Psychiatric Hospital Care Research Articles

Is parricide a stable phenomenon? An analysis of parricide offenders in a forensic hospital

Introducción. Estudios anteriores demuestran que la enfermedad mental severa es frecuente entre los parricidas.Objetivo. Investigar las características psiquiátricas y sociodemográficas, los métodos de asesinato y los antecedentes penales de criminales acusados de parricidio remitidos a un centro de salud mental forense en Brasil.Materiales y métodos. La muestra estuvo constituida por todos los pacientes acusados de parricidio que contaban con asistencia psiquiátrica en el Instituto Psiquiátrico Forense Dr. Maurício Cardoso. Se realizó un análisis transversal de las variables sociodemográficas de los parricidas y sus víctimas, las características del crimen y el diagnóstico psiquiátrico.Resultados. La mayoría de parricidas eran jóvenes (29.2±9.4) con bajo nivel de educación (5.4±3.9); 100% eran varones adultos, 94.4% solteros y 77.8% no tenía antecedentes penales. Todos los delincuentes actuaron solos, en su mayoría en contra de personas mayores (63.3±13.2) y en casa de sus padres (83.3%). Solo uno utilizó arma de fuego; 10 eran patricidas y 6 matricidas, 1 asesinó a su padrastro y 1 cometió doble parricidio. Tras cometer el asesinato, 27.8% trató de escapar de la escena del crimen. La mayoría de los condenados sufrían esquizofrenia (61.1%) o personalidad antisocial (16.7%).Conclusiones. El patrón observado en relación con las características de uso de armas, víctima y asesino es consistente con investigaciones previas, lo que permite concluir que este fenómeno es relativamente estable y homogéneo. Se debe garantizar evaluación psiquiátrica forense a quienes hayan cometido parricidio, dada la alta prevalencia de enfermedad mental en estos individuos.

What Influences Treatment Satisfaction in Patients with Personality Disorders? A Naturalistic Investigation in a Hospitalization Setting.

Treatment satisfaction of different mental disorders is still poorly understood, but of high clinical interest. Inpatients of a general psychiatric care hospital were asked to fill out questionnaires on satisfaction and clinical variables at admission and discharge. On the basis of an exploratory approach, differences in treatment satisfaction among diagnostic groups were examined by means of one-way analysis of variance. Potential associated clinical and socio-demographic variables were studied using multi/univariate tests. Patients with personality disorders (n=18) showed a significantly lower treatment satisfaction (ZUF-8, Zurich Satisfaction Questionnaire) and a slightly lower improvement of symptoms (CGI, Clinical Global Impression) and global functioning (GAF, Global Assessment of Functioning scale) than that of other diagnostic groups (n=95). Satisfaction in patients with personality disorders correlated much stronger with the symptom improvement and slightly with the functioning level than in patients without personality disorders. Interestingly, in patients with personality disorders psychopharmacological treatment in general (present versus not present) was independent from satisfaction. This exploratory investigation suggests that a lower satisfaction of patients with personality disorders in a general psychiatric hospital is mainly based on a reduced improvement of the symptoms and of the global functioning level.

What influences treatment satisfaction in patients with personality disorders? A naturalistic investigation in a hospitalization setting

Treatment satisfaction of different mental disorders is still poorly understood, but of high clinical interest. Inpatients of a general psychiatric care hospital were asked to fill out questionnaires on satisfaction and clinical variables at admission and discharge. On the basis of an exploratory approach, differences in treatment satisfaction among diagnostic groups were examined by means of one-way analysis of variance. Potential associated clinical and socio-demographic variables were studied using multi/univariate tests. Patients with personality disorders (n=18) showed a significantly lower treatment satisfaction (ZUF-8, Zurich Satisfaction Questionnaire) and a slightly lower improvement of symptoms (CGI, Clinical Global Impression) and global functioning (GAF, Global Assessment of Functioning scale) than that of other diagnostic groups (n=95). Satisfaction in patients with personality disorders correlated much stronger with the symptom improvement and slightly with the functioning level than in patients without personality disorders. Interestingly, in patients with personality disorders psychopharmacological treatment in general (present versus not present) was independent from satisfaction. This exploratory investigation suggests that a lower satisfaction of patients with personality disorders in a general psychiatric hospital is mainly based on a reduced improvement of the symptoms and of the global functioning level.

Surrogate markers of visceral fat and response to anti-depressive treatment in patients with major depressive disorder: a prospective exploratory analysis

Background: Body mass index (BMI) and body weight have been shown to be associated to treatment outcome in patients with major depressive disorder, but this relationship is not clear. Visceral fat might be an underlying mechanism explaining this relationship.Aims: The aim of this study was to prospectively investigate whether visceral fat, as measured by hip-to-waist ratio and waist circumference, affects treatment outcome in patients with major depressive disorder in patients attending a hospital psychiatric care unit in Denmark.Methods: The study was conducted as an observational prospective study including 33 patients with major depressive disorder. Assessments were made at enrolment and after 8 weeks. Primary variables were hip-to-waist ratio and waist circumference. Outcome were remission or response of depressive symptoms measured with the Hamilton Depression Rating Scale (HAM-D17) interviews and HAM-D6 self-rating questionnaires.Results: No differences were found in outcome between groups of patients with high vs low visceral fat in this population.Conclusions: The lack of association was evident for all surrogate markers of visceral fat, and suggests that visceral fat has no impact on outcomes of depressive symptoms. However, study limitations might have contributed to this lack of association, especially sample size and considerable variations on multiple parameters including treatment received during the 8 weeks of follow-up.

Deinstitutionalisation, imprisonment and homelessness

In May 2016, Winkler et al published a systematic review on cohort studies following up patients after discharge from long-term psychiatric hospital care.[1][1] The study did not show relevant numbers for imprisonment or homelessness after discharge. The authors concluded that the study contradicted

Pharmaceutical care in a long-stay psychiatric hospital

ObjectivesThe aim of this study was to evaluate implementation of services provided by a clinical pharmacist for long-term-hospitalised patients with schizophrenia in a pharmaceutical-care-naive developing country.MethodThis was a prospective, healthcare-system,...

Restraint Reduction at a Pediatric Psychiatric Hospital: A Ten-Year Journey.

Restraints are used as one of the safety interventions for children and adolescents in various community, hospital, and treatment settings. Although considered safety interventions, restraints are known to have many adverse effects on children and staff, including injuries; even reports of death are noted in the literature. In an effort to reduce the use of restraints and to provide trauma-informed care in a 52-bed Pediatric Psychiatric Hospital, a quality improvement project was launched. Primary prevention principles based on trauma-informed and strength-based care were utilized to provide care for children and adolescents. Hospital leadership played an instrumental role in bringing positive culture change. Staff involvement and training in restraint reduction and prevention tools played a key role in this project. Debriefing and problem solving were effective interventions for the prevention of restraints. Involvement of youth and family in treatment planning built stronger relationships with staff and paved the way for better communication and trust, and improved understanding of strengths and needs of children and adolescents. Over a 10-year period, mechanical restraints decreased by 100%, from 485 in 2005 to "zero" in 2014 and none in the last 3 years. Physical restraints decreased by 88%, from 3,033 in 2005 to 379 in 2014.

Psychiatric hospital admission and long-term care in patients with very-late-onset schizophrenia-like psychosis.

In this register-based study the rates and durations of psychiatric hospitalizations were compared between patients with very-late-onset schizophrenia-like psychosis (VLOSLP, n = 918) and elderly patients with illness onset before 60 years (n = 6142). The proportion of patients ending up in long-term care (LTC) or long-lasting psychiatric hospital care (LLP) was also studied. A sample of patients with schizophrenia aged 65 or over was collected from the Finnish Hospital Discharge Register. Psychiatric hospitalizations were calculated per year, and logistic regression was used to compare onset groups and factors associated with ending up in LTC/LLP. Between 1999 and 2003, 27% of patients with VLOSLP and 23% of patients with earlier onset had at least one psychiatric hospitalization (p = 0.020). When the rates of patients' stays in psychiatric hospital per year were compared, the only difference was that in the first year 14% (141/918) and 11% (679/6142) had at least one day in psychiatric hospital (p < 0.001) respectively. In logistic regression onset group of schizophrenia was not associated with LTC/LLP, except weakly the VLOSLP group in women (p = 0.042, OR 1.23). Patients having any cardiovascular disease (p < 0.001, OR 0.63) or a respiratory disease (p = 0.008, OR 0.73) were less likely to end up in LTC/LLP. The patients with VLOSLP needed more psychiatric hospital care than those with earlier illness onset. Ending up in LTC/LLP was equally common in both onset groups, but some physical diseases, such as cardiovascular and respiratory, diminished the likelihood of this.

Seclusion experienced by mental health professionals.

Seclusion in psychiatric inpatient care means confining service users in a locked room. Service users and staff seem to have different opinions on the usefulness of seclusion. This is possibly the first time when two mental health nurses went voluntarily into seclusion and reported their experiences. The nurses felt that the seclusion room was inhumane and proposed improvements to seclusion in general and to the seclusion facilities in particular. Seclusion in psychiatric hospital care refers to isolating a service user from other service users and staff, most often in a locked and unfurnished room. Service users' experiences of seclusion are mostly negative, and although some have seen a rationale for its use, mental health nurses should be encouraged to evaluate current seclusion practices from the service user's perspective. In this small-scale experiment, two mental health nurses were voluntarily secluded for 24 h. The aim was to explore the experience of being secluded, to understand and evaluate the impact of seclusion in greater detail, and to encourage discussion on one of the controversies in mental health nursing. To the best of our knowledge, this is the first attempt to evaluate the impact of seclusion based on mental health nurses' firsthand experiences. The nurses received usual seclusion treatment and described their experiences of this every 6 h. Based on the nurses' experiences, seclusion, even in voluntary, safe and planned circumstances, may increase anxiety and frustration. Seclusion was viewed negatively and the physical environment was considered inhumane. The nurses offered some practical suggestions for updating seclusion practices and re-designing seclusion facilities. Mental health nurses, who frequently decide on and invariably implement seclusion, are key to improving seclusion practices.

Resource use and financing of guideline-adherent psychotherapeutic inpatient care

The financing of psychiatric psychotherapeutic care in Germany is determined by the German psychiatric staffing regulations which are unchanged since 1991. Psychotherapy was established after 1991 as an effective and indispensable treatment of mental and behavioral disorders. The aim of this study was to empirically investigate the use of psychiatrists' and psychologists' working time for psychotherapy in guideline-adherent hospital care. A further aim was to compare these results to the resources defined by the German psychiatric staffing regulations and in the new prospective payment system for psychiatry and psychosomatics in Germany. University hospitals for psychiatry and psychotherapy were asked to retrospectively provide data of patients for which guideline-adherent care was possible. Participating institutions provided both data describing the staff time utilization of psychotherapeutic services provided by psychiatrists and psychologists and patient classifications according to the German psychiatric staffing regulations and the new prospective payment system for psychiatry and psychosomatics. Resources defined by the German psychiatric staffing regulations covered a mean of only 71 min of psychotherapy per patient and week while the actual mean intensity of psychotherapeutic care provided by the participating hospitals was 194 min per patient and week. The associated use of staff time was 102 min per patient and week. Both figures increased during an inpatient episode. The resources defined by the German psychiatric staffing regulations covered only 70 % of medical and psychological personnel. The current configuration of the new prospective payment system for psychiatry and psychosomatics covered only 59 % of staff time. The results of this study provide another unambiguous recommendation to adjust the out-dated German psychiatric staffing regulations to the current evidence and S3 guidelines for psychiatric psychotherapeutic hospital care. In particular, more resources are required for the provision of psychotherapeutic care.

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire.

BackgroundThe aim of our study was to identify patient- and care-related factors that are associated with patients’ satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient’s point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22).MethodsThis cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels.ResultsTwo hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (β=0.15). Clinical improvement was moderately associated with higher global satisfaction (β=−0.15), higher satisfaction with quality of care (β=−0.19), and higher satisfaction with food (β=−0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (β, 0.20–0.43) except food, and for seclusion with global satisfaction (β=−0.33) and personal experience (β=−0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (β=−0.15).ConclusionThis study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient’s satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients’ management, and health outcomes in psychiatric hospitals.

La mortalité à l’hôpital psychiatrique de Tunis : étude rétrospective sur 11 ans

Mortality in patients in psychiatric hospitals is reported to be two to three times as high as in the general population. In Tunisia, we do not have any figures on mortality and causes of death in psychiatric inpatients. The aim of our study was to assess the mortality rate in a psychiatric hospital in comparison to the mortality rate in the general population, to determine the patients' profile, and to identify the causes and risk factors for these deaths. We performed a retrospective, descriptive and comparative study. We examined the records of all patients who died during their stay in the different wards of psychiatry at the Razi Hospital in Tunis. We also scrutinized reports of autopsies in the Forensic Medicine unit at Charles-Nicolle Hospital in Tunis over a period of eleven years from January 1st, 2000 to December 31st, 2010. We conducted a descriptive study to calculate the standardized mortality ratio (SMR) aiming to highlight any existing excess mortality among the psychiatric inpatients compared to the general population. This ratio was obtained by dividing the observed number of deaths by the expected number of deaths. In the analytical study, our sample was compared to a control population made-up of randomly selected living patients among those admitted to the Razi hospital in 2010. This study allowed us to investigate the risk factors for premature mortality in psychiatric inpatients. The average rate of mortality was two deaths per 1000 inpatients per year. Twenty-four percent (24%) of deaths involved institutionalized patients. Compared to the general population, premature mortality was noted among patients aged less than 40 (SMR=1.9). The older the patients were, the closer to 1 the SMR was. The average age at death was 51.38 years; 65% of patients were male, 60% had a low socio-economic level, 54% had a comorbid medical condition. Forty-two percent (42%) of deceased patients were diagnosed with schizophrenia with the paranoid form being the most prevalent (44%), 13% had bipolar disorder, 22% had psycho-organic disorders (mental retardation, dementia, delirium). Antipsychotics were the most prescribed psychotropic drugs. High doses were used. Forty percent of cases (40%) consisted of sudden deaths. A cause for death was identified in 80% of cases. In 92% of cases, the death was classified as being "natural". Main causes were respiratory (26%) and cardiovascular (9%). Accidental causes accounted for 8% of deaths. In 20% of cases, the cause remained undetermined. Three factors were identified as independent predictors of mortality among mental patients: age at death (OR=3.9 among patients older than 40), psychiatric diagnosis (OR=2.9 among patients with psychotic or mood disorders compared to other diagnoses) and combination of antipsychotic drugs (OR=6.09 in patients receiving more than two antipsychotics). Young psychiatric inpatients seem to be at high risk of premature death: the SMR in our study was 1.9. It ranged between 2.15 and 6.55 in other similar studies. This increased risk mainly concerns non-natural deaths. The leading natural cause of death in our population was represented by thromboembolic accidents. Such a high thromboembolic risk may be explained by the mental illness itself, by physical restraint as well as by antipsychotic treatment. Diagnosing medical conditions in psychiatric patients is often a daunting task: history of the patient is sometimes unreliable and clinical features might be modified by psychotropic agents. Patient-related risk factors for premature death include poor socio-economic level, access-to-care difficulties, positive family and personal history of mental and/or medical disorders, smoking, substance abuse, unhealthy diet and lack of physical activity. Moreover, iatrogenic effects of psychotropic drugs (combination of antipsychotics was more common in deceased patients than in controls) and inadequate medical care in psychiatric hospitals (lack of ECG devices, in particular) partly account for such a high mortality. Identifying risk factors for deaths in psychiatric hospitals highlights needed changes in psychiatric management strategies taking into account the patient's characteristics as well as the drugs' safety profile. Further studies with larger samples are needed to better highlight risk factors for premature death in psychiatric inpatients. Identifying such risk factors is necessary to develop efficient preventive strategies.

Predicting psychosis and psychiatric hospital care among adolescent psychiatric patients with the Prodromal Questionnaire

The Prodromal Questionnaire (PQ) identifies psychiatric help-seekers in need of clinical interviews to diagnose psychosis risk. However, some providers use the PQ alone to identify risk. Therefore, we tested its predictive utility among 731 adolescent psychiatric help-seekers, with a 3–9-year register-based follow-up. Nine latent factors corresponded well with postulated subscales. Depersonalization predicted later hospitalization with a psychosis diagnosis (HR 1.6 per SD increase), and Role Functioning predicted any psychiatric hospitalization (HR 1.3). Published cut-off scores were poor predictors of psychosis; endorsement rates were very high for most symptoms. Therefore, we do not recommend using the PQ without second-stage clinical interviews.

Care in psychiatric hospital under the perspective of a nursing team

The present study is aimed at describing the perception of the nursing team concerning the care in a psychiatric hospital. The research used a qualitative approach, exploratory type, using focus group technique, with five participants, in August 2011, in Niteroi, RJ, Brazil. From the data analysis five categories emerged, covering: sensitive listening; personal availability; therapeutic projects; human issues of the team; Traditional Psychiatry vs. Psychosocial Paradigm tension. It was concluded that despite the research, the subjects were still working at the hospital model. It was possible to bring awareness in a human, comprehensive and complete manner. But this perception of care has frailties once it does not bring any evidence of scientific basis of nursing. It is recommended that the professional nursing team invest in their role of caring in the context of the Psychiatric Reform, in the pursuit of an approach centered on the subject and in his way of living.

PSICHIKOS SVEIKATOS SLAUGYTOJŲ PATIRIAMOS AGRESIJOS RAIŠKA PSICHIATRIJOS PROFILIO LIGONINĖSE

Tyrimo metodas. Tyrimo metu buvo naudotas autoriaus Nico Oud originalus klausimynas POPAS (angl. Perception of Prevalence of Aggression Scale) ir papildomai sudarytas klausimynas. Apklausta 300 psichikos sveikatos slaugytojų, dirbančių respublikinėse psichiatrijos profilio ligoninėse. Tyrimo rezultatai. Dažniausiai pasireiškianti agresijos forma - žodinė agresija ir grasinanti žodinė agresija, žeminantis agresyvus pacientų elgesys ir pasireiškia dažnai ar labai dažnai. Pacientų sunkus fizinis smurtas, seksualinis priekabiavimas, įvykusios savižudybės bei bandymai nusižudyti pasireiškia dažnai ir labai dažnai. Labai dažnai eidami į palatą, kur yra agresyvus pacientas, slaugytojai praneša kolegoms, o įėję į palatą išlieka tarp paciento ir durų, o jei gali durys paliekamos atidarytos, stengiasi, kad paciento aplinkoje nebūtų nereikalingų dirgiklių, triukšmo, kurie didintų frustraciją ir mažintų impulsų kontrolę, stengiasi neparodyti, kad išsigando, neatsitraukia, išlaiko dėmesį, kalbina pacientą, leidžia žodžiais išreikšti pyktį. Slaugytojams, kurių skyriuose gydomiems pacientams diagnozuoti psichikos ir elgesio sutrikimai dėl psichoaktyvių medžiagų vartojimo, yra didesnė tikimybė patirti žodinės, grasinančios žodinės agresijos formas, provokacinio agresyvus elgesio pasireiškimai dažnesni, labai dažnai beveik du kartus nei respondentams, kurių pacientams ši liga nenustatyta. Grasinančios fizinės agresijos pasireiškimo tikimybė dažnai ir labai dažnai yra beveik tris kartus didesnė nei respondentams, kurių pacientams ši liga nenustatyta. Pacientams, turintiems suaugusiųjų asmenybės ir elgesio sutrikimų, sunkaus smurto tikimybė prieš save dažnai ir labai dažnai yra tris kartus didesnė nei pacientams, kuriems ši liga nenustatyta. Ir atvirkščiai, respondentams, kurių skyriuose gydomi pacientai, sergantys šizofrenija, šizotipiniu ir kliedesiniu sutrikimais, žeminančio agresyvaus elgesio ir pasyvaus agresyvaus elgesio pasireiškimo tikimybė dažnai ir labai dažnai yra mažesnė nei pacientams, kuriems ši liga nenustatyta.

EPA-1476 – Suicide prevention project in finland: focus on outpatient care

The suicide rate has been traditionally high compared to countries of the European Union. The rate increased during decades after second world war until the early 1990's. Moreover, the suicide rate has followed closely the alcohol consumption rate. A national suicide prevention project was carried out in the late 1980's, which had the intent to increase access to low-threshold services and specialized psychiatric care. Physicians and psychiatrists were educated in the recognition of depression at a time when novel antidepressants were introduced and secondary level services were deinstitutionalized. Aims The review the successfulness of efforts to decrease suicides in Finland in the light of scientific studies. Results The rate of suicide has decreased considerably and its association with the use of alcohol has weakened. Although the use of alcohol increased in the 1990's the rate continued to decrease. Two studies have linked the decrease in rate of suicide with the sale and use of antidepressants. This trend appears to be especially pronounced among men. Additionally, evidence shows that the replacement of hospitalbased services with outpatient care has had a positive impact on suicide mortality of patients, who have received care in psychiatric hospitals. The decrease in suicide rate is associated with intensive outpatient care. Conclusion In the long run, the national suicide prevention project has been successful, although other factors, such as increase of standard of living and general wellbeing among citizens of Finland, have been likely contributors.

EPA-0737 - Ethics of care in a psychiatric hospital: “conflictual cooperation” and “ethics of resistance” in the multidisplinary caregivers team.

The psychiatric hospital is a dreaded, but respected institution for it receives people who are very upset. In this demanding situation it is a challenge for the care giver to preserve his capacity to receive and listen while avoiding the danger of an operative sort of practice that disingularizes the patient. The stength hospital teamwork is its rich variety of contributions. The groups conflictual cooperation allows people to be welcomed and recognized in spite of everything. An exemple of ‘Ethics of resistance’ practice is The Psychotherapy of the Depressed Patient in the Hospital (PPDH). This is one of these institutions that resist this disingularization. While adapting to the requirements of a psychiatric clinic there are times for personal human encounters rather than therapeutic gatherings in a hospital. A paper written in the PPDH and elements from literature show how this specific therapeutic position works. It can only exist through dialogue and be contained through hospital teamwork. It is a very precious and particularly for patients suffering from depression and caught up in autoagressive decompensation.

Determinanten direkter Kosten bei persistierender Positivsymptomatik psychotischer Erkrankungen

To analyze direct costs and cost determinants in psychotic patients with persistent positive symptoms (PPS). A total of 330 patients with PPS were recruited via 6 university clinics and interviewed about service utilization in the previous 3 months. After monetary valuation, costs were analyzed via generalized linear mixed models with gamma distribution and log-link function to identify determinants of direct costs. The mean costs were 7,065 € and resulted predominantly from psychiatric hospital care (63 %), assisted living (17 %) and complementary services (8 %). We found statistically significant associations between direct costs and an increasing score of the negative subscale of the Positive and Negative Syndrome Scale (+ 2,484 € per point, p < 0.001) and experiencing less than one social contact per week (- 2,272 €, p = 0.003). PPS incurred substantial direct costs which primarily resulted from hospital treatment, and were strongly associated with symptom severity.

Psychosis, Psychiatry, and Escape: A Social Work Academic's Retrospective Self-Narrative

This is a self-narrative account written retrospectively by a UK-based social work academic reflecting on the direct experience of being a psychiatric inpatient. A contextualization is established for the experience of psychosis and the psychiatric response. Psychosis is justified as a rational response that challenges the otherness often adopted toward users of mental health services. The psychiatric system is found to be restrictive and disempowering, posing a barrier to recovery. Personal narrative experience is analyzed considering the strengths of psychiatric care, which are contrasted against informal support mechanisms. Informal support proves to be beneficial as opposed to coercive psychiatric hospital care.

Undignified care

Patient dignity in involuntary psychiatric hospital care is a complex yet central phenomenon. Research is needed on the concept of dignity's specific contextual attributes since nurses are responsible for providing dignified care in psychiatric care. The aim was to describe nurses' experiences of violation of patient dignity in clinical caring situations in involuntary psychiatric hospital care. A qualitative design with a hermeneutic approach was used to analyze and interpret data collected from group interviews. Findings reveal seven tentative themes of nurses' experiences of violations of patient dignity: patients not taken seriously, patients ignored, patients uncovered and exposed, patients physically violated, patients becoming the victims of others' superiority, patients being betrayed, and patients being predefined. Understanding the contextual experiences of nurses can shed light on the care of patients in involuntary psychiatric hospital care.