It is estimated that about 10 million children and adolescents worldwide, annually suffer from psychiatric disorders. They often require hospital treatment because they are not coping with their psychiatric condition at home or there is a lack of supervision. Suicide amongst adolescents who are experiencing a crisis is a bleak reality. In-patient treatment provides the necessary structure and supervision in order to secure a stable environment which is vital for treating adolescents. Treatment usually includes a therapeutic programme provided by members of the multi-professional team. Since there is at present no adolescent in-patient treatment facility in the Nelson Mandela Bay to provide psychiatric care to adolescents who are experiencing a mental problem, these patients are admitted to psychiatric hospitals which cater only for the needs of adult patients or they are referred to facilities in other provinces. The goals and objectives of this study are firstly, to explore and describe the perceptions of mental health professionals working in psychiatric hospitals regarding what should be included in a therapeutic programme for adolescents and secondly, to develop guidelines for treating adolescents that can be implemented in psychiatric hospitals in the Nelson Mandela Bay. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included various professionals who provide services at psychiatric hospitals in the Nelson Mandela Bay. Purposive sampling was utilized. Semi-structured interviews were conducted to collect information-rich data and field notes were kept. The interviews were transcribed and Tesch’s eight steps of data analysis were followed to create meaning from the data collected. Themes were identified and grouped together to form new categories. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. Literature was reviewed in order to identify research that was done previously regarding adolescent psychiatric in-patient programmes in order to bridge the gaps that were identified. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness which consists of the following four constructs, namely, credibility, transferability, dependability and confirmability. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as beneficence, justice and fidelity.

In recent years there have been several studies concerning themselves with such topics as mental patients' attitudes toward hospital personnel and mental patients' beliefs about mental illness. However, these studies are not without fault. They have been strictly empirical in approach, with no theoretical framework from which to predict and/or explain the results they have obtained. These studies also have failed to control for potentially important variables such as whether a patient, has had previous admissions to a mental hospital. The present study attempted to surmount these shortcomings. Drawing upon Heider's (1946) balance theory, it was predicted that if the patients' attitudes toward the staff changed in a positive direction (as a study by Reznikoff, et al. [I960] suggests is the case), those beliefs about mental illness held by the patients which were dissimilar to the staff's beliefs would converge toward those beliefs held by the staff. This study also controlled for the no prior admissions ---prior admissions variable, a variable Wolfensberger's (1956) study suggests may be important. The Semantic Differential was used to measure the patients' attitudes toward the staff while the Information Questionnaire (Nunnally, 1957, 1961) was used to measure their beliefs about mental illness. These two questionnaires were administered twice: the first time being no longer than four days after admission to the hospital; the second time being approximately three weeks after the first administration. The results of this study indicated that patients' attitudes toward the staff (aides in this particular study) do increase in a favorable direction, but this had no influence on the patients' beliefs about mental illness as had been predicted. The patients' beliefs about mental illness did not change toward the staffs' (aides) beliefs but rather remained the same over the two testings. Possible reasons for the failure of this study to support the prediction were discussed. Also, the validity of the Information Questionnaire was seriously questioned. / Arts, Faculty of / Psychology, Department of / Graduate

Although the effectiveness of assertive training has been investigated with a wide variety of clinical and non-clinical populations, few studies have investigated the effectiveness of these techniques with prison inmates. This study investigated the use of symbolic modeling and behaviour rehearsal to increase assertive skills and.decrease inappropriate aggressiveness with prison inmates. Thirty male inmates volunteered for a four week assertive training programme and were randomly assigned to a modeling, behaviour rehearsal, and a placebo control group. Ten other subjects were used as a test-retest control group. The modeling group received videotape-mediated modeling in which positive and negative assertions were demonstrated to 16 standardized situations. The behavioural rehearsal group received opportunities to shape and practice appropriate assertions to the same situations without the aid of viewing filmed models. The placebo control group viewed discussion films and the test-retest group received no treatment intervention. Self-reported measures, in-laboratory behavioural ratings, and in vivo behavioural assessments were used to assess changes in assertiveness, aggressiveness, and anxiety. Results indicated that inmates in the treatment groups significantly increased their verbal assertive skills (i.e., verbal content), but not their non-verbal skills (i.e., eye contact, latency, loudness). The efficacy of assertive training techniques in regard to their differential impact on verbal and non-verbal skills components and aggressiveness are discussed. On in vivo behavioural measures of assertiveness observed on the wards no differences resulted between treatments and controls. This indicated that verbal assertiveness learned in training did not generalize to other unfamiliar situations. Also the behavioural changes in the laboratory occurred without corresponding changes in self-reported assertiveness. The discrepancy between findings as measured by in-laboratory assessments and in vivo assessments is discussed in terms of generalization of skills environment receptivity to change, and other factors responsible for the differences. All the response components were affected by the particular type of situation presented. Assertiveness changed as a function of social-interpersonal context of positive feeling siutations, negative hostile situations, and situations simulated inside and outside the prison setting. These findings suggest that future investigations ought to develop methodologies for identifying the environmental stimuli which influence assertiveness in order to train clients in situations related to their assertive deficits. / Arts, Faculty of / Psychology, Department of / Graduate

M.A. (Clinical Psychology) / Please refer to full text to view abstract

The purpose of this study is to investigate the relationships between ordinal birth position, family size, and psychiatric diagnosis, in patients at a state-mental hospital.

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The purpose of this thesis is to provide a descriptive study of psychiatric and social variables related to aged first admissions to a private psychiatric hospital in the calendar years 1959 through 1963. The study also seeks to determine what, if any, relationship exists between background characteristics of the patients and their diagnoses. Finally, the diagnosis of the patient is compared with a series of patient outcome variables to determine the relationship, if any, between diagnosis and selected recovery variables. Due to the nature of the data used, the emphasis of the thesis is upon describing relationships rather than testing hypotheses.

Workforce shortages are a major concern of health care and the creation of a positive workplace is central to the attraction and retaining of employees where employees are motivated to be loyal towards their employer by a positive work experience rather than by financial rewards (Manion, 2009:XIII). This positive work experience can include the providing of workplace support that is tailored to the specific experiences and wishes of psychiatric nurses working at a private mental health care setting. Work demands encountered by psychiatric nurses can vary from personal stresses related to the interpersonal nature of working with the challenging behaviour of mental health care users, to environmental stresses related to an environment reflecting inadequate workplace support. Stuart and Laraia (2005:11) described the role of the psychiatric nurse in any mental health care setting as depending on certain factors in the organisation. This include the philosophy, goals, prevailing understanding of mental health, the needs of the mental health care users, number of available personnel, communication structure, understanding of their individual roles, available resources and the presence of effective nurse mentoring. As a professional psychiatric nurse, I identified the need for effective workplace support to psychiatric nurses working in a private mental health care setting by observing signs of burnout in psychiatric nurses and by listening to employees verbalising their need for workplace support. The purpose of the research was to conduct an Appreciative Inquiry in order to generate an in-depth understanding of the experiences and wishes of psychiatric nurses regarding workplace support in a private mental health care setting. The objectives of the research were to explore and describe the experiences of psychiatric nurses regarding workplace support, to explore and describe the wishes of psychiatric nurses regarding workplace support in a private mental health care setting and to propose recommendations regarding workplace support. Proposed recommendations will have reference to psychiatric nursing research, psychiatric nursing education, psychiatric nursing management and psychiatric nursing practice, in order to facilitate more effective means to provide workplace support and to facilitate the promotion of the mental health of psychiatric nurses. I decided to use an Appreciative Inquiry framework in order to explore the experiences and wishes of psychiatric nurses regarding workplace support. The importance of Appreciative Inquiry lies in the appreciation of the behaviour and the responses of individuals instead of focusing on their problems. Appreciative Inquiry identifies that which is positive in any system and connects to or builds on it in order to “heighten energy, vision and action for change” (Cooperrider, Whitney&Stavros, 2008:XV). The meta-theoretical perspective that guided this researcher was the Theory for Health Promotion in Nursing. The essential purpose of this theory is health promotion for an individual, group, family or community (University of Johannesburg, 2009:4). The individual is in interaction with the environment, which consists of an internal and external environment. The internal environment comprises the body, mind and spirit dimensions of the individual. The external environment comprises the physical, social and spiritual dimensions of the individual. The interactions of these dimensions in the environment of the individual influence the health status of the individual on a continuum (University of Johannesburg, 2009:5). The experiences and wishes regarding the providing of workplace support pertaining to the internal and external environments of the psychiatric nurse were examined in order to facilitate the promotion of the mental health of the psychiatric nurse. The theoretical and methodological perspective that guided this research was Appreciative Inquiry. Appreciative Inquiry uses a process known as the 4-D cycle, which is the process that is employed to facilitate change or to generate the power of Appreciative Inquiry (Whitney&Trosten-Bloom, 2003:6). For this research on workplace support, I employed the first two phases of Appreciative Inquiry, namely the discovery phase and the dream phase as part of the data collection. The discovery phase involves the appreciation or discovering of that which is positive, life giving or effective and the dream phase involves the imagining of new possibilities. As a unique paradigm, Appreciative Inquiry questions traditional approaches to problem solving by accepting organisational challenges using an affirmative approach. An affirmative approach includes an appreciation of the positive by focussing on successes, strengths and potential (Cooperrider, Whitney&Stavros, 2008:433). Appreciative Inquiry views organisations as an individual centre of immense imagination and possibilities, intended to function as solutions (Cooperrider, Whitney&Stavros, 2008:16-17). I used a qualitative design, which was exploratory, descriptive and contextual. I integrated an Appreciative Inquiry approach into this design. I used purposeful sampling, which Polit and Beck (2007:763) define as a sampling method where participants are selected based on who will be the most informative regarding the topic of the research, namely workplace support in this research. The data collection methods used was naïve sketches, small core group inquiries and individual interviews with members of nursing management. The small core group inquiries included written answers on the interview schedule from the one-on-one interviews, transcribed feedback from the discussion phase, the positive core map, the nominal group technique, field notes and reflective interviews. The small core group inquiries were structured around one-on-one interviews that participants conducted with each other in groups of two, using an interview schedule. During the data analysis phase, I used two different techniques in order to analyse the available data, namely the nominal group technique and open coding. I used a tree as symbol for workplace support at this mental health care setting. The roots of the tree symbolised the willingness of management to provide workplace support to their employees. The trunk of the tree symbolised the holistic approach to workplace support. The branches of the tree symbolised the identified themes. I represented the discovery phase categories as the green leaves of the tree. I represented the dream phase categories as pink buds. I proposed recommendations relating to psychiatric nursing research, psychiatric nursing education, psychiatric nursing management and psychiatric nursing practice. The aim of these recommendations was to facilitate more effective means of providing workplace support, from a holistic perspective, in order to facilitate the promotion of mental health of psychiatric nurses working at this mental health care setting. / AFRIKAANS : Tekorte in die arbeidsmag is ʼn bron van groot besorgdheid vir gesondheidsorg, en die skep van ʼn positiewe werkplek is sentraal tot die aantrekking en behoud van werknemers in gevalle waar werknemers deur middel van ʼn positiewe werkservaring, eerder as ʼn finansiële vergoeding, gemotiveer word om lojaal teenoor hul werkgewer te wees (Manion, 2009:XIII). Hierdie positiewe werkservaring kan die verskaffing van werkplekondersteuning, wat op die spesifieke ervarings en wense van psigiatriese verpleegspraktisyns wat in ʼn privaat geestesgesondheidsomgewing werk, geskoei is, insluit. Werkseise wat psigiatriese verpleegspraktisyns teëkom kan wissel van persoonlike stres verwant aan die interpersoonlike aard van om met die uitdagende gedrag van geestesgesondheidsgebruikers te werk, tot omgewingstres verwant aan ʼn omgewing wat ontoereikende werkplekondersteuning bied. Stuart en Laraia (2005:11) beskryf die rol van ʼn psigiatriese verpleegspraktisyn in enige geestesgesondheidsomgewing as afhanklik van sekere faktore in die organisasie. Dit sluit die filosofie, doelwitte, heersende begrip van geestesgesondheid, die behoeftes van die geestesgesondheidsgebruikers, die aantal beskikbare personeel, die kommunikasiestruktuur, begrip vir die individuele rolle, beskikbare hulpbronne en die teenwoordigheid van effektiewe verpleegsbegeleiding in. As ʼn professionele psigiatriese verpleegspraktisyn het ek die behoefte aan effektiewe werkplekondersteuning vir psigiatriese verpleegspraktisyns wat in ʼn privaat geestesgesondheidsomgewing werk, waargeneem toe ek na tekens van uitbranding by die psigiatriese verpleegspraktisyns opgelet het, en na die werknemers geluister het wanneer hulle hul behoefte aan werkplekondersteuning verwoord het. Die doel van hierdie studie was om ʼn Waarderende Ondersoek te loods ten einde ʼn indiepte begrip van die ondervindings en wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning in ʼn privaat geestesgesondheidsomgewing te bewerkstellig. Die doelstellings van die studie was om die ondervindings van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning te beskryf ten einde die wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning in ʼn privaat geestesgesondheidsomgewing te ondersoek en te beskryf en om aanbevelings te maak met betrekking tot werkplekondersteuning. Voorgestelde aanbevelings verwys na psigiatriese verpleegsnavorsing, psigiatriese verpleegsopleiding, psigiatriese verpleegs-bestuur en psigiatriese verpleegspraktyk, om meer effektiewe metodes te fasiliteer ten einde werkplekondersteuning te voorsien en die geestesgesondheid van psigiatriese verpleegspraktisyns te bevorder. Ek het besluit om ʼn Waarderende Ondersoekraamwerk te gebruik te einde die ervarings en wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning te ondersoek. Die belangrikheid van ʼn Waarderende Ondersoek lê in die waardering van die gedrag en terugvoer van individue, in plaas van om op hul probleme te fokus. Waarderende Ondersoek identifiseer dit wat positief is in enige stelsel en sluit daarby aan of bou daarop om energie, visie en aksie vir verandering te verhoog (Cooperrider, Whitney&Stavros, 2008:XV). Die meta-teoretiese perspektief wat die navorser gelei het, was die Teorie vir Gesondheidsbevordering in Verpleging. Die hoofdoel van hierdie teorie is die gesondheidsbevordering van ʼn individu, groep, gesin of gemeenskap (Universiteit van Johannesburg, 2009:4). Die individu is in interaksie met die omgewing, wat uit ʼn interne en eksterne omgewing bestaan. Die interne omgewing sluit die liggaamlike, verstandelike en geestelike dimensies van die individu in. Die eksterne omgewing sluit die fisiese, sosiale en geestelike dimensies van die individu in. Die interaksies van hierdie dimensies in ʼn individu se omgewing beïnvloed die gesondheidstoestand van die individu op ʼn kontinuum (Universiteit van Johannesburg, 2009:5). Die ervarings en wense met betrekking tot die voorsiening van werkplekondersteuning wat met die interne en eksterne omgewings van die psigiatriese verpleegpraktisyn verband hou, is ondersoek ten einde die bevordering van die geestesgesondheid van die psigiatriese verpleegpraktisyn te fasiliteer. Die teoretiese en metodologiese perspektief wat hierdie studie gelei het, was Waarderende Ondersoek. Waarderende Ondersoek gebruik ʼn proses wat as die 4-D siklus bekend staan. Hierdie proses word gebruik om verandering te fasiliteer of om die krag van Waarderende Ondersoek te verseker (Whitney&Trosten-Bloom, 2003:6). Vir hierdie navorsing oor werkplekondersteuning het ek die eerste twee fases van Waarderende Ondersoek, naamlik die ontdekkingsfase en die droomfase, as deel van dataversameling gebruik. Die ontdekkingsfase sluit die waardering of ontdekking van wat positief, lewegewend of effektief is, in, en die droomfase sluit die verbeelding van nuwe moontlikhede in. As ʼn unieke paradigma, bevraagteken Waarderende Ondersoek tradisionele benaderings tot probleemoplossing deur organisatoriese uitdagings met ʼn regstellende ingesteldheid te benader. ʼn Regstellende benadering sluit die waardering van die positiewe in, deur op suksesse, sterkpunte en potensiaal te fokus (Cooperrider, Whitney&Stavros, 2008:433). Waarderende Ondersoek sien organisasies as ʼn individuele sentrum met onmeetlike verbeelding en moontlikhede, met die voorneme om met oplossings vorendag te kom (Cooperrider, Whitney&Stavros, 2008:16-17). Ek het ʼn kwalitatiewe ontwerp, wat verduidelikend, beskrywend en kontekstueel van aard was, gebruik. Ek het ʼn Waarderende Ondersoekbenadering met hierdie ontwerp geïntegreer. Ek het doelbewuste steekproefneming, wat Polit en Beck (2007:763) definieer as ʼn steekproefnemingsmetode waar deelnemers gekies word op grond van wie die meeste inligting oor die tema van die navorsing sal verskaf, wat in hierdie navorsing werkplekondersteuning is. Die dataversamelingsmetodes wat ek gebruik het, was naïewe sketse, klein kerngroep-ondersoeke en individuele onderhoude met lede van die verpleegsbestuur. Die klein kerngroep-ondersoeke het geskrewe antwoorde op die onderhoudskedule van die een-tot-een onderhoude, getranskribeerde terugvoer van die besprekingsfase, die positiewe kernkaart, die nominale groeptegniek, veldnotas en reflektiewe onderhoude ingesluit. Die klein kerngroep-ondersoeke was gegrond op een-toteen onderhoude wat die deelnemers met mekaar, in groepe van twee, gevoer het, deur van ʼn onderhoudskedule gebruik te maak. Tydens die dataontledingsfase het ek twee verskillende tegnieke gebruik om die beskikbare data te ontleed, naamlik die nominale groeptegniek en oopkodering. Ek het ʼn boom as simbool vir werkplekondersteuning in hierdie geestesgesondheidsomgewing gebruik. Die wortels van die boom het die bestuur se vrywilligheid om werkplekondersteuning aan hul werknemers te bied, gesimboliseer. Die stam van die boom het die holistiese benadering tot werkplekondersteuning gesimboliseer. Die takke van die boom het die geïdentifiseerde temas gesimboliseer. Die kategorieë van die ontdekkingsfase is deur die groen blare voorgestel, en die kategorieë van die droomfase deur pienk botsels. Ek het aanbevelings gemaak met betrekking tot die psigiatriese verpleegsnavorsing, psigiatriese verpleegsopleiding, psigiatriese verpleegsbestuur en psigiatriese verpleegspraktyk. Die doel van hierdie aanbevelings is om meer effektiewe metodes vir die verskaffing van werkplekondersteuning, uit ʼn holistiese perspektief, te fasiliteer, ten einde die geestesgesondheidsbevordering van psigiatriese verpleegpraktisyns wat in hierdie geestesgesondheidsomgewing werk, te fasiliteer. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted