Made available in DSpace on 2016-04-26T14:56:12Z (GMT). No. of bitstreams: 1 Fernando Sfair Kinker.pdf: 1600474 bytes, checksum: 102ff8855026256b6714c0dab0d11cf0 (MD5) Previous issue date: 2007-04-09 / This dissertation has as its object the transformation experience of a psychiatric hospital located in an inland city of the Brazilian Northeast. It gives an account of the Federal Government intervention performed by the Ministry of Health in that hospital that took place in 2005 and makes some reflections about the role of the mental institutions in the contemporary society. We argue that nowadays psychiatric hospitals do not operate based on a disciplinary logic, that supported the development of the asylums for many years, but under a new logic of abandoning, tuned with the new forms of deregulation that characterize the new standards of sociability of the present times. The theoretic framework has contributions from Franco Basaglia and collaborators, in the perspective of practical-theoretical deinstitutionalization, and from Michel Foucault s works on the psychiatric hospital genealogy and the relation between power and knowledge. Also there are, although fragmentary and punctual, references to many others authors and concepts within which we highlight the Edgar Morin s concept of Complexity, that warn us to not simplify neither the madness phenomenon, nor the responds given to it. The body of the work is compounded by a logbook, written by the time of the events, and reflections related to it. The stake here is that demonstrating this new logic of abandoning of the mental institutions, this account may contribute to the practice and theory of the current psychiatric reform in Brazil / O objeto desta dissertação é a experiência de transformação de um hospital psiquiátrico localizado numa cidade do interior nordestino. Seu objetivo é relatar a experiência da intervenção federal que lá se deu em 2005 e tecer reflexões relativas ao papel do manicômio na sociedade contemporânea. Partiu-se da hipótese de que o hospital psiquiátrico atual funciona nem tanto a partir de uma lógica disciplinar, que acompanhou durante anos o desenvolvimento do asilo, mas de uma nova lógica do abandono, em sintonia com as novas formas de desregulamentação que caracterizam os novos padrões de sociabilidade dos tempos atuais. Seu estofo teórico são as contribuições de Franco Basaglia e colaboradores, na perspectiva teórico-prática da desinstitucionalização, e a obra de Michael Foucault, no que se refere à genealogia do hospital psiquiátrico e às relações saber/poder. Estão presentes também, ainda que de forma fragmentada e pontual, vários outros autores e conceitos. Dentre esses conceitos, destaca-se o de complexidade, presente nas idéias de Edgar Morin, que alerta para a necessidade de não simplificar o fenômeno da loucura nem as respostas dadas a ele. O corpo do trabalho é composto por um diário de bordo , escrito à época dos acontecimentos, e de reflexões teóricas a ele associadas. A aposta é que, ao demonstrar na prática o significado dessa nova lógica do abandono, este relato possa também contribuir para a prática e a teoria da reforma psiquiátrica em andamento no Brasil

Made available in DSpace on 2014-12-17T15:38:49Z (GMT). No. of bitstreams: 1 CintiaGB_DISSERT.pdf: 782539 bytes, checksum: 1cd1039b2eef4544b15926fdef7c22d3 (MD5) Previous issue date: 2010-10-07 / The existence of chronic inhabitants in the psychiatric hospitals imposes a challenge to the Psychiatric Reform, that proposes things such as the gradual and progressive way to extinct mental institutions, once the permanence of the hospital in the system is only necessary because there is not a net of well structured substitute services capable of receiving that demand. This work considered relevant to deepen the knowledge about those people who passes their lives jailed by the walls of psychiatric hospitals and compose significant part of the world population. It also aimed to investigate the problem relative to the condition of being an inhabitant of a psychiatric hospital the Dr. Jo?o Machado Hospital (HJM), in the city of Natal/RN. The paper used different points of view (patients , families and professionals ) to define the profile of the inhabitants, to identify the possibility of insertion in substituting social equipment, to know the expectations of the inhabitants and their relatives regarding to the exit of the life shelter, to investigate the demands related to the net of cares social support for making feasible the discharge and to identify the difficulties that are involved in the exit of the chronic inhabitant of the hospital. There were defined three methodological phases: delineation of the identification, socio-economic and clinical profile of the inhabitants of the HJM; semi-structured interviews with professionals; and open interviews with inhabitants and family. It concluded that the psychiatric institutionalization contributes to the generation of chronic inhabitants in the psychiatric hospitals. Among the professionals, it was detached the defense of desospitalization, but an existence of devices of the asylum model. The relatives showed a resistance to participate in the care and the inhabitants exposed their desire to leave the hospital, as well like the wish of permanence. It was considered important: the construction of an extra-hospital net that enables to desinstitutionalization; the qualification of the technical; orientation to the family, stimulating its participation in the process of caring; give freedom to the individuals in mental suffering, enabling them to be ahead of their lives and express their desires and opinions; the implementation of an extended clinic that is capable of building new possibilities; and a subjectivity guided by the social enclosure / A exist?ncia de moradores cr?nicos nos hospitais psiqui?tricos imp?e um desafio ? desinstitucionaliza??o proposta pela Reforma Psiqui?trica, na medida em que o hospital se coloca como ?nica alternativa assistencial, enquanto n?o h? uma rede de servi?os substitutivos suficiente para acolher essa demanda. Considerou-se relevante aprofundar o conhecimento acerca desses sujeitos que passam suas vidas isoladas pelos muros de hospitais psiqui?tricos e comp?em parcela significativa da popula??o mundial. Objetivou-se investigar a problem?tica relativa ? condi??o de ser morador de um hospital psiqui?trico Hospital Dr. Jo?o Machado (HJM), na cidade de Natal/RN por parte dos t?cnicos, dos familiares e dos moradores, com vistas a: definir o perfil destes; identificar a possibilidade de inser??o em equipamentos sociais substitutivos; conhecer as expectativas dos moradores e familiares em rela??o ? desinstitucionaliza??o; investigar as demandas de cuidados e suporte social para viabiliz?-la e identificar as dificuldades envolvidas nesse processo. Realizaram-se tr?s etapas metodol?gicas: delineamento do perfil identificat?rio, s?cio-econ?mico e cl?nico dos moradores do HJM; entrevistas semi-estruturadas com t?cnicos do HJM e entrevistas abertas com moradores e familiares. Constatou-se que a institucionaliza??o psiqui?trica contribui para a gera??o de moradores cr?nicos nos hospitais psiqui?tricos. Entre os t?cnicos, destacou-se a defesa pela desospitaliza??o, mas tamb?m a exist?ncia de discursos institucionalizantes. Os familiares expuseram uma recusa ? participa??o no cuidado e os moradores evidenciaram a vontade de sair do hospital, bem como o desejo de perman?ncia. Verificou-se a import?ncia: da constru??o de uma rede extra-hospitalar que possibilite a desinstitucionaliza??o; da capacita??o da equipe t?cnica em rela??o ao exerc?cio de pr?ticas desinstitucionalizantes; da orienta??o ? fam?lia, estimulando a participa??o desta no cuidado; de possibilitar a apropria??o de suas vidas pelos sujeitos em sofrimento mental e a express?o de seus desejos e opini?es e da efetiva??o de uma cl?nica ampliada instauradora de uma subjetividade pautada na inclus?o social

1 online resource (vii, 138 leaves : ill.) / Following an awareness of an increased turn over of staff in the eating disorder unit as compared with other specialised units, in a psychiatric hospital in Johannesburg, South Africa, Tara Hospital, the researcher was motivated to investigate the issue. An exploratory, descriptive based research was chosen to explore and gain information about the topic and its implications. A qualitative research approach was used to gain insight into the perceptions and needs of the team working on the unit. The case study method was used. A pilot study was undertaken to test the validity of the interview schedules. The sampling category was a non- probability one. Individuals were selected from the population of staff working on the unit. Participants were selected from two groups, those who were presently working on the unit and those who had previously worked on the unit and now working in other units. Interview procedure involved personal semi-structured interviews conducted by the researcher and analysed qualitatively and a structured interview questionnaire analysed quantitatively. The researchers assumption that many staff members move from working in an eating disorders unit was confirmed and is due to the following: Staff turnover is due to constant exposure to occupational stress and burnout. Feelings of helplessness, a sense of being unappreciated and excessive exposure to conflict from the patients. In addition, staff experience minimum rewards leading to lowered job satisfaction due to the patients slow recovery rates and a poor prognosis of the illness. Staff also experience a change in their eating patterns and an increased awareness around food and food issues. Recommendations to the staff include: * Psycho-education on eating disorders. * Implementation of strategies to provide supportive care for all staff members. * Education on stress management and strategies to prevent staff burnout and lowered job satisfaction. * A multidisciplinary teamwork approach by the staff, when working in the unit. / Social Work / M. A. (Social Science in Mental Health)

Cette thèse vise à comprendre la dynamique du travail effectué par des professionnels de la santé mentale dans un hôpital psychiatrique public de Rio Grande do Sul, Hospital Psiquiátrico São Pedro (HPSP), et ses implications par rapport à la douleur et le plaisir. Les objectifs spécifiques sont: d'analyser l'organisation du travail, la détermination des relations de douleur et de plaisir, et connaître les stratégies de défense collective et de la santé, produites par ces travailleurs. La contribution théorique et méthodologique sont la psychodynamique du travail, de Christophe Dejours, appliquée strictu sensu, dans ses stades de développement. Nous avons utilisé les auteurs cités par leur liaison avec les thèmes: le travail: Marx, Dejours, Nardi, Lancman et Pitta, la folie et la santé mentale: Amarante, Magnolia Mendes, hôpital psychiatrique: Foucault et Dias, le service public: Rollo, Antunes, Castel, entre autres. Le sondage a une approche qualitative, qui est conforme au désir de comprendre les implications des travaux d'une institution marquée par la folie et la sphère publique par rapport à la subjectivité de leurs employés. Les données ont été recueillies au moyen de pré-recherche et des réunions avec le groupe des travailleurs, formé par des professionnels travaillant dans des unités d'hospitalisation pour malades aigus, dont le profil évolue pour les usagers de drogues, plus précisément le Crack. Il a été estimé que ces travailleurs sont dans un espace «entre», c'est à dire dans un espace de transition, qui aura des implications dans le processus de travail et de santé. Il a été constaté qu'ils utilisent des stratégies collectives de défense, comme l'éloignement, le durcissement et les plaintes et les stratégies collectives de la santé, exprimées à travers le commerce et l'aide, “l'oxygénation” et de changements possibles. Ces stratégies, cependant, sont en fait très conservatrices, n'ont pas changé la façon dont le travail est organisé. D'autre part, ces strategies aident à minimiser la douleur et d'obtenir un certain plaisir. L'étude constate l'existence de «chaînes», qui aggravent la souffrance au travail: le poids de la folie, l´ingérence politique, l´appauvrissement des ressources, les conditions et l´organisation du travail, où la précarité des liens relationnels avec les collègues est identifiée comme la plus grande charge. Un autre aspect souligné dans la recherche est le fait que les politiques publiques pour l'employé n'atteint pas les besoins internes, agissent pour surveiller les institutions. Les résultats ont montré l'importance de la construction d'un espace de discussion légitime dans l'hôpital São Pedro, qui permet de provoquer la force collective du groupe. Ainsi, il est possible de promouvoir la reconnaissance et la construction d'un sens pour le travail, fournissant plus de plaisir pour les travailleurs et pour donner la santé à ceux qui travaillent avec la santé. / Esta dissertação busca compreender a dinâmica do trabalho realizado por profissionais de saúde mental, de um hospital psiquiátrico público do Estado do Rio Grande do Sul, Hospital Psiquiátrico São Pedro,(HPSP), e suas implicações em relação ao sofrimento e ao prazer. Os objetivos específicos são: analisar a organização do trabalho, identificar a relação de sofrimento e prazer; e, conhecer as estratégias coletivas de defesa e de saúde, produzidas por estes trabalhadores. O aporte teórico metodológico utilizado foi a Psicodinâmica do Trabalho, de Christophe Dejours, aplicado de forma strictu sensu, em suas etapas de desenvolvimento. Para dialogar com esse referencial, recorreu-se a autores vinculados à temática do trabalho: como Marx, Dejours,Nardi, Lancman, e Pitta; loucura e saúde mental, Amarante, Magnólia Mendes; hospital psiquiátrico, como Foucaut e Dias; serviço público, Rollo, Antunes, Castel, dentre outros. A pesquisa possui abordagem qualitativa, o que é coerente com à intenção de entender as implicações do processo de trabalho em uma instituição, marcada pela loucura e pela esfera pública, em relação à subjetividade dos seus trabalhadores. Os dados foram obtidos através da pré-pesquisa e dos encontros realizados com o grupo de trabalhadores, formado por profissionais que atuam em unidades de internação de pacientes agudos, cujo perfil está se modificando para usuários de drogas, mais especificamente, de crack. Percebe-se que esses trabalhadores se encontram em um espaço do “entre”, ou seja, em um espaço de transição, que vai trazer implicações no processo de trabalho e de saúde. Constatou-se que eles utilizam estratégias coletivas de defesa, tais como: afastamento, endurecimento e reclamação; e estratégias coletivas de saúde, manifestadas através de trocas e ajuda, oxigenação e mudanças possíveis. Essas estratégias, no entanto, operam de forma conservadora, pois não alteram o modo pelo qual o trabalho está organizado. Permitem, por outro lado, minimizar o sofrimento e obter algum prazer. O estudo constata a existência de “grilhões” que exacerbam o sofrimento no trabalho: o peso da loucura, os atravessamentos políticos, o sucateamento dos recursos, as condições e a forma de organização do trabalho, em que a precariedade dos vínculos relacionais com os colegas é apontado como a maior carga. Outro aspecto ressaltado na pesquisa é o fato de que as políticas públicas existentes, voltadas ao trabalhador, não dão conta, na prática, da demanda interna, pois são ações que atuam, em sua maioria, no sentido de fiscalizar as instituições. Fica evidenciada a importância de se construir, no Hospital Psiquiátrico São Pedro, um espaço de discussão legítimo, que possibilite instigar a força coletiva do grupo. Assim, acredita-se ser possível fomentar o reconhecimento e a construção de um significado para o trabalho que proporcione mais prazer aos trabalhadores e que viabilize saúde a quem trata da saúde. / This essay searches for the understanding of the dynamics of the work made by mental health professionals of one psychiatric public hospital in the state of Rio Grande do Sul named Hospital Psiquiátrico São Pedro (HPSP) and its implications related to suffering and pleasure. The specific objectives are: to analyze the organization of the work; to identify the relation between suffering and pleasure and to know common strategies of defense and health produced by these workers. The theoretical-methodological subsidy used was Christopher Dejours’ Psychodynamics at Work applied in a strictu sensu pattern during its development stage. To work with such reference we looked for authors linked to the theme work such as Marx, Dejours, Nardi, Lancman and Pitta; madness and mental health, Amarante, Magnólia Mendes; psychiatric hospital, such as Foucault and Dias: public service, Rollo, Antunes, Castel, among others. The research is qualitative-based which is coherent to the intention of understanding the implications of the working process inside an institution surrounded by insanity and by the public domain in relation to the subjectivity of its employees. Data were obtained through a beforehand research and from the meetings held with the group of workers composed by the professionals who act in units of the asylum with seriously insane patients whose profile has changed to drug addicts, more specifically, crack. We came to the conclusion that these workers are found in a space “in between”, that is, in a transition space which will bring implications in the labor and health process. We also noticed that they use common health defense strategies manifested through the exchanges and help, oxygenation and possible changes. But these strategies work in a conservative model because they don’t alter the way the work is organized in itself. They allow, on the other hand, to minimize the suffering and to get some kind of pleasure. The study suggests the existence of mental links or mental chains which increase the suffering at work: the burden of madness, the political obstructions, the resources defraying, the conditions and the organization of the work where the poor relationship entailment among the workmates is appointed as the biggest burden. Another point to be considered in the research is the fact that the existing public politics made for the workers are not sufficient in practice to fulfill the internal demand due to the fact that they are actions that happen, in its majority, to control the institution. It is made clear the importance of making at Hospital Psiquiátrico São Pedro a real discussion scene that will promote the investigation of the common strength of such group. Therefore, we believe that it is possible to foment the acknowledgement and the making of a meaning to work that will bring pleasure for the employees and promote health to the ones that treat it.

Cette thèse vise à comprendre la dynamique du travail effectué par des professionnels de la santé mentale dans un hôpital psychiatrique public de Rio Grande do Sul, Hospital Psiquiátrico São Pedro (HPSP), et ses implications par rapport à la douleur et le plaisir. Les objectifs spécifiques sont: d'analyser l'organisation du travail, la détermination des relations de douleur et de plaisir, et connaître les stratégies de défense collective et de la santé, produites par ces travailleurs. La contribution théorique et méthodologique sont la psychodynamique du travail, de Christophe Dejours, appliquée strictu sensu, dans ses stades de développement. Nous avons utilisé les auteurs cités par leur liaison avec les thèmes: le travail: Marx, Dejours, Nardi, Lancman et Pitta, la folie et la santé mentale: Amarante, Magnolia Mendes, hôpital psychiatrique: Foucault et Dias, le service public: Rollo, Antunes, Castel, entre autres. Le sondage a une approche qualitative, qui est conforme au désir de comprendre les implications des travaux d'une institution marquée par la folie et la sphère publique par rapport à la subjectivité de leurs employés. Les données ont été recueillies au moyen de pré-recherche et des réunions avec le groupe des travailleurs, formé par des professionnels travaillant dans des unités d'hospitalisation pour malades aigus, dont le profil évolue pour les usagers de drogues, plus précisément le Crack. Il a été estimé que ces travailleurs sont dans un espace «entre», c'est à dire dans un espace de transition, qui aura des implications dans le processus de travail et de santé. Il a été constaté qu'ils utilisent des stratégies collectives de défense, comme l'éloignement, le durcissement et les plaintes et les stratégies collectives de la santé, exprimées à travers le commerce et l'aide, “l'oxygénation” et de changements possibles. Ces stratégies, cependant, sont en fait très conservatrices, n'ont pas changé la façon dont le travail est organisé. D'autre part, ces strategies aident à minimiser la douleur et d'obtenir un certain plaisir. L'étude constate l'existence de «chaînes», qui aggravent la souffrance au travail: le poids de la folie, l´ingérence politique, l´appauvrissement des ressources, les conditions et l´organisation du travail, où la précarité des liens relationnels avec les collègues est identifiée comme la plus grande charge. Un autre aspect souligné dans la recherche est le fait que les politiques publiques pour l'employé n'atteint pas les besoins internes, agissent pour surveiller les institutions. Les résultats ont montré l'importance de la construction d'un espace de discussion légitime dans l'hôpital São Pedro, qui permet de provoquer la force collective du groupe. Ainsi, il est possible de promouvoir la reconnaissance et la construction d'un sens pour le travail, fournissant plus de plaisir pour les travailleurs et pour donner la santé à ceux qui travaillent avec la santé. / Esta dissertação busca compreender a dinâmica do trabalho realizado por profissionais de saúde mental, de um hospital psiquiátrico público do Estado do Rio Grande do Sul, Hospital Psiquiátrico São Pedro,(HPSP), e suas implicações em relação ao sofrimento e ao prazer. Os objetivos específicos são: analisar a organização do trabalho, identificar a relação de sofrimento e prazer; e, conhecer as estratégias coletivas de defesa e de saúde, produzidas por estes trabalhadores. O aporte teórico metodológico utilizado foi a Psicodinâmica do Trabalho, de Christophe Dejours, aplicado de forma strictu sensu, em suas etapas de desenvolvimento. Para dialogar com esse referencial, recorreu-se a autores vinculados à temática do trabalho: como Marx, Dejours,Nardi, Lancman, e Pitta; loucura e saúde mental, Amarante, Magnólia Mendes; hospital psiquiátrico, como Foucaut e Dias; serviço público, Rollo, Antunes, Castel, dentre outros. A pesquisa possui abordagem qualitativa, o que é coerente com à intenção de entender as implicações do processo de trabalho em uma instituição, marcada pela loucura e pela esfera pública, em relação à subjetividade dos seus trabalhadores. Os dados foram obtidos através da pré-pesquisa e dos encontros realizados com o grupo de trabalhadores, formado por profissionais que atuam em unidades de internação de pacientes agudos, cujo perfil está se modificando para usuários de drogas, mais especificamente, de crack. Percebe-se que esses trabalhadores se encontram em um espaço do “entre”, ou seja, em um espaço de transição, que vai trazer implicações no processo de trabalho e de saúde. Constatou-se que eles utilizam estratégias coletivas de defesa, tais como: afastamento, endurecimento e reclamação; e estratégias coletivas de saúde, manifestadas através de trocas e ajuda, oxigenação e mudanças possíveis. Essas estratégias, no entanto, operam de forma conservadora, pois não alteram o modo pelo qual o trabalho está organizado. Permitem, por outro lado, minimizar o sofrimento e obter algum prazer. O estudo constata a existência de “grilhões” que exacerbam o sofrimento no trabalho: o peso da loucura, os atravessamentos políticos, o sucateamento dos recursos, as condições e a forma de organização do trabalho, em que a precariedade dos vínculos relacionais com os colegas é apontado como a maior carga. Outro aspecto ressaltado na pesquisa é o fato de que as políticas públicas existentes, voltadas ao trabalhador, não dão conta, na prática, da demanda interna, pois são ações que atuam, em sua maioria, no sentido de fiscalizar as instituições. Fica evidenciada a importância de se construir, no Hospital Psiquiátrico São Pedro, um espaço de discussão legítimo, que possibilite instigar a força coletiva do grupo. Assim, acredita-se ser possível fomentar o reconhecimento e a construção de um significado para o trabalho que proporcione mais prazer aos trabalhadores e que viabilize saúde a quem trata da saúde. / This essay searches for the understanding of the dynamics of the work made by mental health professionals of one psychiatric public hospital in the state of Rio Grande do Sul named Hospital Psiquiátrico São Pedro (HPSP) and its implications related to suffering and pleasure. The specific objectives are: to analyze the organization of the work; to identify the relation between suffering and pleasure and to know common strategies of defense and health produced by these workers. The theoretical-methodological subsidy used was Christopher Dejours’ Psychodynamics at Work applied in a strictu sensu pattern during its development stage. To work with such reference we looked for authors linked to the theme work such as Marx, Dejours, Nardi, Lancman and Pitta; madness and mental health, Amarante, Magnólia Mendes; psychiatric hospital, such as Foucault and Dias: public service, Rollo, Antunes, Castel, among others. The research is qualitative-based which is coherent to the intention of understanding the implications of the working process inside an institution surrounded by insanity and by the public domain in relation to the subjectivity of its employees. Data were obtained through a beforehand research and from the meetings held with the group of workers composed by the professionals who act in units of the asylum with seriously insane patients whose profile has changed to drug addicts, more specifically, crack. We came to the conclusion that these workers are found in a space “in between”, that is, in a transition space which will bring implications in the labor and health process. We also noticed that they use common health defense strategies manifested through the exchanges and help, oxygenation and possible changes. But these strategies work in a conservative model because they don’t alter the way the work is organized in itself. They allow, on the other hand, to minimize the suffering and to get some kind of pleasure. The study suggests the existence of mental links or mental chains which increase the suffering at work: the burden of madness, the political obstructions, the resources defraying, the conditions and the organization of the work where the poor relationship entailment among the workmates is appointed as the biggest burden. Another point to be considered in the research is the fact that the existing public politics made for the workers are not sufficient in practice to fulfill the internal demand due to the fact that they are actions that happen, in its majority, to control the institution. It is made clear the importance of making at Hospital Psiquiátrico São Pedro a real discussion scene that will promote the investigation of the common strength of such group. Therefore, we believe that it is possible to foment the acknowledgement and the making of a meaning to work that will bring pleasure for the employees and promote health to the ones that treat it.

Cette thèse vise à comprendre la dynamique du travail effectué par des professionnels de la santé mentale dans un hôpital psychiatrique public de Rio Grande do Sul, Hospital Psiquiátrico São Pedro (HPSP), et ses implications par rapport à la douleur et le plaisir. Les objectifs spécifiques sont: d'analyser l'organisation du travail, la détermination des relations de douleur et de plaisir, et connaître les stratégies de défense collective et de la santé, produites par ces travailleurs. La contribution théorique et méthodologique sont la psychodynamique du travail, de Christophe Dejours, appliquée strictu sensu, dans ses stades de développement. Nous avons utilisé les auteurs cités par leur liaison avec les thèmes: le travail: Marx, Dejours, Nardi, Lancman et Pitta, la folie et la santé mentale: Amarante, Magnolia Mendes, hôpital psychiatrique: Foucault et Dias, le service public: Rollo, Antunes, Castel, entre autres. Le sondage a une approche qualitative, qui est conforme au désir de comprendre les implications des travaux d'une institution marquée par la folie et la sphère publique par rapport à la subjectivité de leurs employés. Les données ont été recueillies au moyen de pré-recherche et des réunions avec le groupe des travailleurs, formé par des professionnels travaillant dans des unités d'hospitalisation pour malades aigus, dont le profil évolue pour les usagers de drogues, plus précisément le Crack. Il a été estimé que ces travailleurs sont dans un espace «entre», c'est à dire dans un espace de transition, qui aura des implications dans le processus de travail et de santé. Il a été constaté qu'ils utilisent des stratégies collectives de défense, comme l'éloignement, le durcissement et les plaintes et les stratégies collectives de la santé, exprimées à travers le commerce et l'aide, “l'oxygénation” et de changements possibles. Ces stratégies, cependant, sont en fait très conservatrices, n'ont pas changé la façon dont le travail est organisé. D'autre part, ces strategies aident à minimiser la douleur et d'obtenir un certain plaisir. L'étude constate l'existence de «chaînes», qui aggravent la souffrance au travail: le poids de la folie, l´ingérence politique, l´appauvrissement des ressources, les conditions et l´organisation du travail, où la précarité des liens relationnels avec les collègues est identifiée comme la plus grande charge. Un autre aspect souligné dans la recherche est le fait que les politiques publiques pour l'employé n'atteint pas les besoins internes, agissent pour surveiller les institutions. Les résultats ont montré l'importance de la construction d'un espace de discussion légitime dans l'hôpital São Pedro, qui permet de provoquer la force collective du groupe. Ainsi, il est possible de promouvoir la reconnaissance et la construction d'un sens pour le travail, fournissant plus de plaisir pour les travailleurs et pour donner la santé à ceux qui travaillent avec la santé. / Esta dissertação busca compreender a dinâmica do trabalho realizado por profissionais de saúde mental, de um hospital psiquiátrico público do Estado do Rio Grande do Sul, Hospital Psiquiátrico São Pedro,(HPSP), e suas implicações em relação ao sofrimento e ao prazer. Os objetivos específicos são: analisar a organização do trabalho, identificar a relação de sofrimento e prazer; e, conhecer as estratégias coletivas de defesa e de saúde, produzidas por estes trabalhadores. O aporte teórico metodológico utilizado foi a Psicodinâmica do Trabalho, de Christophe Dejours, aplicado de forma strictu sensu, em suas etapas de desenvolvimento. Para dialogar com esse referencial, recorreu-se a autores vinculados à temática do trabalho: como Marx, Dejours,Nardi, Lancman, e Pitta; loucura e saúde mental, Amarante, Magnólia Mendes; hospital psiquiátrico, como Foucaut e Dias; serviço público, Rollo, Antunes, Castel, dentre outros. A pesquisa possui abordagem qualitativa, o que é coerente com à intenção de entender as implicações do processo de trabalho em uma instituição, marcada pela loucura e pela esfera pública, em relação à subjetividade dos seus trabalhadores. Os dados foram obtidos através da pré-pesquisa e dos encontros realizados com o grupo de trabalhadores, formado por profissionais que atuam em unidades de internação de pacientes agudos, cujo perfil está se modificando para usuários de drogas, mais especificamente, de crack. Percebe-se que esses trabalhadores se encontram em um espaço do “entre”, ou seja, em um espaço de transição, que vai trazer implicações no processo de trabalho e de saúde. Constatou-se que eles utilizam estratégias coletivas de defesa, tais como: afastamento, endurecimento e reclamação; e estratégias coletivas de saúde, manifestadas através de trocas e ajuda, oxigenação e mudanças possíveis. Essas estratégias, no entanto, operam de forma conservadora, pois não alteram o modo pelo qual o trabalho está organizado. Permitem, por outro lado, minimizar o sofrimento e obter algum prazer. O estudo constata a existência de “grilhões” que exacerbam o sofrimento no trabalho: o peso da loucura, os atravessamentos políticos, o sucateamento dos recursos, as condições e a forma de organização do trabalho, em que a precariedade dos vínculos relacionais com os colegas é apontado como a maior carga. Outro aspecto ressaltado na pesquisa é o fato de que as políticas públicas existentes, voltadas ao trabalhador, não dão conta, na prática, da demanda interna, pois são ações que atuam, em sua maioria, no sentido de fiscalizar as instituições. Fica evidenciada a importância de se construir, no Hospital Psiquiátrico São Pedro, um espaço de discussão legítimo, que possibilite instigar a força coletiva do grupo. Assim, acredita-se ser possível fomentar o reconhecimento e a construção de um significado para o trabalho que proporcione mais prazer aos trabalhadores e que viabilize saúde a quem trata da saúde. / This essay searches for the understanding of the dynamics of the work made by mental health professionals of one psychiatric public hospital in the state of Rio Grande do Sul named Hospital Psiquiátrico São Pedro (HPSP) and its implications related to suffering and pleasure. The specific objectives are: to analyze the organization of the work; to identify the relation between suffering and pleasure and to know common strategies of defense and health produced by these workers. The theoretical-methodological subsidy used was Christopher Dejours’ Psychodynamics at Work applied in a strictu sensu pattern during its development stage. To work with such reference we looked for authors linked to the theme work such as Marx, Dejours, Nardi, Lancman and Pitta; madness and mental health, Amarante, Magnólia Mendes; psychiatric hospital, such as Foucault and Dias: public service, Rollo, Antunes, Castel, among others. The research is qualitative-based which is coherent to the intention of understanding the implications of the working process inside an institution surrounded by insanity and by the public domain in relation to the subjectivity of its employees. Data were obtained through a beforehand research and from the meetings held with the group of workers composed by the professionals who act in units of the asylum with seriously insane patients whose profile has changed to drug addicts, more specifically, crack. We came to the conclusion that these workers are found in a space “in between”, that is, in a transition space which will bring implications in the labor and health process. We also noticed that they use common health defense strategies manifested through the exchanges and help, oxygenation and possible changes. But these strategies work in a conservative model because they don’t alter the way the work is organized in itself. They allow, on the other hand, to minimize the suffering and to get some kind of pleasure. The study suggests the existence of mental links or mental chains which increase the suffering at work: the burden of madness, the political obstructions, the resources defraying, the conditions and the organization of the work where the poor relationship entailment among the workmates is appointed as the biggest burden. Another point to be considered in the research is the fact that the existing public politics made for the workers are not sufficient in practice to fulfill the internal demand due to the fact that they are actions that happen, in its majority, to control the institution. It is made clear the importance of making at Hospital Psiquiátrico São Pedro a real discussion scene that will promote the investigation of the common strength of such group. Therefore, we believe that it is possible to foment the acknowledgement and the making of a meaning to work that will bring pleasure for the employees and promote health to the ones that treat it.

MCur / Department of Advanced Nursing Science / Nursing students’ absenteeism has become a very serious concern in every higher educational institution in the whole world especially those of nursing. This study was conducted to investigate factors leading to student nurses’ absenteeism in Limpopo College of Nursing during Psychiatric Nursing Science clinical placement. A quantitative approach using descriptive design was used. Purposive sampling method was used to get a sample of two hundred and six (206) of students who have absented themselves before. Data was collected through a self-report scale in the form of questionnaires of structured questions, entered and analysed using SPSS version 24. Ethical considerations were adhered to throughout. The correlation between clinical factors and absenteeism was determined. The main reported factors for absenteeism were: student nurses being treated as a workforce in the clinical areas; shortage of staff in the clinical areas; study for tests and examinations; inadequate supervision of student nurses by professional nurses; and being inconsiderate of student nurses request for days off in the clinical area. This study recommends that the college should make a provision of one week of study for student nurses between the period of clinical placement and tests or final examinations as most of the respondents indicated that they absent themselves due to study for tests and examinations. The Department of Health should find a way of not overworking students due to shortage of staff in the wards but consider them for experiential learning. A research study should be conducted to develop a model to reduce student nurses absenteeism. / NRF

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: South Africa has transformed its mental health service provision from in-hospital care to community-based rehabilitation. Although the idea is sound, the process places the caregiving families under an immense pressure. The aim of this study was to explore the impact that the de-institutionalisation process has had on the families as they care for their child with intellectual disability. The study was conducted by means of qualitative, unstructured interviews with families that have had a child de-institutionalised from Alexandra Hospital in the Western Cape. All of the patients were diagnosed with a dual diagnosis of intellectual disability and mental illness. Even though the patients were in group-homes or attended a day care centre, final responsibility for the patients lay with the parents. Three main themes emerged from the interviews that describe the impact of deinstitutionalisation, viz. the characteristics of the family member with intellectual disability (aggressive, abusive and self-destructive behaviour of the patient), the effect that these characteristics had on the family (marital stress and health risks to the care giver), and community and resource factors. The study placed the family central to its environment and discussed the impact deinstitutionalisation had on its environment as a whole. It was concluded that the burden that de-institutionalisation places on the families far exceeded their ability to cope with these circumstances. This status quo could be improved if adequate resources and skills are given to families prior to de-institutional / AFRIKAANSE OPSOMMING: In Suid-Afrika is geestesgesondheidsorg van hospitaliserende na gemeenskapsgebaseerde rehabilitasie, omskep. Terwyl hierdie stap wel as lewensvatbaar mag voorkom, plaas die proses ‘n hewige las op die sorggewende gesin. Die doel van hierdie studie was om die omvang van die impak hiervan op ‘n gesin met ’n lid met intellektuele gestremdheid en psiegiatriese siekte, te bepaal – nadat so ‘n pasient uit die inrigting ontslaan is. Die ondersoek is uitgevoer by wyse van kwalitatiewe, ongestruktureerde onderhoude met gesinne wie se lede met die diagnose uitgeplaas is deur die Alexandra Hospitaal in die Wes-Kaap. Elkeen van die pasïente is gediagnoseer met ernstige intellektuele gestremdheid, asook bykomende gedragsafwykings. Ten spyte van die feit dat die betrokke pasïente deur groepshuise of dagsorg eenhede versorg word, bly hulle hul ouers se verantwoordelikheid. Drie temas het ontstaan wat die impak van ontslag uit die inrigting omskryf, te wete die karaktertrekke van die gestremde gesinslid (aggressie, misbruikende en vernielsugtige gedrag van die pasïent), die effek van hierdie karaktertrekke op die gesin (stres op die huwelik en potensiële gesondheidsrisiko wat dit vir die versorger inhou), en die gemeenskap en ondersteunende faktore. Tydens die ondersoek is die gesin sentraal geplaas ten opsigte van die omgewing. Die impak van ontslag van die gediagnoseerde pasïent uit die inrigting op die omgewing as geheel, word bespreek. Daar is tot die slotsom gekom dat die vermoë van die gesin wat die las moet dra as gevolg van die ontslag, ver oorspan word. Hierdie toedrag van sake sou egter verlig kon word indien toereikende hulpbronne en vaardighede aan sulke gesinne beskikbaar gestel word alvorens so ‘n pasïent ontslaan is.

This diploma thesis deals with the study of the new development of the current development area of the town of Kroměříž in its northeastern part behind the psychiatric hospital between the streets Lutopecká and Havlíčková. This territory connects the local part of Terezov and Barbořina. The aim of the study was to propose new housing for more than 1,200 inhabitants in a currently unbuilt area in accordance with a valid territorial plan. The solved territory is divided into three stages of construction. The northeastern part follows the existing housing development with two-storey apartment buildings. In the rest of the area there are designed individual houses and partly terraced houses. The area is complemented by a kindergarten, shops and a parking house. In accordance with the territorial plan there is also a park and a sports ground with a playground and a sports hall. The character of the territory is greatly influenced by some already existing engineering networks and their protection zones, the transfer of which is economically disadvantageous. Due to the marginal position of the solved territory, the study proposes the extension of the service by public transportation by another two places. The new transport link between streets Lutopecká and Havlíčková would cause a significant traffic movement to increase over the area, so the study envisages a calm traffic in the form of a maximum speed limitation of 30 km/h and the communication system consists of two-way and one-way communications. Transportation is provided by the garages belonging to family houses supported with parking along the roads. In the apartment part, parking is possible in the outdoor parking lots and to supplement the necessary capacity, the study also proposes a parking house.

Department of Advanced Nursing Science / MCur