Background: Little is known about young adults with Head Injury (HI) who are discharged to nursing homes; particularly with regards to the impact that living environment has on their quality of life (QOL). To date QOL profiles in HI are limited and much of this research has also been confined to those who live in the community. The degree to which existing profiles are meaningful in young adults with HI living in nursing homes is uncertain and further investigation is required. Methods: The present study aims to investigate whether QOL differs for individuals with HI living in nursing homes compared to individuals with HI living in the community and healthy peers. 33 participants were recruited into one of three groups; HI nursing home (n = 11), HI community group (n = 11) and a healthy control group (n = 11). The groups were compared on generic and disease specific self-report measures of QOL. In order to create a picture of factors which are associated with QOL following HI; the HI groups completed a number of measures assessing psychosocial variables (depression, self-esteem, contact with family and friend and completion of recreational activities). Results: No differences in ratings of QOL between the HIN group and HICC and healthy control groups were found. Relationships were found between levels of depression, self-esteem and QOL after HI. Conclusion: No evidence was found to support the hypothesis that QOL is poorer for young adults with HI living in nursing homes. Further support is provided for a number psychological variables associated with QOL. Further research is required to replicate and extend these findings.

Cette thèse examine le processus d’institutionnalisation d’une expertise gestionnaire dans le champ de la psychiatrie publique à travers la mise en œuvre d’un système d’information standardisé (le RIM-P) censé permettre une description détaillée de l’activité soignante. Le questionnement que nous proposons est double. Il s’agit d’une part, de définir les conditions par lesquelles ce dispositif parvient à investir le fonctionnement des secteurs psychiatriques. D’autre part, nous proposons de développer une réflexion sur les formes de mobilisation collective déployées par les acteurs de ces organisations pour faire face à l’imposition d’un nouveau système normatif. En reconstituant le processus d’imposition du RIM-P, nous montrons comment il participe à l’intrusion de la logique de la performance et de la rationalité instrumentale à finalité économico-financière au sein des établissements de soins. Nous montrons ensuite qu’une hybridation entre connaissance médicale et gestionnaire constitue un préalable indispensable à sa mise en œuvre. Puis, à partir d’une enquête par observation transversale, nous rendons compte des usages, par les agents rationalisateurs et par les soignants, de ce système d’information standardisé. Nous révélons des situations très diversifiées selon les établissements et liées notamment à leur capacité à mettre en place une « technostructure » dont la légitimité repose sur la maîtrise de dispositifs de gestion complexes dédiés à la coordination et au contrôle du travail soignant. Nous montrons enfin la force de l’action critique des soignants et la manière dont est inventée une gestion alternative davantage en accord avec les expériences professionnelles des différentes catégories d’acteurs. / This thesis examines the process of institutionalization of management expertise in the field of public psychiatry through the implementation of a standardized information system (RIM-P) which is intended to allow a detailed description of the care activity. The study that we propose is twofold. On the one hand, we will attempt to define the conditions in which the system is able to invest the functioning of psychiatric sectors. On the other hand, we propose to consider the forms of collective mobilization deployed by actors in these organizations in order to deal with the imposition of a new regulatory system. By reconstructing the process of imposition of the RIM-P, we show how it contributes to intruding on the logic of performance and instrumental rationality for economic and financial purposes within healthcare institutions. We then show that hybridization between medical knowledge and management is a prerequisite for its implementation. Then, from an observational survey, we report on the use by official rationalizers and caregivers of this standardized information system. We reveal highly diversified situations depending on the institution which are linked to their ability to implement a "techno structure" whose legitimacy rests on the mastery of complex management systems dedicated to the coordination and control of healthcare work. Finally, we show the strength of the critical action of caregivers and how alternative management can be established which is more in line with the professional experience of the different categories of actors.

There have been many studies of Victorian asylums and their inmates, but the Edwardian asylum, and child inmates, have been largely unrepresented. This thesis attempts to redress these imbalances and contribute to the history of mental deficiency by describing the innovations, developments, and practices within the West Riding Pauper Lunatic Asylum (WRPLA) and its annexe, Stanley Hall. As part of the Poor Law system Stanley Hall took in idiot and imbecile boys as young as three years, where, as part of the response of alienists towards mentally deficient children, an attempt was made to educate them to a degree of self- sufficiency. In this way Stanley Hall was an institution that went beyond its perception as a custodial establishment and practised new approaches to care, at a time when these boys were defined within the Poor Law under the universal category of 'lunatic'. This study focuses on the role of William Bevan Lewis, the Medical Superintendent of the WRPLA (1884-1910), and the 163 idiot and imbecile boys admitted to Stanley Hall between 1901 and 1910. Consideration is given to the early dissemination of knowledge from this asylum and its influence through the teaching and training of medical students and asylum medical officers. The function and operation of Stanley Hall and the 'experiences' of the inmates is explored through institutional records and the evidence of Bevan Lewis to the Royal Commission on the Care and Control of the Feeble-minded (1905-1908). Stanley Hall pre-dated other mental deficiency colonies and anticipated the conclusions of the Royal Commission which recommended specialised care for mentally deficient children. Issues of care for this group were intensely debated during the Edwardian period leading to the Mental Deficiency Act (1913) that defined this group and influenced their care for almost another fifty years. The records of Stanley Hall demonstrate the individuality of the boys, and allow the analysis of the involvement of their families in the committal of their children. The subsequent involvement (or lack thereof) in the care of their children is also examined. The ultimate fates of the boys are considered, and an attempt made to bring the regime at Stanley Hall 'back to life'.

Thesis (M.Cur.) -- University of Limpopo, 2015 / The purpose of the study was to investigate the experiences of families towards psychiatric state patients during LOA. A qualitative, phenomenological, exploratory, descriptive and contextual design was used. Non-probability sampling of the purposive type was used to explore and describe the experiences of families towards psychiatric state patients during LOA. Data were collected from ten (10) families by using semi-structured face-to-face interviews. Data were audio recorded and field notes were also written. Trustworthiness was ensured by applying credibility, transferability, confirmability and dependability. Transferability was ensured by utilizing purposive sampling to include participants. Confirmability was ensured by collecting data from the participants who have experience on the problem studied. Data were analysed qualitatively by using Tech’s open coding method. Results from the study shows that families experiences uncontrolled and disruptive behaviour from the psychiatric state patients during LOA. Guidelines for the study include: Families of psychiatric state patients should receive counselling and be involved in family therapy prior and after the psychiatric state patient’s LOA. Family members of psychiatric state patient experience emotional pain, therefore they need support from multidisciplinary team members to assist them to facilitate promotion, maintenance and restoration of their mental health as an integral part of their health. Recommendations include improvement of aspects in nursing practice, nursing education and nursing research. Key words: Experiences, family, psychiatric state patients, Leave of absence. DEFINITION