The purpose of this qualitative, explorative, descriptive and contextual study was to explore and describe nurses’ experiences of hostile behaviour from mentally ill patients in the psychiatric ward of a general hospital and to propose recommendations to the hospital management to support nurses who experienced hostile behaviour from mentally ill patients. Purposive sampling was used to identify the twelve nurses who participated in this study. Data were collected through in-depth face-to-face interviews, drawings and field notes. The data were analysed using Tesch’s descriptive method of open coding and the findings revealed that nurses experienced verbal abuse, physical abuse and sexual harassment from mentally ill patients, and had varied negative and positive responses to these forms of hostile behaviour. Main challenges were identified and recommendations were made to the hospital management to support nurses who experience hostile behaviour from mentally ill patients. / Health Studies / MA (Public Health)

Submitted in full compliance with the requirements for the Masters Degree of Technology: Nursing Department of Postgraduate Nursing Studies, Durban Institute of Technology, 2004. / The aim of this quasi-experimental study was to compare the effectiveness of a Nurse-facilitated cognitive group intervention, a Volunteer-led support group intervention and a standard treatment Control group on mild to moderately depressed Indian women at an urban community psychiatric clinic in KwaZulu-Natal in terms of their levels of depression and self-esteem over a three-month period. Since antidepressants alone are ineffective in the treatment of depression, the study evaluated group interventions as adjunctive treatments. The first intervention involved 15 group sessions based on Gordon’s teachings (1988a and 1988b), whilst the second intervention consisted of 15 craft-making group sessions. A purposive sample of 45 depressed women was selected and randomly allocated to the three groups. Sample selection criteria included a Beck Depression Inventory score between 9 and 29, being aged between 25 and 65 years and using antidepressant medication. For ethical reasons, all participants continued with their “standard” antidepressant treatment throughout the study. The Personal Profile Questionnaire (PPQ), the Beck Depression Inventory Scale (BDI) 1978, the Rosenberg Self-Esteem Scale (RSE) 1965, the Life-Experience Survey (LES) 1977 questionnaire and a question on exercise were used to assess the effectiveness of the group interventions. Pre-test (prior to the introduction of the intervention) and two sequential Post-test scoring (after 6 and 12 weeks of interventions) were undertaken using the above-named instruments. The Kruskal Willis and Friedman’s test were used to detect changes in levels of depression and self-esteem between and within the three groups respectively, at the p = 0.05 levels of significance. The intergroup comparison showed statistically significant improvements in the BDI score of Experimental groups 1 and 2, with p = 0.00. There were no changes in the Control group. The intra-group comparison showed statistical significant improvements during the study within the intervention groups (p = 0.00 in both cases) but not in the Control group. No statistically significant change in the RSE amongst or within the three group was detected. The study has shown that group interventions as an adjunct to antidepressant treatment are beneficial as rehabilitation programmes for depressed women. Furthermore, volunteers and psychiatric nurses with training in using group interventions may be useful in assisting depressed patients to enhance their quality of life. / Lundbeck Pharmaceutical Company

Bakgrund: I Sverige beräknas 14-20% av befolkningen lida av psykisk ohälsa. Egenvård är handlingar som utförs i syfte att upprätthålla hälsa och är central inom den psykiatriska omvårdnaden. Sjuksköterskor möter personer med psykisk ohälsa i olika vårdsituationer och därför krävs kompetens om hur egenvård bör tillämpas i den psykiatriska omvårdnaden. Syfte: Att beskriva sjuksköterskors erfarenheter av hur egenvård tillämpas inom psykiatrisk omvårdnad. Metod: Kvalitativ intervjumetod med induktiv ansats tillämpades. Studien genomfördes inom öppen- och slutenvårdspsykiatrin i en mellanstor svensk kommun. Materialet bestående av nio intervjuer transkriberades och analyserades därefter med hjälp av konventionell innehållsanalys. Resultat: Sjuksköterskorna arbetade utifrån ett professionellt förhållningssätt i syfte att utbilda patienten och individanpassa vården. De beskrev att egenvård som begrepp sällan användes men att de tillskrev många omvårdnadshandlingar till just egenvård. Sjuksköterskorna beskrev att insikt, eget ansvar, motivation och delaktighet var förmågor som var avgörande hos patienten för en fungerande egenvård. Sjuksköterskorna erfor dock att en allt för stor tilltro till medicineringen och bristande kompetens hos vårdgivarna bidrog till att patienternas egenvård försummades då problem ofta löstes kortsiktigt och patienterna blev kvarvarande inom psykiatrin. Konklusion: Bland de intervjuade sjuksköterskornas var den generella uppfattningen att egenvårdsfilosofin inte har anammats inom den psykiatriska omvårdnaden, vilket resulterar i att patienterna blir kvar inom den psykiatriska vården under en obefogat lång tid genom att patienternas sjukdomsförlopp förlängs. / Background: In Sweden, 14-20 percent of the population has reduced psychiatric health. Self-care is actions done to maintain health and is crucial in psychiatric nursing care. Nurses meet people with reduced psychiatric health in care situations and therefore knowledge about how self-care should be used in the care of the psychiatric patient is important. Aim: The aim of this study was to describe nurses’ experience of how self-care is applied in psychiatric nursing care. Method: A qualitative interview study was conducted in out- and incare psychiatric care in a middle-size Swedish municipality. Nine interviews was transcribed and thereafter analyzed with a conventional content analysis. Result: The nurses was found to work from a professional approach in order to educate and individualize care. They described that the concept of self-care was rarely used but that they ascribed many actions of nursing care to self-care. The nurses described that insight, responsibility, motivation and participation were the determinant abilities of the patient for a functional self-care. Yet, nurses believed that a greater faith for the medication and lack of competence of the care givers contributed to neglection of the patients’ self-care when problems often were short-term solved and the patients remained in psychiatric care. Conclusion: In the group of interviewed nurses, the general opinion was that the concept of self-care not has been embraced in psychiatric nursing care. According to the nurses, it results in patients remaning in psychiatric care during an unjustified long time and that the course of illness becomes extended.

Non-compliance to treatment remains one of the greatest challenges in mental health care services, and knowledge about how to improve this is still a problem. The aim of this study is to critically synthesize the best available evidence regarding interventions to promote psychiatric patients’ compliance to mental health treatment. This study aims to provide the clinical practitioner with accessible information on interventions to promote psychiatric patients’ compliance to mental health treatment. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What is the current evidence on interventions to promote psychiatric patients’ compliance to mental health treatment? Selected electronic databases that were accessible were thoroughly searched: SA-Nexus (NRF), ProQuest, EBSCOhost Platform, ScienceDirect, Web of Knowledge, Cochrane Library, Sabinet and Google Advanced Scholar were searched for primary studies that were published from 2001 to 2011. Primary studies in any language with an abstract in English were included in the search results. The following key words were used in the search: intervention, mental health treatment, psychiatric treatment, compliance, adherence, psychiatric patients, mental health care user and combinations thereof. Pre-determined inclusion and exclusion criteria were applied during the selection of studies. Sixteen studies (n = 16) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP), the (JHNEBP) John Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool and the American Dietetic Association’s (ADA) Evidence Analysis manual. Finally only fourteen studies (n = 14) were identified as evidence that answers the literature review question appropriately. Evidence extraction, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in ADA’s manual (ADA, 2008:62). The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, education and research. Study findings indicated several interventions that can improve patients’ compliance in mental health treatment. Adherence therapy and motivational interviewing techniques during in-hospital stay improved the compliance of psychiatric patients. The use of Meds-help Pharmacy-based Intervention and Treatment Adherence Therapy Program for all Healthcare Professionals improved compliance to treatment for severely mentally ill. A Treatment Initiation and Participation Program and the use of Management Flow Sheet Interventions for Depressed Patients in Out-Patient Settings improved overall compliance of depressed patients in out-patient settings. Community mental health nurses trained in Medication Management improved psychiatric patients’ compliance to treatment at the community health care centres. Antipsychotic medication combined with therapeutic antipsychotic psycho-social interventions improved compliance of treatment for early-staged schizophrenia patients in out-patient settings. The use of Risperidone injections during the provision of home care and the long-acting injectable antipsychotic and atypical antipsychotic treatment used for schizophrenic patients served to improve compliance of mental health treatment in out-patient settings for schizophrenic patients. It is thus recommended that nurses should be exposed to clinical training regarding treatment compliance interventions of mental health care users during formal nursing education to enhance the mental health care practice and stimulate more innovative research on treatment compliance on the clinical field. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012

Ward environment as assessed by the Ward Atmosphere Scale was the focus of this exploratory study. The Ward Atmosphere scores of 110 patients hospitalized on two units for acute psychiatric care in a state hospital were analyzed for determining differences along the dimensions of population factors, sex and program change. Significant differences in attitude were obtained on certain of the ten scales for each of the three comparisons. The premise of ward atmosphere being a global entity as implied in the literature was not upheld in this population. Sex differences were noted and introduction of an individualized patient management program evoked significant changes in opinions concerning ward atmosphere. A number of interpretations for these results were offered and implication for future research was suggested.

Children and adolescent psychiatric inpatients (n = 25) versus staff (n = 35) milieu perceptions were measured with the Ward Atmosphere Scale (WAS) Form K (Kids). The perceptions were compared with previous data collected in 1981, 1982, and 1984 on the same unit. The 1993 staff and patients continued to perceive the unit as a therapeutic environment despite recent restrictions on length of stay due to health care reform. The views of the staff and patients were found to be divergent but less so than in previous years. Additionally, the more seriously ill a patient was determined to be, the more negatively he or she perceived the environment. Differences in perceptions between day shift versus night shift and administrative versus non-administrative staff were also found and discussed. Staff perceptions versus their ideal conceptions were also investigated and compared with those of the 1984 staff. The 1994 staff was found to more closely approximate their ideals than the 1984 staff.

Syftet med studien var att undersöka vilka faktorer i psykiatrisk rehabiliteringsteori som var de viktigaste stödjande och hindrande faktorerna för att deltagare i arbetslivsinriktad rehabilitering skulle kunna slutföra gymnasial/eftergymnasial utbildning och få ett arbete på dagens arbetsmarknad. Deltagarna i denna studie kom från fyra verksamheter inom Supported Education (SEd) i Sverige. Faktorerna för både stödjande och hindrande faktorer ville jag få fram i prioritetsordning, eftersom jag från tidigare forskning upplevde det svårt att veta vad som först ska prioriteras i arbetet med rehabilitering genom utbildning och arbete/anställning. Detta för att skapa en djupare förståelse för vad som är viktigt för personer med psykiska funktionshinder/ohälsa för att påbörja och slutföra utbildning, men också för att se om tjänsten SEd har potential att användas inom socialt arbete i form av arbetslivsinriktad rehabilitering och återhämtningsinriktat stöd för psykisk ohälsa och psykiska funktionshinder. För att besvara detta använde jag en enkät med tio kvantitativa slutna frågor och sju kvalitativa öppna frågor.      SEd är ett stödprogram inom arbetslivsinriktad rehabilitering för att välja, påbörja och slutföra utbildning på gymnasial och eftergymnasial nivå främst för personer med psykiska funktionshinder/psykisk ohälsa. Diskussioner pågår om att andra målgrupper utan psykiska funktionshinder/psykisk ohälsa ska kunna få detta stöd för att slutföra utbildningar.      Från resultatet av studien fick jag fram ett antal teman för vad som stödjer och hindrar slutförandet av utbildning. Resultatet visade att deltagarna generellt är nöjda med stödet de får från SEd. Mest framträdde personalens genuina engagemang, förmåga till empati och ett respektfullt bemötande som de avgörande faktorerna för att deltagarna skulle påbörja och slutföra utbildning. Andra faktorer som stödde deltagarna var att de fick stöd att slutföra studieuppgifter, att stödet inte var tidsbegränsat, att deltagarna hade regelbundna enskilda stödsamtal med personal, att de upplevde gemenskap och tillhörighet i SEd och att studie- och yrkesvägledning genomfördes som ledde till en individuell handlingsplan som följdes upp kontinuerligt.        Hindrande faktorer för deltagarna med SEd var att lokalerna var för små och studiecoacherna var för få. Generella hinder för deltagarna att slutföra utbildning var psykisk ohälsa (till exempel ångest, fobi, depression), svårigheter med studieekonomin, svårigheter med socialt samspel, svårigheter med koncentration, brist på studieteknik och svårigheter att slutföra uppgifter, ADHD, ADD, dyslexi, missbruk, svårigheter med att orka med ett högt studietempo och brist på stöd med att slutföra uppgifter. Detta resultat analyserade jag med hjälp av psykiatrisk rehabiliteringsteori. Jag förde sedan en diskussion där jag lyfte fram de utmaningar och möjligheter som vi kan se i framtiden för SEd. / The purpose of this study was to examine which factors in the psychiatric rehabilitation theory that were the most important supporting and hindering factors for getting participants in Vocational Rehabilitation to complete secondary/postsecondary education and get a job in todays labour market. The participants in this study came from four Supported Education (SEd-) projects in Sweden. I wanted to get forth the factors in order of priority since I found it difficult to find which factors to prioritize first in the work of rehabilitation through education and employment. I did this to get a deeper understanding of what is most important for persons with psychiatric disabilities/mental illness to be able to complete secondary/postsecondary education, but I also did it to investigate if the service of SEd has the potential of being used in social work in the shape of vocational rehabilitation and recoveryoriented support for mental illness and psychiatric disabilities. To be able to answer those questions I used a questionnaire with ten quantitative closed questions and seven qualitative open questions..      Supported Education (SEd) is a supportprogram aimed at supporting persons mainly with psychiatric disabilities/mental illness to choose, start and complete education on secondary and postsecondary level. There are ongoing discussions about whether other target groups without psychiatric disabilites/ mental illness could get this support to complete education.       From the results of the study I found a number of themes for what supported or hindered the participants in completing their education. The results showed that the participants generally were very satisfied with the support they got from the staff in SEd. Most of all it was the staffs genuine engagement, empathy and a respectful treatment that stood forth as the crucial factors that affected the participants to complete their education. Other factors that also supported the participants to complete their education is that they got support with completing their study tasks, there were no time limit for the support, the recurrent individual counseling sessions with staff, the experience of fellowship and belonging and educational and vocational guidance that supported the participants in forming an individual action plan which was followed up continuosly.       Hindering factors with SEd for the participants were that the localities were too small and that the study coaches were too few. Hindering factors in completing education in general was mental illness (e.g. anxiety, phobia and depression), difficulties with economy, difficulties in socialising with people, difficulties with concentration, lack of a technique for studying and difficulties with completing tasks, ADHD,ADD, dyslexia, addiction, problems to adjust to a high tempo in the education and lack of support with completing tasks. I analyzed these results by using the psychiatric rehabilitation theory. I then discussed the challenges and possibilities that we can see in the future with the SEd-method.

The purpose of this qualitative, explorative, descriptive and contextual study was to explore and describe nurses’ experiences of hostile behaviour from mentally ill patients in the psychiatric ward of a general hospital and to propose recommendations to the hospital management to support nurses who experienced hostile behaviour from mentally ill patients. Purposive sampling was used to identify the twelve nurses who participated in this study. Data were collected through in-depth face-to-face interviews, drawings and field notes. The data were analysed using Tesch’s descriptive method of open coding and the findings revealed that nurses experienced verbal abuse, physical abuse and sexual harassment from mentally ill patients, and had varied negative and positive responses to these forms of hostile behaviour. Main challenges were identified and recommendations were made to the hospital management to support nurses who experience hostile behaviour from mentally ill patients. / Health Studies / M. A. (Public Health)

Este trabalho é resultado de uma pesquisa do tipo estudo de caso, realizada em um macro-hospital público psiquiátrico de uma cidade do interior do Estado da Bahia. Enfoca o desenvolvimento das atividades dos enfermeiros no cotidiano institucional, suas formas de lidarem com as situações e as relações sociais estabelecidas com os demais profissionais de saúde que trabalham no hospital. Como docente da disciplina Enfermagem Psiquiátrica, tenho relação direta com o local, acompanhando estágio de estudantes de enfermagem, haja vista o convênio firmado entre a Secretaria de Saúde do Estado e a Universidade Estadual de Feira de Santana, a qual pertenço. Procedi a um recorte do campo, delimitando o espaço de um Pavilhão de internamento masculino. Como estratégia de levantamento dos dados utilizei a observação participante, entrevista semi-estruturada com os enfermeiros e demais membros que com ele convivem no dia-a-dia de trabalho, além de alguns documentos importantes na contextualização do trabalho desse profissional. Procedi a apresentação das atividades dos enfermeiros, estabelecendo a trama entre eles e deles com os demais profissionais da saúde. Observei uma grande concentração de suas tarefas em torno dos fazeres burocráticos, além de ver evidenciada a figura do paciente como intercorrências a serem resolvidas, denotando a visão que têm do doente mental. Na convivência com os outros profissionais, vêm-se como centro, apesar de essa visão nem sempre ser compartilhada por esses. Pelos dirigentes, o enfermeiro é visto como o grande contornador de situações, o que o coloca em uma posição politicamente conveniente na manutenção dos interesses majoritários. Nesse hospital, o profissional enfermeiro ocupa diversas funções hierarquicamente estratégicas junto à Diretoria, com a qual mantém contato direto e diário. As condições em que vivem os pacientes da instituição são extremamente precárias e degradantes para qualquer ser humano. A falta de prioridade dada à política de saúde mental no Estado contribui fortemente para a manutenção do modelo assistencial tradicional, ainda implementado nesse hospital. / The following study is the result of a case report held at a public pychiatric hospital of a city in the State of Bahia-Brazil. We focus on the development of nurses’ activities in the institutional routine and on their ways of dealing with situations and social relations with the other health professionals working at that hospital. Being a profesor in the Psychiatric Nursing field at Universidade Estadual de Feira de Santana (UEFS), I have direct contact at that hospital due to nursing students’ training (as a result of a partnership between the State Health Bureau and UEFS). We have mode a field sampling by taking one male, in-patient ward. We have used, as data-collecting strategy: participative observation, semi-structured questionaires applied to the nurses and other staff members who share daily work with them, and some documents which are important for contextualizing the work of such profesionals. We have presented the nursing tasks by establising their connections among nurses themselves and between nursing and other health profesionals. We have found great concentration of burocratic work among their tasks. Besides, we have found evidence of patients being considered medical problems to be solved, which expresses nurses’ views of the mentally-ill. In the staff daily routine, nurses considered themselves as being the core. However, this issue was not so evident when we looked upon the other profesionals’ views. Administrators considered nurses as being great situation managers. This places nurses at a politically-convenient situation for keeping majoritative interests. At this hospital, nurses have various hierarquically estrategic functions, close to the Board of Directors and having direct contact with them, daily. The living conditions of the patients in such institution are extremely poor and humiliating for any human being. The lack of priority given to mental health policies in this State of Bahia greatly contributes for the traditional assistential model, still playing at such hospital.

Introdução: A Lei nº. 10.216 redireciona o modelo assistencial em saúde mental, enfatizando a convivência comunitária e a atenção extra-hospitalar para portadores de distúrbio mental. No entanto, o Brasil enfrenta um grande desafio na consolidação da reforma psiquiátrica, a qual difunde-se nos discursos, porém as ações de implementação não acontecem na mesma proporção. Constata-se em Ribeirão Preto, o número insuficiente de serviços comunitários, além da fragilidade dos vínculos de integração do usuário com estes serviços. Esses fatos acabam refletindo nas taxas de internações e reinternações psiquiátricas. Objetivos: Identificar o perfil sociodemográfico e as condições clínicas das reinternações psiquiátricas no período de janeiro de 2006 a dezembro de 2007 no Hospital Santa Tereza, buscando-se associação entre estas variáveis. Metodologia: Para a coleta dos dados foi criado um instrumento \"Levantamento de reinternações psiquiátricas; em seguida foram examinados os prontuários de reinternações, utilizando-se o relatório anual de movimentação dos pacientes. Foi construído um banco de dados com todas as variáveis presentes no instrumento de coleta de dados. Resultados e discussão: Dos 2.025 prontuários encontrou-se 681 pacientes reinternados, sendo a maioria proveniente da DRS XIII, branca, entre 40 e 49 anos, masculino, solteiros e nível fundamental incompleto. A maioria das reinternações foi motivada pelo abandono do tratamento isolada ou associada a outras causas e com internações anteriores de 1 a 4 vezes, em outros hospitais psiquiátricos. Os diagnósticos prevalentes foram esquizofrenia, transtorno afetivo bipolar, transtornos mentais e comportamentais devido ao uso de álcool, transtornos específicos da personalidade. O estado físico foi bom, na admissão e na alta. Quanto ao estado mental observouse que 85% dos pacientes que entram calmos preservaram este estado. Os tratamentos predominantes foram o farmacológico e o psicológico. A idade do início da doença nos homens (32 anos) é maior do que as mulheres (18 anos) (P=0,0011). O tempo de permanência na internação hospitalar é maior para as mulheres do que para os homens, na faixa dos 40 aos 49 anos (T>t=0,032). Conclusões: Este estudo possibilitou conhecer as características sociodemográficas e clínicas dos pacientes reinternados no Hospital Santa Tereza de Ribeirão Preto. Confirmou-se que o fluxo de atendimento está de acordo com os princípios de regionalização e hierarquização preconizados pelo Sistema Único de Saúde. A proveniência da maioria das reinternações foi de Ribeirão Preto e a maior proporção dos pacientes já havia sido internada em outros hospitais psiquiátricos. Encontrou-se correlação positiva entre sexo e algumas variáveis, como idade, escolaridade, estado civil, motivo da internação, estado físico na admissão, internações anteriores em outros hospitais psiquiátricos, tipo de alta, tratamento durante a internação e estado físico na alta, bem como com a idade. O estado mental na alta correlacionou-se com a idade dos pacientes reinternados. / Introduction: Law number 10.216 gives a new direction to the mental health care model, emphasizing on community living and extra-hospital care for people with mental disorders. However, Brazil is facing a great challenge to consolidate the psychiatric reform, which is broadly discussed, but effective actions do not follow the same rate. In Ribeirao Preto there are insufficient community services. As a consequence, there is an effect on psychiatric hospitalizations and rehospitalizations. Objectives: to identify the sociodemographic profile and the clinical conditions of psychiatric patients that were rehospitalized from January 2006 to December 2007 in the Santa Tereza Hospital, seeking an association between these variables. Methodology: the data was collected using a tool created specifically for this means, named \"A survey of psychiatric rehospitalizations\". Next, the records of patients who were hospitalized were analyzed according to the annual patient flow report. A data bank was created, comprising all the variables from the data collection instrument. Results and discussion: It was found that 681 of the 2,025 patient records referred to re-hospitalized patients, most of whom had been referred from the DRS XIII Regional Health Directory, were white, between 40 and 49 years old, male, single, and had incomplete primary education. Most rehospitalizations were due to the patients dropout exclusively or in association with other causes and with previous hospitalizations occurring between 1 and 4 times in other psychiatric hospitals. The prevalent diagnoses were: schizophrenia, bipolar affective psychosis, mental and behavior disorders due to the use of alcohol, and specific personality disorders. The patients physical condition was good at both admission and discharge. As for the patients mental condition, it was observed that 85% of the patients who enter calmly remain that way. The predominant treatments were pharmacological and psychological. The age of onset in men (32 years) is higher than that in women (18 years) (P=0.0011). The length of stay is higher among women compared to men, for the age range 40 to 49 years (T>t=0.032). Conclusions: This study made it possible to learn about the sociodemographic and clinical characteristics of patients who were rehospitalized in the Santa Tereza Hospital in Ribeirão Preto. It was confirmed that the service flow is in accordance with the principles of regionalization and hierarchization recommended by the Unified Health System. Most rehospitalized patients lived in Ribeirão Preto and most had already been hospitalized in other psychiatric hospitals. A positive correlation was found between gender and other variables, such as age, education level, marital status, reason for hospitalization, physical condition at admission, previous hospitalizations, type of discharge, treatment during hospitalization, and physical condition at discharge, as well as age. The patients mental condition at the moment of discharge was correlated with the age of rehospitalized patients.