Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Magister Curationis - MCur / Background: Nurses, because of their close contact with these patients, are frequently victims of assault. The aim of the study is to explore and describe the lived experiences of nurses, who have been assaulted by patients at a Western Cape psychiatric hospital. Research Design: A qualitative approach, using a phenomenological research design was used to achieve the aim of the study. The target population was nurses, who are employed at the hospital under study. A purposive sampling, consisting of six nurses, was selected to participate in this study. Data were collected by means of unstructured interviews with nurses who met the inclusion criteria. Data saturation was reached after the sixth individual interview. The interviews were audio taped and transcribed, verbatim, and field notes were taken, as well. Collaizi’s method of data analysis was used to analyse the data and to identify themes and categories. The major themes that emerged were: Self-care incongruent to intrapersonal interest; Personal responses to trauma; Incongruence between patient behaviour and participant work experience; unprotected staff vulnerable to patient aggression; required and received supportive interventions. Ethical clearance was obtained from the Senate Ethics Committee at the University of the Western Cape. Permission to conduct the study was obtained from the Research Ethics Committee at a psychiatric hospital under study, as well as from the Department of Health, Western Cape. Participants were drawn from different units of the hospital. Findings: The findings revealed that nurses working at this psychiatric hospital frequently encounter assault and violence by patients, while providing care, to the extent that they view the workplace environment as unsafe and insecure. The way they experienced the assaults had some similarities; they all complained that they felt neglected by management after the assaults and that they experienced multiple bodily reactions to trauma. Recommendations: From the data gathered, it appeared that nurses were calling for support from those in authority, be it supervisors or hospital management. Some of the recommendations made by the researcher were: regular refresher courses on self-awareness training; counselling/debriefing; skills development workshops on management of aggression; and the feasibility of paying a special allowance to staff. Conclusion: The study revealed that lack of management support perpetuates the cycle of violence experienced, which, in most incidents, has a spill over effect in the personal lives of the nurses, who have been assaulted by patients. It is the researcher’s belief that nurses should be supported in this stressful environment.

This study served as a preliminary investigation of the effectiveness of an understudied complementary (to traditional treatment approaches) intervention for military related PTSD. Specifically, the utilization of a nonprofit organization’s intensive three-week training program and use of psychiatric service dogs (PSDs) for PTSD and associated symptom amelioration. The sample included two separate cohorts of military veterans (n = 7 and n = 5) with prior diagnoses of PTSD. Participants completed a battery of self-report measures assessing PTSD and related symptoms, depression, perception of social support, anger, and overall quality of life. Participants also completed an attention bias task that was utilized to objectively assess changes in attentional bias to threat. Participants completed the measures one month prior to the training (baseline), at arrival to the training site, at the end of each week of the training, and at one and six month follow-up. Results indicated that, for all participants, there was a statistically significant decrease in PTSD and depression symptoms. In addition, for most participants, these decreases were both clinically significant and reliable. Further, participants reported significant reductions in anger and improvement in perceived social support and quality of life. Data from the attentional bias task was inconclusive. Limitations of the study include a lack of control group and small sample size. Despite this, the findings of this study indicate that utilizing PSDs as a complementary treatment for PTSD could yield beneficial results in terms of symptom amelioration and improvement to overall quality of life for veterans suffering from PTSD.

Made available in DSpace on 2018-08-01T22:57:56Z (GMT). No. of bitstreams: 1 tese_6914_Laisa Barroso Ribeiro PPGBF Dissertacao de mestrado 21 08 2015 Orientadora Profa Dra Ana Paula Bittencourt.pdf: 1615838 bytes, checksum: 4ec46cda64c8ecf496eb91b48761a25c (MD5) Previous issue date: 2015-08-21 / A relação maternal perinatal tem fundamental importância no desenvolvimento de circuitos neurais saudáveis que permanecerão como herança mental ao longo da vida. Logo, eventos adversos nesse período tem potencial para desencadear psicopatologias na idade adulta, aumentando a vulnerabilidade a transtornos psiquiátricos e abuso de substâncias. Neste trabalho foi realizada a Separação Maternal (SM) em ratos Wistar machos, no intuito de mimetizar um evento estressor sustentado na infância de humanos. Em seguida, os animais foram submetidos ao protocolo de Enriquecimento Ambiental, uma estratégia não farmacológica empregada num período de plasticidade cerebral, como estratégia potencial para reverter os efeitos prejudiciais da SM. Na idade adulta, procederam-se os testes comportamentais, para aferição de depressão, ansiedade e abuso de álcool, e bioquímicos, como a dosagem de corticosterona plasmática, indicativo da reatividade do eixo hipotálamo-hipófise-adrenal (HHA) ao estresse agudo, e dosagem de dopamina e seus metabólitos em estruturas envolvidas em processo de gratificação cerebral via mesocorticolímbica (núcleo accumbens e córtex pré-frontal). A análise estatística foi realizada por meio do teste t de Student, análise de variância de uma via, duas vias, três vias ou medidas repetidas. Observamos que um protocolo de SM mais extenso tem maior impacto no desenvolvimento de comportamento depressivo na idade adulta. Não observamos hiperresponsividade do eixo HHA em animais separados em resposta a estresse agudo. O EA aumentou a preferência pelo consumo de sacarose e SM e EA concomitantemente aumentaram os comportamentos ativos no Teste do Nado Forçado, sugerindo potencial antidepressivo do EA. O EA parece ter potencial ansiolítico, ao reduzir a ansiedade aprendida aversiva no Teste de Odor de Predador, sem efeito significativo da SM nesses comportamentos. A SM aumenta a preferência pelo consumo de etanol e o EA foi capaz de prevenir esse efeito. No córtex pré-frontal a SM aumentou a quantidade de dopamina e o EA aumentou o turnover dopaminérgico, sugerindo recuperação até certo ponto da atividade dopaminérgica cortical. No núcleo accumbens, SM e EA concomitantemente reduziram os níveis de DOPAC, sem alteração no turnover dopaminérgico. SM e EA parecem não interferir nas memórias de curta e longa duração. Dessa forma, observamos por meio de alterações comportamentais e bioquímicas que eventos adversos perinatais aumentam a vulnerabilidade ao desenvolvimento de abuso de álcool e outros transtornos psiquiátricos na idade adulta; e o EA, empregado na fase de plasticidade neural, tem potencial para exercer efeito compensatório sobre os déficits gerados.

Masters in Public Administration - MPA / Absenteeism is a serious problem globally, and it entails a high cost for organizations. Shortage of nurses is a world-wide concern and absenteeism worsens the existing shortage in hospitals. In order for hospitals to run smoothly and render quality nursing care, regular attendance is required. The South African health institutions are faced with challenges of poor working conditions, low pay, as well as physical exhaustion from the workload. These challenges are seen as contributing to nurse absenteeism. The overall aim of this study was to describe factors that contribute towards absenteeism among nurses in an acute psychiatric hospital in the Western Cape Province of South Africa. The study was carried out in an acute psychiatric hospital in Cape Town. Only permanently employed nursing staff at Valkenberg Hospital and Community service nurses were considered for the study. This study was quantitative in nature and it used the descriptive survey design. A self-administered questionnaire was used as a tool for data collection. The sample size of this study consisted of 135 (67.5%) nurses. It was drawn from a hospital population of 200 nursing staff. A number of factors emerged as significantly contributing to nurse absenteeism. The results show that 69% of participants agree that they were absent as they are dissatisfied with pension funds, medical aid contributions and the criteria for issuing incentive bonuses. Moreover the same percentage of participants, 69% strongly felt that the amount of work was overwhelming due to the fact that the staff patient ratio is too high. About 51% of participants were not satisfied with their progression in their career of nursing. About 68% of participants were not satisfied with the sufficiency of equipment and 51 % were unhappy with working conditions. The results also show a significant rate of absence of female nurses and older nurses. Absenteeism has become a major challenge that cuts across many organisations and national borders. It is a global phenomenon. The study, in hint sight, recommends that the physical working conditions of the institution need to be revamped to accommodate employees’ basic needs. It further recommended that staff patient ratio be revised, as it places tremendous pressure on nurses in terms of excessive workload. A facility like pre-school also needs to be provided as the female nurses appear to be more absent from work due to their multi-task roles.

Abstract The genomic organization and mRNA expression of the human GNAL gene on chromosome 18p11.2, a region that has been associated with bipolar disorder and schizophrenia, was determined. The GNAL gene was shown to span over 80 kb and consist of twelve exons, and its structure was very similar to adenyl cyclase stimulating G protein GSα. The start site of transcription was revealed by 5'-RACE. Two polyadenylation signals were found, and 3'-RACE assay was used to verify the functional site. The GNAL gene was expressed as approximately 6 kb transcripts in various regions of the human brain, and no alternative splicing was detected. One informative CA-dinucleotide repeat of 11 alleles and 74% heterozygosity was found in intron 5, and two single nucleotide polymorphisms in introns 3 and 10 were detected by SSCP. During characterization of the GNAL gene, two previously unknown genes were found. A novel intronless gene C18orf2 coding for a functionally unknown protein was localized to intron 5 of the GNAL gene. By semiquatitative RT-PCR, C18orf2 mRNA was found to be moderately expressed in all tissues studied here. Another novel gene, metallophosphoesterase MPPE1, was found to reside adjacent to the 3'-end of the GNAL gene in a tail-to-tail orientation. The deduced amino acid sequence revealed a highly conserved metallophosphoesterase motif gDxH..(16-60)..GDxxdr..(13-34)..GNH[DE], which is typical for various phosphate hydrolyzing enzymes, especially serine/threonine protein phosphatases. The MPPE1 gene contained fourteen exons and spanned about 27 kb. MPPE1 was expressed as a single mRNA of 2.2 kb in various regions of the human brain but not in any other tissues. Four different alternatively spliced forms of MPPE1 were detected by RT-PCR, and each transcript was shown to partially overlap with the 3'-untranslated region of the GNAL gene.

D.Cur. / It was established during research that I have done for my master’s degree that therapists experience secondary traumatisation in a specific private psychiatric clinic when they listen to the trauma filled stories of their clients. This often led to the therapist’s personal and professional disintegration. The main purpose of this research was to describe, operationalise and evaluate a model for the advanced psychiatric nurse practitioner to facilitate the mental health of therapists who experience secondary traumatisation in a specific private psychiatric clinic in South Africa. I used a qualitative, descriptive, contextual and theory-generating research design to achieve the above purpose. The development of the model consisted of four steps. Step one consisted of concept analysis that included the identification, classification and defining of the central, essential and relational concepts in the model. During concept analysis, facilitation of wholeness was identified as the most relevant concept for the model instead of mental health. It was evident that personal disintegration became the specified concept and focussed aspect in terms of secondary traumatisation in this research project. Step two consisted of a description of how the identified and defined central concepts interrelate with each other as part of the model. During step three, the model to facilitate wholeness in therapists with personal disintegration due to secondary traumatisation in a specific private psychiatric clinic was described. The structure of the model was described in terms of its purpose, assumptions and context. Definitions of the central concepts, as well as the relationship statements between the central and essential concepts, were described. The structure of the model was also described in terms of a visual representation that included the dynamic and interactive narrative process of deconstruction, choosing of alternatives and celebration.

Magister Curationis - MCur / Background: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002.Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town.Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital serviceMethod/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire.The study made use of 120 participants between the ages of 18 and 60.Findings: Generally respondents were satisfied with the care provided in thispsychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to.Conclusions: General inpatient satisfaction in psychiatric hospital care was good.However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.

Magister Curationis - MCur / Background: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002. Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town. Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital services. Method/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire. The study made use of 120 participants between the ages of 18 and 60. Findings: Generally respondents were satisfied with the care provided in this psychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to. Conclusions: General inpatient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.