Workplace violence directed at student nurses in training in psychiatric institutions is a significant concern as it negatively affects the quality of learning and causes the students to have a negative perception of nursing as a profession. The absence of scientific data describing the perceptions of student nurses about workplace violence and their clinical learning outcome motivated the researcher to conduct the study. Quantitative, descriptive research was conducted to explore the influence that workplace violence will have on clinical learning outcomes of student nurses who are studying psychiatric nursing at psychiatric institutions in KwaZulu-Natal, in South Africa. Data was gathered using a 71 question questionnaire, which was adapted from the one used by Hewett (2010). With the necessary permission from the health authorities, the campus principals and the nursing students, a group of 4th year student nurses (n=163) from 6 campuses of the KwaZulu-Natal College of Nursing (KZNCN) who have worked in psychiatric units for at least 3 months and longer participated in the study. The study highlighted the types of workplace violence encountered by student nurses, the effects of workplace violence on students’ academic performance and the barriers to the reporting of workplace violence encountered by the student nurses. The study revealed that there is a large amount of non-physical, some physical and a few incidents of sexual violence directed towards the student nurses at the psychiatric institutions, and that it has a negative impact on student learning. The recommendations emanating from the study support the idea of a shared responsibility between healthcare and education institutions and the focus is on preparing and equipping the student psychiatric nurses to confront, withstand and break the cycle of workplace violence. / Health Studies / M.A. (Nursing Science)

Submitted in fulfillment of requirements for the Degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introducion Mental health nurses face challenging positions in practice. They are required to support and care for people hospitalised for treatment of mental illnesses on their recovery journeys but are also expected to manage ward administrative tasks, admit patients, attend meetings, dispense medication and communicate with patients (Gunasekara, Pentland, Rodgers and Patterson 2014: 101; Fourie, Mc Donald, Connor and Bartlett 2005: 135). It has been suggested that mental health nurses spend more time managing the ward environment and staff matters resulting in little time to develop and maintain therapeutic patient relationships (Fourie et al. 2005: 135). Problem Statement Research conducted in other countries identified the roles of the psychiatric nurse and mental health care nurses as attending to patients’ basic needs, assistance with self-care activities, monitoring and administering medication, ensuring safe environments in the health care setting and health education (Rungapadiachy, Madill and Gough 2004; Bowers 2005; Seed, Torkelson and Alnatour 2010). Although there is evidence of studies in psychiatric and mental health nursing locally, little is known about the roles of registered nurses and psychiatric nurses at in-patient facilities. OBJECTIVES • To explore which mental health problems are most commonly seen amongst psychiatric patients at these facilities. • To investigate the challenges faced by psychiatric nurses when caring for psychiatric patients. • To investigate what specialized knowledge and skills are required when nursing such patients. • To investigate whether their education and training prepared them adequately to deal with psychiatric patients and suggest guidelines to strengthen nursing education. METHODOLOGY The study utilized a quantitative non-experimental descriptive design to survey registered nurses and psychiatric nurses at in-patient psychiatric facilities in KwaZulu-Natal. A census was utilized in this study as the entire population was sampled. Data were collected using survey questionnaires. Phase two of the study, qualitative content analysis of Psychiatric nursing curricula strengthened the survey findings. FINDINGS Findings of this study showed that 98.4% of respondents believe psychiatric nursing care is an important aspect of holistic nursing practice. Respondents agree that challenges are commonly encountered in psychiatric nursing practice and that they are prepared to deal with these patients. However the aspects most frequently identified as needing greater attention in the Psychiatric nursing curricula were The Mental Health Care Act no 17 of 2002 and practical management of aggression, violence and de-escalation / M

O presente trabalho tem por objetivo refletir sobre a atuação/inserção dos trabalhadores em saúde mental na implantação da rede substitutiva de saúde mental do município de São Paulo, entre os anos de 1989 e 1992. A discussão, orientada pelas contribuições da Psicologia Social como descrita por Pichon-Rivière, apoia-se em dados coletados a partir da observação grupos de supervisão clínica/institucional. Estes grupos são parte do Projeto de Formação Permanente em Recursos Humanos na Área de Saúde Mental, resultado do convênio entre a Prefeitura do Município de São Paulo e a Universidade de São Paulo (PMSP/USP), através do termo aditivo entre Secretaria Municipal de Saúde e Instituto de Psicologia (SMS/PST-IPUSP), cuja realização se deu paralelamente à implantação da rede referida. Ressignificar e construir/superar limites conceituais, teóricos, técnicos, práticos; e problematizar as contradições, conflitos e dúvidas decorrentes da prática são fundamentais na substituição de práticas antimanicomiais. Ao enfocar a contradição entre saberes e práticas do modelo psiquiátrico tradicional X modelo antimanicomial, analisou-se os conflitos de natureza objetiva e/ou subjetiva, emergentes no contexto de trabalho e relacionados principalmente à concepção de loucura, constituição da equipe multiprofissional e formação dos trabalhadores em saúde mental na construção de práticas inspiradas nos princípios antimanicomiais. Constatou-se que contradições ('loucura/doença mental x saúde mental’, ‘loucura/desrazão X razão’, ‘anormalidade/patologia x normalidade’, ‘saber x não saber’, ‘modelo médico x não médico’, ‘terapêutico x não terapêutico’) provenientes da quebra do modelo manicomial desencadeiam processos de indiscriminação, emergentes nas relações intersubjetivas, tendo como efeito a perda de limites (‘trabalhadores x usuários’, ‘técnicos x não técnicos’, ‘neurose x psicose’, ‘eficiência x ineficiência’ de técnicas, ‘público x privado). Assim, a construção destes novos modelos, ligada a desconstrução do manicômio, apresenta-se como uma tarefa complexa, cuja realização não se restringe ao âmbito das práticas, pois carrega consigo contradições inerentes ao sistema social do qual advém (burguesia X proletariado, movimentos sociais x Estado, sociedade global x instituição de saúde, instituição x trabalhadores, trabalhadores em saúde mental x usuário/familiares e usuários x familiares). / The aim of the present study is to analyse the performance of mental health workers in the implementation of a new model of mental health care is the municipality of São Paulo, in the years 1989 to 1992. This study is based on data collected from the observation of groups of clinical/institutional supervision and is guided by the contributions of the Social Psychology as proposed by Pichon-Rivière. These groups were part of a Project for Continued Education in Human Resources in the Mental Health Area, agreed between the Municipality of São Paulo and the University of São Paulo (PMSP/USP), through the Municipal Health Secretarial and the Institute of Psychology (SMS/PST-IPUSP). The Project was developed at the same time as a new model for mental health care was implemented. An analyses indicate that to substitute the asylum practice it’s essential to give a new meaning to conceptual, theoretical, technical and practical limits and to bring to discussion the contradictions, conflicts and doubts which emerge in action. Focusing the contradiction between knowledge and practice in the traditional psychiatric model and in the anti-asylum model, we analysed the objective/subjective conflict emerging in the context of work and related mainly to the conception of madnees, the building-up of a multiprofessional team and the education of mental health workers in the developement of a practice based on the anti-asylum principles. Our findings show that the contradictions (madness/mental illness X mental health, madness/unreason X reason, abnormality/pathology X normality, knowledge X non-knowledge, medical X non medical model, therapeutic X non therapeutic) that result from the break of the asylum model foster a process of indiscrimination emerging in the inter subjective relationship and have the effect of loss of limits (workers X users, technician X non-technician, neurosis X psychosis, efficiency X inefficiency of techiniques, public X private). Thus the construction of these new model, linked to the ‘disconstruction’ of an asylum model, is a complexe task that cannot be restricted to the bounds of practice, since it has contradiction which are inherente to the social system from which it derives (bourgeoisie X workers, social movements X state, global society X health institution, institution X workers, workers in mental health X users/family and users X family).

O presente trabalho tem por objetivo refletir sobre a atuação/inserção dos trabalhadores em saúde mental na implantação da rede substitutiva de saúde mental do município de São Paulo, entre os anos de 1989 e 1992. A discussão, orientada pelas contribuições da Psicologia Social como descrita por Pichon-Rivière, apoia-se em dados coletados a partir da observação grupos de supervisão clínica/institucional. Estes grupos são parte do Projeto de Formação Permanente em Recursos Humanos na Área de Saúde Mental, resultado do convênio entre a Prefeitura do Município de São Paulo e a Universidade de São Paulo (PMSP/USP), através do termo aditivo entre Secretaria Municipal de Saúde e Instituto de Psicologia (SMS/PST-IPUSP), cuja realização se deu paralelamente à implantação da rede referida. Ressignificar e construir/superar limites conceituais, teóricos, técnicos, práticos; e problematizar as contradições, conflitos e dúvidas decorrentes da prática são fundamentais na substituição de práticas antimanicomiais. Ao enfocar a contradição entre saberes e práticas do modelo psiquiátrico tradicional X modelo antimanicomial, analisou-se os conflitos de natureza objetiva e/ou subjetiva, emergentes no contexto de trabalho e relacionados principalmente à concepção de loucura, constituição da equipe multiprofissional e formação dos trabalhadores em saúde mental na construção de práticas inspiradas nos princípios antimanicomiais. Constatou-se que contradições ('loucura/doença mental x saúde mental’, ‘loucura/desrazão X razão’, ‘anormalidade/patologia x normalidade’, ‘saber x não saber’, ‘modelo médico x não médico’, ‘terapêutico x não terapêutico’) provenientes da quebra do modelo manicomial desencadeiam processos de indiscriminação, emergentes nas relações intersubjetivas, tendo como efeito a perda de limites (‘trabalhadores x usuários’, ‘técnicos x não técnicos’, ‘neurose x psicose’, ‘eficiência x ineficiência’ de técnicas, ‘público x privado). Assim, a construção destes novos modelos, ligada a desconstrução do manicômio, apresenta-se como uma tarefa complexa, cuja realização não se restringe ao âmbito das práticas, pois carrega consigo contradições inerentes ao sistema social do qual advém (burguesia X proletariado, movimentos sociais x Estado, sociedade global x instituição de saúde, instituição x trabalhadores, trabalhadores em saúde mental x usuário/familiares e usuários x familiares). / The aim of the present study is to analyse the performance of mental health workers in the implementation of a new model of mental health care is the municipality of São Paulo, in the years 1989 to 1992. This study is based on data collected from the observation of groups of clinical/institutional supervision and is guided by the contributions of the Social Psychology as proposed by Pichon-Rivière. These groups were part of a Project for Continued Education in Human Resources in the Mental Health Area, agreed between the Municipality of São Paulo and the University of São Paulo (PMSP/USP), through the Municipal Health Secretarial and the Institute of Psychology (SMS/PST-IPUSP). The Project was developed at the same time as a new model for mental health care was implemented. An analyses indicate that to substitute the asylum practice it’s essential to give a new meaning to conceptual, theoretical, technical and practical limits and to bring to discussion the contradictions, conflicts and doubts which emerge in action. Focusing the contradiction between knowledge and practice in the traditional psychiatric model and in the anti-asylum model, we analysed the objective/subjective conflict emerging in the context of work and related mainly to the conception of madnees, the building-up of a multiprofessional team and the education of mental health workers in the developement of a practice based on the anti-asylum principles. Our findings show that the contradictions (madness/mental illness X mental health, madness/unreason X reason, abnormality/pathology X normality, knowledge X non-knowledge, medical X non medical model, therapeutic X non therapeutic) that result from the break of the asylum model foster a process of indiscrimination emerging in the inter subjective relationship and have the effect of loss of limits (workers X users, technician X non-technician, neurosis X psychosis, efficiency X inefficiency of techiniques, public X private). Thus the construction of these new model, linked to the ‘disconstruction’ of an asylum model, is a complexe task that cannot be restricted to the bounds of practice, since it has contradiction which are inherente to the social system from which it derives (bourgeoisie X workers, social movements X state, global society X health institution, institution X workers, workers in mental health X users/family and users X family).

Thesis (Ph.D.)--University of Pennsylvania, 2002. / Includes bibliographical references (p. 339-357).

Department of Advanced Nursing Science / MCur

MPH / Department of Public Health / See the attached abstract below

Workplace violence directed at student nurses in training in psychiatric institutions is a significant concern as it negatively affects the quality of learning and causes the students to have a negative perception of nursing as a profession. The absence of scientific data describing the perceptions of student nurses about workplace violence and their clinical learning outcome motivated the researcher to conduct the study. Quantitative, descriptive research was conducted to explore the influence that workplace violence will have on clinical learning outcomes of student nurses who are studying psychiatric nursing at psychiatric institutions in KwaZulu-Natal, in South Africa. Data was gathered using a 71 question questionnaire, which was adapted from the one used by Hewett (2010). With the necessary permission from the health authorities, the campus principals and the nursing students, a group of 4th year student nurses (n=163) from 6 campuses of the KwaZulu-Natal College of Nursing (KZNCN) who have worked in psychiatric units for at least 3 months and longer participated in the study. The study highlighted the types of workplace violence encountered by student nurses, the effects of workplace violence on students’ academic performance and the barriers to the reporting of workplace violence encountered by the student nurses. The study revealed that there is a large amount of non-physical, some physical and a few incidents of sexual violence directed towards the student nurses at the psychiatric institutions, and that it has a negative impact on student learning. The recommendations emanating from the study support the idea of a shared responsibility between healthcare and education institutions and the focus is on preparing and equipping the student psychiatric nurses to confront, withstand and break the cycle of workplace violence. / Health Studies / M.A. (Nursing Science)

Nesta pesquisa estudamos o estabelecimento das áreas científicas neurologia, psiquiatria e psicologia, em São Paulo, no período entre 1889 e 1936, principalmente através de artigos científicos em periódicos médicos paulistas. A partir da instalação da República, iniciou-se um movimento médico de organização da sociedade e promoção da ciência que se expressou nas áreas em questão através de Franco da Rocha e de sua obra no Hospício do Juquery. Tanto ele quanto seus sucessores criaram o que se pode chamar de escolas paulistas em torno das disciplinas estudadas. A partir de uma conceituação de corpo neurológico elaborada por Foucault, constatamos que a elaboração desse corpo pelos estudiosos realinhou fronteiras entre neurologia, psiquiatria e psicologia, com a migração de moléstias entre esses grupos. Esse corpo neurológico adquiriu características próprias paulistas, em momento de afirmação de São Paulo no fim do período estudado. / With this research, we studied the stablishment of neurology, psychiatry and psychology in São Paulo, between 1889 and 1936, mainly by articles in scientific journals of São Paulo. Since the Republic starting, a medical movement tried to organize the society and promote science. This factors had expression in the concerned areas by Franco da Rocha and his work in Juquery Asylum. He and his followers created something that we can call schools of São Paulo around the studied scentific fields. With a conception of neurologic body elaborated by Foucault, we observed that the researchers rearranged the frontiers among neurology, psychiatry and psychology, with the migration of diseases from one to other of these disciplines. The neurologic body received its own caracterization of São Paulo, in a moment of reinforcement of that place in the end of the focused period.

Mental health care in South Africa has long been governed by inequalities (Foster & Swartz, 1997). During apartheid, those who did not speak English and Afrikaans could not access mental health services in the same way as those who did (Foster & Swartz, 1997). One main reason for this is the majority of mental health practitioners could not, and were not required to speak languages other than English and Afrikaans (Swartz, 1991). The South African mental health literature suggests that language and communication must be prioritised if there is to be an improvement in mental health care services for those individuals who do not speak English and Afrikaans (Bantjes, 1999; Drennan & Swartz, 1999; Swartz & Drennan, 2000; Swartz & MacGregor, 2002). Drawing on Prasad's (2002) interpretation of Gadamer's critical hermeneutic theory and utilising thematic networks analysis (Attride-Stirling, 2001), this study investigated the process of translated clinical assessment interviews within a psychiatric hospital in the Eastern Cape Province within South Africa. Results of the study revealed that contextual factors, issues concerning linguistic and cultural heritage, clinicians' role expectations regarding translators' role performance, as well as relational dynamics regarding individual levels of control and influence within the translation triad, all impacted on the effectiveness of communication, translation and service provision. These fmdings are supported by literature on the theory and practice of translation that identifies these issues as prominent (Robinson, 2003). Specific recommendations regarding the formalisation of translation practices within the hospital setting, as well as the familiari~ation of clinical practitioners and psychiatric nurses with the intricacies of translation processes are offered.