O objeto de estudo desta pesquisa qualitativa é o entendimento dos trabalhadores dos hospitais psiquiátricos sobre a Reforma Psiquiátrica e como lidam com esse processo. A finalidade é contribuir para a ampliação arsenal teórico prático da Reforma Psiquiátrica e propor novas luzes para a sua análise. Tem como objetivos: conhecer o que os trabalhadores dos hospitais psiquiátricos pensam sobre a função do hospital psiquiátrico no contexto da Reforma Psiquiátrica; compreender como os trabalhadores de saúde mental lidam com o processo da desinstitucionalização nas suas práticas. O cenário do estudo foi dois hospitais psiquiátricos, um público e outro privado, sem fins lucrativos, integrados ao SUS e situados no município de São Paulo. Participaram deste estudo 12 (doze) trabalhadores (de nível médio e superior). Os dados empíricos foram obtidos por meio de entrevista individual semi-estruturada. O material empírico foi analisado de acordo com as categorias analíticas: instituição, institucionalização, transição, desinstitucionalização e crise e foi referenciado em Minayo. A análise dos dados deu origem às categorias: a) o hospital psiquiátrico: o lugar da crise; b) a internação da crise; c) desinstitucionalização: a desconstrução de saberes; d) o hospital e a rede em crise; e) a persistência da cultura hospitalocêntrica; f) o hospital psiquiátrico e a família em crise; g) o hospital psiquiátrico e a sociedade. Os trabalhadores descrevem um novo hospital, cuja função é o acolhimento da crise e internação de curta permanência; identificam medidas reformistas de ordem técnica e administrativa, ocorridas no hospital como: especialização no atendimento da clientela; regime de internação de curta permanência x cronicidade; intervenção multidisciplinar x trabalho isolado; melhoria da estrutura física e de recursos humanos; melhoria da ambiência; implantação de projeto terapêutico; redução de leitos hospitalares, em função do atendimento às exigências das portarias ministeriais. Evidencia-se o entendimento de desinstitucionalização como desospitalização. Os discursos dos entrevistados evidenciam uma relação em crise do hospital psiquiátrico com a rede substitutiva de atenção à saúde mental de base comunitária. Os trabalhadores enfrentam dificuldades no processo de des-internação de pacientes com grave problemática social. O hospital psiquiátrico tem sido a própria contradição no atual modelo de atenção em saúde mental no Município de São Paulo e, portanto, nesta perspectiva, sustenta dentro de si as várias contradições advindas de sua própria gênese enquanto instituição, somadas às condições atuais em que se encontra “inexistente" na rede. O hospital psiquiátrico: lugar da crise porque lugar das contradições / The object of study of this qualitative research is the understanding of the psychiatric hospital\'s workers about the Psychiatric Reform and how they deal with this process. The purpose of the study is to contribute for the expansion of the Psychiatric Reform\'s theoretical-practical arsenal and propose new lights to its analyses. Objectives are: know what the psychiatric hospital\'s workers think about the psychiatric hospital in the context of the Psychiatric Reform; understand how mental health workers deal with the process of desinstitutionalization in their practices. The scenery of this study were two psychiatric hospitals, one public and the other private, nonprofit, integrated to SUS and placed in the city of São Paulo. 12 (twelve) workers (medium level and high education) participated in the study. Empirical data were gathered through semi-structured individual interview. The empirical material was analyzed according to the categories: institution, transition, desinstitutionalization and crises, according to Minayo. Data\'s analyses originated the categories: a) the psychiatric hospital: the crisis\'s place; b) crisis\' hospitalization; c) desinstitutionalization: knowledge\'s deconstruction ; d) the hospital and the net in crisis; e) hospital-centered culture\'s persistence; f) the psychiatric hospital and the family in crisis g) the psychiatric hospital and society. Workers described a new hospital, which\'s function is welcoming of crises and short-term hospitalization; it\'s identified reformist\'s technical and administrative measures in the hospital, such as: humanization; attendance of clientele\'s specialization ; short term hospitalization regime X chronic ness; muldisciplinary intervention x isolated work; physical structure\'s and human resource\'s improvement; environment\'s improvement; therapeutic project implantation; hospital wards\' reduction, due to the attendance of Ministry laws. It leads to the understanding of desinstitutionalization as des-hospitalization. Interviewed\'s speech show articulation in crisis between the psychiatric hospital and the substitutive mental health care net, community based. Workers deal with difficulties in the process of des-hospitalization of patients with serious social problematic. The psychiatric hospital has been the contradiction itself in the current mental health care model in the city of São Paulo and, therefore, in this perspective has in itself many contradictions that come from it\'s own genesis as an institution, added to current condition in which it \"doesn’t exist\" in the net. The psychiatric hospital: the crisis\'s place because the place of contradictions

Sabe-se que enfermeiros que atuam em unidades de internação psiquiátrica, desenvolvem múltiplas tarefas com diferentes graus de exigências e responsabilidades, as quais, dependendo do ambiente e da forma como está planejado e organizado o trabalho podem expor este profissional aos riscos ocupacionais presentes, com conseqüências negativas para a sua saúde bem como, para qualidade do cuidado prestado aos pacientes. Dentre estes riscos, destaca-se os psicossociais. Os riscos psicossociais relacionam-se à aspectos de planejamento, organização e gerenciamento do trabalho que podem provocar desgaste físico e emocional ao trabalhador. Este estudo tem o objetivo de caracterizar os riscos psicossociais relacionados ao trabalho de enfermeiros de um hospital psiquiátrico e as estratégias para o seu gerenciamento. É um estudo descritivo utilizando a abordagem qualitativa dos dados. Os participantes foram 25 enfermeiros inseridos há mais de 6 meses no local de estudo e a coleta de dados foi realizada por meio de entrevistas semiestruturadas no período de novembro à janeiro 2014/15. Para análise dos dados foi utilizado o método de análise temática. O trabalho foi aprovado no CEP da EERP/USP. Os resultados mostraram sete categorias de riscos psicossociais tais como: formação profissional, ambiente e equipamento de trabalho, relacionamento interpessoal, carga e esquema de trabalho, recursos humanos, interface trabalho-família, violência. Não foram identificadas estratégias organizacionais para o gerenciamento dos riscos, entretanto, os enfermeiros relataram a implementação de estratégias individuais para aliviar as tensões e/ou riscos gerados no ambiente de trabalho tais como: recorrer a presença da família, cinema, música, leitura, exercícios físicos, busca por terapias, religião, viagens e passeios. O estudo contribuiu preenchendo lacunas na produção de conhecimento sobre riscos ocupacionais a que estão expostos os profissionais enfermeiros de saúde mental no contexto hospitalar. Além disso, os resultados podem fornecer subsídios para gestores conhecerem detalhadamente as condições de trabalho aos quais estão expostos enfermeiros psiquiátricos, na perspectiva de implementar estratégias preventivas e/ou conservativas no ambiente laboral / It is known that nurses who work in psychiatric inpatient units, develop multiple tasks with different levels of requirements and responsibilities, which, depending on the environment and how it is planned and organized the work can expose these professionals to occupational risks present with negative consequences for their health as well, to quality of care provided to pacientes.Dentre these risks, we highlight the psychosocial. Psychosocial risks are related to aspects of planning, organization and management of work that can cause physical and emotional stress to the worker. This study aims to characterize the psychosocial risks related to the work of nurses in a psychiatric hospital and strategies for its management. It is a descriptive study using a qualitative approach. The participants were 25 nurses inserted for more than six months at the study site and the data collection was carried out through semi-structured interviews in the period from November to January 2014/15. For data analysis we used the method of thematic analysis. The study was approved by CEP- EERP / USP. The results showed seven psychosocial risk categories such as vocational training, environment and work equipment, interpersonal relationships, work load and work schedule, staffing, work-family interface, violence. Organizational strategies for managing the risks have been identified, however, the nurses reported the implementation of individual strategies to ease tensions and / or risks arising in the workplace such as: enlist the presence of the family, cinema, music, reading, exercises physical, search for therapies, religion, travel and tours. The study contributed filling gaps in knowledge production about occupational hazards they are exposed to professional mental health nurses in hospitals. In addition, the results can provide information for managers to know in detail the working conditions to which they are exposed psychiatric nurses with a view to implement preventive strategies and / or conservative in the work environment

The purpose of this study was to assess the special needs of the families of hospitalized mental patients. The study focused upon the time prior to and including the decision to hospitalize a mentally ill family member. Particularly, the researchers wished to examine the stresses that the family encountered in attempting to deal with a disturbed member as well as their concerns regarding psychiatric hospitalization and the effect which it had upon the family.

In India, various underlying gender related structural factors (i.e., interpersonal violence, lack of social supports, limited opportunities, poverty, and gender biases in mental health practice) serve to keep women living with serious mental illness isolated in psychiatric institutions. Despite this, narratives of women living with serious mental illness and their experiences within institutions have received limited visibility in research. The present study addresses this crucial gap by documenting the lives of women who are former inpatients of a mental hospital and are currently residing at a halfway home in India. I adopted a social constructivist narrative approach to incorporate women’s experiences and examine the context and ways in which their experiences were shaped and situated. Specifically, the study explored the following questions. 1. How do women describe their experiences and perceptions related to the illness and living at a psychiatric institution (i.e., mental hospital and the halfway home)? 2. What are the physical and social characteristics of the halfway home serving women living with serious mental illness in India? I answered the first question using narrative data, collected through 34 in-depth interviews with 11 women residents at the halfway home, I examined the second question using field notes that included everyday observations and interactions with women residents, staff members, and interviews with the Director, the Psychologist, the Social Worker, and the Head Housemother at the halfway home. Thereafter, using the theories of self-in-relation (Miller, 1976; Surrey, 1985), institutionalization (Goffman, 1961), and intersectionality (Crenshaw, 1990), I dissect the two research questions further to analyse how women’s experiences and perceptions related to illness and institutionalization are shaped by their gender and social positioning. Using a gender lens, I also critically examine the psychosocial rehabilitation program at the halfway home and ways in which it supports women living with serious mental illness. I used Fraser (2004) guidelines to analyse the narrative data and Emerson, Fretz & Shaw (1995) guidelines to analyse field notes. Women’s narratives highlight that gender and social positioning significantly shape their experiences of living with mental illness in India. Women perceived their discriminatory social context, particularly restrictive gender norms, a lifetime of denied opportunities, loss of relationships, and violence both in the natal and marital family as factors that contributed and/or exacerbated their illness experiences. Women’s narratives of institutionalization were also embedded in discriminatory social contexts. Poverty and gender disadvantage were the primary reasons for women’s admission to mental hospitals. Furthermore, the shift in care from institutions like mental hospitals to less restrictive institutions like the halfway home did not necessarily improve the lives of women living with serious mental illness. Women share several gender-specific barriers to leaving the halfway home. Furthermore, psychiatric institutions often mirrored patriarchal social relations by perpetuating illness and gender related biases in the delivery of care.

published_or_final_version / Public Health / Master / Master of Public Health

Background Smoking prevalence is the highest in people with mental illness. As more and more countries develop governmental regulations to protect employees from exposure to environmental tobacco smoke, complete smoking bans or partial smoking bans have been introduced in many psychiatric hospitals. Objectives To systematically review the literature to examine the impact of smoking bans in psychiatric hospitals, to identify the obstacles to implement tobacco-free policy and provide recommendations for policy-making in Mainland China on implementing tobacco-free policy in psychiatric hospitals. Methods Multiple searches for key words were conducted through electronic sources including PubMed, Medline, PsycINFO, Cochrane Library, Google Scholar, and CNKI database for all relevant English language and Chinese language articles. The PICO (patient problem or population, intervention, comparison and outcomes) indicators were used as basic inclusion/exclusion criteria, data extraction and quality assessment. Results A total of 227 studies were identified (188 English language articles including 4 reviews and 39 Chinese language articles), and 25 articles (19 English articles and 5 Chinese articles) were included in this paper. For the English language studies, psychiatric inpatients generally had positive attitudes towards the tobacco-free policy in psychiatric hospitals and increasing number of inpatients wanted to quit smoking after hospitalized in a tobacco-free psychiatric hospital. Increasing number of staff members working in psychiatric hospitals were supportive of the tobacco-free policy compared to previous reviews. No change in patients’ aggressive behaviors after implementing smoking bans in the psychiatric hospitals was observed in most studies. Factors identified for successful implementation of tobacco-free policy in psychiatric hospitals included comprehensive planning time, good leadership and significant attitudinal and system changes, high level and consistency of staff support and cohesive teamwork, extensive training for staff and effective use of nicotine replacement therapy (NRT). For the Chinese language studies, negative outcomes of psychiatric inpatients were observed after a total smoking ban in one psychiatric hospital, but positive effects were observed when only the smoking amount was controlled in four psychiatric hospitals. Conclusions The tobacco-free policy aims at eliminating tobacco smoking for both staff members and patients in psychiatric hospitals so as to create a healthy place for work and stay. This goal can be achieved with the efforts of the hospitals and staff, and the cooperation of patients. National legislation to ban smoking in all hospitals, indoor and outdoor, are urgently needed in China Mainland. / published_or_final_version / Public Health / Master / Master of Public Health

In KwaZulu-Natal, South Africa, many of those who search for solace from mental illness draw on one or more of the three vigorous therapeutic traditions of healing to which the region is heir. Western psychiatry and its formal institutions have a long history in this region: in 1868, the Colony of Natal passed southern Africa's first 'lunacy legislation'; and in 1880, the Natal Government Asylum was opened on the Town Hill, Pietermaritzburg. Although founded on the precepts of nineteenth century liberalism, by 1910, the Pietermaritzburg Mental Hospital (as it was now known) increasingly reflected a national concern with a racialised 'mental science' and Natal psychiatry became somewhat marginalized within a broader network of national asylum administration. During World War 1, too, the white citizens of Pietermaritzburg sought to have future expansion of the asylum halted, and its inmates hidden from public view. Although the story of Western psychiatry in Natal and Zululand is important for any history of mental illness in South Africa, in the nineteenth and early twentieth centuries, colonial psychiatry had relatively limited significance for the majority of people. Since the nineteenth century, African understandings of and treatments for illness have proved especially resilient, interacting with and at times adopting - and adapting - elements of Western biomedicine, as well aspects of healing strategies whose origins lie in Indian concepts of health and medicine first brought with indentured workers from the 1860s. For whites, as well as for Africans and Indians, committal to the asylum came, most typically, at the end of a lengthy quest to find a cure for mental illness. Throughout the nineteenth and early twentieth centuries, other sectors of healing proved to be remarkably flexible, offering new explanations for apparently new forms of illness - including insanity - that accompanied the political, economic and social upheavals of the time, as well as producing new therapies, strategies, and specialists to meet them. It is this variety of responses to mental illness, and ways of attempting to negotiate a path to a state of mind that might be termed 'mental health', that this dissertation traces. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

Background and Research Problem: It is well-known that nurses around the world are exposed to various forms of violence at their workplaces. In psychiatric facilities, many of these incidents are perpetrated by patients against nurses. There is a perception that the current legislation and regulations in the country do not adequately protect psychiatric nurses (health care workers in general) against workplace violence. The preliminary literature suggested that most quantitative studies on workplace violence in psychiatric facilities have concentrated on secondary and tertiary psychiatric hospitals looking at the prevalence, the association between demographic factors and violence behaviour, nurses‟ therapeutic responses, and the impacts on the quality of care. Studies on workplace violence in a psychiatric facility for adults with intellectual disability in the country are limited. Secondly, it appeared from the preliminary literature review that similar studies have not looked at this phenomenon from the individual resilience perspective.Therefore, this study will seek to determine the factors associated with the psychological response of nurses‟ victims of inpatient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Aim: To determine factors associated with the psychological response of nurses‟ victims of in-patient violence in a psychiatric facility for adults with intellectual disability in Cape Town. Objectives: To describe the (1) individual resilience of nurses working at a psychiatric facility for adults with intellectual disability; (2) psychological response of nurses‟ victims of in-patients‟ violence at a psychiatric facility for adults with intellectual disability; and (3) association between the individual resilience characteristics and the psychological responses of nurses victims of in-patients‟ violence in a psychiatric facility for adults with intellectual disability.Methodology: Descriptive-exploratory design using a quantitative approach was used.All categories of nurses (professional nurse, enrolled nurse and enrolled nursing assistance) working at the psychiatric facility for adults with intellectual disability were eligible for the study. Convenient sampling was conducted to select 127 participants who met the inclusion criteria. Self-administered questionnaire was used to collect data. Data was analysed using the SAS V9.3 computer programme. Ethical clearance was obtained from University as well as approval from the management of the psychiatric facility prior to approaching the study participants. Results: The results of the study showed high level of resilience among nurses on Assessment of Resilience Scale (82.9%, n=104); nurses psychological responses to violence were equally distributed between avoidance (mean =4.65 and SD=1.36), intrusion (mean= 4.55 and SD=1.50), hyper arousal (mean=4.46 and SD=1.60) resulting in total mean of 13.67 (SD=4.14) on the revised Impact of Event Scale (IES-R). Measure of association between resilience and the impact of violence on the psychological wellbeing of nurses showed that nurses with high resilience score (82.9%, n=104) fitted the symptoms of PTSD on the IES-R. Spearman Rank correlations (r) analysis showed the total scores of IES-R (r=0.04, p=0.68), avoidance (r=0.01, p= 0.34), intrusion (r=0.08,p=0.34), and hyper-arousal (r= -0.002, p=0.97). Further research looking at the nurses‟ reliance and their responses using resilience theory is needed. / Magister Curationis - MCur

Nursing is developing a science for explaining our interventions_ Hormones play a vital role in the female response pattern and that must be assessed in order for nursing to justify its actions. This descriptive design studied 30 women between the ages of 30 and 45 examining psychiatric addmissions and premenstrual syndrome (PMS). Two hypotheses were considered: 1) There is no difference in the incidence of admission to psychiatric facilities of women for depression, schizophrenia, or other psychiatric crises during the paramenstruum of their menstrual cycle and 2) There is no difference in the incidence of premenstrual syndrome symptoms among women admitted to psychiatric facilities during their paramenstruum.Data was obtained by questionnaire and chart review. The nominal data was analyzed using chi-square. No significant results were found statistically. The practical significance of the study is that 20 of the 30 women were admitted during their paramenstruum. / School of Nursing

<p>Aggressive and violent behaviour in inpatient mental health facilities is found worldwide and is a frequent and serious clinical and nursing care problem. Despite the importance of international research findings and recommendations, it appears that patients perceptions of the possible contributing factors toward aggressive and violent behaviour in mental health facilities is an area of enquiry that has not been widely explored in South Africa in general, or in the Western Cape, in particular. It is against this background that this study endeavoured to investigate the external and situational contributing to patients aggressive and violent behaviour in mental health facilities in Cape Town, as seen from patients perspectives.</p>