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

Although I was trained as a nurse, I became curious about the views of psychiatric nursing staff as to what they feel would create a clinical learning environment for them. This was as a result of having my dearly beloved father admitted to a medical ward, and being on the receiving side of care. This created a fear in me that surprised me. I was scared at how my father would be treated if I was not present to witness his care. As a nurse, strangely, I felt that I could not trust the nurses to provide safe clinical care for/with my father. I began to feel concerned about the competencies of nurses as I observed the care that was being offered to him. My observation and experience was that the ward environment generated an atmosphere that needed a form of nursing care that was collaborative and transparent where the hand-over between professionals communicated the needs of the patients in their care – from making sure that patients’ bedding is comfortable, to checking whether they are trying to communicate something, to being sure that their medication has been properly given. This aroused my curiosity as to whether nursing staff themselves had views as to what is needed to have, or to create, an environment that sustained their original urge to take up nursing in the first place. I thus became curious to investigate the views and experiences of both qualified and non-qualified psychiatric nurses with the aim of improving the clinical learning environment within acute adult inpatient wards, as well as secure adult and male adolescent mental health inpatient wards, as these wards raise crucial issues to do with control, power, seclusion, rights and responsibilities, issues that are not easy for nurses to learn to deal with in their classroom training. For this study I interviewed sixteen staff members of wards within the National Health Service and the private sector. The staff varied in their experiences and qualification, from qualified mental health nurses to non-qualified nurses. My findings show that: (1) Nurses often felt the ward organisation had hindered their learning through the way in which it worked to organise them. (2) Nurses would have liked to experience a different kind of learning. However they were not sure in what way or how they would like the learning experience to be. (3) The expert nurses were able to work in a competent manner despite the sense of the organisation organising their practices, as they were able to sense which of the limited number of organisational possibilities were open to them so that their choices allowed for their practices to be learning experiences as well as providing sound clinical care. (4) Learning dialogues happen in contexts where nurses feel supported and where the episode of care in which they are engaged is also supported by a team approach and resourceful pulling together of skills and abilities. (5) There was a lack of space(s) for the nurses to use for reflection. (6) Nurses also expressed the need for supervision after an episode or critical event had taken place. (7) Throughout all the areas I inquired into, what was strongly echoed was that the psychiatric nurses all felt that they needed a voice within the organisation and its hierarchy of team structures within these wards. There was a felt sense that the nurses wanted and at times needed more expert nurses working in the teams. Overall, I was struck by the abilities which were brought to the forefront as the nurses shared their views and experiences of how they felt organised by the organisation. They were able to explore the factors that they felt would improve the quality of care that nurses provide and were able to share what they believe will help them in co-creating standards for how the clinical environment could become a learning environment for the nurses.

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.

M.Cur. / Please refer to full text to view abstract

Background: Since 2008 there is a law stating that patients who do not require institutional forensic psychiatric care may be moved to non-institutional forensic care, with special conditions. RättspsyK is a national quality register where all of the 25 forensic care units in Sweden collect information about their patients and their care. Previous analysis showed that a considerable amount of patients continue to receive institutional forensic psychiatric care despite they are assessed and found ready to move onto non-institutional forensic care. Aim: The objective of this study was to identify factors affecting why patients were still in institutional forensic care despite assessed to be ready for non-institutional forensic care.Method: First, yearly assessment of each patient between 2009 and 2014 was drawn from the RättspsyK register. Answers to the specific question, Question 10, were analyzed with descriptive statistics and were planned to be used in regression analyses as dependent variable. Result: 1900 patients were included. During analyses the fact that answers to this question were not trustable was found, therefore no exact prevalence of inpatients kept in institutional forensic care despite assessed ready for non-institutional care could be determined. Other information revealed that lack of housing and lack of collaboration were the most frequent reasons for this phenomenon. Conclusion: The present study could not give answer to the original question, but pointed out avalidity problem in the Swedish Forensic Psychiatry Register. The result calls for caution and for the need of validation of RättspsyK register.

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)

Student Number : 7632299 - MSc research report - Faculty of Health Sciences / The purpose of this research was to ascertain and examine the current genetic knowledge of the nurses in their final year of the Diploma in Comprehensive Nursing (General Nursing, Community Nursing, Psychiatric Nursing) and Midwifery. The research design was an exploratory, descriptive, quantitative survey, using a sample of final year student nurses at two of the three nursing colleges in Gauteng. Data were collected through the use of a self-administered paper-based questionnaire, which was adapted from a questionnaire used for a study to assess the genetic knowledge of general practitioners (Trenton, 2003). The questionnaire was adapted using the broad outline for subject content given in the curriculum for the four-year Diploma in Comprehensive Nursing (General Nursing, Community Health and Psychiatric Nursing) and Midwifery, the South African Nursing Council regulations, and the Department of Health Policy Guidelines. Random sampling was utilised to select two of the three nursing colleges in Gauteng and the total population of final year students was used as the sample. Data were analysed by means of descriptive statistics. It was concluded through this study that, although nurses showed fairly adequate knowledge in the areas of teratogens and multifactorial inheritance, they showed a lack of knowledge with regard to basic genetic inheritance patterns, genetic conditions, epidemiology and prenatal diagnostic techniques. It can thus be recommended that an expanded component of genetics be included in the basic curriculum of the four year Diploma in Comprehensive Nursing (General, Community, Psychiatric) and Midwifery programme in accordance with programmes initiated in other countries.

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.

A família representa a unidade de equilíbrio de cada indivíduo, podendo ser comparada ao seu eixo central. No entanto, ao perceber a doença, há uma desestruturação e desequilíbrio no contexto familiar, costuma-se dizer que ao adoecer uma pessoa da família, esta também adoece. Acompanhando os preceitos da Reforma Psiquiátrica, observamos um aumento de alternativas de atendimento a pessoas com transtornos mentais: Centros de Atenção Psicossocial, Residências Terapêuticas e mais recentemente, propostas de atendimento de pacientes com transtornos mentais pelo Programa de Saúde da Família. Com o objetivo de reintegração ao meio sociofamiliar; a abordagem da reabilitação psicossocial favorece inovações relacionadas ao conhecimento teórico e a aproximação com o território vivencial de cada usuário, ampliando as oportunidades de inserção social dos mesmos, e recuperando-os enquanto cidadãos. Este trabalho teve como objetivo conhecer o significado da convivência entre pacientes e familiares no contexto do domicílio, utilizando como sujeitos os usuários do Centro de Reabilitação e Hospital-Dia do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Trata-se de uma pesquisa qualitativa, em que foram realizadas entrevistas semi-estruturadas, acompanhadas da caracterização do domicílio de cada indivíduo. A técnica utilizada para organização dos discursos foi baseada na análise de conteúdo temática de Bardin (1977). Nos discursos dos sujeitos, podemos perceber, ao mesmo tempo em que observamos, que o domicílio é um local de trocas afetivas, contendo particularidades que identificam cada indivíduo com a sua história e sua subjetividade. Percebemos que nele podem acontecer relações estereotipadas, favorecendo a cronificação da doença por meio de atitudes perpetuadas pelos próprios familiares. É a cristalização da loucura, do pensamento manicomial que acompanha cada cena familiar. O presente estudo sugere que a assistência domiciliária em saúde mental representa um importante instrumento na abordagem do indivíduo com transtorno mental e sua família. Esta permite aos profissionais entender a dinâmica familiar no seu próprio meio, verificando possibilidades e/ou dificuldades de envolvimento dos familiares no tratamento e acompanhamento do usuário, visando à sua reintegração na família e na sociedade. / The family represents the equilibrium of each individual and might be compared to their central axle. However, the family represents the unit of balance of each individual, being able to be compared to their central axle. However, when noticing the illness there is a lack of structure and disequilibrium in the familiar context, it’s common to say that when someone gets sick in the family, the family also becomes ill. Following the rules of the Psychiatric Reformation we observe an increase of attendance alternatives to the people with mental disturbance: Centers of Psychosocial Attention, Therapeutical Residences and more recently, proposals of attendance of patients with mental disturbance by the Program of Health of the Family. With the objective of reintegration to the social family environment; the approach of the psychosocial rehabilitation favors innovations related to the theoretical knowledge and the approach with the existential territory of each user, extending their chances of social insertion recovering them while citizens. This research had as objective to know the meaning of the living between patients and their families in the context of the domicile, using as individuals, users of the Center of Rehabilitation and Hospital-Dia of the Institute of Psychiatry of the Hospital of the Clinics of the College of Medicine of the University of São Paulo. This is a qualitative research, where they had been carried out semi-structured interviews, followed by the characterization of the domicile of each individual. The technique used for organization of the speeches was based on the thematic analysis of the content of Bardin (1977). In the speeches of the individuals, we can perceive that at the same time that we observe the domicile is a place of affective exchanges, contending particularitities that identify each individual with its background, and its subjectivity. In it can happen stereotyped relations, favoring an increase of the illness by means of proper attitudes perpetuated by the family. It is the crystallization of madness, of the manicomial thought that followed each familiar scene. The present study suggests that the domiciliary assistance in mental health represents an important instrument in approaching the individual with mental disturbance and his/her family. This allows the professionals to understand the familiar dynamics in its proper environment, verifying possibilities and/or difficulties of involvement of the family in the treatment and the accompaniment of the user, aiming at his/her reintegration in the family and in the society.

Ao ingressar no curso de enfermagem, muitos estudantes apresentam atitudes negativas em relação aos transtornos mentais e as pessoas com esses diagnósticos. Diversas definições sobre atitude têm sido apresentadas, mas existe uma concordância de que a atitude pode ser considerada como uma predisposição para responder, de maneira consistente favorável ou desfavorável, em relação a um dado objeto. Estudos realizados com indivíduos adolescentes nos Estados Unidos da América, Austrália e Inglaterra, sobre a introdução de disciplinas referentes aos transtornos mentais, apontaram um melhor entendimento desses transtornos pelos alunos, que apresentaram, também, atitudes menos estigmatizadas sobre eles. Portanto, saber mais sobre essas atitudes é particularmente importante, principalmente relativo ao aluno de enfermagem, tendo em vista que muitos estudos têm apontado as dificuldades dos enfermeiros para lidar com pessoas que apresentam alterações psíquicas ou comportamentais em diferentes serviços de assistência psiquiátrica. O objetivo deste estudo foi avaliar a evolução das atitudes de alunos de enfermagem frente aos transtornos mentais durante sua formação acadêmica e verificar a influência da opção de escolha da profissão e das áreas de atuação específicas, nessas atitudes. Para isso, alunos de quatro turmas de enfermagem do Curso Bacharelado em Enfermagem da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, durante os quatro anos de sua formação responderam a um Formulário de Dados Pessoais, Opção de Escolha da Profissão e Preferência por Área de Atuação Específica e a Escala de Opiniões sobre os Transtornos Mentais. Os resultados mostraram que a faixa etária predominante foi de 17 a 21 anos, predomínio do sexo feminino, diferenças estatisticamente não significantes em relação à opção por área de atuação, embora se suponha que houveram mudanças dessas opções ao longo do curso. No que se refere ao curso de enfermagem ser a primeira opção de escolha no vestibular, 43% dos alunos não tinham a enfermagem com sua primeira escolha de curso, enquanto que 57% dos alunos tinham a enfermagem como escolha de profissão. Quanto às atitudes dos alunos frente aos transtornos mentais e as pessoas com esses diagnósticos, foi observado que ao longo do curso as atitudes dos alunos apresentaram uma evolução positiva, gradual e lenta, estatisticamente significante entre os alunos no primeiro e no quarto ano, mas estatisticamente não significante entre os alunos ano a ano. Desta forma, pode-se concluir que a instrução acadêmica, particularmente as provenientes de disciplinas da área de enfermagem psiquiátrica, levou a evolução positiva das atitudes desses alunos frente aos transtornos mentais e as pessoas com esses diagnósticos, que esta evolução ocorreu de forma lenta e progressiva e não teve relação com opção por área de atuação. Isso é extremamente importante, pois atitudes positivas por parte dos profissionais de enfermagem certamente influenciam favoravelmente o processo terapêutico desenvolvido às pessoas com diagnósticos de transtornos mentais, e, disciplinas da área de enfermagem psiquiátrica e de saúde mental no curso de graduação em enfermagem, ministradas por professores altamente capacitados, são fundamentais para garantir as referidas atitudes / When they enter the nursing course, many students have negative attitudes towards mental disorders and people with these diagnoses. Different definitions of attitudes have appeared, but there is a consensus that attitude can be considered a predisposition to react consistently favorably or unfavorably towards a given object. Studies involving adolescents in the United States, Australia and England on the introduction of subjects on mental disorders appointed the students\' better understanding of these disorders, who also presented less stigmatized attitudes towards them. Therefore, knowing more about these attitudes is particularly important, mainly regarding nursing students, as many studies have appointed nurses\' difficulties to cope with people presenting mental or behavioral problems at different psychiatric care services. The objective in this study was to assess the evolution in nursing students\' attitudes towards mental disorders in their academic education and to verify the influence of professional choice and specific activity areas on these attitudes. Therefore, students from four class groups of the Nursing Bachelor course at the University of São Paulo at Ribeirão Preto College of Nursing answered a Personal Data, Professional Choice and Preference of Specific Activity Area Form and the Opinion Scale on Mental Disorders during the four years of their course. The results showed that the predominant age range was between 17 and 21 years, mainly women, statistically non-significant differences in the activity area chosen, although changes in these options are supposed to exist along the course. As to nursing as the preferred choice on the entry exam, nursing was not the first choice for 43% of the students, while 57% of the students had chosen nursing as their profession. Concerning the students\' attitudes towards mental disorders and people with these diagnoses, it was observed that, along the course, these students\' attitudes evolved positive, gradual and slowly, with a statistically significant difference between first and fourth-year students but no statistical significance among the students year by year. Thus, it can be concluded that academic education, particularly resulting from psychiatric nursing subjects, led to the positive evolution of these students\' attitudes towards mental disorders and people with these diagnoses, that this evolution happened slow and progressively and was unrelated with the activity area chosen. That is extremely important, as nursing professionals\' positive attitudes certainly exert favorable influence on the therapeutic process involving people diagnosed with mental disorders. Psychiatric nursing and mental health subjects in undergraduate nursing courses, taught by highly trained lecturers, are fundamental to guarantee these attitudes