The contemporary mental health profession is facing a crisis of recruitment and retention. Services provided are complex, practically and conceptually. On one hand, assessments and treatments are provided, but on the other, staff become responsible for the administration of coercive security discourses and arrangements. This complex phenomenon can leave mental health personnel vulnerable to criticisms in exactly how best they should discharge their duties within an occupational remit of duality. Working in the correct or most appropriate way is a constant challenge for staff as they must meet with approval from both managers and colleagues negotiating a path between formal rules and informal norms. This exploratory study was undertaken within a mental health NHS Trust in the North of England. It interviewed twenty participants from a range of areas of work, namely hospital wards, occupational therapy departments and the community setting. A narrative interviewing technique has been used to collect occupational histories and stories which have been used in an attempt to illuminate the contemporary issues facing clinical staff. Findings suggest that their contemporary care delivery is much more complex than previously known and that there is a diverse range of background and conceptual challenges which workers face in addition to their organisationally prescribed practical mandates of work. Six normative orders of work have emerged from data that has been collected; bureaucracy, risk management, competence, morality, physical environment and care versus control. Participant reflections on professional autonomy and responsibility shed light on the perceived rationality of policies and procedures and 'governance at a distance' taking place in response to bureaucratic and risk reduction imperatives. Indeed, such work is demanding and the management of a professional 'performance', and the self regulating and adaption of emotion have been seen to be an important dimension in the observation of occupational competence and work-based socialisation processes. Furthermore, personnel are engaged in a complex and fluid role duality where they must personally reconcile their role as care provider whilst also maintaining levels of physical security in a contemporary and technologically advanced healthcare environment. In this thesis, it is argued that these normative aspects of work typify the social nature of mental health work and, in addition, take place under the auspices of Goffmanesque theorisations of the 'total institution', 'mortification of self and 'social contamination'. These findings draw particular attention to an under acknowledged aspect of mental health based inquiry where the formal and informal spheres of work are observed to co-mingle within the environment of psychiatry. In doing so, questions arise over the rationality of some systems of work which 'shop-floor' staff are engaged within, yet, at times, have very little opportunity to shape as individual practitioners.

No description available.

acase@tulane.edu / Background: For the past two decades, Louisiana’s health status has ranked among the lowest in the nation. In 2009, Louisiana was ranked 47th in the nation which indicated marginal improvements from their 49th position in 2008. 1, 2 In addition, the 2009 Commonwealth State Scorecards Report ranked the Louisiana health system performance, in terms of health outcomes, among the poorest in the nation.One reason for this disparity could be attributed to shortages of physicians and other healthcare resources in the state. These shortages were exacerbated by the damage done by the 2005 hurricanes to hospitals and physicians’ practices in New Orleans, and throughout the state.3 Today, 86 percent of Louisiana parishes are designated health professional shortage areas by the Health Resources and Services Administration Shortage Designation Branch (HRSAS). 4 Specifically, 126 areas in Louisiana are considered as primary care shortage areas. 5 Louisiana is ranked 6th in the nation in percent of the population lacking access to primary care. 5According to the Medical Education Commission, approximately 40 percent of Louisiana’s medical school graduates and physicians leave the state after completing their medical residencies. 6 Study Design: Using data from the 2006-2007 Louisiana State Board of Medical Examiners (LSBME) providers’ data set and the 2007-2008 Blue Cross Blue Shield (BCBS) of Louisiana providers’ data to report active physicians by specialty and location in the state, this cross-sectional study analyzed disparities in statewide health system performance, measured by mortality amenable to healthcare (MAHC). Age-adjusted standardized mortality rates (ASMR) from all conditions amenable to healthcare were derived and extracted from the Centers for Disease Control and Prevention (CDC) The Distribution of Physician Workforce in Louisiana: Implications for Outcomes of Care Compressed Mortality File (CMF).7 The CMF is a county-level national mortality and population database spanning the years 1968-2006. The model controlled for sociodemographic factors and health care resources available in the different parishes. Population data were obtained from the 2006-2007 county-specific Area Resource File (ARF). The unit of analysis was the parish. Results: Louisiana is facing a maldistribution of physicians by specialty (primary care vs. specialty care) and geography. Furthermore, throughout Louisiana, health system performance as measured by ASMR from all conditions amenable to healthcare varied widely. Conclusion: Variations in parish physician supply did not explain variations in MAHC. Rather, significant associations were found between socio-economic factors and MAHC / 1 / Maysoun Dimachkie Masri

Bakgrund: Tidigare forskning visar på att patientens andliga omvårdnadsbehov inte får tillräckligt utrymme inom vården i jämförelse med patientens fysiska omvårdnadsbehov. Tidigare forskning visar även att patienter har behov av att erhålla andlig omvårdnad då detta kan mildra patienters lidande. Andlig omvårdnad delas in i två perspektiv: icke religiös och religiös. Syfte: Att belysa vårdpersonalens erfarenhet av andlig omvårdnad ur ett icke religiöst perspektiv.  Metod: En allmän litteraturöversikt genomfördes för att belysa vårdpersonalens erfarenheter av andlig omvårdnad ur ett icke religiöst perspektiv. Resultatet baserar sig på tio vetenskapliga artiklar varav sju var kvalitativa, två kvantitativa samt en med blandad design, vilka analyserades enligt Fribergs (2012) metod för resultatanalys. Resultat: Fynden av denna studie resulterade i att fyra stycken teman upprättades; Vårdpersonalens upplevelse av andlig omvårdnad, vårdpersonalens strategier till att utöva andlig omvårdnad, vårdpersonalens upplevda hinder till att utöva andlig omvårdnad samt vårdpersonalens upplevelse av andlig omvårdnad relaterat till Holistisk vård. Slutsats: Andlig omvårdnad anses vara en del av Holistisk vård men vårdpersonal upplever svårigheter till att applicera det i praktiken utifrån diffus definition. Andlig omvårdnad ska relateras till patientens välbefinnande och inte medicinska diagnoser. Förslag på vidare forskning: Samtliga resultatartiklar som inkluderades i denna studie bedömer att det är av stor vikt att vidare forskning bör handla om definitionen av andlig omvårdnad ur ett icke religiöst perspektiv. Författarna anser att vidare forskning även behöver ta fram strategier till att utöva andlig omvårdnad ur ett icke religiöst perspektiv. / Background: Previous research shows that patient spiritual care needs may not be enough space in health care in comparison to the patient's physical care needs . Previous research also shows that patients need to receive spiritual care as this can alleviate patients' suffering. Spiritual care is divided into two perspectives : non-religious and religious. Aim; To highlight the health professionals experience of spiritual care from a non- religious perspective. Method: A general literature review was conducted to illustrate the health professionals experiences  of spiritual nursing from a non religious perspective . The result is based on ten scientific articles which seven were qualitative , two quantitative and one with a mixed design, which were analyzed according to Friberg (2012 ) method for analysis of results. Results : The findings of this study resulted in four themes were established ; Health professionals experience of spiritual care , health professionals strategies to pursue spiritual care , health professionals perceived obstacles to the exercise of spiritual care and health professionals experience of spiritual care related to holistic care . Conclusion: spiritual care considered be a  part of holistic care of health professionals but experience difficulties to apply in practice by the diffuse definition . Spiritual care should be related to the patient's well-being and not medical diagnoses. Suggestions for further research: All results-articels that were included in this study believes that it is essential that further research should focus on the definition of spiritual care from a non- religious perspective . The authors believe that further research also needs to develop strategies to exercise spiritual care from a non- religious perspective.

The process of recovery from addiction is a multifaceted process that involves the efforts of clients, professionals and the broader community. Additional challenges to recovery are present for individuals who use solvents. This study investigates how professionals, involved in the provision of services to clientele who use solvents, understand the process of healing in their collaborative work. Using a narrative methodology, semi-­‐structured interviews were conducted with professionals employed in providing recovery-based services to individuals who use volatile solvents. The stories of these professionals demonstrate how they view their clients as “just like everyone else” despite what the dominant cultural story says about their possibilities for recovery. The professionals told stories which are in extreme opposition to the story of dominant culture and involved groupings of “us” (professionals) versus “them” (others). These stories, and how they were told, are discussed in relation to hope for professionals who provide health and housing services.

The process of recovery from addiction is a multifaceted process that involves the efforts of clients, professionals and the broader community. Additional challenges to recovery are present for individuals who use solvents. This study investigates how professionals, involved in the provision of services to clientele who use solvents, understand the process of healing in their collaborative work. Using a narrative methodology, semi-­‐structured interviews were conducted with professionals employed in providing recovery-based services to individuals who use volatile solvents. The stories of these professionals demonstrate how they view their clients as “just like everyone else” despite what the dominant cultural story says about their possibilities for recovery. The professionals told stories which are in extreme opposition to the story of dominant culture and involved groupings of “us” (professionals) versus “them” (others). These stories, and how they were told, are discussed in relation to hope for professionals who provide health and housing services.

Effective educational efforts require knowledgeable health professionals to promote breastfeeding and instigate changes in individual behavior. This research was conducted to assess breastfeeding knowledge, and attitudes, beliefs, and intentions among students and professionals in health-related fields. A 5-year prospective study was conducted to investigate breastfeeding knowledge, and attitudes, beliefs, and intentions regarding breastfeeding in the workplace among nutrition students (n=69) while in school and later while in the workplace. A 47-item questionnaire was mailed to participants to survey knowledge, and attitudes, beliefs, and intentions related to breastfeeding in the workplace along with demographic information. From baseline to follow-up, nutrition students had a significant increase in breastfeeding knowledge (P<0.001), and change in attitudes (P<0.01) and change in intentions (P<0.02) regarding breastfeeding in the workplace. Sources of breastfeeding information were predictors of attitudes and intentions regarding breastfeeding in the workplace. In a separate study, a cross-sectional comparison of nutrition students (n=270) and non-nutrition students (n=271) at Virginia Tech demonstrated that nutrition students had significantly higher scores on breastfeeding knowledge, and attitudes, beliefs, and intentions regarding breastfeeding in the workplace scales (all P<0.001) compared to non-nutrition students. The 47-item questionnaire was also used in this investigation with junior, senior, and graduate students enrolled at Virginia Tech in spring of 20004. In both nutrition and non-nutrition students, attitudes and beliefs were significant predictors (both P<0.001) of intentions regarding breastfeeding in the workplace. In a final study, a cross-sectional evaluation of the Caribbean Association of Home Economics (CAHE) (n=71) revealed that respondents had mean (&#177;SD) scores of 5.76 + 1.34 for breastfeeding knowledge, 3.67 + 0.50 for attitudes, and 4.23 + 0.68 for beliefs related to breastfeeding in the workplace. Based on the 35-item survey, attitudes regarding breastfeeding in the workplace were positive predictors of beliefs (P<0.001). Overall, nutrition students, nutrition graduates, and CAHE members are knowledgeable about breastfeeding and possess positive attitudes and intentions regarding breastfeeding in the workplace. Attitudes regarding breastfeeding in the workplace are critical to intended behaviors. Nutrition program graduates may be effective educators of and advocates for breastfeeding and for breaking barriers to breastfeeding in the workplace. / Ph. D.

Mental health concerns are presented in primary care settings regularly, yet a majority of these issues go undetected or are misdiagnosed by primary care physicians (PCPs). This may be due to a lack of mental health training for PCPs during their medical education. Over time, medical school curricula have evolved to include mental health training in order to bridge this gap in the healthcare system and to more readily identify patients in need of mental health services. The current study investigated AMA-accredited medical school curricula from universities across the US and US territories (N = 170) who train physicians in primary care, family medicine, or other generalist tracks. Data on mental health training were collected from the public websites of each school. Results showed that most universities indicated at least some type of required mental health training (85.3%), which were either didactic or experiential in nature. Although this result appears encouraging, further examination reveals that this training was most often limited to only one 4-week psychology-related course and a 6-week psychiatry rotation. Overall, many universities indicated at least one required course (N = 95), and most universities reported a required psychiatry rotation (N = 135). Moreover, only 12.9% of the sample reported having at least both didactic and experiential training required. The implications of this are varied. First, PCPs often have only a short amount of time with their patients, reducing their ability to fully assess both medical and mental health. A lack of exposure to mental health needs may lead to missed opportunities for intervention and improvement in patient health. Second, it is important for mental health professionals to work closely with PCPs in primary healthcare settings in order to improve rates for detection and treatment of mental health problems. In addition to improved patient outcomes, having mental health professionals integrate within primary healthcare can serve to decrease the stigma associated with seeking mental health treatment, as well as reduce long-term healthcare costs. This can also increase access to care for those individuals who are unable to see a mental healthcare provider, especially in rural areas. Finally, overall health may improve in relation to better mental healthcare, since medical and mental health have been consistently shown to significantly influence one another.

Section A situates female clinical psychologists with children within the wider socio-historical context of working-mothers. Theoretical and empirical evidence of modernist and post-modernist approaches on the development of the working-mother identity is provided. This is followed by the literature on mothers employed in the caring profession and in psychology. The review highlights the need to further explore the relationship between social, professional and personal for female clinical psychologists with children within a socio-constructionist perspective. Section B investigates the social and professional challenges encountered by female clinical psychologists with children. Clinical psychology is an increasingly female profession, and many clinical psychologists are or will be mothers. Yet, proportionately fewer reach consultant positions (Band 8c and above) compared to their male colleagues. Existing historical professional structures, and traditional societal ideologies about motherhood and employment might be continuously negotiated within broader social positionings of working-mothers. This study aimed to explore the constructions of a sample of clinical psychologists who are mothers (CP-Ms) of their social identity. Foucauldian discourse analysis was used to explore the discourses available and drawn upon by CP-Ms to construct their professional and motherhood identity, and what were the subject positions they occupied. Ten qualified female clinical psychologists with pre-school children employed in a local NHS Trust were individually interviewed. CP-Ms’ identity was constructed as either a mother or a clinical psychologist, as being similar and different to other working-mothers. CP-Ms discoursed psychological knowledge and practices as potentially damaging their motherhood experience and their social relationships; they also discoursed motherhood and psychology as mutually enriching. Motherhood and professional identity were discoursed in opposition to one another, and yet the participants also constructed their CP-M identity as a continuous dynamic journey of reframing, of which they were agentic. This study suggests that the construction of CP-Ms’ identity is complex as it involves actively negotiating contradictions and overlaps between motherhood and clinical psychology. Further research is needed. Professional and clinical implications are discussed. Section C aims to elaborate on the research skills learnt during the research process, and on the abilities that need to be further developed. It continues with a critical appraisal of the study, before reflecting on possible clinical recommendations. Lastly, a potential new project is presented.

Bakgrund: Vårdrelaterade infektioner är vanligt förekommande över hela världen.Det innebär en hög kostnad, ökat lidande och medför fler vårddygn för patienten.God handhygien är den viktigaste påverkbara faktorn för att minska vårdrelateradeinfektioner. Det är sjuksköterskans ansvar att säkerställa rutiner för en godhandhygien. Syfte: Syftet är att beskriva vårdpersonalens följsamhet till riktlinjer för handhygien. Metod: En litteraturstudie där datainsamlingen valdes att göra från 10 olikakvantitativa studier. Genom analysen gjordes en sammanställning av de resultat somsvarade på vårt syfte och frågeställningar. Resultat: Resultatet redovisas i tre stapeldiagram med tillhörande text. Förstarubriken är följsamhet till riktlinjer för handhygien medel %. De två andradiagrammen är följsamhet till riktlinjer för handhygien före och efter patientkontaktsamt sjuksköterskor och läkares följsamhet till riktlinjer för handhygien. Huvudfynden i litteraturstudien visade att följsamhet till handhygien varierar i allastudier och att det är statistiskt säkerställt att fler vårdpersonal utför handhygienefter patientkontakt än före samt att fler sjuksköterskor än läkare följde riktlinjer förhandhygien. Konklusion: Det finns brister i följsamhet till handhygien. Kunskapen omsmittspridning och handhygien mellan olika arbetsmoment i den patientnära vårdenär otillräcklig. Ytterligare forskning behövs och alla länder måste sträva efter sammamål.