BAKGRUND: Litteraturen antyder att sjuksköterskor stigmatiserar och diskriminerar patienter med vissa diagnoser, i synnerhet schizofreni och borderline personlighetsstörning (BPS). BPS beskrivs som den psykiatriska diagnos med störst laddning och kring vilken det florerar flest stereotypa fördomar. SYFTE: Genom granskning av befintlig forskning i form av originalartiklar publicerade i vetenskapliga tidskrifter avser denna studie att sammanställa befintlig kunskap om sjukvårdspersonals attityder till patienter med borderline personlighetsstörning med eller utan självskadebeteende. METOD: Systematisk litteraturstudie. Litteratursökningar utfördes i databaserna PubMed, CINAHL och SCOPUS. RESULTAT: 21 studier inkluderades i resultatet. En rad olika studier påvisade en allmänt negativ attityd gentemot patienter med BPS med eller utan självskadebeteende. Vårdpersonal skattade mer negativa erfarenheter av att vårda patienter med BPS i jämförelse med schizofreni och depression. Vårdpersonal tenderade att skatta patienter med BPS som mer farliga, mindre trovärdiga samt ansåg att de hade mindre interpersonella färdigheter. SLUTSATS: Vårdpersonal, inte minst sjuksköterskor uppvisar negativa attityder i en icke försumbar utsträckning till patienter med BPS med eller utan självskadande beteenden. Detta kan leda till en inadekvat vård och behandling för den berörda patientgruppen. / BACKGROUND: The literature shows that nurses stigmatize and discriminate against patients with certain diagnoses, particularly schizophrenia and borderline personality disorder. Borderline personality disorder is generally described as being among the more heavy psychiatric conditions, and therefore very mired in stereotypes and prejudices. AIM: To summarize the current knowledge regarding attitudes of health professionals relating to borderline personality disorder and self-harm. METHOD: Systematic literature review. Literature search was made in the databases PubMed, CINAHL and SCOPUS. RESULTS: 21 studies were included in the results. A variety of studies demonstrated a general attitude of negativity toward patients with BPD with or without tendencies of self-harm. Clinicians reported more negative experiences working with BPD patients than with schizophrenia or depression patients. Caregivers tended to assess BPD patients as being more dangerous, less credible and having less interpersonal skills. CONCLUSION: Healthcare professionals, especially nurses, exhibit negative attitudes to a significant extent toward BPD patients as well as patients with self-harm tendencies. This may lead to inadequate care.

There are many choices of specialists to be utilized in a sport medicine support staff. The effectiveness of any athletic training program depends on the organization and utilization of these specialists. The purpose of this investigation was to review current practices of accessibility, utilization, and compensation of sports medicine support staff at NCAA Division I, II, and III institutions. A random sample of 225 NCAA institutions equally stratified by level (Division I, II, 111) was obtained from the National Association of Collegiate Directors of Athletics (NACDA) directory. A questionnaire was sent to 75 head athletic trainers in each of three NCAA divisions levels. Of the 225 questionnaires mailed, 178 were returned representing a 79% response rate.The accessibility and utilization of support staff was equally distributed with respect to gender and sports at all division levels. When examining the support staff, Division I had consistently higher accessibility and utilization rates than Division II and Ill. This study may assist athletic trainers to evaluate or update their program by reviewing current practices of accessibility utilization, and compensation of support staff. / School of Physical Education

This study was designed to investigate differences in administrative attitude adopted by line versus staff type administrators of community college based allied health career education programs when professionally and non-professionally related job responsibilities were considered.The population included 126 administrators each of whom represented a community college which hosted from five to fifteen allied health career programs, inclusively, and which maintained a full time equivalent enrollment of 2000 or more students. Seventy-three administrators identified themselves as line type and fifty-three as staff type.Data for the study constituted responses to a questionnaire survey instrument comprising twenty statements divided equally between professionally related and nonprofessionally related job responsibilities. Responsibility statements were adapted from conference reports citing specific competencies for allied health career administration.Participants responded to each of the twenty responsibility statements by selecting one of five equally marked referent positions on a leadership-management scale. Responses were quantified as line and staff group mean scores and analyzed statistically. Five null hypotheses were tested using non-directional t tests at the 0.001 level of significance. Where significance was determined, F tests were employed to verify homogeneity of variance. Three hypotheses were structured to test inter-group score differences when all and sub-sets of responsibilities were considered. Two hypotheses were employed to test intragroup score differences when professionally versus nonprofessionally related statements were considered.Analysis of data, organized relative to each of the hypotheses, led to the following conclusions:Line type administrators, as a group, adopted a moderate position of leadership when all twenty job responsibility statements were considered. Staff administrators tended toward an attitude of management. The difference was statistically significant.When professionally related statements were considered, both line and staff groups adopted attitudes of leadership. Line administrators, however, adopted a stronger referent than did staff. The difference was significant.Statistically significant difference was determined between line and staff responsibility referents to nonprofessionally related statements. Line administrators tended to a leadership referent and staff adopted a slight managerial referent.Observably large standard deviations for line and staff group mean scores necessitated tests of homogeneity of variance. These tests showed statistical significance when line versus staff group scores were compared in response to all twenty responsibility statements as well as in response to professionally related statements. Frequency polygon plots of individual scores depicted a bimodal distribution of staff respondent scores.The line administrator group adopted a position of leadership for both professionally and non-professionally related statements of job responsibility. This referent was expressed more so for the former set of responsibilities than the latter. The difference between referents was statistically significant.Staff administrators adopted a group attitude slightly on the leadership side of the leadership-management scale when professionally related statements were considered and slightly on the management side for non-professionally related statements. The difference, however, was not statistically significant.Tabulation of descriptive data revealed that approximately three-fifths of both line and staff respondents possessed a health career credential. Fifty-two per cent of line respondents compared to thirty-three per cent of staff reported that they occupied their position for five or more years.In summary, this study confirmed differences in attitudes of leadership and management adopted by line versus staff type administrators of allied health career programs when identical statements of job responsibility were considered. Ambivalence of staff group leadership and management attitude to responsibilities was also noted. The inherent nature of the line type administrative position as opposed to a staff type suggests a basis for these findings.

Typescript. / Thesis (Ed. D.)--University of Hawaii at Manoa, 1981. / Bibliography: leaves 231-243. / Photocopy. / xvii, 243 leaves, bound 29 cm

The premise of this research was focused on ascertaining how variables such as work environment, pay, supervision, co-workers and promotion impacts on job satisfaction of civil servants at an institution residing under the Department of Health in the Western Cape.

This study explores the teaching role of activists and community advocates who have become involved in the education and preparation of mental health professionals. Placed in the transcultural mental health context, the study aims to identify central features of the 'teaching role' of consumer and carer advocates as they have become employed via participatory strategies and employment scenarios within mainstream teaching programs and transcultural mental health centres. / The research approach used for this exploration is based on hermeneutics and ethnography, where I visit organisations and individual advocates on a participant- observation basis. This approach locates my researcher role as a central reflexive author in generating and interpreting data from experiences of organisational teaching practice, from conversing with advocates and clinical educators and from collecting and reading consumer and carer perspectives on reform in mental health care. Making interpretations from these social experiences means that I make selective use of relevant autobiographical details and knowledge from my employment in the mental health sector. / The central theme of the study is how consumer and carer advocates teach via the notion of lived experience, a key expression of recent workforce development policy in Australian mental health. The research outcomes from this focus indicate that the teaching work of advocates in contributing authoritative knowledge of self and others is influenced by many factors intrinsic to their performed representative role, rather than exclusively by their personal experience as a consumer or carer, as the policy of lived experience would suggest. I argue that the requirements of teaching as defined by the expectations of employing organisations and the clinical audience, and by traditions in representative advocacy and professional education all shape the way in which advocates build and express their knowledge in educational work. / From this broad interpretation, the study also argues that organisations in mental health need to carefully think about the way they construct teaching positions for community advocates and support their work. Performance expectations of representing others, being able to portray cultural understandings, effectively educating clinicians, utilising their personal stories and histories, and meeting other employment related tasks place diverse and possibly contradictory pressures on the consumer or carer wishing to express their perspective to the workers in the sector. / The study's major emphasis on the role requirements of advocate/ teachers and organisational expectations is then connected to a broader conversation about how (consumer) participation models are able to facilitate and support the involvement of community and identity groups not traditionally associated with the consumer movement. This focuses attention on how existing consumer models are bound to the language of consumerism and mental illness. The implications of these boundaries for realizing the ideals of participation in mental health are then discussed. This helps to contextualise the idea of whether the mental health sector is in a position to facilitate a democratic recognition of the service needs of different community groups. / Thesis (PhDNursing)--University of South Australia, 2005

This thesis endeavours to explore, describe and portray the author's attempt to work with the people of Vanuatu, a small island nation in the South Pacific, establishing a preventative eye care project. The goal of this study is to offer a contribution to the understanding of cross-cultural health work in Vanuatu. / Thesis (PhD)--University of South Australia, [2000]

This study explores the teaching role of activists and community advocates who have become involved in the education and preparation of mental health professionals. Placed in the transcultural mental health context, the study aims to identify central features of the 'teaching role' of consumer and carer advocates as they have become employed via participatory strategies and employment scenarios within mainstream teaching programs and transcultural mental health centres. / The research approach used for this exploration is based on hermeneutics and ethnography, where I visit organisations and individual advocates on a participant- observation basis. This approach locates my researcher role as a central reflexive author in generating and interpreting data from experiences of organisational teaching practice, from conversing with advocates and clinical educators and from collecting and reading consumer and carer perspectives on reform in mental health care. Making interpretations from these social experiences means that I make selective use of relevant autobiographical details and knowledge from my employment in the mental health sector. / The central theme of the study is how consumer and carer advocates teach via the notion of lived experience, a key expression of recent workforce development policy in Australian mental health. The research outcomes from this focus indicate that the teaching work of advocates in contributing authoritative knowledge of self and others is influenced by many factors intrinsic to their performed representative role, rather than exclusively by their personal experience as a consumer or carer, as the policy of lived experience would suggest. I argue that the requirements of teaching as defined by the expectations of employing organisations and the clinical audience, and by traditions in representative advocacy and professional education all shape the way in which advocates build and express their knowledge in educational work. / From this broad interpretation, the study also argues that organisations in mental health need to carefully think about the way they construct teaching positions for community advocates and support their work. Performance expectations of representing others, being able to portray cultural understandings, effectively educating clinicians, utilising their personal stories and histories, and meeting other employment related tasks place diverse and possibly contradictory pressures on the consumer or carer wishing to express their perspective to the workers in the sector. / The study's major emphasis on the role requirements of advocate/ teachers and organisational expectations is then connected to a broader conversation about how (consumer) participation models are able to facilitate and support the involvement of community and identity groups not traditionally associated with the consumer movement. This focuses attention on how existing consumer models are bound to the language of consumerism and mental illness. The implications of these boundaries for realizing the ideals of participation in mental health are then discussed. This helps to contextualise the idea of whether the mental health sector is in a position to facilitate a democratic recognition of the service needs of different community groups. / Thesis (PhDNursing)--University of South Australia, 2005

Doctor of Health Science / The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research. / thesis (BPsychology(Hons))--University of South Australia, 2004.