinator’handling, it shows some possibilities and some limits of this type of treatment, considering the context where it happens and the patients that usually compose those types of groups. (FAPESP)

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

O emprego da psicoterapia de grupo no atendimento em saúde mental, sobretudo em contextos institucionais, tem se expandido em ritmo acelerado em nossa realidade, não havendo uma expansão correlata de pesquisas na área, conforme aponta a literatura especializada. Esse estudo visa contribuir com o conhecimento sobre essa prática, estudando um grupo de apoio com pacientes psiquiátricos ambulatoriais (16 sessões), em condições naturais, em um serviço de saúde mental de Ribeirão Preto. Objetivou-se compreender as possibilidades e limites dessa intervenção descrevendo o desenvolvimento do grupo através das formas de manejo do coordenador e investigando os fatores terapêuticos presentes no grupo segundo a perspectiva de seus participantes. O grupo foi composto por dez pacientes de ambos os sexos, de 29 a 65 anos, predominantemente casados e com escolaridade de 1o grau incompleto. Com diagnósticos psiquiátricos diversos, tinham indicação prevalente de uso de medicação ansiolítica e/ou antidepressiva. Observação e registro audio-gravado do grupo e Questionário do Incidente Crítico (QIC) constituíram as principais fontes de dados. Consultas aos prontuários dos pacientes e notas de campo também foram realizadas durante o período de coleta de dados. Os dados foram analisados por procedimentos qualitativos e quantitativos. Efetuou-se, com base na transcrição e nos registros de observação das sessões, a descrição da temática e da dinâmica das mesmas. A análise do manejo do grupo foi realizada por procedimentos de análise categorial de conteúdo das intervenções do coordenador (N=1904). A análise das respostas dos pacientes ao QIC (N=112), foi realizada por procedimentos de análise categorial de conteúdo, tendo como base um sistema descritivo dos fatores terapêuticos proposto na literatura. Os dados dos prontuários e as anotações de diário de campo foram utilizados na contextualização dos dados derivados da análise das outras fontes. Os resultados da análise do manejo do grupo nos remetem a oito categorias de intervenção: reiteração (48%); investigação (16%); elucidação (13%); confrontação (11%); enquadre (7%); avaliação (2%); orientação (1%) e fala interrompida (2%). O sistema a priori de categorias de análise do QIC não se mostrou suficiente para a classificação de todas as respostas, levando à criação de novas categorias. Nossos resultados apontam para a presença de dez categorias derivadas da percepção dos pacientes sobre o grupo: universalidade (23%); aprendizagem vicária (22%); distanciamento (13%); desesperança (9%); instilação de esperança (7%); altruísmo (6%); aceitação (5%); auto revelação (4%); orientação (4%) e catarse (3%). Apenas 5% das respostas ao QIC foram não classificáveis. Estes resultados remetem à presença de fatores terapêuticos e não terapêuticos no grupo, tal como vivenciado pelos pacientes. Assim, este estudo possibilita uma compreensão sobre o modo como os pacientes vivenciaram o processo deste grupo – tendo em vista os sentidos que produziram a partir de sua participação neste – e, em conjunção com seus quadros clínicos e com o entendimento sobre o funcionamento do grupo através da descrição de seu manejo, situa algumas possibilidades e limites deste tipo de tratamento, considerando o contexto em que ocorre e a clientela que usualmente o integra. (FAPESP) / The use of group psychotherapy in mental health attendance, specially in institutional contexts, it has been expanding in a accelerated rhythm in our reality, with no correlate expansion of researches in this area, according to the specialized literature. This study aims to contribute with the knowledge about this practice, by studying in natural conditions, a support group with psychiatric outpatients (16 sessions) in a mental health center of Ribeirão Preto. It was objectified to understand the limits and the possibilites of this type of treatment, by describing group’s development through the cordinator’s handling and investigating the therapeutic factors existing on this group according to the participants’perspective. The group was composed by ten patients of both sexes, aging 29 to 65 years old, mainly married and having not complete junior hight school. With several psychiatric diagnoses, they pointed out the principal use of anxiolytics and antidepressant medication. Observation and audio-recorded tapes of the group, and the Critical Incident Questionaire (CIQ) constituted the main sources of data. Consultations to the patients'' files and field notes were also accomplished during the period of data collection. The data were analyzed by qualitative and quantitative procedures. Based on sessions’ transcription it was made the thematic and dynamic description of all the group’meetings. The analysis of the group’s handling was accomplished by procedures of categorial content analysis of the coordinator''s interventions (N=1904). The analysis of the patients’answers to the CIQ (N=112) was also accomplished by procedures of categorial content analysis, based on a descriptive system of the therapeutic factors proposed in the literature. The data origineted from the files and the fields notes were used on the comprehension of the data derived from the analysis of the other sources. The analysis of the cordinator’s handling of the group resulted in eight categories of intervention: reiteration (48%); investigation (16%); elucidation (13%); confrontation (11%); setting rules (7%); evaluation (2%); guideness (1%) and interrupted speach (2%). The descriptive system of the therapeutic factores used on the initial analysis of QIC was not sufficient for classification all the answers, driving us to new categories. Our results point for the presence of ten categories derived from the patients'' perception of the group: universality (23%); vicarious learning (22%); distant (13%); hopeless (9%); instilation of hope (7%); altruism (6%); acceptance (5%); self disclosure (4%); guideness (4%) and catharsis (3%). Just 5% of CIQ‘s answers were not classify. These results show us the presence of therapeutic and non therapeutic factors in the group, according to the patients’perspective. Thus, this study contribute to an understanding about the way patients lived the process of this group according to the meanings produced by them after the group’sessions and, in conjunction with their clinical condition and with the understanding of the group development through the description of the cordinator’handling, it shows some possibilities and some limits of this type of treatment, considering the context where it happens and the patients that usually compose those types of groups. (FAPESP)

Abstrakt Bakgrund. Aggressivt beteende är vanligt inom hälso- och sjukvården, med konsekvenser som försämrad arbetstillfredsställelse och burnout. Syftet med studien är att undersöka samband mellan egenskattad utsatthet för aggressivt samt våldsamt beteende och arbetstillfredsställelse, burnout samt sjukskrivning inom den psykiatriska öppenvården. Design. Tvärsnittsstudie med kvantitativ ansats. Metod. Analys av data, insamlat hösten 2014, från totalt 129 respondenter har utförts i SPSS. Resultatet visar att 20,6 % av respondenterna ofta är utsatt för aggressivt beteende samt att 7,3 % ofta är utsatt för våldsamt beteende. Inget samband sågs mellan att vara utsatt och dess inverkan på arbetstillfredsställelse samt burnout. Däremot ses en signifikant skillnad vad gäller utsatthet mellan de undersökta orterna. Slutsats. Den undersökta gruppen är sällan utsatt för våldsamt beteende, men däremot hög förekomst av aggressivt beteende. Trots utsattheten skattades arbetstillfredsställelsen högt. Nyckelord: Aggressivt beteende, våldsamt beteende, arbetstillfredsställelse, burnout, psykiatrisk öppenvård. / Abstract Background. Aggressive behavior is common in health care, with consequences such as impaired job satisfaction and burnout. The aim of the study is to investigate the relationship between self-rated exposure to aggressive and violent behavior, and job satisfaction, burnout and sick-leave in psychiatric outpatient care. Design. Cross-sectional study with a quantitative approach. Method. Analysis of data collected in autumn 2014 from a total of 129 respondents was performed in SPSS. The result shows that 20.6% of respondents are often exposed to aggressive behavior and 7.3% are often exposed to violent behavior. No association between being exposed and its impact on job satisfaction and burnout. In contrast the results show significance difference in terms of exposure between studied cities. Conclusion The examined groups are rarely exposed to violent behavior, however, there is a high incidence of aggressive behavior. The job satisfaction were estimated high despite the exposure. Keywords:Aggressive behavior, violent behavior, job satisfaction, burnout, psychiatric outpatient.

There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.

Bakgrund: Inom psykiatrisk omvårdnad används stödjande samtal som en omvårdnadsåtgärd. Det har framkommit i forskning att patienter upplever god effekt av stödjande samtal. Däremot saknas det forskning kring vad ett stödjande samtal är, utifrån psykiatrisjuksköterskans perspektiv. Syfte: Syftet med studien var att belysa vad ett stödjande samtal är utifrån psykiatrisjuksköterskans perspektiv. Metod: Kvalitativ metod med induktiv ansats har använts. Datamaterialet har analyserats med kvalitativ innehållsanalys. Psykiatrisjuksköterskor inom vuxenpsykiatrisk öppenvård har intervjuats i två regioner i sydvästra Sverige. Tio stycken semistrukturerade intervjuer har genomförts. Resultat: I resultatet framkommer att psykiatrisjuksköterskor anser att det stödjande samtalet ska stärka och identifiera patientens egna resurser. Relationen mellan psykiatrisjuksköterskan och patienten är betydelsefull. Det stödjande samtalet beskrivs som otydligt, saknar struktur och syfte samt tenderar att ha en låg status då det ibland används i väntan på annan behandling. Samtidigt framkommer att det finns en stor frihet med det stödjande samtalet då det inte behöver anpassas till ramar som i en terapi. Konklusion: Det stödjande samtalet är en betydelsefull uppgift där psykiatrisjuksköterskan är bäst lämpad att utföra samtalet. Detta på grund av det omvårdnadsperspektiv psykiatrisjuksköterskan besitter. Det stödjande samtalet är en insats som bör prioriteras inom den vuxenpsykiatriska öppenvården. / Background: In psychiatric nursing, supportive conversations are used as a nursing measure. Research has shown that patients experience a good effect of supportive conversations. On the other hand, there is a lack of research on what a supportive conversation is from the psychiatric nurse's perspective. Aim: The aim of this study was to shed light on what a supportive conversation is from the psychiatric nurse's perspective. Method: Qualitative method with inductive approach has been used. The data material has been analyzed with qualitative content analysis. Psychiatric nurses in adult psychiatric outpatient care have been interviewed in two regions in southwest of Sweden. Ten semi-structured interviews were conducted. Result: The results show that psychiatric nurses believe that the supportive conversation should strengthen and identify the patient's own resources. The relationship between the psychiatric nurse and the patient is of great importance. The supportive conversation is described as unclear, lacks structure and purpose and tends to have a low status as it is sometimes used while the patient is waiting for other treatment. At the same time, it becomes clear that supportive conversation offers a great deal of freedom as it does not need to be adapted to the framework as in a therapy. Conclusion: The supportive conversation is an important task where the psychiatric nurse is best suited to carry out the conversation. This is due to the nursing perspective of the psychiatric nurse. The supportive conversation is an initiative that should be prioritized in adult psychiatric outpatient care.

Syftet med studien var att undersöka sjuksköterskors och skötares upplevelser av möten med patienter i psykiatrisk öppenvård.   Bakgrund – I psykiatrisk öppenvård möter sjuksköterskor och skötare många olika människor med individuella behov. Sedan tidigare forskning har det framkommit att patienters känsla av trygghet uppkommer genom faktorer som personalens inställning och empati. Relationen mellan personal och patient är viktig för patientens känsla av att bli tagen på allvar samt att bli bekräftad. För personer som lever med psykisk sjukdom är det viktigt med en långsiktig relation som grundar sig i förtroende och öppenhet. En god relation kan byggas om personalen kan befinna sig på patientens nivå och få patienten att känna sig viktig och betydelsefull. En fungerande allians tar tid att utveckla, men den utgör sedan en god grund för ett gott samarbete och har goda effekter på psykisk ohälsa.   Design – Kvalitativ design med fenomenologiskt förhållningssätt användes.   Metod – 8 intervjuer genomfördes med sjuksköterskor och skötare i psykiatrisk öppenvård på tre öppenvårdsmottagningar i norra Sverige under december 2015 – februari 2016 och analys gjordes med kvalitativ innehållsanalys.   Resultat – I psykiatrisk öppenvård ansågs relationen mellan vårdare och patient utgöra en stor grund, och fram för allt att det var en trygg relation. Denna trygghet kunde bland annat skapas genom vårdarnas tillgänglighet till patienterna. Fyra kategorier identifierades; Bemöta patienter, Upplevelser av att göra bedömningar, Upplevelser av att vara i patientens hemmiljö och Upplevelser av att arbeta i öppenvård.   Slutsats – Det arbete som sjuksköterskor och skötare utför genom möten med patienter i psykiatrisk öppenvård är betydelsefullt för så många människor med psykisk ohälsa. Genom att få ta del av vårdarnas upplevelser kan det bidra med ökad förståelse om deras betydelse för patienternas psykiska mående. Men samtidigt deras utsatthet då de kan försättas i problematiska situationer. Resultatet kan på så sätt bidra till att relevanta utbildningar och insatser kan identifieras och förhoppningsvis implementeras i verksamheterna. / The aim of this study was to investigate the nurses and assisted nurse mentals experiences of encounters with patients in psychiatric outpatient care.   Background – In psychiatric outpatient care nurses and assisted nurse mentals meets many different people with individual needs. Since previous research has shown that patients' sense of security generated by factors such as staff attitude and empathy. The relationship between staff and patients is important for the patient's feeling of being taken seriously and to be confirmed. For people living with mental illness, it is important to have a long-term relationship based on trust and transparency. A good relationship can be built if the staff can be at the patient level and make the patient feel important and significant. A working alliance takes time to develop, but it then forms a good basis for a good working relationship and has good effects on mental health.   Design – A qualitative design with a phenomenological approach was used.   Method – 8 interviews were conducted with nurses and assisted nurse mentals in psychiatric outpatient care in three outpatient clinics in northern Sweden during December 2015 - February 2016 and analyzed using qualitative content analysis.   Results – In psychiatric outpatient care the relationship between caregiver and patient was considered as a significant basis, and above all that it was a secure relationship. This security could, among other things be created by carers’ availability to patients. Four categories were identified; Meet patients, Make the right assessments, Be in the patient's home environment and Work in outpatient care.   Conclusion – The work that nurses and assisted nurse mentals carrying through in their meetings with patients in psychiatric outpatient care is important for so many people with mental illness. By getting the benefit of carers’ experiences it may contribute to a better understanding of their importance to the patients’ psychological being. But at the same time their vulnerability as they can be placed in problematic situations. The results can therefore contribute to relevant educations and initiatives can be identified and hopefully implemented in the clinics.

Det inträffar omkring 17 000 självmordsförsök i Sverige per år och hälften av dessa leder till psykiatrisk vård. Suicidriskbedömningar görs i psykiatrisk öppenvård av bland annat psykologer. Genom fem intervjuer undersökte vi ett i stort sett outforskat område: hur psykologer inom psykiatrisk öppenvård upplevde sitt arbete med suicidnära patienter. Vi använde tematisk analys för att analysera materialet vilket resulterade i två huvudteman: Att jobba på gränsen – med undertemana Mellan liv och död, Mellan arbete och fritid och Mellan att vara psykolog och människa – respektive Att balansera mellan acceptans och intervention – med undertemana Förr eller senare så händer det samt Resurser och coping. En återkommande dimension i temana var Emotionella reaktioner. Resultatet ger en bild av att psykologerna känner oro för patienterna och att denna oro kan användas som en del i suicidriskbedömningen. Vår tolkning är att psykologernas arbete kan spilla över på deras fritid och att detta i förlängningen kan tänkas ge konsekvenser så som medkänsleutmattning. Vi har tolkat psykologernas berättelser som att de använder copingstrategier för att återhämta sig från sin arbetsbelastning. I vårt resultat framträder en bild av att arbetet med suicidnära patienter kan vara vardag för psykologer inom psykiatrin. Vidare kan arbetet utgöra en känslomässig belastning för psykologer som är annorlunda jämfört med den belastning som uppstår i arbetet med icke-suicidnära patienter. / About 17,000 suicide attempts occur in Sweden each year, half of which lead to psychiatric care. Psychologists are one of the professional groups that conduct suicide risk assessments in psychiatric outpatient care. In this study we examine an relatively unexplored area: how psychologists in outpatient psychiatric care experience their work with suicidal patients. A thematic analysis of five interviews was conducted. The analysis resulted in two main themes: Working at the boundary – with sub themes Between life and death, Between work and leisure time and Between being a psychologist and a human – and Balancing between acceptance and intervention – with sub themes Sooner or later it will happen and Resources and coping. A recurring dimension in all themes was Emotional reactions. The findings provide a picture that the psychologists worry about the patients and that this worry can be used as a part of the suicide risk assessment. Our analysis shows that the psychologists’ work can spill over into their leisure time. This may eventually have effects, such as compassion fatigue. Our interpretation of the narratives suggests that the psychologists use coping-strategies to recover from their workload. The results also show that working with suicidal patients can be part of the daily work of psychologists in psychiatric care. Further more, our analysis shows that working with suicidal patients can include an emotional exhaustion on psychologists that is different from the exhaustion that might arise in the work with non-suicidal patients.

Bakgrund: Den psykiska ohälsan ökar stadigt i Sverige. Genom folkhälsomyndighetens mätningar 2016 visade resultatet att 16 procent av befolkning lider av psykisk ohälsa. Det har framkommit att genom samtal med sjuksköterska kan den som lider av psykisk ohälsa få stöd och kraft till att egna förmågor stärks. En förutsättning för att kunna ge en god vård är att skapa en god vårdrelation mellan vårdare och patient. Syfte: Syftet med denna studie är att belysa vad sjuksköterskor inom psykiatrisk öppenvård upplever som vårdande i samtal med patient. Metod: Tio semistrukturerade intervjuer har genomförts och dessa har analyserats med en kvalitativ innehållsanalys. Resultat: Resultatet redovisas i tre kategorierna; Att känna engagemang för patienten, som belyser vikten av att lyssna och hörsamma patientens berättelse och förstå patienten utifrån dennes livsvärld. Det framkom att ett syfte för samtalet ses som viktigt. Vidare beaktades respekten för patientens integritet och förmågan att anpassa samtalen utifrån varje enskild individ. Skapa och fördjupa relationen, handlar om att trygghet och tillit i vårdrelationen är en förutsättning för ett vårdande samtal. Vidare uttrycks att en stadigvarande kontakt är gynnsamt för relationen och samtalen. Utrymme för utveckling, belyser vikten av patientens önskemål i samtalet, och samtalet som möjlighet till förändring. Slutsats: Studien visar på att sjuksköterskor upplever det vårdande samtalet som betydelsefullt. För att lyckas med detta behövs insyn i det vårdande samtalets betydelse och att det får ta tid att lära känna patienten. Utifrån studien kan slutsatsen dras att sjuksköterskorna har en god värdegrund med patienten i fokus. / Background: Psychological ill health is steadily increasing in Sweden. By the Public Health Authority's measurements in 2016, the result showed that 16 percent of the population suffered from mental health. It has been found that through talks with a nurse, the person suffering from mental health can get support and power to strengthen his / her own abilities. A prerequisite for being able to provide a good care is to create a good care relationship between caregivers and patients. Purpose: The purpose of this study is to highlight what nurses in psychiatric outpatients experience as carers in conversation with patients. Method: Ten semi- structured interviews have been conducted and these have been analyzed with a qualitative content analysis. Results: The result is presented in three categories; To feel commitment to the patient, describing the importance of listening and hearing the patient's story and understanding the patient based on his life. It is described that a purpose of the caring communication is considered important. Respect for the patient's integrity and the ability to adapt the conversation from each individual is described. Create and deepen the relationship, be sure that safety and trust in the care relationship is a prerequisite for a caring communication. It is expressed that a constant contact is favorable to the relationship and the conversation. Space for development highlights the importance of the patient's wishes in the conversation. As well as the conversation as a possibility of change. Conclusion: The study shows that nurses experience the caring communication as significant. In order to succeed, insight into the importance of caring communication needs to be taken and that it may take time to get to know the patient. Based on the study, the conclusion can be drawn that nurses have a good value base with the patient in focus.

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