<p>Compulsory treatment is regulated by the Care of Alcoholics and Drug Abusers Act (LVM; 1988:870), and aims, among other things, at motivating addicts to treatment. Research has, up til now, mostly disregarded the client-perspective on compulsory measures. This dissertation has its starting point in the experiences of 54 alcohol- and drug addicts. The intention is to describe and analyse their view on coercive care and the possibilities to become motivated for change and/or voluntary treatment in such a context.</p><p>A central question during the interviews (which took place at five different institutions for compulsory commitments) is the addicts´ problem recognition, desire for help and willingness to participate in treatment. These dimensions are also illuminated quantitatively by use of a questionnaire. The results of this questionnaire form the basis of a division of the addicts into three groups with varying de-gree of treatment motivation. Comparisons between the groups are done with reference to the evaluation of present treatment context and of the institutions’ efforts to enhance motivation. In addition to this the groups are compared regarding how they perceive limita-tions in their freedom of action.</p><p>The results showed that the three groups had different motiva-tional structures. The “least motivated” stated that the addiction was not their major problem and wanted no help with that aspect of their lives. The “middle-group” claimed to have alcohol-/drug problems that, however, were not too serious. They were not sure that the coercive care was adequate for their situation. The “most motivated” said that they had vast problems with their addiction, were help-seeking and satisfied with having the chance to participate in any kind of treatment program at all. Less differences between the groups were noticeable when it came to a direct evaluation of com-pulsory treatment. The majority reported that they, through the co-ercion, had been exposed to violations of their autonomy. Whether motivated for treatment or not, the interviewees were also sceptical about the possibilities of the institutions to enhance motivation among the incarcerated addicts.</p><p>In the dissertation, addiction and motivation is furthermore dis-cussed from the perspective of rational choice and motivational the-ory. It is concluded that committed addicts think and act strategically in order to maximise their personal use of involuntary incarcerations. It is also asserted that their view on what happens during commit-ment, in some respects, is opposed to the “establishment’s”. For instance, the addicts claim that you don’t become motivated by way of compulsory treatment, while the opposite of their notion form the basis of the legislation.</p>

Compulsory treatment is regulated by the Care of Alcoholics and Drug Abusers Act (LVM; 1988:870), and aims, among other things, at motivating addicts to treatment. Research has, up til now, mostly disregarded the client-perspective on compulsory measures. This dissertation has its starting point in the experiences of 54 alcohol- and drug addicts. The intention is to describe and analyse their view on coercive care and the possibilities to become motivated for change and/or voluntary treatment in such a context. A central question during the interviews (which took place at five different institutions for compulsory commitments) is the addicts´ problem recognition, desire for help and willingness to participate in treatment. These dimensions are also illuminated quantitatively by use of a questionnaire. The results of this questionnaire form the basis of a division of the addicts into three groups with varying de-gree of treatment motivation. Comparisons between the groups are done with reference to the evaluation of present treatment context and of the institutions’ efforts to enhance motivation. In addition to this the groups are compared regarding how they perceive limita-tions in their freedom of action. The results showed that the three groups had different motiva-tional structures. The “least motivated” stated that the addiction was not their major problem and wanted no help with that aspect of their lives. The “middle-group” claimed to have alcohol-/drug problems that, however, were not too serious. They were not sure that the coercive care was adequate for their situation. The “most motivated” said that they had vast problems with their addiction, were help-seeking and satisfied with having the chance to participate in any kind of treatment program at all. Less differences between the groups were noticeable when it came to a direct evaluation of com-pulsory treatment. The majority reported that they, through the co-ercion, had been exposed to violations of their autonomy. Whether motivated for treatment or not, the interviewees were also sceptical about the possibilities of the institutions to enhance motivation among the incarcerated addicts. In the dissertation, addiction and motivation is furthermore dis-cussed from the perspective of rational choice and motivational the-ory. It is concluded that committed addicts think and act strategically in order to maximise their personal use of involuntary incarcerations. It is also asserted that their view on what happens during commit-ment, in some respects, is opposed to the “establishment’s”. For instance, the addicts claim that you don’t become motivated by way of compulsory treatment, while the opposite of their notion form the basis of the legislation.

The purpose of this study was to examine in which way personnel who work with LVM approach their client’s integrity, autonomy and their participation in decision making. We used a semistructured interview when we interviewed three social workers, one placement secretary and four care personnel who work at institutions for LVM. In the theoretical approach of this study we used the total institutions and the user influence by clients. The study has shown that personnel’s considerations to their client’s integrity, autonomy and participation in decisions are a convoluted problem. Care personnel who work at institutions are the unit that has the best opportunities to consider their client’s desires.  The placement secretary has a certain possibility to consider their clients desires when determining their placement. The unit of personnel that has a significant limitation when it comes to their client’s integrity and autonomy are social workers. Since LVM is a law of constraint it’s causing an insult to the client by losing their autonomy. In this regard it is impossible to consider clients integrity. / Syftet med denna studie var att få fördjupad kunskap kring hur personal som arbetar med LVM förhåller sig till sina klienters integritet, autonomi och medverkan i beslut. Genom att använda semistrukturerade intervjuer har tre socialsekreterare, en placeringssekreterare samt fyra behandlingspersonal på LVM-hem intervjuats. De teoretiska perspektiv som ligger till grund för denna studie är totala institutioner samt brukarmakt. Studien har visat att personals hänsynstagande till klienters integritet, autonomi och medverkan i beslut är en komplex fråga. Behandlingspersonal på institutioner är de som har störst utrymme att ta hänsyn till sina klienter. Placeringssekreterare har en viss möjlighet att kunna tillgodose klientens önskemål vid beslut om dennes placering. Den yrkeskategori som präglas av en markant begränsning till klientens integritet och autonomi är socialsekreterare. Genom att LVM som tvångslag medför en kränkning av en klient så mister denne sin autonomi. I detta avseende blir en hänsyn till en klients integritet i princip omöjlig.

När en socialsekreterare ska utreda en klient enligt Lag om Vård av Missbrukare i vissa fall (LVM) behöver denne ta ställning utifrån många olika perspektiv. Syftet med denna studie var att ge kunskap om LVM-ärenden ur socialsekreterarens perspektiv samt att belysa deras tankar, uppfattningar och erfarenheter av LVM-handläggning. Undersökningens empiriska material grundar sig på kvalitativa semistrukturerade intervjuer med åtta socialsekreterare. För att kunna tolka och analysera vårt material använde vi oss av utilitarismen och det salutogena perspektivet som tolkningsram. Resultatet visar på att socialsekreterarna upplever både för- och nackdelar i arbetet med lagstiftningen. Socialsekreterarna upplever handläggningen av LVM-ärenden likt ett dilemma. Socialsekreterarna anser att lagen är nödvändig då de i avsaknad av denna skulle känna en stor maktlöshet av att inte kunna ingripa i allvarliga situationer där klienten riskerar att avlida till följd av sitt missbruk. De anser även att tillämpningen av lagen medför stora inskränkningar i den enskilda klientens integritet och att klienten i mötet riskerar att bli kränkt utan noga eftertanke från socialsekreterarens sida. Resultatet visar även på att socialsekreterarna så långt som det är möjligt respekterar klientens autonomi men att autonomin vid fråga om liv och död måste förbises. / There are many different perspective to take under consideration when a social secretary is about to investigate a client according to the Law on Care of Addicts in certain cases (LVM). The purpose of this study was to provide knowledge, from a social secretaries perspective, about their thoughts, perceptions and experiences of the LVM-process. The studies empirical material was based on qualitative semi-structured interviews with eight social secretaries. We used the utilitarianism and the salutongenic perspective, sense of coherence as interpretative framework to analyze and interpret our empirical material. The result shows that social secretaries experiences about the legislation have both advantages and disadvantages. They feel that LVM-processing is like a dilemma. Social secretaries think that the law is necessary for them to be able to intervene in serious situations when the clients are likely to die as a result of their addiction. They also feel that the application of the law entails large restriction for the clients individual integrity and that the client, without careful consideration from the social secretary´s side, risk to be violated. The result also shows that the social secretaries, as far as possible, wants to respect the client´s autonomy but it must be overlooked in matter of life and death.

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The purpose of this paper is to determine the established law and make researches into non-institutional compulsory care (“mellantvång”) paragraph 22 The Care of Young Persons (Special Provisions) Act (from now on called LVU) and examine whether the administration of the law is in harmony with the best interests of the child. This paper combines two methods : traditional judicial method and a social science method. In the juridical part the sources of law have been studied and in the social sciences part semi-structured interviews have been conducted with five respondents. The theoretical framework consists of ideas and theories about the best interests of the child, a concept which is one of the UN Convention on the Rights of the Child's core principles. This study shows that the legislator has identified a problem and an existing need and found a solution to this by introducing a non-institutional compulsory care, paragraph 22 LVU. The problem is that Social Services do not make use of the restraint. Only 30 decisions under § 22 LVU are taken annually in Sweden. For the legal rights of the individual and the best interests of the child, the Social Services are required to make decisions under this article instead of the current use of the informal threat of non-institutional compulsory care.

This study aimed to analyze statements made by professional practitioners and clients in verdicts related to compulsory drug treatment. The statements were examined in order to illustrate their contribution to the social construction of drug addicts. The study also aimed to address the power professionals have over individuals with drug problems. The data consisted of twelve verdicts obtained from administrative courts located in three different geographical areas in Sweden. Based on a qualitative approach we used a critical discourse analysis as a framework for the examination of vocabulary and sentence structures. The findings were further examined through a social constructivist approach and power theories. The results showed how all parties in the verdict can contribute to the social construction of drug addicts through substantial information that is given as well as the use of additional terms and discursive words. Themes and patterns identified within the statements showed how the clients’ life situation were described in terms of homelessness, unemployment, mental illness and crime. The results also showed that the clients were described as either responsible for or victimized by the drugs, a description that has a high impact on how the clients are subsequently perceived. It was also prominent that the professional statements, compared to the client’s, enjoyed higher degrees of credibility. The professional statements were also more often perceived as true due to the choice of words and structures of the sentences. Consequently, we could illustrate how professionals by the authority granted by their job title are given the power to depict and affect the social construction of drug addicts as a group.

Bakgrund: Främsta syftet med tvångsvård är att skydda patienten från att skada sig själv eller andra. Patienter som vårdas under tvång inom psykiatrisk slutenvård har begränsad möjlighet att påverka och vara delaktiga i sin vård. Syfte: Att belysa patienters upplevelser av att vårdas under tvång i den psykiatriska slutenvården. Metod: En litteraturöversikt har genomförts. Nio vetenskapliga artiklar analyserades enligt en femstegsmodell. Artiklarna hämtades från databaserna Cinahl och PsycInfo. Resultat: Det framkom både positiva och negativa upplevelser av att vårdas under tvång. Upplevelserna sammanfattades i tre teman: Avsaknad av information och kontroll, Önskan om förståelse istället för försummelse och Insikt om tvångsvårdens nödvändighet. Konklusion: Vårdpersonalens attityder och bemötande är avgörande faktorer för hur patienter upplever tvångsvården. / Background: The main purpose of coercive care is to protect patients from injuring themselves and/or others. Patients treated under coercive care in psychiatric care have limited possibilities to influence and participation in their care. Aim: To illuminate patients' experiences of being cared for in locked psychiatric care. Method: A literature review was conducted. Nine scientific articles were analyzed following a five-step model. The articles were retrieved from the databases Cinahl and PsycInfo. Results: There were both positive and negative experiences of being cared for under coercion. The experiences were summarized in three themes: Lack of information and control, Wishing for understanding instead of neglect and Insight into the necessity of compulsory care. Conclusion: The attitudes and treatment of caregivers are crucial factors in how patients experience compulsive care.

Bakgrund: Delaktighet som är lagstyrd innebär att patienter får information om sin vård och har möjligheter att vara med i planeringen där vården utformas efter deras egna behov och önskemål. Dessa förutsättningar gäller även patienter som vårdas under tvång. Delaktighet gynnar återhämtningsprocessen, minskar den negativa upplevelsen av tvångsvården samt bidrar till empowerment som stärker patienternas välbefinnande och autonomi.   Syfte: Hur kan sjuksköterskor utforma och genomföra vården i samråd med de tvångsvårdade patienterna för att främja delaktighet?   Metod: Denna intervjustudie har en kvalitativ metod med induktiv ansats. Sjutton semistrukturerade intervjuer har genomförts och analyserats med hjälp av kvalitativ innehållsanalys.   Resultat: I föreliggande studie har flera faktorer framkommit som påverkar delaktighet inom sluten psykiatrisk heldygnsvård, där patienterna vårdas på tvång, som redovisas i följande kategorier: Att bygga upp en vårdrelation, Att visa respekt och ta hänsyn till patienter som individer, Att vården framställs mer begriplig för patienter, Att möjliggöra för patienter att ha inflytande över sin egen vård, Att se närstående som stöd, Att se omgivningen som hälsofrämjande resurs.   Slutsats: För att främja de tvångsvårdade patienternas upplevelse av delaktighet när de vårdas på en psykiatrisk heldygnsvårdavdelning kan vara en svår och komplex process. Det förfaller i denna studie att det är viktigt för sjuksköterskor att vårda utifrån ett livsvärldsperspektiv, för att förstå individens behov och önskemål. Det är också viktigt att arbeta med att bygga en vårdrelation, visa respekt och ta hänsyn till patienter som individer, göra att vården framställs mer begriplig och att se närstående som stöd för att kunna främja upplevelsen av delaktighet / Background: Participation that is governed means that patients receive information about their care and have opportunities to participate in the planning, where care is tailored to their own needs and wishes. These conditions also apply to patients under involuntary care. Participation favours the recovery process, reduces the negative experience of coercion, and creates empowerment that strengthens patient well-being and autonomy.   Purpose: How can nurses design and implement healthcare in co-operation with the involuntary treated patients to promote participation?   Method: This interview study has a qualitative method with inductive approach. Seventeen semi structured interviews have been conducted and were analyzed by using qualitative content analysis.   Results: In the present study, several factors have been identified that affect participation  in psychiatric  department, where the patients are care for under compulsion, which are reported in the following categories: Building a care relationship, Showing respect and taking into account patients as individuals, Making care more understandable for Patients, Enabling patients to have influence over their own care, family members are considered as support in the caring process, Seeing the environment in the department as a health promotion resource.   Conclusion: In order to promote the compulsive careers' experience of participation when cared for in a psychiatric day care department, it can be a difficult and complex process. It is due in this study that it is important for nurses to take care of a life-world perspective, to understand the needs and wishes of the individual. It is also important to work on building a healthcare relationship, showing respect and taking into account patients as individuals, making care more comprehensively, and seeing related people in support of promoting the perception of participation.

Syfte: Att beskriva svenska sjuksköterskors uppfattningar om hur våld påverkar omvårdnaden inom akutsjukvården. Metod: En kvalitativ studie med sex stycken intervjuer inom akutsjukvården i södra Sverige. Analysen utfördes med en systematisk textkondensation. I examensarbetet används Bubers relationsfilosofi som teori för att förstå och diskutera hur mötet påverkas av en undvikande sjuksköterska. Resultat: Omvårdnaden påverkas och en särbehandling av patienten skapas när sjuksköterskor upplever våld riktat mot sig. Kommunikationen och mötet med patienten blir lidande och sjuksköterskorna undviker att ge omvårdnad till patienten som en hantering av våldet. Patienten blir även utsatt för tvångsvård utan läkarintyg på grund av våldsamheten. Känslor som uppstår är framförallt rädsla för patienten och rädsla för att ha gjort någonting fel. Slutsats: Våldet skadar inte endast vårdpersonalen. Den våldsamma patienten riskerar att bli ignorerad och tvångsvårdad. Arbetet kan ge kunskap om hur våld uppstår, kan undvikas och avledas. Detta är även applicerbart på all vårdpersonal och inte endast sjuksköterskor. Ett undvikande beteende och fördröjd vård för patienten betyder inte minskad våldsamhet, istället kan det bidra till våldsamhet. Nyckelord: Kommunikation, lidande, tvångsvård, våld, våldsamma patienter, övergrepp. / Title in English: Violence in healthcare: Violence against nurses creates patient suffering- an empirical interview study Aim: To describe Swedish nurses’ perception about how the violence affects the nursing care in the emergency medical care. Method: A qualitative study based on six interviews in the emergency medical care, in the southern part of Sweden. The analysis was conducted with a systematic text condensation. In the examination paper Buber’s relation philosophy is used as a theory to understand and discuss how the meeting is affected by an avoiding nurse staff. Results: The nursing care is affected, and a special treatment was given to patients when nurses experienced violence against themselves. The communication and the meeting with the patient is suffering and the nurses are avoiding the patients to handle the violence. The patient is also exposed to custodial care without a doctor’s certificate. Feelings that develop are chiefly fear of the patient and a fear of having done something wrong. Conclusion: The violence is not only hurting the nursing staff. The violent patient is also risking being ignored and having custodial care. The examination paper can give knowledge about how violence starts, can be avoided and averted. This can give knowledge to not only nursing staff but all health professionals. An avoiding manner and averting nursing care do not mean less violence, instead it can start the violence.  Keywords: Abuse, communication, custodial care, patient security, violent patients.