M.Cur. (Psychiatric Nursing) / Burnout has severe consequences for the psychiatric nurse as individual and for the mental health delivery system because of an increase in staff turnover and a decrease in the quality of patientcare. Psychiatric nurses suffering from burnout have the potential to experience job satisfaction, if job satisfaction can be facilitated. Job satisfaction of the psychiatric nurse will promote the mental health for her as individual, her patients, colleagues, family and the community. The following aims were set for the research project: Exploring and describing the aspects which cause and promote burnout amongst psychiatric nurses at a private psychiatric hospital; and to formulate guidelines for the psychiatric nursing specialist to facilitate job satisfaction of psychiatric nurses, as an integral part of mental health by means of mobilisation of resources. Nursing for the Whole Person Theory was used as the theoretical framework for this qualitative,contextual study. Botes' Model (1995:4-9) for Nursing Research was used to structure theresearch. The measures which were used to ensure reliability,validity and credibility of the research, were that of Guba (inKrefting, 1991:214-222).A pilot study was conducted to prevent obstacles during gathering and analysis of data. Specific criteria were set for selectionof participants. After conducting a pilot study, fiveparticipants were purposively selected from the target populationat a private psychiatric clinic.Individual focus interviews were recorded on tape and latertranscribed. Data gathering and data analysis were divided in two phases. Three questions were asked during -Phase 1 regarding burnout, and one during - Phase 2- regarding guidelinesfor the prevention of burnout. Data was analyzed systematicallyand descriptive, combining Tesch's (in Creswell, 1994:115) and Kerlinger's (1986:479) methods.

M.Cur. (Psychiatric Nursing) / Psychiatric nursing forms part of basic nursing education in South Africa which is done in four years, either at diploma level or degree level. The psychiatric nurses are only trained in basic psychiatric nursing and are not well equipped to work effectively with children. Even though psychiatric nurses do not have enough skills and knowledge, it is expected of them to work in child psychiatric wards without adequate knowledge and skills. This creates discomfort to the internal environment of a nurse and the situation can be stressful to the nurse. Psychiatric nursing has two important components which are: supporting people at a reasonable level of functioning which they cannot maintain independently; and facilitating a higher level of functioning in people for whom this is possible. Child psychiatry is one of the specialities in the psychiatric division. ‘The description of the practice of the professional nurse in the field of child psychiatry in South Africa is vague and undeveloped and there are only a few nurses in South Africa with knowledge and skills to set guidelines for this area of practice (Makhele, 2006:36)’. Psychiatric nurses working in psychiatric hospitals undergo different experiences on a daily basis. In this research study, the researcher wondered as to what psychiatric nurses working with children diagnosed with mental illness, experience on a daily basis. The researcher then asks the following questions: 1. What are the lived experiences of psychiatric nurses working with children diagnosed with mental illness? 2. What can be done to assist the psychiatric nurses, working with children diagnosed with mental illness, in order to facilitate their mental health? This research study was done to: 1. To explore and describe the lived experiences of psychiatric nurses, working with children diagnosed with mental illness; and 2. To formulate guidelines in order to facilitate these psychiatric nurses’ mental health. In order to explore and describe the lived experience of psychiatric nurses who work with children diagnosed with mental illness, the researcher used a qualitative design. The researcher utilised phenomenology, in order to explore and describe the experiences of these psychiatric nurses in the context of their working environment. Purposive sampling method was used. In-depth phenomenological interviews were used to collect data. Tesch’s method in Creswell (2011: 113) of open coding was utilised for the analysis of the data. The results were re-contextualised within the literature. The findings of this study provided the detailed content of professional psychiatric nurses’ experience when working with children diagnosed with mental illness. Two themes which were identified are: 1. Theme 1 A challenging experience associated with tensions inherent to the contextual demands of psychiatric nurses working with children diagnosed with mental illness. 2. Theme 2 Psychiatric nurses experience of contextual demands which requires a process of continuous adjustment Guidelines on how to promote the mental health of psychiatric nurses working with children diagnosed with mental illness were derived from the research findings. In conclusion, presently psychiatric nursing training appears to rely upon individual training institutions putting into practice government policy in a fragmented fashion with no cohesive strategy. Where psychiatric nurses receive good quality training which includes child psychiatry, it is clear that good quality and appropriate interventions to children with mental illness and emotional problems can be achieved.

Earlier studies show that when psychiatric out- and in-patient care units work together the risk for hospitalization decreases, leads to increased flexibility and shorter in-patient periods. At a psychiatric clinic in western Sweden there are routines in place regarding the transfer of patients from in-patient to out-patient care. The aim of this study was to describe nurses' experience of how out-and in-patient clinics collaborate during patients in-patient care. This is a qualitative study with an inductive approach. Ten nurses participated through semi structured interviews. The result ended up in two domains and eight subthemes and one theme, the diffuse responsibility – makes us not understand each other. Nurses in both out- and in-patient care experience uncertainty as to who has the responsibility for patients' treatment-plans and also uncertainty in how communication between the two parties works. Nurses in in-patient care experience that the out-patient care are uninterested, and nurses in out-patient care experience that in-patient care does not follow treatment-plans. In Conclusion both nurses in out- and in-patient care describe a need for an improved partnership. Some find that they are unsure of their role and their responsibility in the partnership. Structures for an improved partnership need to be implemented from the staff leadership, to be able to live up to the national guidelines and ensure that patients receive the treatment which serious psychiatric illness needs.

This study was designed to assess the reliability of "The Psychiatric Rating Scale for Diagnostic Classification of Children and Adolescents" as an instrument for determining diagnoses congruent with DSM-III criteria. In Phase I graduate students from a University doctoral program in psychology independently rated case vignettes and completed the 64-item rating scale to arrive at Axis I or II diagnoses consistent with DSM-III classifications for Disorders Usually First Evident in Infancy, Childhood, or Adolescence. Subsequent correlations to determine individual scale reliability yielded significantly positive correlations. Clinicians practicing in three diverse metropolitan mental health settings acted as raters in Phase II of the study. Paired raters jointly interviewed a total of 54 child or adolescent patients and independently completed the rating scale to arrive at Axis I or II diagnoses. These diagnoses were subsequently correlated with diagnoses previously obtained by traditional psychometric methods. Phase II interrater agreement was 92 percent for Axis I and II combined, with a .96 correlation. Rating scale diagnoses when correlated with traditional psychometic diagnoses yielded an overall rate of agreement on Axis I of 95 percent for Rater 1 and 90 percent for Rater 2 and correlations of .96 and .95 respectively. Clinicians were asked to rate a case vignette having previously been given an erroneous diagnosis. This attempt to assess rater expectancy effects yielded an agreement rate of 100 percent for the correct diagnosis. These results supported both major hypotheses of the study at a minimum of the .001 level of significance. They also confirmed a prior belief concerning limited intrusion upon rating scale reliability from rater expectancies. As a reliable and objective method of eliciting, structuring, and evaluating patient information, the rating scale could aide in reducing interdisciplinary interview variability and time expenditures among clinicians while providing an appropriate foundation for entry into treatment.

The dissertation discusses the provision of mental health care delivery by the Government of British Columbia, and the role and focus of Riverview Hospital in a changing organizational environment. The developing policy of regional and community service necessitates reorganization of the hospital's programs, in order to integrate and coordinate the components of the system. The question of the optimal organization for delivery of service in Riverview is examined through a discussion of the theoretical background for the provision of care to the mentally disordered, the development of mental health services in the province, and the alternatives and externalities which impinge on the provision and operation of the hospital's services. The intra-hospital planning, designed to effect an organizational response to environmental pressures, is outlined. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Thesis (M. Cur.) --University of Limpopo, 2015 / Background: Re-admission is a common problem encountered in psychiatric care. Re-admissions are often, but not always, related to a problem inadequately resolved in the prior hospitalization. A better understanding of factors leading multiple psychiatric admissions is needed. Such knowledge can help planners to set priorities and to make appropriate services and resources available to mental health care users and their families after hospital discharge. Objective: The purpose of this study was to explore the factors leading to re-admission of mental health care users at the Thabamoopo Psychiatric Hospital, Limpopo Province. Methodology: A qualitative phenomenological research approach was used to explore the factors leading to readmission of mental health care users. Purposive sampling was used to select participants of the study at the Thabamoopo Hospital. Twelve one-on-one semi-structured interviews were conducted. Ethical clearance was granted by the Medunsa Research Ethics Committee and permission to collect data was granted by the Limpopo Department of Health. The data were analysed through Tesch’s method of analysis. Results: The research findings indicate that the use of substances, non-adherence to psychiatric medication, the nature of the illness and social problems contributes to readmission of mental health care users. Conclusion and recommendations: In order to deal with factors related to re-admission of mental health care users, the mental health care practitioners, mental health care users and their families must be involved and work together.

The hypotheses investigated were (1) as measured by a test of impulse control, elopers are more impulsive than non-elopers, and (2) as measured by a test of impulse control, males are more impulsive than females. The Self-Report Test of Impulse Control (STIC) and the Barratt Impulsiveness Scale (BIS) were administered to 76 female and 40 male patients at the time of admission to an open psychiatric hospital. Of these, 20 females and 10 males eloped. The first hypothesis was only partially supported. The second hypothesis was not supported. The BIS was found to be a potential predictor of elopers. The data also suggested that males elope later than females.

A definitive association between adverse childhood experiences (ACEs) and negative physical and mental health outcomes has been established. There is evidence that individuals in forensic psychiatric facilities are disproportionately exposed to ACEs, which may impact severity, prognosis, and age of onset of psychiatric symptoms, including behavioral concerns of institutional aggression, self-harm behaviors, and suicide attempts. Such psychiatric and behavioral concerns are often managed through multiple psychotropic prescriptions, leading to psychotropic polypharmacy. This study evaluated the relationship between ACEs, mental health and behavioral concerns, and psychotropic polypharmacy through analysis of archival data from a forensic inpatient psychiatric facility. A total of 182 patients met inclusion criteria. Through a comprehensive record review, ACE scores, mental health outcomes, behavioral concerns, and prescription practices were ascertained and subjected to a series of regression analyses. Results indicate that the current participants experience greater prevalence of ACEs and mental health outcomes, as well as higher rates of psychotropic polypharmacy. These relationships are mediated by history of self-harm behaviors. The higher polypharmacy rates yield greater negative side effects with the need to manage with additional medications. Taken as a whole, ACEs are a relevant consideration, as childhood adversity may lead to a lifetime of difficulty with managing emotional distress and symptoms of psychopathology. Pharmacological treatment may be necessary, particularly with those who experience more complex mental health outcomes. However, a primary focus on psychotropic intervention can result in high rates of medications and polypharmacy with significant side effects. Incorporation of non-pharmacological intervention should be a primary consideration with forensic inpatients to circumvent the potential for psychotropic polypharmacy and related negative consequences.

Topic: Structuring of inpatient behavioral programming in child-adolescent psychiatric, residential treatment, and juvenile justice settings. Purpose: To review the underlying theory underpinning current practices and recommend remedies to the uncovered problems. Sources: A review of the literature from 1965 to 2001 from selected nursing and medical psychiatric and mental health publications. Conclusions: Intensive professional and staff education and greater precision in communication about patients' behaviors are needed in many settings. There is also a need to move away from generic treatment approaches and return to individual treatment planning based on individual assessments and the unique needs of an increasingly volatile and complex in-patient population.

Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.