published_or_final_version / abstract / Community Medicine / Master / Master of Public Health

<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>

There have been many studies of Victorian asylums and their inmates, but the Edwardian asylum, and child inmates, have been largely unrepresented. This thesis attempts to redress these imbalances and contribute to the history of mental deficiency by describing the innovations, developments, and practices within the West Riding Pauper Lunatic Asylum (WRPLA) and its annexe, Stanley Hall. As part of the Poor Law system Stanley Hall took in idiot and imbecile boys as young as three years, where, as part of the response of alienists towards mentally deficient children, an attempt was made to educate them to a degree of self- sufficiency. In this way Stanley Hall was an institution that went beyond its perception as a custodial establishment and practised new approaches to care, at a time when these boys were defined within the Poor Law under the universal category of 'lunatic'. This study focuses on the role of William Bevan Lewis, the Medical Superintendent of the WRPLA (1884-1910), and the 163 idiot and imbecile boys admitted to Stanley Hall between 1901 and 1910. Consideration is given to the early dissemination of knowledge from this asylum and its influence through the teaching and training of medical students and asylum medical officers. The function and operation of Stanley Hall and the 'experiences' of the inmates is explored through institutional records and the evidence of Bevan Lewis to the Royal Commission on the Care and Control of the Feeble-minded (1905-1908). Stanley Hall pre-dated other mental deficiency colonies and anticipated the conclusions of the Royal Commission which recommended specialised care for mentally deficient children. Issues of care for this group were intensely debated during the Edwardian period leading to the Mental Deficiency Act (1913) that defined this group and influenced their care for almost another fifty years. The records of Stanley Hall demonstrate the individuality of the boys, and allow the analysis of the involvement of their families in the committal of their children. The subsequent involvement (or lack thereof) in the care of their children is also examined. The ultimate fates of the boys are considered, and an attempt made to bring the regime at Stanley Hall 'back to life'.

The purpose of the present study was to assess patient improvement in a specific freestanding partial hospital. Improvement was assessed in two specific areas: 1) symptom reduction as measured by the Symptom Check List-90-Revised (SCL-90-R) and 2) social adjustment as measured by the Social Adjustment Scale Self-Report (SAS-SR) at admission, discharge and three month follow-up. In addition, improvement was assessed from two perspectives: 1) patient evaluation and 2) therapist evaluation. Results indicated that there was statistically significant improvement from admission to discharge on the SCL-90-R and the SAS-SR. This improvement was maintained from discharge to three month follow-up. Findings also revealed statistically significant improvement when analyzed from both the patient perspective and the therapist perspective.

Ward environment as assessed by the Ward Atmosphere Scale was the focus of this exploratory study. The Ward Atmosphere scores of 110 patients hospitalized on two units for acute psychiatric care in a state hospital were analyzed for determining differences along the dimensions of population factors, sex and program change. Significant differences in attitude were obtained on certain of the ten scales for each of the three comparisons. The premise of ward atmosphere being a global entity as implied in the literature was not upheld in this population. Sex differences were noted and introduction of an individualized patient management program evoked significant changes in opinions concerning ward atmosphere. A number of interpretations for these results were offered and implication for future research was suggested.

Children and adolescent psychiatric inpatients (n = 25) versus staff (n = 35) milieu perceptions were measured with the Ward Atmosphere Scale (WAS) Form K (Kids). The perceptions were compared with previous data collected in 1981, 1982, and 1984 on the same unit. The 1993 staff and patients continued to perceive the unit as a therapeutic environment despite recent restrictions on length of stay due to health care reform. The views of the staff and patients were found to be divergent but less so than in previous years. Additionally, the more seriously ill a patient was determined to be, the more negatively he or she perceived the environment. Differences in perceptions between day shift versus night shift and administrative versus non-administrative staff were also found and discussed. Staff perceptions versus their ideal conceptions were also investigated and compared with those of the 1984 staff. The 1994 staff was found to more closely approximate their ideals than the 1984 staff.

O presente trabalho de modificação de comportamento, foi realizado em um pavilhão de crianças de um hospital psiquiátrico do Estado. Fez-se um levantamento das condições do pavilhão das crianças para identificar as dificuldades existentes e planejou-se juntamente com a equipe técnica do pavilhão mudanças no ambiente físico que propiciavam condições para produzir modificações no comportamento das crianças e das atendentes. A rotina diária do pavilhão se centralizava em torno de duas atividades principais: situação de banho e situação de refeições. A programação de mudanças ambientais foi feita de modo a atingir especificamente cada uma dessas situações bem como os períodos intermediários entre as mesmas. Os resultados mostraram que com a implantação das mudanças ambientais realizadas no pavilhão das crianças foi observada uma acentuada melhora no repertório comportamental das crianças e no padrão comportamental das atendentes. Essas mudanças se mantiveram após a nossa saída da instituição. / The present work of behavior modification was accomplished in a ward of children in a state psychiatric hospital. It was an evaluation of the condition of the children´s ward to identify the difficulties and together with the staff of the ward, there was planned some changes in the physical environment so that favorable conditions would produce modification in the behavior of the children and the attendants. The daily routine of the ward consisted of two main activities: situation of the bath and situation of the meals. The programming of those changes was planned in a way to effect especially each one of these situations and their intermediate periods as well. The situations were reorganized by using the physical and human resources of the place. The results showed that with the environmental changes set up in the children\'s ward there was observed a strong improvement in the behavior repertory of children and in the pattern of behavior of the attendants. Those changes continued after the period which we left the hospital.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-09-21T12:29:01Z No. of bitstreams: 1 Amanda Teixeira Rizzo.pdf: 831694 bytes, checksum: f5f7aa1de95da62e96f6a0682094d6a8 (MD5) / Made available in DSpace on 2017-09-21T12:29:01Z (GMT). No. of bitstreams: 1 Amanda Teixeira Rizzo.pdf: 831694 bytes, checksum: f5f7aa1de95da62e96f6a0682094d6a8 (MD5) Previous issue date: 2017-09-15 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / This dissertation utilizes as a fundamental point of investigation a clinical enigma experienced during a psychoanalytic care in a psychiatric hospital. The case is of a patient who in his third hospitalization, to treat his symptoms of alcohol and drug abuse, manifested a type of transference different from previous treatments. We observed the establishment of transference love which was adopted as the conductor of the analysis. One question summons us to the research: what was different about this third hospitalization? From this clinical experience we gather repercussions in the conduction of the analysis and also the life of the patient both which requested a more specific investigation of the psychoanalytic concepts of identification and incorporation, since the reveal of “Gringo’s” existence as an identification figure after the impact of an interpretation. Thus a clinical-theoretical discussion is presented aiming to articulate the issues raised by the case and its implications to the psychoanalytic clinic in regards to treatments offered by psychiatric institutions specifically concerning the field of chemical dependency / Esta dissertação utiliza como ponto fundamental de investigação um enigma clínico vivenciado durante um atendimento psicanalítico em um hospital psiquiátrico. O caso é de um paciente que em sua terceira internação, para tratar seus sintomas de abuso de álcool e drogas, manifestou um tipo de transferência diferente dos tratamentos anteriores. Observamos a instalação do amor de transferência e esta foi adotada como condutora da análise. Uma questão nos convoca a pesquisa: o que foi diferente nessa terceira internação? A partir dessa vivência clínica recolhemos repercussões na condução da análise e para a vida do paciente que também solicitaram uma investigação mais específica dos conceitos psicanalíticos de identificação e incorporação, desde a revelação da existência de Gringo como uma figura identificatória após o impacto de uma interpretação. Dessa forma, apresentamos uma discussão clínico-teórica que visa articular os temas suscitados pelo caso e suas implicações para a clínica psicanalítica nos tratamentos oferecidos por instituições psiquiátricas, especificamente no campo da dependência química

O presente trabalho de modificação de comportamento, foi realizado em um pavilhão de crianças de um hospital psiquiátrico do Estado. Fez-se um levantamento das condições do pavilhão das crianças para identificar as dificuldades existentes e planejou-se juntamente com a equipe técnica do pavilhão mudanças no ambiente físico que propiciavam condições para produzir modificações no comportamento das crianças e das atendentes. A rotina diária do pavilhão se centralizava em torno de duas atividades principais: situação de banho e situação de refeições. A programação de mudanças ambientais foi feita de modo a atingir especificamente cada uma dessas situações bem como os períodos intermediários entre as mesmas. Os resultados mostraram que com a implantação das mudanças ambientais realizadas no pavilhão das crianças foi observada uma acentuada melhora no repertório comportamental das crianças e no padrão comportamental das atendentes. Essas mudanças se mantiveram após a nossa saída da instituição. / The present work of behavior modification was accomplished in a ward of children in a state psychiatric hospital. It was an evaluation of the condition of the children´s ward to identify the difficulties and together with the staff of the ward, there was planned some changes in the physical environment so that favorable conditions would produce modification in the behavior of the children and the attendants. The daily routine of the ward consisted of two main activities: situation of the bath and situation of the meals. The programming of those changes was planned in a way to effect especially each one of these situations and their intermediate periods as well. The situations were reorganized by using the physical and human resources of the place. The results showed that with the environmental changes set up in the children\'s ward there was observed a strong improvement in the behavior repertory of children and in the pattern of behavior of the attendants. Those changes continued after the period which we left the hospital.

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