Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.

Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.

Submitted by Glaucia Fernanda Galeazzi Nóbile null (glau_fgn@hotmail.com) on 2016-10-17T11:57:20Z No. of bitstreams: 2 Dissertação Glaucia F G Nobile.pdf: 848569 bytes, checksum: 59f429f76637b7e07ef432d1f29935fe (MD5) Dissertação Glaucia F G Nobile.pdf: 848569 bytes, checksum: 59f429f76637b7e07ef432d1f29935fe (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-10-21T15:48:33Z (GMT) No. of bitstreams: 1 nobile_gfg_me_bauru.pdf: 848569 bytes, checksum: 59f429f76637b7e07ef432d1f29935fe (MD5) / Made available in DSpace on 2016-10-21T15:48:33Z (GMT). No. of bitstreams: 1 nobile_gfg_me_bauru.pdf: 848569 bytes, checksum: 59f429f76637b7e07ef432d1f29935fe (MD5) Previous issue date: 2016-08-26 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O estudo da interação terapêutica possibilita conhecer variáveis interpessoais responsáveis pelas mudanças ocorridas nos comportamentos do cliente na terapia, dessa maneira, a pesquisa com interação terapêutica poderá auxiliar os terapeutas a identificar quais comportamentos tornam a intervenção mais eficaz. A presente pesquisa tem por objetivo descrever os comportamentos da interação terapêutica, a partir de análises sequenciais, tendo o comportamento do terapeuta e do cliente como categoria critério e descrever os qualificadores dos comportamentos. Participaram dois universitários com transtorno de ansiedade social e uma terapeuta. A terapia realizada foi individual, analítico comportamental, incluindo o treino de habilidades sociais e as sessões foram gravadas em vídeos. Onze sessões de cada cliente foram categorizadas, após a concordância entre observadores, utilizando o protocolo de categorias do Sistema Multidimensional de Categorização de Comportamentos na Interação Terapêutica (SiMCCIT) e o software The Observer. Foi realizada análise sequencial tendo o comportamento do terapeuta e do cliente como categoria critério e, na sequência foi conduzida a análise de frequência dos qualificadores dos comportamentos: tom emocional e gestos ilustrativos. Os resultados da análise sequencial, tendo o comportamento do terapeuta como critério, destaca algumas sequências da interação terapêutica, os comportamentos do terapeuta Solicitação de Relato e Facilitação favoreceram o Relato do cliente, as categorias Informação, Interpretação e Recomendação favoreceram a ocorrência de Concordância do cliente. Os resultados da análise sequencial tendo o comportamento do cliente como critério, destacam para o comportamento do terapeuta Solicitação de Relato que favoreceu o Relato do cliente e os comportamentos Solicitação de Reflexão e Facilitação favoreceram o comportamento Relações do cliente. Os resultados da frequência dos qualificadores dos comportamentos apresentam o predomínio da emoção neutra e positiva leve e ausência de emoção negativa, tanto para o terapeuta quanto para o cliente e, na maioria das categorias, ocorreu frequência maior de gestos ilustrativos do que sua ausência, com exceção da categoria Solicitação de Relato. Discute-se que o padrão encontrado nas sequências de comportamentos, em que favorecem o Relato e Relações do cliente e a ocorrência da emoção neutra e positiva leve na interação, pode ser recomendado para o atendimento de pessoas com transtorno de ansiedade social. / The study of therapeutic interaction enables to know interpersonal variables responsible for changes in clients, through behavior therapy; so, research with therapeutic interaction may assist therapists to identify behaviors that make interventions most effective. This research aims to describe the behaviors of therapeutic interaction, from sequential analysis, and the therapist's behavior and client as a criterion category and describe the qualifiers of the behaviors. They attended two university students with social anxiety disorder and a therapist. The therapy was performed individual, behavioral analytic, including social skills training and the sessions were recorded on video. Eleven sessions each client were categorized following the agreement between observers, using the Multidimensional System categories protocol behaviors Categorization in Interaction Therapy (SiMCCIT) and The Observer software. It performed sequence analysis with the therapist's behavior and customer category as the criterion and following was conducted frequency analysis of qualifiers behavior: emotional tone and illustrative gestures. The results of sequence analysis, and the therapist's behavior as a criterion, highlights some sequence of therapeutic interaction, the therapist behaviors Reporting Application and Facilitation favored customer report, the categories Information, Interpretation and Recommendation favored the occurrence of Customer Agreement . The results of sequential analysis with customer behavior as a criterion, stands for the Reporting Request therapist behavior that favored the client reporting and behavior reflection Application and Facilitation favored customer relations behavior. The results of the frequency qualifiers behavior show the predominance of the light neutral and positive emotion, and absence of negative emotion both the therapist and for the customer and, in most categories, occurred more frequently illustrative gestures that its absence, except category Report Request. It is argued that the pattern found in the sequences of behaviors that favor the reporting and customer relations and the occurrence of mild neutral and positive emotion in interaction, can be recommended for the care of people with social anxiety disorder. / FAPESP: 2014/18745-5

Resumo: A despeito da eficácia de vários programas de intervenção com cuidadoras ter sio divulgada na literatura, supõe-se que conhecer os procedimentos e resultados não seja suficiente para esclarecer quais comportamentos do terapeuta determinam as mudanças. Pesquisadores propõem que o entendimento do processo de mudança que ocorre em terapia, possa partir da análise da interação terapêutica. A presente pesquisa tem por objetivo, descrever a interação terapêutica estabelecida entre terapeuta e clientes, ou seja, investigar como terapeuta e clientes comportam-se em uma intervenção de grupo e analisar a influência exercida entre ambos. Participaram da pesquisa, uma Terapeuta Comportamental com experiência de três anos, duas mães e uma avó. Foram designadas para a análise, cinco de de treze sessões filmada, num total de 10 horas. Para a análise dos dados, foi utilizado o software The Observer XT, capaz de selecionar imagens, quantificar dados e realizar análises sequenciais. Os dados foram organizados em termos de frequencia e duração das categorias de comportamentos dos participantes e também foram realizadas análises de correlação e sequenciais. Resultados principais: a) as categorias do terapeuta apresentadas com percentuais de ocorrência e duração elevados foram: Aprovação, Recomendação, Interpretação, Informação e Solicitação de relato; b) constatou-se que as categorias Recomendação, Informação e Solicitação de reflexão foram apresentadas com frequencia maior em relação ao grupo de clientes, já as demais, Aprovação, Interpretação, Solicitação de relato, Reprovação e Empatia, foram apresentadas com frequencia maior às clientes individualmente; c) as categorias dos clientes: Relato, Concordância, Estabelece relações e Oposição, representaram as categorias com maiores percentuais de ocorrência e duração para as três clientes; d) as análises de correlação revelaram a existência. / Abstract: In spite of the efficiency of many interventional programs, it is believed that believed that knowing the procedures and results of such programs is not enough to clarify which attitudes performed by the therapist leaded to the actual results. Researchers propose that the understanding of the changing process originates from the analysis of the interaction established between therapist and client. The present study thus has the purpose of describing the therapeutic interaction established among therapist and clients, specifically to investigate how they behave in a group intervention analyzing therfore the influence that one has on the other. The participants were a Behavioral Therapist, two mothers and one grandmother. Five of thirteen taped sessions were randolmly designated for analysis. The software The Observer XT was designated for the data analysis. They were organized in categories classified by frequency and duration of the participants' behavior, as well as undergone to the correlational and sequential analyses. The duration and frequency were: Approval, Recommendation, Interpretation, Information and Report Solicitation; b) it was observed that the therapist's categories such as Recommendation, Information, and Thinking Request were presented in a higher frequency in relation to the clients group, yet the others such as Approval, Interpretation, Report Request, Criticism and Empathty were presented in a higher degree to the clients individually c) the categories of the clients such as Report, Concordance, Establish Relations and Opposition, represented the categories with higher percentages of requency and duration for the three clients that participated in the research; d) the correlation analysis revealed the existence of correlations among the therapist's categories, for example, Approval and Information; therapist and client's such as Interpretation... (Complete abstract click electronic access below) / Orientador: Alessandra Turini Bolsoni-Silva / Coorientador: Sonia Beatriz Meyer / Banca: Denis Roberto Zamignani / Banca: Olga Maria P. Rolim Rodrigues / Mestre

Submitted by Karina Ferraz Tozze null (karinatozze@hotmail.com) on 2016-03-28T19:57:17Z No. of bitstreams: 1 Dissertação - Karina Tozze [versão ABNT].pdf: 1723728 bytes, checksum: a2c5f262400c681171b7621b2ee21b29 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-29T18:49:35Z (GMT) No. of bitstreams: 1 tozze_kf_me_bauru.pdf: 1723728 bytes, checksum: a2c5f262400c681171b7621b2ee21b29 (MD5) / Made available in DSpace on 2016-03-29T18:49:35Z (GMT). No. of bitstreams: 1 tozze_kf_me_bauru.pdf: 1723728 bytes, checksum: a2c5f262400c681171b7621b2ee21b29 (MD5) Previous issue date: 2016-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A supervisão de estágio é um processo de ensino e de aprendizagem que visa gerar mudanças no comportamento do estagiário/terapeuta, a fim de facilitar a prática clínica do futuro psicólogo. Diante disso, a presente pesquisa foi dividida em dois estudos complementares. O primeiro estudo buscou apresentar dados referentes a uma intervenção realizada por terapeutas com pais que se queixavam de problemas de comportamentos internalizantes dos filhos. Foram feitas aplicações de instrumentos nos pais para avaliar a efetividade dos atendimentos e analises dos dados referentes ao processo terapêutico, por meio da descrição da interação terapêutica. O que se obteve nesse estudo, foi de que os pais, após a intervenção, reduziram as queixas levantadas antes dos atendimentos. A interação terapêutica se mostrou como uma ferramenta importante que contribuiu para a melhora dos clientes. Pretendeu-se compreender melhor o processo de supervisão de estágio e se a supervisão era uma variável a ser considerada diante dos dados observados no primeiro estudo. A partir da identificação e descrição de categorias comportamentais do supervisor de estágio e de estagiários durante o processo de supervisão oral e escrita. O mesmo estudo também descreveu se as estagiárias aplicaram ou não as recomendações dadas pela supervisora, além de identificar quais foram essas recomendações. Notou-se que as recomendações fornecidas pela supervisora foram seguidas, em sua maior parte, e possibilitaram a aquisição de habilidades terapêuticas por parte das estagiárias, havendo uma contribuição para o fim das queixas trazidas pelos clientes. Ao fim, questões metodológicas e novas possibilidades de pesquisa foram discutidas. / The probation supervision is a process of teaching and learning that aims to generate changes in behavior trainee / therapist in order to facilitate future clinical psychologist practice. About that noted the importance of developing research involving probation supervision for psychological support that are conducted in group form. Therefore, the present reserarch was separed into two complementary studies. The first study aimed to present data relating to an intervention performed by trainees / therapists with parents who complained of problems of internalizing behaviors of their children. So instruments applications were made to parents to evaluate the effectiveness of psychological support. In addition, data on the therapeutic process were analyzed by describing the therapeutic interaction. It has been obtained in this study was that parents after the intervention reduced the complaints raised before the sessions. About the therapeutic interaction that was show as an important tool contributing to the improvement of patients. Then was intended to understand the probation supervision process and supervision was one variable to be considered face of data observed in the first study. This way the second study identified and described behavioral categories of the probation supervisor and trainees during the process of oral and written supervision. The same study also described if the trainees applied or not the recommendations given by the supervisor and identified what were these Recomendations. That way it was observed that the Recommendations provided by the supervisor both reports as in probation supervision environment were followed, for the most part, and made possible the purchase of therapeutic skills by the trainees, That way it was observed that the recommendations provided by the supervisor, both reports as the very probation supervision environment were followed, for the most part and made possible the acquisition of therapeutic skills by the trainees, in the course of probation and so having a contribution to the end of complaints brought by the parents. After methodological issues and new research possibilities were discussed.

Made available in DSpace on 2014-06-11T19:29:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-16Bitstream added on 2014-06-13T20:58:56Z : No. of bitstreams: 1 silveira_ff_me_bauru_prot.pdf: 732799 bytes, checksum: 950f182c84db1a563df6a89c3e056dcc (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A despeito da eficácia de vários programas de intervenção com cuidadoras ter sio divulgada na literatura, supõe-se que conhecer os procedimentos e resultados não seja suficiente para esclarecer quais comportamentos do terapeuta determinam as mudanças. Pesquisadores propõem que o entendimento do processo de mudança que ocorre em terapia, possa partir da análise da interação terapêutica. A presente pesquisa tem por objetivo, descrever a interação terapêutica estabelecida entre terapeuta e clientes, ou seja, investigar como terapeuta e clientes comportam-se em uma intervenção de grupo e analisar a influência exercida entre ambos. Participaram da pesquisa, uma Terapeuta Comportamental com experiência de três anos, duas mães e uma avó. Foram designadas para a análise, cinco de de treze sessões filmada, num total de 10 horas. Para a análise dos dados, foi utilizado o software The Observer XT, capaz de selecionar imagens, quantificar dados e realizar análises sequenciais. Os dados foram organizados em termos de frequencia e duração das categorias de comportamentos dos participantes e também foram realizadas análises de correlação e sequenciais. Resultados principais: a) as categorias do terapeuta apresentadas com percentuais de ocorrência e duração elevados foram: Aprovação, Recomendação, Interpretação, Informação e Solicitação de relato; b) constatou-se que as categorias Recomendação, Informação e Solicitação de reflexão foram apresentadas com frequencia maior em relação ao grupo de clientes, já as demais, Aprovação, Interpretação, Solicitação de relato, Reprovação e Empatia, foram apresentadas com frequencia maior às clientes individualmente; c) as categorias dos clientes: Relato, Concordância, Estabelece relações e Oposição, representaram as categorias com maiores percentuais de ocorrência e duração para as três clientes; d) as análises de correlação revelaram a existência. / In spite of the efficiency of many interventional programs, it is believed that believed that knowing the procedures and results of such programs is not enough to clarify which attitudes performed by the therapist leaded to the actual results. Researchers propose that the understanding of the changing process originates from the analysis of the interaction established between therapist and client. The present study thus has the purpose of describing the therapeutic interaction established among therapist and clients, specifically to investigate how they behave in a group intervention analyzing therfore the influence that one has on the other. The participants were a Behavioral Therapist, two mothers and one grandmother. Five of thirteen taped sessions were randolmly designated for analysis. The software The Observer XT was designated for the data analysis. They were organized in categories classified by frequency and duration of the participants' behavior, as well as undergone to the correlational and sequential analyses. The duration and frequency were: Approval, Recommendation, Interpretation, Information and Report Solicitation; b) it was observed that the therapist's categories such as Recommendation, Information, and Thinking Request were presented in a higher frequency in relation to the clients group, yet the others such as Approval, Interpretation, Report Request, Criticism and Empathty were presented in a higher degree to the clients individually c) the categories of the clients such as Report, Concordance, Establish Relations and Opposition, represented the categories with higher percentages of requency and duration for the three clients that participated in the research; d) the correlation analysis revealed the existence of correlations among the therapist's categories, for example, Approval and Information; therapist and client's such as Interpretation... (Complete abstract click electronic access below)

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