Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place. Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea.  Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees. Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.

Department of Advanced Nursing Science / MCur

MCur / Department of Advanced Nursing Science

MCur / Department of Advanced Nursing Science / Background: In South Africa the Mental Health Care Act No. 17 of 2002 direct district hospitals to render 72-hour assessment of the MHCU’s. In Vhembe district 72- hour assessment is implemented in public general hospital. Purpose: The study determined the experiences of family members regarding 72-hour assessment admission of MHCU’s at selected hospital in Vhembe District. Methodology: The research design was qualitative, exploratory, descriptive and contextual in nature. The study population consisted of the family members of the MHCU’s admitted for 72-hour assessment. Purposive sampling was used to select 10 family members. This study used in-depth individual interviews to collect data until data saturation was reached and analysed using Tesch’s steps. Ethical consideration and measures to ensure trustworthiness were given attention to throughout the study. Results: Three themes emerged from analysed data which is negative experiences of family’s members, family member’s experience on coping mechanism and structural constraints. Recommendations: This study recommends further research study on the development of a model to support the family members in their caregiving role The study recommends further research study on the experiences of the health care professional regarding 72-hour assessment of a MHCU’s / NRF

The subject of this diploma thesis is the involvement of users of psychiatric care in the process of planning and realization of psychiatric care reform at the macro level of policy making. The aim of the research is to describe and understand this involvement. In the research are describer possibilities of participation in the phases of involvement, its form, purpose, formal regulation of opportunities, expectations of respondents, perceived power and barriers in involvement. The data was collected during interviews with key actors and studies of relevant documents. The results relate to the theoretical concepts of coproduction, patient-oriented care, strategic and human rights documents (the Convention on the Human Rights of People with Disabilities). The element of power is described through the typology of Sherry Arnstein's participation ladder. Evidence of interviews indicates elements of tokenism and disadvantages. There is a low (one-person) representation of users in reform bodies, lack of time for discussion in consultative bodies, lack of information and lack of capacity (people, time, resources) for greater development of patient organizations. Respondents have identified barriers as the socio-economic situation, lack of capacity for macro-level involvement, mental health constraints or...

En cette ère d’hypertravail (Charest et Rhéaume, 2008) menant à une plus grande charge de travail, les travailleurs souffrent. Malgré cela, peu d’études ont abordé la question de la prise en charge de la santé mentale au travail dans une perspective syndicale. Nous avons ainsi approfondi nos connaissances sur les initiatives syndicales de prise en charge des risques psychosociaux (RPS) au Québec. Ce mémoire cherche donc à répondre à la question de recherche : comment se façonnent les capacités d’agir d’un syndicat local en matière de prise en charge des risques psychosociaux au travail? Pour y répondre, nous avons utilisé plusieurs écrits portant sur les ressources de pouvoir à la disposition des syndicats, les cadres identitaires et les ressources normatives pouvant venir influencer les capacités d’agir des syndicats en matière de prise en charge des risques psychosociaux. En plus de ces écrits, nous avons aussi porté une attention sur l’influence que peut exercer la collaboration patronale-syndicale sur le développement des capacités d’agir des syndicats. Nos données de recherche ont été amassées grâce à une étude de cas, où nous avons fait 8 entretiens semi-dirigés auprès d’un syndicat local affilié à la FTQ dans le secteur de la métallurgie au Québec. Nos résultats démontrent que certaines ressources et certains éléments des cadres identitaires exercent une influence positive sur les capacités d’agir du syndicat en matière de prise en charge des RPS : le réseautage externe et les intérêts partagés par le groupe de référence et le groupe d’opposition. Toutefois, les ressources et les éléments des cadres identitaires exercent une influence négative sur les capacités d’agir du syndicat en matière de prise en charge des RPS : nous pensons au projet syndical et aux ressources organisationnelles. / In this era of hyper-work (Charest and Rhéaume, 2008) leading to a greater workload and a strong subjective investment at work, workers are suffering. Despite this, few studies have addressed the issue of managing mental health in the workplace from a trade union perspective. We have thus deepened our knowledge of union initiatives for the management of psychosocial risks (PSR) in Quebec. This thesis therefore seeks to answer the research question: how are the capacities of a local union to act in terms of taking charge of psychosocial risks at work? To answer this, we used several writings on the power resources available to unions, identity frameworks and normative resources that can influence the development of unions' capacities to act in terms of taking charge of psychosocial risks. In addition to these writings, we also paid attention to the influence that labour-management collaboration can exert on the development of union capacities to act. Our research data was gathered through a case study, where we conducted 8 semi-structured interviews with a local union affiliated with the FTQ in the metallurgy sector in Quebec. Our results show that certain resources and certain elements of identity frameworks have a positive influence on the union's capacities to act in terms of taking charge of PSR: external networking and the interests shared by the reference group and the group of opposition. However, certain resources and elements of identity frameworks have a negative influence on the union’s capacity to act in terms of taking charge of RPS: we are thinking of the union project and organizational resources.

No description available.

Bakgrund: Nationellt eftersträvas en digital omställning där digital och fysisk vård integreras inom hälso- och sjukvården. Incitament för denna omställning är att ge invånare ökad tillgänglighet till vård men också att nå en ökad delaktighet för invånare. Den digitala omställningen av vården och därmed integrering av digitala vårdkontakter är inom regionalt driven psykiatri ännu i sin linda. Detta trots växande evidens, framsteg i utveckling och tillgång till digitala verktyg, en pandemi som forcerat barriärer och ökad samhällelig acceptans för vård på distans. En förutsättning för att digitala vårdtjänster integreras som en legitim del av vård och behandling vid psykisk ohälsa är att vårdpersonal integrerar digitala arbetssätt och vårdkontakter i yrkesvardagen.  Idag är lite känt om hur vårdpersonal inom specialiserad öppenvårdspsykiatri i Sverige uppfattar en sådan omställning.   Syfte: Studiens huvudsyfte är att undersöka möjligheter och hinder som vårdpersonal inom regionalt driven öppenvårdspsykiatri upplever vid omställning där patienter erbjuds kombination av fysisk och digital vård.  Metod: Ett webbaserat frågeformulär med öppna och slutna frågor utformades. Insamlade data analyserades med kvalitativ innehållsanalys utifrån en deduktiv ansats utifrån Theoretical Domains Framework (TDF). Deltagare i studien var vårdpersonal verksamma i regionalt driven psykiatrisk öppenvård för vuxna i en region i Södra Sverige. Resultat: Baserat på TDF ramverket identifierades områden som påverkar vårdpersonalen genom att utgöra möjligheter eller hinder för att använda digitala vårdformer som arbetssätt.  Resultatets höga överensstämmelse med tidigare forskning antyder att identifierade TDF- domäner kan användas för att stärka acceptansen och implementeringen av digitala vårdformer inom ramen för psykiatrisk öppenvård. / Background:  In Sweden, a digital transition is sought where digital and physical care, Digi-physical healthcare, are integrated into public health care. A digital transition is one approach to meet the increasing need for health services that significantly challenges the health system but also aims to achieve increased patient participation. The digital transformation of care and the integration of e-mental health is still in its infancy in public psychiatry. This is despite growing evidence, progress in development, and access to digital tools, a pandemic that has pushed through barriers and increased acceptance of Digi-physical healthcare. A prerequisite for the integration of Digi-physical healthcare as a routine in public psychiatry depends on the acceptance of health care professionals. Aim: This study aims to investigate barriers and facilitators, as perceived by health care professionals, for implementing a combination of physical and digital care in Swedish public psychiatry.   Methods: Participants were health care professionals active in public outpatient psychiatry in a region in Southern Sweden. A web-based questionnaire with open and closed questions was designed. Collected data was analyzed with qualitative content analysis based on a deductive approach using the Theoretical Domains Framework (TDF). Results: Based on the TDF framework, barriers and enablers that influence mental health care professionals to apply the distance format as a way of working were identified. The result`s high agreement with previous research, suggests that identified TDF domains can be used to strengthen the acceptance and implementation of Digi-physical healthcare within psychiatric outpatient care.

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs. / Health Science / M.A.(Nursing Science)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs. / Health Science / M.A.(Nursing Science)