Josefin

Talking about the international educational level of midwifes, in Sweden midwifery is a nursing speciality on one year masters level. A BSN is required to enter midwifery training, and I believe that basically the same goes for most Scandinavian countries.

Here in Sweden we have nurse anesthetists and from what I know, they are rather independent in their work. Since I´m in a completely different area myself I´m not sure about their exact duties, but they do for example intubations. Normally in Sweden there is not an anesthetist (physician) present in the surgery room all the time, this person walks between several rooms and the nurses handle the responsibility for the patient during the surgery. I believe that in general nurses in Sweden are quite independent in their work and many times they perform advanced medical-surgical duties. There is a debate going on though, about the trend going towards nurses becoming more and more like physician assistants than being true experts in nursing. I don´t know if that is the case everywhere in the country though, I think it could be related to where you get your nursing education. I work at a university with a high status medical faculty and of course, that has an impact on nursing education, which is in the same faculty and departments as where the physicians get their education. Being a registered nurse is a completely accepted choice of career in Sweden, although not high status in the same way as physicians and dentists. I would say that being a registered nurse is valued about the same as being a teacher, the salary is also more like a teachers. There is a clear difference in status, independency, salary and status between being a registered nurse educated in the university than being an assistant nurse with no university education.

Oh, I hope it will turn out well, happy that I could help! /Josefin

Addition to above: Now after posting this it struck me that the term custodial mental healthcare might not be correct. To explain, it means involuntary mental healthcare.

Hi, I´m glad to try to answer your questions; hope you can use the answers. If you have more questions, please don´t hesitate to contact me. This will be a long reply, if you use this I would very much like to see the final result (only if you find it appropriate of course). 1. What country are these questions pertaining too? - Sweden- I´m sorry that my English is far from perfect... :) 2. Does this country have an equivalent of the Baker Act? - I´m not that familiar with the Baker Act, but from what I understand it's an act that protects the individual from being committed under the wrong circumstances. In Sweden mental healthcare is strongly regulated by the law, there is a special law for custodial mental healthcare ("The law concerning custodial mental healthcare"). Basically three accessories have to be fulfilled for a person to be committed against his or her will: 1. the person must suffer from a SERIOUS mental disorder (i.e. psychosis, mania, suicide attempt) assessed by a registered physician. 2. The person must declare that he or her resist voluntary care 3. It must be assessed that the care can't be given under other forms than in a specialized hospital for mental healthcare 24/7. The law also enact that it should be assessed whether the person could be consider a danger for him/herself or other persons. There are also some new paragraphs regulating custodial mental healthcare in outpatient clinics under certain circumstances. Voluntary mental healthcare is regulated by the main healthcare laws in Sweden and does not differ from other areas of healthcare. 3. How does a mentally ill person get committed to a psych facility? - There are basically two ways of be committed to mental healthcare in Sweden. 1. Either the person seeks help voluntary, either at a psychiatric emergency unit (24/7) or at an outpatient clinic or primary healthcare centre (office hours). The care can than take place either in a hospital or in an outpatient clinic, depending on the severity of the condition. 2. The patient is brought to a psychiatric emergency unit against his or her will, mostly with help from the police or social services. This could be indicated either by for example neighbors, relatives or by serious disturbing actions in public. Please note that relatives and friends never can determine whether the person is going to be committed for care or not, this decision can only be made by a registered physician. Only if a person is committed for care under this law the person could be forced to take medications against his or her will, forced not to leave the hospital or separated (not isolated though) from other patients. 4. How long can they be confined to a psych facility? - If committed voluntary the care could go on for as long as the patient wish to stay, or until assessed well enough to go on to an outpatient clinic by the responsible care team. Patients committed voluntary could basically leave the hospital whenever they like, and could only be converted to custodial care if the person fulfills the three accessories mentioned above PLUS that the person needs to be assessed to be a serious threat against own or others health. Generally the goal is to keep the time in the hospital as short as only possible. If the person is committed under the law about custodial mental healthcare the care is regulated strongly. First the registered physician (could be someone in a primary healthcare setting or anywhere) issues a hospital order according to the law mentioned above. This order needs to be evaluated within 24 hours by a psychiatrist and then an executive psychiatrist of the clinic (NOT the same one evaluating the order at first) decides whether the patient should be hospitalized or not. If the patient is committed for care it can take place for 4 weeks. After this the patients is entitled to a legal assistance to appeal the care in the country court. If the court rejects the appeal the care could go on for another 4 months and then again for six months after a new trial. It must be said that it is very rare that the care continues this long. The chief physician could choose to abort the care before that, and in most cases the patient accepts voluntary care within days or a few weeks. 5. What are the requirements for discharge? - Always, that the patient is assessed well enough to assimilate care at an outpatient clinic. This is the goal for voluntary as well as custodial mental healthcare. 6. Who pays for the treatment? - The government. Healthcare is free in Sweden, for every citizen, paid by taxes. There is a small fee (about 12 $/day) for persons seeking voluntary and treated at hospital. 7. Are health care services readily available to the mentally ill? - Yes. However there is a frequent debate going on about cut down in mental healthcare standard in Sweden, though I do believe that it is fairly easily accessed. 8. What medications are being used? - All kind of psychiatric medications, I have to say that there are no limitations of that, other that older medications that are considered dated are not used. The newest and properly evaluated medications in all psychiatric conditions are used; however first choice can differ slightly on the individual physician. There is a yearly limit for what every citizen pay for medications every year, about 180 $/year. After that medications are free. The Swedish Council on Technology Assessment in Health Care decides for the whole healthcare system which treatment options are most effective for each condition, based on international research. http://www.sbu.se/en/ 9. Are there alternative or folk medicine being used? - No, that is actually considered somewhat suspicious in Swedish health care, though people can choose to buy for example St John's wort themselves in alternative medical shops. Alternative medications are never used in governmental healthcare though. 10. What are the stigmas attached to mental disorders? - There are the regular stigmas that are common in all western cultures I believe. People still think of mental healthcare as "One flew over the cuckoo's nest" and think that people with schizophrenia have multiple personalities and so on. Really annoying according to me, people generally don't seem to see "ordinary depressions" as mental disorders, only people marked by disease are "the real psychos" (sic!) so to speak. And generally I believe that many people associate violence to people with mental disorders. Sad but true. 11. How are people with mental health disorders treated? - Within the healthcare system I believe people generally (there are of course sad exceptions) are treated professionally as with any other disease. The best available treatment should be given. In society in general I think it may differ from case to case. People with high social status to begin with could out their depressions and gain great sympathy from other. Other persons with low social status could be more stigmatized. 12. What role does a family play in an individual's care? - It is recommended that family should be involved as much as appropriate in the care of the patient, if the patient self wishes so of course. Adult patients always choose themselves if they want their family to know that they are committed or that they even are in contact with the healthcare system. 13. How would you describe the care received by the mentally ill? - Although many people complain about bad healthcare standard in Sweden I think that we in comparison with many other countries provide really high standard of the mental healthcare (as well as other healthcare). Above all, no one is excluded or receive less quality because of no insurance. If this system is optimal or not is not for me to decide though. Everything can of course get better, but in general the standard of care must be considered high, and the patients integrity and legal security is high.

I believe that there might be some diffrences between the scandinavian countries as well. I have never worked outside Sweden myself, but from what I have heard other colleuges with experience say are RN nursing work generally more advanced and comes with more responsibility here compared to Finland, Norway and Denmark. Norway pay much more though, thats why many swedish nurses choose to work there. The swedish system seems to be more like the one in US with assistant nurses doing most of the basic care. Talking about grades, here we only have two grades: Passed or failed. Passed means you need to score from 75% to 100% depending on course. There are lots of discussing going on here at the moment about the fact that the hospitals complains about students not being ready for work after exam. My opinion is that it migtht be so compared to what it was like before when education took place almost only at the hospital. Though- now we are educating academic nurses who have their strength i other areas, like life long learning and research. Im not so sure that it is what the hospitals want though, cause with that comes staff that wont settle with the same working conditions as before. Well, well. There is a lot to say in this subject. Im sorry for my quite poor english today, might be because it is the day after new years eve...

I work at a community mental health unit and feel that I recieve a lot more respect for the job I do, compared to other nurses I know who are working in other "traditional" areas. It might be a bit different since I work in Sweden, but my job as a "psych nurse" is really independent and advanced. I have my "own" patients and run CBT(cognitive behavioural therapy) sessions, do my own consults at other parts of the hospital etc. My job is not much about routine, I plan my own day, from my own office. I feel that both other nurses and physicians give me a lot of cred and respect, my opinion matters! I also believe that many nurses (and physicians as well) might not be aware of what great opportunities there are for nurses in psychiatric care. I love my job, although I am now offered a job as project manager, which means that I wont work with patients at all. A pity since I love working with people, but ofcourse also a challenge.

Well. It depends, if the tests are marked with "acute" it takes about 20 mins. Otherwise about 40 mins- 2 hours depending on what time of day they are sent.

PLEASE! I can see you are not political, you got something terribly wrong here... It`s NOT Turkey destroying 2000 year old carvings/statues, it`s AFGHANISTAN which is a country ruled by high traditional talibans. Afghanistan has become a dictature where women live in fear to be stoned to death if they are showing anything but the eyes outside their own house. To compare Turkey to Afghanistan is like comparing... hmmm... I can`t come up with anything like it!!! Beside this- I can`t believe this... It sounds really sick- an expression of a fight within the turkish society you can`t imagine if you have not been in the country. Turkey is a country with a white and a black side. One side (mainly upper class) are living exactly as we are in Rome, NY, Stockholm, Copenhagen, Paris etc. The other side of the country is, as mentioned before in this thread, traditional low-educated muslems who are living in a very traditional way. Turkey is truly an interesting country, I recommend you all to visit it at least one time. If anyone have questions about the country or society, you are welcome to e-mail me!