A Atenção Primária à Saúde é reconhecida como base para um sistema de informação em saúde (SIS) eficiente, razão pela qual justifica-se a importância de reestruturação a fim de atender os novos conceitos tecnológicos de integração das informações e interoperabilidade entre os SIS. Tal relevância resultou na Estratégia e-SUS AB composta: pelo Sistema de Informação em Saúde para Atenção Básica (SISAB); e pelo e-SUS AB. Dessa maneira, passou a ser o SIS vigente para fins de financiamento e de adesão aos programas de estratégias da Política Nacional de Atenção Básica. A pluralidade dos cenários de informatização e conectividade resultou na disponibilização de dois sistemas de software - Coleta de Dados Simplificada (CDS) e Prontuário Eletrônico do Cidadão -, responsáveis por alimentar o SISAB. Relatos de usuários do e-SUS AB identificaram falhas na capacitação e dificuldades para sanar dúvidas, reforçando a importância de uma educação permanente para qualificar as práticas em saúde, além da imprescindibilidade de olhar para as possíveis lacunas nos sistemas próprios. Este estudo teve como objetivos: elaborar um protótipo com oportunidades de melhorias para o módulo CDS do e-SUS AB, integrado no sistema proprietário utilizado no local da pesquisa; e desenvolver e avaliar um manual web, elaborado a partir de um diagnóstico de dúvidas e dificuldades dos agentes comunitários de saúde (ACS). Trata-se de uma pesquisa aplicada, com abordagem qualitativa, na modalidade pesquisa-ação. A população amostral foi constituída pelos ACS alocados em seis Núcleos da Saúde da Família do distrito Oeste do município de Ribeirão Preto e por especialistas de informática, que aceitaram participar da pesquisa por meio da assinatura do Termo de Consentimento Livre e Esclarecido. A coleta de dados ocorreu mediante observação das atividades do ACS utilizando o sistema e-SUS AB, módulo CDS, além de entrevistas não estruturadas. Para o desenvolvimento do protótipo foi utilizado o programa AXURE RP Pro 7.0, que gera protótipos interativos e para o desenvolvimento do manual web foi utilizado linguagem de marcação interpretada por navegadores. Tanto o protótipo quanto o manual web e-SUS foram avaliados por meio de aplicação de questionário. Os resultados evidenciam a importância de conhecer os aspectos relacionados ao modo de trabalho, ou de comportamento, que possam influenciar na qualidade final dos dados inseridos nos SIS. Da mesma maneira, visam a obter insumos para a definição dos requisitos e metas de usabilidade, a fim de atender os diferentes papéis-de-usuário identificados e, ainda, reforça a relevância de olhar para os sistemas próprios, adquiridos no mercado privado ou desenvolvidos no município. A aproximação entre o pesquisador e as pessoas implicadas na situação investigada proporcionou detectar lacunas entre os componentes indispensáveis para efetivar as ações que objetivam a consolidação da informatização em saúde e, sobretudo, delinear potenciais soluções para os problemas apontados / Primary Health Care is recognized as the basis for an efficient health information system, highlighting the importance of restructuring in order to meet the new technological concepts of information integration and interoperability among SIS. This action resulted in the e-SUS AB Strategy composed by the Health Information System for Basic Care (SISAB) and e-SUS AB and became the current health information system for funding and adherence to National Policy strategies programs of Basic Attention. The plurality of computerization and connectivity scenarios resulted in the availability of two software systems: Simplified Data Collection (CDS) and Electronic Health Record, responsible for feeding SISAB. Reports from users of e-SUS AB identified deficiencies in training and difficulties to resolve doubts, reinforcing the importance of a permanent education to qualify health practices beyond the importance of looking at possible gaps in the systems themselves. The purpose of this study was to develop a prototype with improvement opportunities for the CDS module of e-SUS AB, integrated in the proprietary system used at the research site, and to develop and evaluate a web manual, based on a diagnosis of doubts and difficulties of community health agents (ACS). This is an applied research, with a qualitative approach, in the research-action modality. The sample population consisted of the ACS assigned to six Family Health Centers of the western district of the city of Ribeirão Preto and by computer specialists, who agreed to participate in the study through the signing of the Informed Consent Term. Data collection was based on the observation of ACS activities using the e-SUS AB system, CDS module, in addition to unstructured interviews. For the prototype development, the AXURE RP Pro 7.0 program was used, which generates interactive prototypes and for the web manual development, it was used marking language interpreted by browsers. Both the prototype and the e-SUS web manual were evaluated through a questionnaire application. The results show the importance of knowing the aspects related to the way of work, or behavior, that can influence the final quality of the data inserted in the health information system as well as to obtain inputs for the definition of usability requirements and goals, in order to meet the different Identified user roles. Also reinforces the importance of looking at the own systems, acquired in the private market or developed in the municipality. The approximation between the researcher and the people involved in the investigated situation revealed gaps between the indispensable components to carry out the actions that aim at the consolidation of the informatization in health and the delineation of potential solutions to the mentioned problems

Os acidentes de trabalho com exposição ao material biológico (ATMB) entre os profissionais da enfermagem são recorrentes e os seus potenciais agravos os tornam um caso de Saúde Pública mundial. O paradigma hegemônico de análise de acidente de trabalho, conhecido como modelo tradicional, considera apenas os elementos visíveis e pontuais presentes no momento do acidente. Já o modelo sistêmico, além destes elementos, elenca os de natureza distal ou latente ao evento como possíveis fatores causais do acidente. O Modelo de Análise e Prevenção de Acidentes do Trabalho (MAPA) é um instrumento desenvolvido a partir do paradigma sistêmico de causalidade de acidentes e de conceitos da Ergonomia da Atividade. O objetivo deste estudo epidemiológico transversal foi identificar a contribuição dos fatores no nível do trabalhador (individual), variáveis de dentro e de fora do trabalho, e no nível do setor de trabalho, relevantes pelo MAPA para a ocorrência dos acidentes de trabalho com exposição aos ATMB, nos profissionais da enfermagem do Instituto Central do Hospital das Clínicas (ICHC) da Faculdade de Medicina da USP. Os desfechos foram o ATMB por perfurocortante e por contato com fluído do paciente. Um censo que obteve cobertura de aproximadamente 92% (N=1648) foi realizado entre fevereiro e setembro de 2013. Houve a aplicação de seis análises de regressão logística multinível multivariada porque para cada desfecho foi feita uma análise que considerou todos os trabalhadores entrevistados e outras duas, uma para cada turno de trabalho. Em cada uma, primeiramente, foram introduzidas as variáveis no nível do trabalhador, primeiro as de dentro do trabalho, depois as de fora do trabalho. Por último, as variáveis do nível do setor foram introduzidas. Estas variáveis foram obtidas pela lapidação das escalas de trabalho. Os achados mostraram que existiu diferença no comportamento das variáveis tanto ao comparar os fatores associados para cada desfecho quanto ao comprar os fatores associados entre os turnos, no mesmo desfecho. A fim de explicar a diferença dos desfechos, elaborou-se uma hipótese que os elementos envolvidos no ATMB por perfurocortante, principalmente a administração de medicação intravenosa, são essenciais para o quadro de melhora do paciente. Assim, independentemente das condições de trabalho enfrentadas pelo profissional de enfermagem, a exposição aos elementos perfurocortantes devem acontecer. O mesmo não acontece com os elementos envolvidos no ATMB por contato. Outro raciocínio elaborado para explicar a diferença entre os desfechos foi que o nível de percepção de risco para os perfurocortantes é maior do que para o contato com os fluídos do paciente. Já a diferença entre os turnos de trabalho, basicamente foi explicada pela hipótese que o turno da noite é mais adaptado ao trabalho hospitalar do que o diurno, a evidência disso encontra-se na diferença do tempo de serviço entre os dois grupos. / Work accidents from exposure to biological material (ATMB) among nursing professionals are recurrent and their potential health problems make them a public health issue worldwide. The hegemonic paradigm accident analysis work, known as the traditional model, considers only the visible and specific elements present when the accident occurred. The systemic model, however, also lists the distal or latent nature to the event as possible causes of the accident. The Model of Analysis and Accident Prevention (MAPA) is an instrument developed from the systemic paradigm of causality of accidents and concepts of ergonomics of activity. The aim of this cross-sectional epidemiological study was to identify the contribution of factors at worker level (individual), variables from inside and outside work, and in the labor sector. These are stated in MAPA for the occurrence of occupational accidents involving exposure to ATMB in nursing professionals of the Instituto Central do Hospital das Clínicas (ICHC), USPs Faculdade de Medicina. The outcome was the ATMB for sharp injuries or by contact with patient fluid. A census was performed between February and September 2013 with a response rate of approximately 92 per cent (N = 1648). Six analyses were conducted using multivariate multilevel logistic regression because, for each outcome, an analysis was performed that considered all the interviewed workers. A further two analyses were realized for each shift. For each analysis, model-building was performed introducing the worker level variables in the model. The inside-work variables were introduced first followed by outside-work variables. Finally, the sector level variables were introduced. These were created from the nursing staffs schedules for each ICHC job sector. The findings showed that differences exist in the variable behavior when comparing associated factors for each outcome and comparing the associated factors between shifts in the same outcome. In order to explain the difference in outcomes, a hypothesis was formulated that the elements involved in ATMB by sharp injuries, especially during administration of intravenous medication, are essential for the improvement of patient status. In this way, regardless of the working conditions faced by nursing staff, they will be exposed to sharp elements. This is not the case with elements involved in ATMB through contact. One hypothesis to explain this difference between the outcomes is that the level of the risk perception for accidents from sharp objects is higher than those from contact with patient fluids. The difference between work shifts was basically explained by the rationale that the nurses on night shifts are more adapted to hospital work than day workers. This is supported by the difference in length of service between the two groups.

A dor é um fenômeno que está presente na assistência em saúde aos neonatos, e sua identificação, avaliação e tratamento pela equipe de saúde são ações relevantes para o bem estar do bebê, visto que interfere no restabelecimento de sua saúde e pode gerar consequências deletérias a curto, médio e longo prazo. O presente trabalho trata-se de um estudo quali-quantitativo, descritivo exploratório, cujo objetivo foi identificar o manejo da dor neonatal sob a perspectiva da equipe de saúde de uma maternidade de Ribeirão Preto - SP. Na etapa quantitativa do estudo, participaram 81 profissionais de saúde da maternidade: 12 pediatras, 1 técnica do laboratório, 22 enfermeiras e 46 auxiliares/técnicas de enfermagem, que responderam a um questionário de autopreenchimento com questões objetivas sobre dados pessoais, profissionais e dados específicos sobre o conhecimento e a prática da avaliação e manejo não farmacológico da dor neonatal. Na segunda etapa, profissionais considerados líderes de equipe foram convidados a participar, de forma individual, de uma entrevista semiestruturada gravada em áudio que após a transcrição foram submetidas à análise de conteúdo. Da análise dos dados quantitativos, constatou-se que todos os médicos, enfermeiras, técnica do laboratório e a grande maioria (89,1%) das auxiliares/técnicas de enfermagem referiram que o recém-nascido é capaz de sentir dor. 83,3% dos médicos, 77,3% das enfermeiras e 54,3% das auxiliares/técnicas de enfermagem, acreditam que procedimentos potencialmente dolorosos repetidos podem gerar alguma consequência ao neonato. A maioria dos profissionais afirmou que avaliam a dor do recém-nascido, tendo como parâmetros mais frequentes o choro, a mímica facial, e movimentos, construindo uma avaliação subjetiva sem o uso de escalas. As medidas não farmacológicas de alívio da dor mais citadas pelos profissionais foram: a oferta de sacarose a 25%, a sucção não nutritiva e a amamentação, com um predomínio da utilização da sacarose como principal método de escolha. Poucos profissionais de saúde se preocupam em realizar o registro adequado sobre a avaliação e o manejo da dor aguda do recém-nascido. Da análise dos dados qualitativos, 5 categorias e 15 subcategorias surgiram a partir das verbalizações das participantes: 1) \"Fatores facilitadores do manejo da dor neonatal\" (atuação dos profissionais; a utilização de métodos não farmacológicos; o uso sacarose como principal escolha para o alívio da dor neonatal; outras intervenções não farmacológicas), 2) \"Fatores dificultadores do manejo da dor neonatal\" (falhas em como lidar com a dor; excesso de procedimentos dolorosos; fluxo de trabalho e quantidade de recursos humanos), 3) \"Avaliação da dor\" (como e quando avaliar a dor; a importância da avaliação a dor), 4) \"Mudanças necessárias para melhorar o manejo da dor na instituição\" (treinamentos; protocolos e utilização de escalas para avaliação da dor; mudança na atitude dos profissionais e sensibilização da equipe), 5) \"Participação dos pais e/ou família no manejo da dor neonatal\" (vantagens e apoio ao manejo da dor neonatal com participação da família; dificuldades na participação da família no manejo da dor neonatal). Concluiu-se que há um conhecimento superficial dos profissionais de saúde quanto à avaliação e o manejo não farmacológico da dor neonatal aguda nesta maternidade, assim como há falta de protocolos clínicos formais, registros e capacitação dos profissionais de saúde. Considerando-se as propostas do cuidado atraumático, desenvolvimental e humanizado ao recém-nascido, torna-se imperativo mudanças de ações e condutas da equipe de saúde no que se refere ao manejo da dor neonatal, que deverá ser movida e estimulada a partir capacitações profissionais fundamentadas na transferência de conhecimento / Pain is a phenomenon that is present in the health care provided to neonates, and its identification, assessment and treatment by the health team are relevant actions for the welfare of the baby, since they interfere in the reestablishment of their health and may produce harmful consequences in the short, medium and long term. This is a quali-quantitative, descriptive and exploratory study with the aim to identify the management of neonatal pain from the perspective of the health team of a maternity hospital in Ribeirão Preto, São Paulo, Brazil. The quantitative stage of the study involved the participation of 81 health professionals from the maternity: 12 pediatricians, 1 laboratory technician, 22 nurses and 46 nursing technicians/aides, who answered a self-administered questionnaire containing objective questions regarding personal, professional and specific data on the knowledge and practice of the assessment and non-pharmacological management of neonatal pain. In the second stage, professionals who were considered to be team leaders were invited to participate, individually, in a semi-structured interview whose audio was recorded, transcribed and submitted to content analysis. The analysis of the quantitative data evidenced that all physicians, nurses, the laboratory technician and most of the nursing technicians/aides (89.1%) stated the newborn is capable of feeling pain. A total of 83.3% of the physicians, 77.3% of the nurses and 54.3% of the nursing technicians/aides believe that repetitive potentially painful procedures may bring some consequence to the neonate. Most of the professionals stated they assess the pain of the newborn, using their crying, facial mimics and movements as parameters, building a subjective assessment without the use of scales. The non-pharmacological measures for pain relief most commonly cited by the professionals were: offering a 25% sucrose solution, non-nutritional suction and breastfeeding, with prevalence for the use of sucrose as the main chosen method. Few health professionals care to make an appropriate record regarding the assessment and management of acute pain in the newborn. The analysis of the qualitative data generated 5 categories and 15 subcategories, based on the speeches of the participants: 1) \"Facilitating factors in the management of neonatal pain\" (performance of the professionals; use of non- pharmacological methods; use of sucrose as the main choice for relieving neonatal pain; other non- pharmacological interventions), 2) \"Complicating factors in the management of neonatal pain\" (failures in how to deal with the pain; excess of painful procedures; workflow and quantity of personnel), 3) \"Pain assessment\" (how and when to assess; the importance of pain assessment), 4) \"Necessary changes to improve pain management in the institution\" (trainings; protocols and the use of scales to assess pain; changing the attitude of professionals and making the team more sensitive), 5) \"Participation of the parents and/or family in the management of neonatal pain\" (advantages and support in the management of neonatal pain with the participation of the family; difficulties in the participation of the family for managing neonatal pain). In conclusion, health professionals have a superficial knowledge regarding the assessment and non-pharmacological management of acute neonatal pain in the studied maternity hospital. In addition, there is a lack of formal clinical protocols, records and qualification of health professionals. Considering the proposals for non-traumatic, developmental and humanized care to the neonate, it becomes imperative to make changes in actions and conducts of the health team in terms of neonatal pain management, as these professionals must be driven and encouraged based on professional qualifications grounded on knowledge transfer

The present research was conducted in order to ascertain whether differences in attitudes exist between the three main professional groups which are presently the major providers of mental health care -- psychiatrists, clinical psychologists, and social workers -- with respect to six treatment modalities: Individual Psychotherapy, Individual Counseling, Family Therapy, Group Therapy, Psychiatric Medication and Psychiatric Hospitalization. Modalities evaluated include treatments appropriate to a variety of individual, social and biological concepts of mental health/pathology. It was assumed that any such attitudinal differences might reflect biases in the provision of mental health treatment and therefore be an important concern for consumers of mental health care.

At least two studies have been found conducted in the area of audiological in-services and their impact on the people to whom they were presented. In 1981, Dancer and Keiser studied the effects of empathy training on geriatric-care nurses and in 1985, Dampier, Dancer, and Keiser studied changing attitudes of college students toward older persons with hearing loss. Both of the studies investigated the effect of in-service training on empathy, rather than using the traditional academicallyoriented in-service program approach. Both studies found statistical results indicating a significant positive change in the subjects' feelings toward hearing impaired geriatrics. Additionally, Dancer et al. (1981) found a positive significant change in the subjects' perceptions of hearing impaired elderly persons. This study investigated the effect of an in-service training program on nursing home personnel. The in-service that was developed included both empathy training and factual information. It was hypothesized that both elements are important and the inclusion of both could result in a greater change in people's attitude. The empathy portion of this in-service included a taped interview with a hearing impaired older person, a tape dramatizing interactions between hearing impaired and normal hearing individuals, simulated high frequency hearing loss, an "unfair listening test" and suggestions for interacting with hearing impaired people. The factual information included anatomy and physiology of the ear, types of hearing loss, common characteristics of hearing loss among older people, and the impact of hearing loss on speech understanding.

Este estudo abordou a questão do trabalho e do adoecimento em trabalhadores que atuam na área de saúde, notadamente hospitalar. O objetivo foi relacionar as características sociodemográficas, laborais e de saúde dos membros da equipe multiprofissional da Unidade de Terapia Intensiva, com a presença de Transtornos Mentais Comuns e a ocorrência de absenteísmo e presenteísmo. O estudo foi aprovado por Comitê de Ética em Pesquisa (CAAE 54868316700005393). Trata-se de pesquisa epidemiológica, correlacional, analítica, transversal, com abordagem quantitativa, desenvolvida com 54 trabalhadores da equipe multiprofissional de saúde de uma UTI Adulto de um hospital universitário público do interior do Estado de São Paulo. Foram utilizados os instrumentos: Stanford Presenteeism Scale SPS6 para investigação do presenteísmo; Self-Reporting Questionnaire (SRQ-20) para a mensuração do nível de suspeição de Transtornos Mentais Comuns e questionário para caracterização dos dados sociodemográficos, laborais e de alterações de saúde dos participantes. As informações sobre o absenteísmo foram obtidas nos bancos de dados do setor de Recursos Humanos da instituição. Os dados foram coletados em 2016. Entre os trabalhadores estudados houve predomínio de mulheres (75,9%), com média de idade de 39,8 anos e em união estável (56%). Em relação às variáveis ocupacionais, 66,7% eram contratados pela Consolidação das Leis do Trabalho; o maior número de participantes era da enfermagem (66,7%) e a maior parte (31,6%) atua no hospital de 6 a 10 anos. No que diz respeito à ocorrência de sintomatologia dos Transtornos Mentais Comuns, entre as mulheres foram encontrados os valores médios de 4,37 e entre os homens 3,85. A alteração de saúde mais comum foi a cefaleia (63,0%). A avaliação do presenteísmo mostrou que 48,7% apresentaram comprometimento no trabalho e 31,8% tiveram a realização e finalização das tarefas alteradas por este fenômeno. Quanto ao absenteísmo, em relação a meta pactuada de 8,50% ao mês, durante todos os meses os valores foram excedentes. Os resultados mais preocupantes referem-se ao presenteísmo e ao absenteísmo, fenômenos que podem ser resultantes de adoecimentos entre os trabalhadores. Diante deste cenário identifica-se que a saúde destes trabalhadores requer atenção, visto que muitos podem estar comparecendo a seus postos de trabalho mesmo doentes, o que pode levá-los a um maior comprometimento físico e mental / This study approached the issue of work and illness in health personnel, which works with healthcare highlights in the hospital. The study\'s goal has been to relate in socio-demographic characteristics, working conditions and also health members of the multidisciplinary team were working at Adult intensive care units (ICU), with the presence of Common Mental Disorders and the occurrence the in Absenteeism and Presenteeism. The research was approved by the Research Ethics Committee (CAAE 54868316700005393). It is a epidemiological research, correlacional, analytical, cross with quantitative approach. Developed with 54 workers of the multidisciplinary healthcare team a adult ICU carried out in a university hospital public of the interior of São Paulo State. Which used the following the instruments for data collection: Stanford Presenteeism Scale SPS-6 for research in the Presenteeism Self-Reporting Questionnaire (SRQ-20) for the measurement of the level of suspicion of Mental Disorders and a instruments was a semi-structured form aiming to know the reality socio-demographic characteristics, working conditions and also health of those subjects. Information begin Absenteeism data was collected for 12 months were obtained in the databases of the Department of Human Resources of the institution. The data collection in year 2016. Among the study\'s participants, it was observed a female predominance with (75,9%) and an average age of 39,8 years old and steady union (56,0%). Regarding working conditions 66,7% were hired by the Consolidation of Labor Laws; the most reported labor class were the in nurse and most party 31,6 were working at hospital in 6 the in 10 years. With respect to, likelihood of Common Mental Disorders between women average 4,37 and among men was 3,85. The most reported change in the state health was headache (63,0%). Concerning in the Presenteeism 48,7% presented compromised at work and 31,8 % had completion of assigned. In relation to Absenteeism it was observed every months superior tares in the 8,50% as well as. The more important Results was in relation to Absenteeism and Presenteeism phenomena that may result from sicken workers. In face of has been proven that workers health need attention, as well as may be to appearing their working place illness. Witch can do them to major physical and mental impairment

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research. / thesis (BPsychology(Hons))--University of South Australia, 2004.

This thesis endeavours to explore, describe and portray the author's attempt to work with the people of Vanuatu, a small island nation in the South Pacific, establishing a preventative eye care project. The goal of this study is to offer a contribution to the understanding of cross-cultural health work in Vanuatu. / thesis (PhD)--University of South Australia, [2000]

The research examined mental health practitioners' attitudes towards, satisfaction with and use of suicide prevention contracting (SPC) techniques. Survey respondents comprised consultant psychiatrists, clinical psychologists, occupational therapists, mental health nurses, psychologists, registered medical officers and social workers. A self-report questionnaire was mailed to 1347 potential respondents, together with three follow-up letters sent out at two-week intervals. There was a 31% response rate, producing 420 valid questionnaires. The results of the research re-confirm the historical trajectory of SPC, from its early beginnings as a relationship-based suicide-risk assessment technique to one that is used in contemporary practice by practitioners to meet a range of objectives. The research focused on three SPC techniques in operation in clinical practice: verbal no-suicide assurances, no-suicide agreements, and written no-suicide contracts. Analysis of the data suggests a number of important findings. The first of these is that practitioners perceive different utility among these three techniques. Secondly, the least experienced practitioners were significantly less likely to use no-suicide contracts, despite seeing more suicidality and having more formal training in the use of the technique. Thirdly, a practitioner's gender, and formal training were significant in the perception and application of SPC techniques. Finally, suicidal behaviours and completed suicide was a clinical outcome in some situations irrespective of the use and non-use of SPC. The findings of this research are used to provide an emerging conceptual framework and associated nomenclature that inform clinical decision-making in relation to SPC. In addition, a conceptual model is presented which demonstrates that the potential for injudicious use of SPC techniques is as much precipitated by individual factors as it is by broader environmental factors. Key words: no-suicide contracts, suicide prevention contracts, no-suicide agreements, no-suicide decisions, contingency contracting.

Doctor of Health Science / The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice