Background: A key innovation in the provision of inpatient services to facilitate the care and treatment of women with severe postnatal mental illness was the introduction of joint mother and baby psychiatric hospitalisations, where both the mother and baby are admitted to hospital together. This study examined the history of the practice of joint mother and baby admissions across the UK and critically explored the processes relevant to the diffusion of joint admissions and patterns of service development to identify the possible and probable causes for significant differences in service provision across the United Kingdom (UK). Aims: The study examined the documented history of the development of practice of joint mother and baby psychiatric hospital admissions across the UK and in doing so, a) Identified the pattern of service and practice development and the likely reasons for the pattern of the chronology. b) Identified the processes involved in the diffusion of joint mother and baby admissions in the UK, and explored why the practice was sustained (or not). c) Contributed new information to the continued development of innovation diffusion theory and research, and its application to health care service and practice development. Methods: A historical method was used in the study and was reported through the use of historical narrative and analysis. Data was collated from primary and secondary sources of documented evidence which was used to inform the history of joint mother and baby admissions across the UK. Data was analysed using the theoretical framework of diffusion of innovation (Rogers, 2003). Findings: Two versions of the same innovation were identified: joint admissions to side rooms of general adult psychiatric wards or annexed areas of the wards and joint admissions to specialist mother and baby units. Neither version of the practice followed the normal S-curve pattern of adoption in terms of frequency and rate of adoption. After a period of approximately 63 years there are 24 facilities for the provision of joint admissions in the NHS in the UK. The main influencers to the adoption of the practice was perception of risk, social networks internal and external to the NHS, the presence of clinical and political champions to drive the adoption and implementation of the innovation and policy entrepreneurship by clinicians working in the clinical field of perinatal mental health. The development of specific policy, guidelines and in Scotland, legislation, has resulted in a move during the last decade from joint admissions being diffused naturally to side room admissions being actively withdrawn and specialist psychiatric mother and baby units actively being disseminated. There is strong evidence that the diffusion process for specialist mother and baby units is still in motion at the time of reporting. Conclusion: Two competing versions of the same innovation had unusual patterns of diffusion. The influencers identified as relevant to the diffusion patterns of each version of the innovation were essentially the same influencers but they were used in different ways to affect change: rejection of one version of the innovation in favour of adoption of the other. The main influencers on the diffusion of joint admissions changed over the time line of the adoption pattern. Barriers to diffusion included the absence of evidence of effectiveness, the absence of economic evaluation, the position in service divisions of perinatal mental health as a field of practice and the absence of succession planning across professional groups. Recommendations are made for future research.

Este trabalho é resultado de uma pesquisa do tipo estudo de caso, realizada em um macro-hospital público psiquiátrico de uma cidade do interior do Estado da Bahia. Enfoca o desenvolvimento das atividades dos enfermeiros no cotidiano institucional, suas formas de lidarem com as situações e as relações sociais estabelecidas com os demais profissionais de saúde que trabalham no hospital. Como docente da disciplina Enfermagem Psiquiátrica, tenho relação direta com o local, acompanhando estágio de estudantes de enfermagem, haja vista o convênio firmado entre a Secretaria de Saúde do Estado e a Universidade Estadual de Feira de Santana, a qual pertenço. Procedi a um recorte do campo, delimitando o espaço de um Pavilhão de internamento masculino. Como estratégia de levantamento dos dados utilizei a observação participante, entrevista semi-estruturada com os enfermeiros e demais membros que com ele convivem no dia-a-dia de trabalho, além de alguns documentos importantes na contextualização do trabalho desse profissional. Procedi a apresentação das atividades dos enfermeiros, estabelecendo a trama entre eles e deles com os demais profissionais da saúde. Observei uma grande concentração de suas tarefas em torno dos fazeres burocráticos, além de ver evidenciada a figura do paciente como intercorrências a serem resolvidas, denotando a visão que têm do doente mental. Na convivência com os outros profissionais, vêm-se como centro, apesar de essa visão nem sempre ser compartilhada por esses. Pelos dirigentes, o enfermeiro é visto como o grande contornador de situações, o que o coloca em uma posição politicamente conveniente na manutenção dos interesses majoritários. Nesse hospital, o profissional enfermeiro ocupa diversas funções hierarquicamente estratégicas junto à Diretoria, com a qual mantém contato direto e diário. As condições em que vivem os pacientes da instituição são extremamente precárias e degradantes para qualquer ser humano. A falta de prioridade dada à política de saúde mental no Estado contribui fortemente para a manutenção do modelo assistencial tradicional, ainda implementado nesse hospital. / The following study is the result of a case report held at a public pychiatric hospital of a city in the State of Bahia-Brazil. We focus on the development of nurses’ activities in the institutional routine and on their ways of dealing with situations and social relations with the other health professionals working at that hospital. Being a profesor in the Psychiatric Nursing field at Universidade Estadual de Feira de Santana (UEFS), I have direct contact at that hospital due to nursing students’ training (as a result of a partnership between the State Health Bureau and UEFS). We have mode a field sampling by taking one male, in-patient ward. We have used, as data-collecting strategy: participative observation, semi-structured questionaires applied to the nurses and other staff members who share daily work with them, and some documents which are important for contextualizing the work of such profesionals. We have presented the nursing tasks by establising their connections among nurses themselves and between nursing and other health profesionals. We have found great concentration of burocratic work among their tasks. Besides, we have found evidence of patients being considered medical problems to be solved, which expresses nurses’ views of the mentally-ill. In the staff daily routine, nurses considered themselves as being the core. However, this issue was not so evident when we looked upon the other profesionals’ views. Administrators considered nurses as being great situation managers. This places nurses at a politically-convenient situation for keeping majoritative interests. At this hospital, nurses have various hierarquically estrategic functions, close to the Board of Directors and having direct contact with them, daily. The living conditions of the patients in such institution are extremely poor and humiliating for any human being. The lack of priority given to mental health policies in this State of Bahia greatly contributes for the traditional assistential model, still playing at such hospital.

Essa pesquisa qualitativa tomou como objeto de estudo o universo dos moradores e moradoras ararenses do hospital psiquiátrico Antonio Luis Sayão, sob gestão estadual, localizado na cidade de Araras, no interior do Estado de São Paulo. A finalidade é indicar mecanismos para o início de processos de desinstitucionalização dessas pessoas. Os objetivos foram: a) identificar, por meio do Questionário do Censo Psicossocial dos Moradores em Hospitais Psiquiátricos do Estado de São Paulo, os moradores e moradoras nascidas no município e que vivem no interior do hospital; b) investigar, por meio dos dados objetivos e os da impressão dos pesquisadores, quem são, seus recursos e possibilidades; c) propor, a partir da análise dos dados, estratégias de desinstitucionalização, para operacionalização pelo gestor local, se for oportuno. São sujeitos do estudo seis mulheres e cinco homens, cujo tempo de permanência no hospital variou de dez a trinta anos e preenchem os critérios: a) ser natural de Araras; b) familiar ter residência em Araras; c) possuir curador ou procurador e d) estar sob internação involuntária. A pergunta que orientou o estudo foi: Por quê pessoas que possuem renda e familiares no município, sob internação involuntária, permanecem institucionalizadas? As bases teóricas de referência sustentam-se na perspectiva da Desinstitucionalização e da Reforma Psiquiátrica. Os dados empíricos foram obtidos por meio dos Questionários preenchidos por pesquisadores do Censo Psicossocial, após autorização da Área Temática de Saúde Mental do Grupo Técnico de Ações Estratégicas da Secretaria de Estado de Saúde. Os resultados demonstram que os moradores e moradoras vivem amplo processo de institucionalização, despertecimento e apartamento social. As vidas são apropriadas pelo cotidiano e lógica asilar, os direitos fundamentais de cidadania são permanentemente violados: entre os que têm necessidades específicas, como deficiência física ou mental e entre os que têm e os que não têm diagnóstico psiquiátrico. Todos estão sob curatela e recebem renda administrada por terceiros, sem acesso ao dinheiro. Como resposta às necessidades, possibilidades e recursos dessas pessoas, esse estudo recomenda a execução imediata das Diretrizes das Políticas Públicas de Saúde Mental do Ministério da Saúde, das recomendações do Censo Psicossocial no Estado de São Paulo e do Plano Estadual de Saúde 2008-2011 da Secretaria de Saúde de São Paulo e desenha um Projeto de Desinstitucionalização (duas Residências Terapêuticas) para estas pessoas, atendendo suas características e as características do município de Araras. / This qualitative research took as its object of study the universe of Araras residents of the Antonio Luis Sayão psychiatric hospital, under state management, located in the city of Araras in the State of São Paulo. The purpose is to specify mechanisms for the initiation of processes of deinstitutionalization of these people. The objectives were: a) to identify, through the Psychosocial Census Questionnaire of Psychiatric Hospital Residents in the State of São Paulo, the residents born in the city and who live within the hospital; b) to investigate, through objective data and the researchers printing, who they are, their resources and capabilities; c) to propose from the data analysis some strategies of deinstitutionalization, which can be implemented by the local manager, if appropriate. Study subjects are six women and five men, whose time spent in the hospital has ranged from ten to thirty years and meet the following criteria: a) are a native of Araras; b) have a family residence in Araras; c) posses a trustee/proxy and d) is under involuntary admission. The question that guided the study was: Why do people with income and family, under involuntary admission, remain institutionalized? The theoretical bases of reference are maintained in the perspective of Deinstitutionalization and Psychiatric Reform. Empirical data were obtained through questionnaires filled out by Psychosocial Census researchers after authorization by the Secretary of the Ministry of Health\'s Technical Actions Group in the Thematic Area of Mental Health. The results show that the residents live vast institutionalization processes, desperation and social apartment. The lives are suitable for everyday living and logical placement, the fundamental rights of citizenship are constantly violated: between those who have special needs such as physical or mental disabilities and those who have and those who do not have psychiatric diagnoses. All are under the guidance of a trustee and receive income managed by third parties without access to the money. In response to the needs, possibilities and resources of these people, this study recommends the immediate implementation of the Ministry of Healths Public Policy Guidelines for Mental Health, the recommendations of the Psychosocial Census of the State of São Paulo and the São Paulos Health Secretary State Health Plan 2008-2011 and lays out a Deinstitutionalization Project (two therapeutic residences) for these people, given their characteristics and features of the city of Araras.

O campo da Saúde Mental no Brasil tem se voltado para a construção de serviços comunitários de atenção psiquiátrica, pautados nos preceitos da Reforma Psiquiátrica, como possibilidade de substituir a lógica asilar pelo resgate das habilidades sóciorelacionais do doente mental, a partir da reabilitação psicossocial, sob a abordagem interdisciplinar. Entretanto, a experiência em psiquiatria mostra que o doente mental mantém-se transitando entre o serviço comunitário e o hospital psiquiátrico, sendo alvo, ainda hoje, da disciplinarização, violência e privação impostas pela instituição hospitalar. Neste sentido, constituiu objetivo deste estudo apreender o sentido de ser internado em hospital psiquiátrico, a partir do sujeito que vivenciou a experiência da internação. Para alcançar o objetivo proposto, o estudo recorreu ao referencial teóricofilosófico da ontologia fundamental de Martin Heidegger. Participaram da pesquisa quatro sujeitos portadores de transtornos mentais regularmente matriculados em um centro de atenção psicossocial no interior do estado de São Paulo, que aceitaram discorrer sobre a vivência da internação psiquiátrica, como se mostrou a eles, por meio de entrevista semi-dirigida gravada. Para tal, os sujeitos foram convidados a rememorar a experiência de ser internado em hospital psiquiátrico e tecer significações a respeito. A partir da apropriação de elementos do referencial heideggeriano, foi empreendida a Analítica Existencial, que gerou a construção dos Núcleos do Sentido: (a) A mostração do ser-aí no ser-doente-mental; (b) O modo de ser-no-mundo do ser-doente-mental e (c) Ser-no-mundo-cuidado na impessoalidade. Estes núcleos permitiram que a verdade do ser-doente-mental fosse desvelada a partir dele próprio, mediante o entendimento da estrutura do ser-aí (Dasein) proposta por Heidegger, mostrada pelo modo de ocupar-se da internação psiquiátrica. Ao emergir o ser-cuidado-no-mundo-com-o-outro, foi possível delinear o sentido de ser internado em hospital psiquiátrico, cerne da compreensão ontológica da vivência da internação psiquiátrica. / Brazilian Mental Health field has being conducted to building community psychiatric attention services, as possibility to substitute manicomial thinking for rescue of mental patients social-relational abilities, through psicossocial rehabilitee, by interdisciplinary approach. However, psychiatric experience show us that mental patient has kept himself passing through community services and psychiatric hospital, being marked, until today, by disciplinarization, violence and privation forced by hospitable institution. By this meaning, the studys objective was apprehending the meaning of being hospitalized at psychiatric hospital, passing through person that has lived the hospitalizations experience. To reach the objective proposed, the study made use of fundamental ontology of Martin Heidegger theory-philosophic referential. Took part in the search four people that have mental disease, regularly registered in a psicossocial attention service in interior of São Paulo, that accepted talk about psychiatric hospitalization live, like it showed to them, through a semi directed interview that was registered by recorder. For that, people were invited to remember the experience of being hospitalized at psychiatric hospital and weave meanings about that. Through elements by heideggerian referential appropriating, it was applied Existential Analytics, that generated the construction of Meanings Nucleus: (a) Being there showing through mental-patient-being; (b) being-in-world way of mental-patient-being, and (c) Beingcare- in-world by impersonality. These nucleuses revealed the truth of mental-patientbeing by himself, passing by the thinking about Being There structure proposed by Heidegger, that was showed in the way of devote oneself to psychiatric hospitalization. To emerge being-care-in-world-with-other, it was possible to define the meaning of being hospitalized at psychiatric hospital, focal point of ontological comprehension about psychiatric hospitalization live.

Thesis (M.A. (Social Work)) -- University of the North, 1981 / Refer to the document

Thesis (MPH.) --University of Limpopo, 2018 / Background: Employee morale is a critical factor in any organization either be locally and or globally and Botswana is no exception. Mental health nurses have been considered professionals that assist people to regain a sense of coherence over what is occurring to them - be it a result of trauma or some other form of mental distress. Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve service delivery. The aim of the study was to determine the factors influencing nursing staff morale at S’brana Psychiatric Hospital (SPH) in Botswana. Methods: A quantitative, cross sectional study was conducted on 147 respondents. Self-administered questionnaire was used for data collection and it was closed ended. Data was collected at S’brana Psychiatric Hospital (SPH) and stratified random sampling technique was used to select nurses according to their categories. Data were analyzed through SPSS Software v21.0. Results: The results revealed that the majority of the nurses were aged between 26 - 30 years and most of them were females compared to males. It is evident from the results that, there was strong association between number of years and nursing position (χ2(15) = 72.34, p = .000). Also, there was positive correlation between respondents highest qualification in nursing and training received to do the job well (r = .312, n = 147 and p = .000.). Multiple regression analysis showed a statistically significant, F(3, 143) = 46.69, p = .000, and accounted for 70.3% of the variance. Conclusion: This study has revealed that nurses’ morale in SPH can be affected by a number of factors irrespective of their age, work experience, nursing position and ward they work in. The consequences of low staff morale are detrimental to health professionals (nurses) and patients, therefore, it is important for healthcare managers to address the shortcomings in order to counteract the negative effects of low staff morale

This is an exploratory follow-up study of the clientele of the Psychiatric Crisis Unit, a short-term, crisis-oriented inpatient psychiatric ward. The main objective of the research was to test the following null hypothesis: there are no significant differences between those individuals who attempt to gain aftercare treatment as opposed to those individuals who do not following discharge from the Crisis Unit. A sample of fifty-one voluntary patients who consented to participate in the study was used in testing this hypothesis. Each subject completed the Minnesota Multiphasic Personality Inventory (M.M.P.I.) and a sociological questionnaire while in the Crisis Unit, and a follow-up questionnaire was administered via telephone or personal contact approximately one month after discharge. The follow-up information was used to determine whether the subject fell into the "aftercare” or “no-aftercare” group. Data collection lasted from July 1, 1970 to December 15, 1970. The data revealed that there were significant differences between the groups and, thus, the null hypothesis was rejected. The ten M.M.P.I. scales revealed no significant differences between the groups on the individual scales. However, when examined collectively, the aftercare group scored higher than the no-aftercare group on all scales except Self-Sufficiency (which is scored in the opposite direction, corroborating the tendency in the other scales). A discriminant function correctly classified seventy-three percent of the subjects. These results indicate that the aftercare subjects probably viewed themselves as “needing” more help. The significant predictor variables found included prior familial and personal experiences similar to those bringing the subject to the Unit, employment status, age, diagnostic designation, length of hospitalization, referral planning, and self-ratings on a mood scale which was administered upon discharge from the Crisis Unit. These variables were obtained with less effort than the psychological test data. It was found that the aftercare group (compared to the other group) was younger, had a higher rate of unemployment, and had a higher rate of familial and prior personal experiences. They were also diagnosed more frequently as psychotic, with depression ranking second, and rated themselves lower on the mood scale scores. However, the difference between the before and after mood scale scores revealed that these subjects felt they had “gained” more than the no-aftercare subjects. The no-aftercare group was diagnosed more frequently as depressed, with behavior/character disorders ranking second. They tended to rate themselves higher on the mood scale scores. However, the differences between the before and after mood scale scores revealed that they had not “progressed” as much as the aftercare subjects. Although not statistically significant, it was found that the aftercare subjects were hospitalized two days longer than the subjects of the no-aftercare group. More significant is the fact that the aftercare group had a higher rate of rehospitalization than the no-aftercare group. Data collected concerning the referral process revealed that aftercare subjects were more frequently referred for treatment than were subjects of the no-aftercare group. It was speculated that those subjects who perceived themselves and/or were perceived as being "sicker" would seek further help after discharge from the Crisis Unit. The findings also suggested that not all patients need or perceived themselves as needing further help.

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

<p>Much evidence exists that nurses are leaving the public health sector for the private sector, or leaving the country to seek better working conditions and higher salaries. Studies conducted on the job satisfaction of nurses are proof that there is a need to know more about the factors that influence their sense of job satisfaction. Most of these studies focus on the general nursing context. Due to its unique circumstances, many studies abroad have identified the field of psychiatric mental health nursing to investigate job satisfaction of nurses. The minithesis is an attempt to fill the gap that exists in job satisfaction studies in South Africa of nurses in a provincial psychiatric hospital. The study was a cross sectional, correlational, survey design study. The instrument was a self-administered questionnaire, combining a quantitative questionnaire with one qualitative open-ended question. The study was conducted on nurses of all categories in a provincial psychiatric hospital in the Western Cape. Sixty- eight nurses participated in the study. The data was analyzed statistically using the SAS v9 statistical software and Statistical Package for Social Sciences (SPSS). The open-ended question was analyzed qualitatively. The results revealed that the participating nurses were dissatisfied with remuneration, recognition and appreciation, training and development, as well as benefits and incentives. Nurses were most satisfied with supervision and support, interpersonal relationships, and rendering patient care. The study identified the factors influencing job satisfaction and job dissatisfaction of nurses in a provincial psychiatric hospital. Recommendations were made based on the results of the research.</p>

Psychiatric morbidity in the postpartum period has been a subject of research for years that has been plagued by much controversy. Most of the studies have come from Western countries. Studies that were done in Africa have concentrated on psychotic disorders in in-patients. A pilot study done by Cheetham et al (1981) at King Edward VIII Hospital found a high incidence of 'transient situational disturbances', which required further investigation. AIMS AND OBJECTIVES: 1. To document the spectrum of psychiatric morbidity in an out-patient population of postpartum Zulu women; 2. To define predictive factors which would identify women 'at risk'; 3. To assess the feasibility of 'Western' screening instruments; 4. To investigate whether 'postpartum blues' occurs in Zulu women. RESEARCH DESIGN A prospective, descriptive study was undertaken. Sample Selection: 177 postpartum Zulu women attending the ' Well-Baby' Clinic at King Edward VIII Hospital were randomly selected for inclusion in the study. Methodology: Three questionnaires: The General Health Questionnaire- 30, Pitt's Questionnaire of Anxiety and Depression and The Kennerley Blues Questionnaire were administered to the subjects. A Structured Clinical Interview DSM-III (SCID) was conducted in those women with symptoms. FINDINGS: 1. The majority of the sample were between the ages of 20 and 30 years, unmarried, with a Senior Primary education and a baby of 20 weeks. 2. 45.76% of the sample had a psychiatric diagnosis, with 18.07% having major depression. Other disorders included: adjustment disorders, schizophrenia and dysthymia. 3. Significant variables using Chi-square analysis were: inadequate antenatal care, a negative response from the partner and the absence of cultural rituals. No association was found with demographic and obstetric variables. 4. T-test analysis showed a correlation between the questionnaires and the SCID. 5. 37.3% had experienced 'postpartum blues'. CONCLUSIONS: 1. The spectrum of psychiatric morbidity is affective in nature and similar to other studies. 2. 'Postpartum blues' does occur in Zulu women. 3. Antenatal screening with 'Western' instruments could reduce psychiatric morbidity. 4. The nomenclature of puerperal disorders is inadequate and needs review. 5. More prospective, community-based research is needed, especially in rural Zulu women. / Thesis (M.Med.)-University of Natal, Durban, 1992.