Ample empirical evidence highlights the significant prevalence of persons with mental health issues and concurrent disorders involved in the criminal justice system. This population frequently uses services provided by community based non-profit organizations for aid and support. Yet, there is a dearth of research that addresses the prevalence of mental health issues and concurrent disorders amongst those served by such organizations, and the barriers to community reintegration that they face. Focusing on the prevalence of mental health issues and concurrent disorders among individuals involved or at risk of involvement in the criminal justice system, the John Howard Society of Waterloo-Wellington and the University of Guelph embarked upon a mixed-methods community-engaged research partnership. Information for the clients in the ‘Community Aftercare’ program was collected in relation to mental health issues and concurrent disorders. Our data reveal the ‘typical’ profile of the clients accessing the Aftercare program, which includes a high prevalence of mental health issues and concurrent disorders. Further, interviews identified stigma, history of victimization, complex needs, criminal history, diminished welfare state, and a lack of social support/social capital as barriers faced by the Aftercare clients. The Aftercare program, however, acts as a form of social support and builds social capital for the clients. A lack of adequate funding to address the complex needs of the Aftercare clients was identified as a program limitation, and the findings revealed a need for additional funding.

La rencontre des patients addictés suscite fréquemment l’inquiétude. Celle-ci rend difficile l’exercice du soin, même spécialisé, et attaque ses conditions éthiques. Cette thèse se propose d’explorer l’expérience des professionnels de l’addictologie, dans la diversité de leurs approches et de leurs pratiques. Elle s’inscrit dans une épistémologie de la complexité et adopte une méthodologie complémentariste. Des discours socio-anthropologiques, philosophiques et psychanalytiques peuvent ainsi être mis en contact au profit d’une appréhension plurivoque de la problématique éthique et clinique de la relation de soin en addictologie. Dans un premier temps, nous avons exploré de manière qualitative l’expérience des soignants. L’étude « Éthique et Narrativité dans les Addictions » (EthNaA) nous a apporté de nombreuses données sur les sources et les effets de l’inquiétude dans le soin, ainsi que sur des voies de dégagement. Une lecture psychodynamique de ces résultats nous a permis d’extraire une première théorie de la relation de soin : dans la rencontre, soignant et patient se replient sur des positions narcissiques qui déterminent leurs représentations de l’autre et d’eux-mêmes, ainsi que leur modalités de lien ; alternativement monstres et héros, les acteurs s’agrippent et se rejettent dans un climat de défiance qui infiltre tous les espaces ; dans la douleur de cette expérience et dans la conscience des conséquences éthiques pour le patient, les professionnels cherchent des moyens de restaurer une confiance dans un soin de soi et une recherche de soutien à l’ « extérieur », sans toutefois pouvoir s’y engager. Dans un second temps, en tant qu’acteur de ce soin, il était nécessaire que nous présentions notre propre expérience, ainsi que des histoires cliniques, pour pouvoir prétendre soutenir un discours éthique. Cette expérience est très proche de celle des soignants d’EthNaA mais son exposé a permis de souligner l’ancrage intrapsychique des mouvements affectifs décrits précédemment. Cela nous a mis sur la voie d’une seconde théorie capable de soutenir des propositions de nature à restaurer le soin dans ses qualités éthiques et cliniques. La « relation inquiète » met en présence un patient souffrant dans une attente silencieuse, et un soignant désireux de s’investir mais vulnérable, en premier lieu du fait d’un affaiblissement de la fonction tierce en lui comme dans son cadre institutionnel. La relation de soin s’enferme alors dans une circularité qui évoque le cercle des attitudes de Jean-Paul Sartre, entre masochisme, haine, sadisme et amour. Cet amour, présent dans le discours des soignants, reste replié sur soi et défiant. Nous avons alors repris les idées des professionnels d’EthNaA et les avons complétées en proposant un souci de soi, resubjectivant et allié à un réinvestissement de la fonction tierce intériorisée. Cette nouvelle prise de position soignante, dans une affirmation du primat du tiers, doit permettre une reconnaissance de l’autre-patient comme sujet propre. Ce « jeu » entre les protagonistes doit s’inscrire dans une éthique simultanément exigeante et tolérante. La piste « amoureuse » ouverte par les soignants d’EthNaA peut alors rejoindre l’éthique de Vladimir Jankélévitch. La relation de soin entre deux sujets restaurés peut alors se relancer – portée par une nouvelle dialectique entre soin de soi et amour de l’autre, entre inquiétude saisissante et élancement, entre défiance et confiance – sur une trajectoire sinueuse et parfois chaotique, mais qui donne finalement au soin le dernier mot. / The encounter with addicted patients frequently arouses a feeling of disquiet. It renders the practice of care difficult, even in expert settings, and degrades its ethical conditions. The present work explores the experience of professionals from the field of addictions treatment taking account of the diversity of their approaches and practices. It is in line with an epistemology of the complexity and adopts a complémentariste methodology. In this way, sociological, philosophical and psychoanalytical theoretical corpus can be put in discussion in order to comprehend the complexity of the ethical and clinical questions emerging from the care relationship.In a first phase, we conducted a qualitative inquiry of the caregiver’s experience. The study “Éthique et Narrativité dans les Addictions” (EthNaA) provided us with numerous data on sources and effects of disquiet in the care setting, as well as on ways out. A psychodynamical reading of these results led us to a first theory of the care relationship: in the encounter, the caregiver and the patient both withdraw on narcissistic positions which determine how they depict one another and themselves, as well as their ways of establishing mutual bounds; alternatively monsters and heroes, the protagonists grab onto each other and reject each other in a climate of distrust which infiltrates all the areas of the relationship; through the pain of this experience and the consciousness of the ethical consequences for the patient, the caregivers seek resources allowing them to restore a trust by taking care of themselves and looking for support from the “outside”, but they still seem unable to commit themselves in this move.In a second phase, as a professional enrolled in the care of addicted patients, it was necessary that we exhibit our own experience and clinical stories in order to support an ethical stand. Our experience is very similar to the caregiver’s in the study but its report allowed us to underline the intrapsychic integration of the emotional dynamics previously described. It opened the way of a second theory able to support innovative propositions likely to restore the care in its ethical and clinical qualities.The “disquiet relationship” brings a suffering patient in a silent expectation face to face with a caregiver, willing to get involved but vulnerable, in the first place because of the weakening of the function of the third position in the caregiver’s thought as well as in the institutional frame. The care relationship then locks itself in a circularity witch evokes the circle of attitudes described by Jean-Paul Sartre among masochism, hatred, sadism and love. This love, present in the caregiver’s discourses, remains withdrawn into itself and distrustful. We then started again from the caregiver’s ideas, completing them by introducing a care of the self able to restore the subjectivity of the agent through its combination with the reinvestment of the function of the third position in the caregiver’s thought. This new caring stand, through the assertion of the primacy of the third position, shall allow the acknowledgement of the patient as a subject. This “play” between protagonists shall place itself in an ethic simultaneously demanding and tolerant. The “amorous” track opened by the caregivers of the study can then rejoin the ethic of Vladimir Jankélévitch. The care relationship between two restored subjects can then make a fresh start – supported by a new dialectic between care of the self and love of the other, between piercing disquiet and anxious yearning, between distrust and trust – on a sinuous and sometimes chaotic trajectory, but which finally gives to the care the last word.

Nursing specialization involves focusing on nursing practice in an identified specific area within the entire field of professional nursing. A defined specialty scope of practice statement and standards of professional practice, with accompanying competencies, are unique to each nursing specialty. These documents help assure continued understanding and recognition of nursing’s diverse professional contributions. The purpose of this article is to demystify the process for specialty nurses who are creating or revising their specialty nursing scope and standards of practice. We provide best practices for the developmental process based on our recently published scope and standards of specialty nursing practice. The conclusion provides strategies to disseminate scope and standards documents to appropriate stakeholders.

Rationale Although there is evidence that impaired executive functioning plays a role in addictive behavior, the longitudinal relationship between the two remains relatively unknown. Objectives In a prospective-longitudinal community study, we tested the hypothesis that lower executive functioning is associated with more addictive behavior at one point in time and over time. Methods Three hundred and thirty-eight individuals (19–27 years, 59% female) from a random community sample were recruited into three groups: addictive disorders related to substances (n = 100) or to behaviors (n = 118), or healthy controls (n = 120). At baseline, participants completed nine executive function tasks from which a latent variable of general executive functioning (GEF) was derived. Addictive behavior (i.e., quantity and frequency of use, and number of DSM-5 criteria met) were assessed using standardized clinical interviews at baseline and three annual follow-ups. The trajectories of addictive behaviors were examined using latent growth curve modeling. Results At baseline, we found weak to no evidence of an associations between GEF and addictive behavior. We found evidence for an association between a lower GEF at baseline and a higher increase in the quantity of use and a smaller decrease in frequency of use over time, but no evidence for an association with an increase in the number of DSM-5 criteria met. Conclusions Lower EFs appear to lead to a continuing loss of control over use, whereas addictive disorders may develop secondarily after a long period of risky use. Previous etiological models assuming lower EF as a direct vulnerability factor for addictive disorders need to be refined.

This study was concerned with the health implications of new forms of gambling such as casinos, pokie machines and internet gambling for Māori women and their families in Auckland and the Bay of Plenty region of Aotearoa (New Zealand). It set out to discover what culturally appropriate services were available and the extent to which Māori women gamblers were utilising them. The literature documenting Māori perceptions of gambling shows that Māori women gamblers and their partner/whānau members and gambling service providers have been little studied previously. These goals translated into the following specific aims: 1) to study how Māori women problem gamblers, their partner or whānau members and key informants perceived gambling, what it meant to them and why they did it; 2) to investigate the consequences of gambling for Māori women, whānau and service providers in dealing with the effects of gambling; 3) to report on how these three groups dealt with the effects of gambling; and 4) to discover what helped to bring about positive changes for the three groups. All of the aims were achieved. A Māori approach (Kaupapa Māori), combined with a naturalistic approach to data collection, was adopted. Qualitative methods are most appropriate to use when working with some Māori, as there is a growing realisation that research with Māori needs to be interactive. A Māori research procedure modelled on the ritual ceremony of encounter (Pōwhiri) provided an appropriate structure for the development and presentation of the research process. The major focus was on the qualitative data obtained from semi-structured interviews in two locations - Rotorua and Auckland. The interviews were conducted with twenty Māori women gamblers, sixteen whānau members including partners and ten interviews with staff involved in services that provided help for problem gamblers. The three interview schedules were based on a number of broad themes and open-ended questions to obtain meaningful descriptive data. The interviews were audio recorded and used to produce transcripts that were then sent back to the participants for feedback. Qualitative data analysis was conducted on the returned documents. The findings from this study revealed major impacts of the women's socio-economic, familial and societal circumstances on gambling behaviour and its effects, which are areas of concern for mental health professionals and researchers. The mythical Māori canoes on which Māori voyaged from their place of origin (Hawaiiki) to Aotearoa, the Waka, provided an appropriate metaphor to present the interrelationship between the pull and push factors toward gambling, and its implications for society. This is illustrated as a spinning waka, Te Waka Hūrihuri. On the other hand, Te Waka Māia (courageous) demonstrates the relationships between the variables that help Māori women gamblers to cope and helpful strategies found to assist them to modify or stop their gambling behaviour. It is recommended that the government limit the proliferation of gaming venues and continue to encourage development of emerging Māori services. Moreover, a coordinated approach is essential, as Māori women gamblers, partners and whānau members need to heal together for positive outcomes for Māori health development in Aotearoa. The main implication of this study is that a wide range of further research into Māori and gambling is required. Recommendations on ways in which the current delivery of services in Rotorua and Auckland could be improved are: That the Ministry of Health purchase services that establish support groups for Māori people with problem gambling and their whānau, and That non-Māori provider services and organisations support the development of emerging Māori services. Heeding the outcome of this research should help improve New Zealand's existing health policy and capacity for Māori women's health development. It should also enrich our understanding of the adaptation patterns of Māori whānau member/s, and thus should have implications, not only for Māori health policies, but also relevance for the wider field of international cross-comparative research on indigenous gambling and mental health issues. Limitations of this study included a small, localised sample that means the findings can only tentatively be generalised to the wider population of Māori women gamblers. Nonetheless, information gained from the study contributes to understanding of the adaptation patterns of Māori women gamblers, their whānau member/s, and those who are trying to help them. It is hoped that the study will make it at least a little less true that every day is a war day for Māori women and their whānau trying to deal with the problem of gambling.

Registered nurses and registered psychiatric nurses are members of multidisciplinary mental health teams that address the assessment and treatment of vulnerable youth. The phenomenon of interest for this study is nursing's distinct contribution to a multidisciplinary team in this clinical domain. An interpretive description drawing on the perspectives of seven nurses and seven clinicians from the professions of psychiatry, psychology, social work, child and youth care, and registered clinical counselling provides insight into understanding nursing's distinct contribution (NDC) to multidisciplinary mental health teams that serve vulnerable youth (MMHTSVY). Six major themes and multiple subthemes were inductively derived. The findings make explicit nursing’s contribution to MMHTSVY in ways that are meaningful to the clinical practice. / Graduate

В данном исследовании рассмотрены проблемы использования видеоигр современным обществом, а именно проблема регулирования игрового поведения молодежи. Цель исследования: разработка технологии регулирования игрового поведения молодежи на законодательном, институциональном, аппаратном и образовательном уровнях, а также в социальной сфере. В работе были использованы следующие методы исследования: статистический анализ, контент-анализ, эмпирический анализ, вторичный анализ, обобщение, систематизация, классификация. Результаты теоретических и практических исследований отражены в таблицах, рисунках (диаграммах), в приложениях. В приложении приведена разработанная типология жанров с описанием специфики жанра и таблицы, отражающие статистические данные исследования. Материалы ВКР носят выраженный практический характер и могут быть использованы при разработке лекционного курса «Профилактика игрового расстройства», при написании учебно-методических пособий. Материалы диссертации были апробированы на Международной молодежной научно-исследовательской конференции «Инновационный потенциал молодежи: социальная, экологическая и экономическая устойчивость», научно-практической конференции «Максимовские чтения», I Международной научно-практической конференции «Наука нового поколения: конвергенция знаний, технологий, общества». / This study addresses the problems of the use of video games by modern society, namely the problem of regulating the gaming behavior of young people. The purpose of the research: the development of technology to regulate the gaming behavior of young people at the legislative, institutional, apparatus and educational levels, as well as in the social sphere. The following research methods were used in this work: statistical analysis, content analysis, empirical analysis, secondary analysis, synthesis, systematization, classification. The results of theoretical and practical research are shown in tables, figures (diagrams), in applications. The appendix contains the developed typology of genres with a description of the specifics of the genre and a table reflecting the statistical data of the study. The thesis materials are of a pronounced practical nature and can be used in the process of development of a lecture course «Gaming disorder prevention» and teaching aids. The dissertation materials were approved at the International Youth Research Conference «Innovative potential of young people: social, environmental and economic sustainability», Scientific-practical Conference «Maximovskie chtenia», I International Scientific-practical Conference «Science of a new generation: the convergence of knowledge, technology, society».