Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (p. 303-313).

Thesis (doctoral)--Rijksuniversiteit te Utrecht.

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Made available in DSpace on 2014-06-11T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-24Bitstream added on 2014-06-13T19:57:37Z : No. of bitstreams: 1 camargo_rmp_me_botfm.pdf: 510710 bytes, checksum: 338938b2dc2c2feff469bca850f24f40 (MD5) / Ministério da Saúde / Considerando que, além do sofrimento psíquico, as pessoas portadoras de transtorno mental também podem padecer de doenças físicas, e, portanto, podem ser atendidas em serviços não específicos, como o hospital geral, este trabalho teve como objetivo Identificar as percepções dos enfermeiros de um hospital geral acerca dos transtornos mentais ao lidarem com os pacientes psiquiátricos em seu cotidiano de trabalho. Trata-se de uma pesquisa com abordagem qualitativa, as narrativas foram analisadas embasadas na análise temática e o referencial teórico de Benedetto Saraceno e Emerson Elias Merhy, autores que abordam a reabilitação psicossocial e o processo de cuidar, respectivamente. Foram entrevistados dez enfermeiros e da análise dos discursos produzidos emergiram três temas: o preconceito, a carência de conhecimento na área de saúde mental e a deficiência no cuidado. A discussão dos temas demonstrou que o preconceito sobre os portadores de transtorno mentais ainda é presente na percepção dos enfermeiros, aparecendo de diversas maneiras, como mecanismos de defesa, formas de poder e atitudes de exclusão e discriminação. A carência de conhecimento foi evidenciada, tendo como fatores importantes a formação acadêmica e as condições pessoais internas dos sujeitos. Já a deficiência no cuidado apontou a prevalência do modelo biologicista, pautado na medicalização, que tem como consequência a dicotomia no cuidado. A partir destas reflexões, vê-se a importância de haver uma cultura institucional de valorização do cuidado e das pessoas, evidencia-se a necessidade de modificar conceitos antigos, como também, torna-se necessário a articulação da rede de atenção à saúde mental, da qual faz parte o hospital geral, como ferramenta fundamental para uma assistência completa à pessoa portadora de transtorno mental / Considering that besides the psychological distress, people with mental disorders may also suffer from physical illnesses, and therefore, they can be treated in not specific services, such as the general hospital. This study aimed to identify the perceptions of nurses in a general hospital about mental disorders when dealing with psychiatric patients in their daily work. It is a qualitative approach and the narratives were analyzed based on thematic analysis and theoretical of Benedetto Saraceno and Emerson Elias Merhy, authors who address the psychosocial rehabilitation and care process, respectively. Ten nurses were interviewed and the analysis of their speeches came across three themes: prejudice, lack of knowledge on mental health and deficiencies in care. The discussion of the issues showed that prejudice on people with mental disorder is still present in the perception of nurses, appearing in several ways, such as mechanisms of defense, forms of power and attitudes of exclusion and discrimination. The lack of knowledge was evident having as important factors the academic and personal internal conditions of the participants of this study. The deficiency in care, however, showed the prevalence of biological model, ruled by medicalization, which causes the dichotomy in the care. From these reflections, we see the importance of having an institutional culture of appreciation of care and people, showing the need to change old concepts. The articulation of the network of mental health care, witch the general hospital is part of it, is also important, and works as a fundamental tool for expanded and complete assistance to people with mental disorders as well

In recent years there have been several studies concerning themselves with such topics as mental patients' attitudes toward hospital personnel and mental patients' beliefs about mental illness. However, these studies are not without fault. They have been strictly empirical in approach, with no theoretical framework from which to predict and/or explain the results they have obtained. These studies also have failed to control for potentially important variables such as whether a patient, has had previous admissions to a mental hospital. The present study attempted to surmount these shortcomings. Drawing upon Heider's (1946) balance theory, it was predicted that if the patients' attitudes toward the staff changed in a positive direction (as a study by Reznikoff, et al. [I960] suggests is the case), those beliefs about mental illness held by the patients which were dissimilar to the staff's beliefs would converge toward those beliefs held by the staff. This study also controlled for the no prior admissions ---prior admissions variable, a variable Wolfensberger's (1956) study suggests may be important. The Semantic Differential was used to measure the patients' attitudes toward the staff while the Information Questionnaire (Nunnally, 1957, 1961) was used to measure their beliefs about mental illness. These two questionnaires were administered twice: the first time being no longer than four days after admission to the hospital; the second time being approximately three weeks after the first administration. The results of this study indicated that patients' attitudes toward the staff (aides in this particular study) do increase in a favorable direction, but this had no influence on the patients' beliefs about mental illness as had been predicted. The patients' beliefs about mental illness did not change toward the staffs' (aides) beliefs but rather remained the same over the two testings. Possible reasons for the failure of this study to support the prediction were discussed. Also, the validity of the Information Questionnaire was seriously questioned. / Arts, Faculty of / Psychology, Department of / Graduate

This study examined the problem of the lack of understanding of the family's reaction to the psychiatric hospitalization of a family member. A review of the literature indicated that little has been done to increase our knowledge of the family's perception of this event in their lives. It further indicated that these families have needs and concerns resulting from the experience of the psychiatric illness and hospitalization. These needs and concerns were not being addressed by health care workers. This qualitative study utilized the phenomenological approach. Data were obtained from seven families of patients admitted to a psychiatric hospital for the first time. Two unstructured interviews were conducted with each family during the course of the patient's hospitalization. The content of the interviews included discussion of all aspects of the hospitalization with the families directing the emphasis toward the aspects that were important to them. The data were analysed using the method of constant comparative analysis. Major categories were developed which reflected the meaning of the hospitalization experience for the families. The categories included acknowledging the hospital as a solution to the problem, reframing past events to make sense of the present, assimilating the experience into their every-day lives, and questioning the future in relation to the present experience of the illness and the hospitalization. The themes were not found to be discrete, sequential activities but were described as inter-dependent and circular in nature. The data were discussed in relation to the literature reviewed, with comparisons being drawn between those previous studies and the current one. The implications for nursing practice, education, and research were discussed. / Applied Science, Faculty of / Nursing, School of / Graduate

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18202号 / 人健博第19号 / 新制||人健||2(附属図書館) / 31060 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 荒井 秀典, 教授 十一 元三, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

In this study, we examine the relationship between having a support system and the stigma individuals face with depression and anxiety symptoms. The aim of this study was to examine if having a support system acts as a buffer between perceived stigma and mental health symptoms. For this study, I conducted an online survey to measure symptoms of depression and anxiety, experiences with both perceived and internalized stigma, and social support. While 93 total participants engaged in the survey, only 52 fully completed the survey and passed two attention-check questions to ensure no invalid participation (e.g., BOTS) were present. In order to test the study hypothesis, two moderated regression analyses were conducted. Results revealed that both perceived stigma and internalized stigma were significantly and positively related to anxiety and depressive mental health symptoms. However, social support was significantly and negatively related to mental health symptoms only in the model with perceived but not internalized stigma. Finally, no significant interactions between either stigma and social support were found, indicating that social support did not buffer the negative impact of either forms of stigma. Importantly, this study was limited by a small sample size that could have prohibited finding significant results.

Background: With the COVID-19 pandemic, there has been an influx of patients with acute respiratory distress syndrome (ARDS), an inflammatory lung condition. ARDS survivors are at high risk for developing post-traumatic stress disorder (PTSD) due to intensive care unit (ICU) medical treatments/procedures. They are known to have traumatic memories triggered by their sensorium months to years after being discharged from the ICU. One study found that 23% of ARDS survivors experienced long-term PTSD symptoms 2-3 years after hospital discharge (Bienvenu et al., 2018). Unknown is whether there are similarities in the memories and sensory triggers of PTSD amongst ARDS and COVID ARDS survivors. Purpose: The purpose of this study was to 1) identify the most common vivid ICU memories and sensory triggers for PTSD symptoms in survivors of ARDS and COVID positive ARDS; 2) to analyze the frequency of sensory triggers and determine whether differences exist between ARDS and COVID ARDS survivors. Method: A multi-step, thematic analysis of qualitative data from 27 patients was completed (20 COVID ARDS patients and 7 ARDS patients) by a team of 7 researchers. Patients were asked a series of open-ended questions regarding vivid memories and sensory triggers for them. Major themes were generated from their responses. Results: Major themes identified were prevalent in both COVID ARDS and ARDS groups. Prominent vivid memories included medical treatment/procedures, emergence delirium, illusions/hallucinations, vivid nonsense dreams and sensory to dream conversion. Common sensory triggers included seeing medical equipment, hearing beeping/alarms, seeing media depictions of the hospital setting, hospital smells and seeing doctors, nurses, hospitals. Differences between COVID-ARDS and ARDS groups were not notable. Conclusion: The data collected in this study revealed ARDS and COVID ARDS patients experience sensory inputs during their ICU stay that contribute to the development of vivid, long-lasting memories and subsequent PTSD symptoms. Survivors' everyday lives are altered by these symptoms, impacting their ability to work, familial relationships, and likelihood to seek out healthcare. Data from this study is being used in a compressed exposure therapy trial and should be incorporated into future PTSD preventative and treatment interventions.

The study aimed to investigate childhood adversity in a sample of clients with first-episode psychosis. The mediating impact of dissociation and early maladaptive schemas and moderating effect of social support were investigated. The study (N = 42) assessed childhood adversity using the Parental Bonding Instrument and the Childhood Trauma Questionnaire. Early Maladaptive Schema were measured using the Young Schema Questionnaire (Short form), the Dissociative Experiences Scale (2nd Edition) measured Dissociation and the Social Support Questionnaire assessed the quality and size of each participant’s social network. Correlational, mediation and moderation analyses were used. There were high levels of childhood adversity within this sample. Dissociation did not mediate the relationship between childhood adversity and psychosis. Some early maladaptive schemas concerned with unrelenting standards and insufficient self-control mediated the relationship between adversity and psychosis, in particular hallucinations. Social support, in terms of both quality and quantity was an important moderator between childhood adversity and psychosis. The study supports the notion that childhood adversity is a risk factor for psychosis and highlights some evidence about specific mediating and moderating mechanisms.