Dissertations / Theses on the topic 'Mental health|Nursing|Public health'

Background: In low- and lower-middle-income countries (LLMICs), 16% of pregnant and 20% of postpartum women experience common maternal mental health disorders, far surpassing global rates of 10% and 13%, respectively. Maternal depression is associated with poor perinatal outcomes, including maternal, newborn, and early childhood outcomes. The Edinburgh Postnatal Depression Scale (EPDS) was recently validated in Rwanda, yet maternal depression prevalence and associated factors are unknown.

Objectives: The primary objectives of the study are to describe antenatal depression prevalence and its associated factors.

Methods: This is a secondary analysis of the Preterm Birth Initiative-Rwanda randomized controlled trial of group antenatal care (ANC) data obtained between June 2017 – June 2018. Thirty-four health centers in five districts were selected. At each health center, convenience sampling was used to ascertain EPDS scores from the first five women to present for initial ANC each calendar month. A cut-off EPDS score of ≥13 was used to define maternal depression. Multi-level simple and multiple logistic regressions were used to explore associated factors of antenatal depression. The study obtained informed consent and was approved by the Rwanda National Ethics Committee and the University of California, San Francisco institutional review board.

Results: Twenty-percent of women in the antenatal period screened positive for depression. In the adjusted multi-level multiple logistic regression model, family social support, age, ability to communicate with partner, and perceived stress were significantly associated with antenatal depression.

Conclusions: Antenatal and postpartum depression prevalence in Rwanda exceeds LLMIC averages. The authors recommend universal depression screening and treatment for pregnant and postpartum women.

Background: Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically.

Purpose: The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified.

Methods: In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level.

Results: The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.

Individuals diagnosed with dementia make up the majority of the population in skilled nursing facilities (SNFs). Certified Nursing Assistants (CNAs) are the primary caretakers of older adults living in SNFs. The purpose of this grant project was to write a proposal for funding to provide Person-Centered Care (PCC) training to help CNAs enhance their skills to better enhance the quality of life of older adults living with dementia in SNFs.

The goal of PCC training is to help CNAs better understand the signs and symptoms of Alzheimer’s and dementia, improve communication skills, and provide strategies to manage the behavioral and psychological symptoms of dementia. Previous research on PCC has found it to be effective in improving the quality of care of older adults who are affected by dementia and who are living in nursing homes.

Actual submission or funding of the grant was not required for the successful completion of this project.

It is widely supported that there are significant, positive relationships between the occurrence of some mental health symptoms and physical illnesses. Research indicates that the burden experienced by those with a physical and mental illness are magnified compared to individuals who do not experience an illness. More specifically, one of the burdens experienced by individuals is the monetary burden of affording the necessary health services to properly manage their illness. This study attempts to reveal a difference between mental health symptom count for individuals who do and do not experience difficulty affording health care for their physical problems. The first hypothesis states that the indication of medical problems will be associated with greater mental health symptoms. The second hypothesis states that the relationship between medical concerns and mental health symptoms will be moderated by difficulty affording health services. Lastly, the third hypothesis states that the indication of unhealthy behaviors, such as smoking and irregular exercise, will be associated with greater mental health symptoms. All data used in this study is archived data that was gathered by the Institute for Rural Health’s Mobile Health Units during free community health fairs from September 2012 to February 2014. The first hypothesis was supported because the incidence rate of mental health symptom count was increased with the presence of some physical problems. These findings supported previous research that indicated that the presence of physical illness increases the chance of developing a mental illness. The study results revealed that the second hypothesis was not supported since difficulty affording health services did not have a significant effect on the relationship between indicated physical illnesses and mental health symptom count. Previous research reports that there is monetary burden for individuals who experience a physical or mental illness when accessing appropriate health services. This research aimed to explore if that burden would significantly affect the relationship of those illnesses. Lastly, the third hypothesis was supported because mental health symptom count incidence rate was found to increase for individuals partaking in negative health behaviors, such as smoking, and decrease for individuals partaking in positive health behaviors, such as exercising.

The purpose of this study was to investigate the Hardiness level of battered women residing at a South Florida shelter and to investigate if there was a major difference in the hardiness level of women who were first time in a shelter as opposed to those who had been previously in shelters. Using a descriptive design, the Health-Related Hardiness Scale was given to 50 battered women residing at a shelter. The results confirmed our hypothesis that proposed that hardier women would leave their abusive environment. The total hardiness of these women was (M= 148.86 SD= 22.64). Furthermore, no major differences were found among the two groups, the total hardiness for the women who been in shelters before was (M=150.17 SD= 26.06) and for those who were first time users was (M=148.45 SD= 21.81). The results provide a baseline to begin to understand the role that hardiness play in the lives of battered women. These findings and future studies may have implications for breaking the cycle of domestic violence.

Behavioral complications, such as Inappropriate Sexual Behavior (ISB), are developed in many cases of dementia. Sex, even for those with dementia, is a primary need, but supporting this need in an appropriate manner may overwhelm caregivers. The purpose of this project was to create a curriculum for Dementia Friendly Community (DFC) residential caregivers on the topic of sexual expression among older adults with dementia. By offering training on sexuality and dementia it is expected that caregivers can increase the DFC's provision of quality of life. This project presented an assessment tool and plan on how to manage ISB, activities relevant to the discussed topics, and curriculum evaluation forms. Expert reviewers offered recommendations to further improve the curriculum's quality.

A preocupação com a necessidade manifesta de inclusão no processo de produção da vida material por intermédio do trabalho, de uma parcela da população usuária de serviço de saúde mental, deu origem a este estudo. O cenário é o Centro de Atençao Psicossocial Prof. Luiz da Rocha Cerqueira (CAPS), estrutura de atenção à saúde mental substitutiva ao modelo hospitalocêntrico, que opera um projeto terapêutico construído de forma coletiva, a partir das necessidades dos usuários (indivíduos e famílias). Para a apreensão do significado do trabalho e do exercício de trabalhar utilizou-se o referencial do materialismo histórico e dialético, fundamentado no conceito de reabilitação psicossocial e se fez por intermédio da análise dos discursos dos usuários. Pretendeu-se compreender o significado da atividade produtiva do usuário-trabalhador vinculado a um dos Projetos Especiais desenvolvidos no CAPS - a copiadora - como instrumento de intervenção no seu poder de contratualidade social, aqui entendido como uma ampliação da sua capacidade de autonomia e emancipação. A finalidade é ser mais uma peça na construção do arsenal desse modelo de assistência à saúde mental, particularmente no que concerne à reconstrução da prática de enfermagem numa perspectiva transformadora em ralação à forma tradicional de mantenedora da ordem institucional. Os resultados indicam que os usuários possuem representações contraditórias acerca de algumas categorias empíricas, porém, de um modo geral, evidenciam a compreensão do trabalho como um instrumento que lhes possibilita acessar o campo dos direitos sociais. Essa outra condição dos sujeitos pode ser observada pelas mudanças internas e externas que experimentam, além de indicar um movimento de superação da condição anterior de usuário-trabalhador (doente que trabalha) para a de trabalhador-usuário (sujeito doente que pode trabalhar).
This study was born out of the preoccupation with the necessity manifested by a portion of the population which uses the mental health service linked to the process of production of material life through work. The site was the Prof. Luiz da Rocha Cerqueira Center for Psycho-Social Care (CAPS), which operates a therapeutic project assembled in a collective format, based on the needs of the users (individuals and families), structured to offer mental health care in lieu fo a hospital centered setting. Th intention was to understand the significance and practice of work using historic and dialetic materialism as a reference, based upon the concepts of psycosocial reabilitation and was performed throug the analysis of users' discourses. The goal was to aspire to understand the significance of user-worker production activity linked to one of the Special Projects developed by CAPS - The Photocopier - as an intervention instrument within the framwork of the social contract, thath is understood as an amplification of one capacity for autonomy and emancipation. The final objective is being an additional piece in the construction of an arsenal of mental health assistence's models, particulary when it concerns the reconstruction of the practice of nursing as a transforming perspective in relation to the tradition form of maintaining institutional order. The results indicate that users have contradictory representations in regard to somo empirical categories, nevertheless, in general manner, there's evidence of comprehension of work as an instrument that enables them access to social rights. This can be observed by internal and external changes experimented and besides by a movement of overcoming the previous condition of user/worker (patient who works) to worker/user (patient able to work).

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.

Este estudo teve como objetivo analisar a influência de variáveis sociodemográficas, econômicas, comportamentais e de saúde reprodutiva sobre a saúde mental de mulheres em idade fértil, residentes na zona rural do município de Uberaba-MG. Trata-se de um estudo observacional, com delineamento transversal, realizado com 280 mulheres com idade entre 15 e 49 anos e residentes na zona rural do município de Uberaba, Minas Gerais, Brasil, entre outubro de 2014 e maio de 2015. A coleta de dados foi realizada no domicílio das mulheres participantes, por meio dos instrumentos de caracterização sociodemográfica e econômica; comportamental; de saúde reprodutiva - ginecológica e obstétrica; Self-Reporting Questionnaire; Inventário de Ansiedade Traço-Estado e Inventário de Depressão de Beck. Os dados foram analisados no software Statistical Package for Social Sciences, versão 20.0. Utilizamos a análise univariada, por meio da distribuição de frequências absolutas e relativas, e medidas de tendência central, desvio-padrão e medidas de variação. Para a análise bivariada e multivariada dos dados, utilizamos os testes estatísticos: Qui-Quadrado, razões de prevalência, razões de chances de prevalência brutas, Teste t-Student, correlação de Pearson, regressão logística múltipla e regressão linear múltipla. As participantes do estudo tinham em média 33,6 anos e sete anos de estudo. A maioria considerou-se branca, era casada ou em união estável, católica, considerada do lar, sem renda individual mensal, renda individual de um salário-mínimo, renda familiar entre um e dois salários-mínimos, o companheiro era o principal provedor da família e residiam no domicílio de duas a quatro pessoas. A maioria não realizava atividade física, não tinha doença crônica, não fumava, não fazia uso de bebidas alcóolicas e de drogas ilícitas, tinha atividades de lazer e boa convivência com o companheiro. A maioria usava métodos anticoncepcionais, entre eles a laqueadura tubária e o hormonal oral. O principal local de aquisição dos contraceptivos foi \"outros\" (hospital e ambulatório) e a farmácia. A maioria frequentou o ginecologista, realizou Papanicolau, palpação das mamas e mamografia e não teve doença sexualmente transmissível. Apresentaram média de 2,8 gestações, 1,5 aborto, e 2,5 filhos vivos. A maioria não planejou a última gravidez e realizou pré-natal. A prevalência de transtorno mental comum foi de 35,7%. Os escores médios dos sintomas de ansiedade-estado e ansiedade-traço foram de 38,3 e 41,4 pontos, respectivamente, e o escore médio dos sintomas de depressão foi de 8,3 pontos entre as participantes. Após se ajustar ao modelo de regressão logística múltipla, a convivência ruim com o companheiro e a escolaridade associaram-se com o transtorno mental comum. Os modelos de regressão linear múltipla ajustados identificaram que aquelas que referiram convivência ruim com o companheiro e maior número de filhos tiveram maiores escores dos sintomas de ansiedade-estado e ansiedade-traço e as com menor idade, maior escore dos sintomas de ansiedade-traço. Aquelas com convivência ruim com o companheiro e maior número de filhos apresentaram maior escore dos sintomas de depressão. Ressalta-se a importância da transformação da prática de trabalho em saúde, incorporando ações efetivas relacionadas à saúde mental e reprodutiva das mulheres rurais
This study was intended to analyze the influence of sociodemographic, economic, behavioral and reproductive health variables on the mental health of women of childbearing age, living in the rural area of Uberaba-MG. This is an observational study, with cross-sectional design, involving 280 women aged between 15 and 49 years, living in the rural area of the city of Uberaba, Minas Gerais, Brazil, between October 2014 and May 2015. Data collection took place in the homes of the participating women, through the instruments of sociodemographic and economic; behavioral; reproductive health - gynecological and obstetrical characterization; Self- Reporting Questionnaire; State-Trait Anxiety Inventory and Beck\'s Depression Inventory. Data were analyzed by means of the Statistical Package for Social Sciences software, version 20.0. We used univariate analysis, through the distribution of absolute and relative frequencies, measures of central tendency, standard deviation and measures of variation. In order to perform the bivariate and multivariate analysis of data, we used the following statistical tests: Chi-Square, prevalence ratios, gross prevalence odds ratios, Student\'s t-test, Pearson\'s correlation, multiple logistic regression and multiple linear regression. Study participants had an average of 33.6 years and seven years of schooling. Most of them identified themselves as white, married or in a stable union, Catholics, housewives, without monthly individual income, with individual income of a minimum wage, with family income between one and two minimum wages, and they lived in households composed of two to four people, where their partners were the main family providers. Most of them did not perform physical activity, did not have chronic diseases, did not smoke, did not use alcoholic drinks and illicit drugs, had leisure activities and a good coexistence with their partners. Most of them used contraceptive methods, including tubal sterilization, as well as oral and hormonal medicines. The main places of acquisition of contraceptives were \"others\" (hospital and outpatient clinic) and the drugstore. Most of them attended the gynecologist, underwent Pap smear, breast palpation and mammography, and did not have sexually transmitted diseases. They had an average of 2.8 pregnancies, 1.5 abortions and 2.5 children born alive. Most of them did not plan the last pregnancy, but performed prenatal care. The prevalence of common mental disorder was 35.7%. The average scores of the state anxiety and trait anxiety symptoms were 38.3 and 41.4 points, respectively, and the average score of the depression symptoms was 8.3 points among the participants. After being adjusted to the multiple logistic regression model, the bad coexistence with the partner and the schooling were associated with the common mental disorder. The adjusted multiple linear regression models identified that those who reported a bad coexistence with the partner and a greater number of children had higher scores of the state anxiety and trait anxiety symptoms, and those with younger ages had a higher score of the trait anxiety symptoms. Those with bad coexistence with the partner and greater number of children showed a higher score of depression symptoms. It is worth emphasizing the importance of the transformation of the health work practice, thus incorporating effective actions related to the mental and reproductive health of the rural women

As African American (AA) breast cancer survivors live longer with the disease, much attention should be directed to quality of life and factors influencing it. An understanding of survivors' belief that God controls their health and their social support needs is necessary as an effort to develop health care services and programs that are culturally sensitive. This study was the first to explore the association between an individual's belief that God controls their health, social support and quality of life among AA breast cancer survivors. The purpose of this study was to examine the relationship between social support, God Locus of Health Control (GLHC) and quality of life (QoL) among the survivors residing in Illinois. This study's alternative hypotheses predicted after controlling for age, location of residence, marital status, and time since diagnosis, social support and GLHC, combined and individually, would positively correlate to QoL for AA breast cancer survivors.

The study used a descriptive, correlational and quantitative design by testing the variables using hierarchical multiple regression and Pearson correlation. A convenience sample of 92 AA women was recruited from a community hospital, a Federally Qualified Health Centers, a beauty shop, two support groups, a member association that advocates for health care disparities, and local newspapers. Quantitative measures included Social Support Questionnaire (Northouse, 1988), GLHC scale (Wallston et al., 1999), Quality of Life Index - Cancer Version III (QLI - CV III) (Ferrans, 1990), and Demographic Characteristics form created by researcher.

Results concluded QoL was not affected by social support and GLHC, combined, and GLHC, individually. However, social support was a predictor of QoL. Statistically significant relationships were found between social support, QoL and its domains: a) health and functioning subscale, b) social and economic subscale, c) psychological/spiritual subscale and d) family subscale. Statistically significant relationships were not found between GLHC and QoL and its domains. The mean score for social support and GLHC scales were low compared to prior study results. The QLI - CV III mean score was moderately high compared to other study results.

Additional findings concluded women residing in the suburb had statistically significant higher mean QoL than those living in the rural or urban areas of Illinois. Also, married women in this sample had a higher mean QoL than unmarried women. Although AA breast cancer survivors' QoL was not increased by their belief that God controlled their health and the mean social support score was low, the study results provided valuable information for future research and the development of social support programs that are culturally sensitive.

Alarming rates of suicide among production farmers have prompted researchers to investigate factors associated with depressive symptoms among this population. Aspects of farm life and farming can contribute to higher levels of depressive symptoms. Higher levels of depression can also increase an individual’s risk of injury and development of chronic disease, impacting overall quality of life. Despite the approximate 3.5 million farm women in the U.S., current research has focused on the male farmer. Men and women have different responses to stressors, and women in general have a higher prevalence of depressive symptoms. Farm women can be further subjected to stressors associated with farming as an occupation and their gendered role within the agrarian culture. The large number of farm women affected, the relationship of chronic depressive symptoms on health and quality of life, the lack of current research available, and the rising rates of suicide and depressive symptoms among farmers emphasize the need for further investigation of farm women and depressive symptoms. The overall purpose of this dissertation was to 1) explore the current state of the science of farm women and depressive symptoms and identify variables commonly associated with depressive symptoms among farm women, 2) identify variables influencing levels of depressive symptoms within farm women aged 50 and over and identify differences between those women with high depressive symptoms and those with low depressive symptoms, and 3) establish the reliability and validity of the 12-item John Henry Active Coping Scale (JHAC-12) within the sample. A systematic review of the literature revealed that there is a need for more research with strong study designs regarding farm women and depressive symptoms within the context of their environment, culture, and occupation. The review identified multidimensional factors from farm women’s lives that influence their level of depressive symptoms. Farm women’s ethnicity, the agrarian culture, family and social relations, as well as specific demographics were identified as key variables associated with an increased risk of higher depressive symptoms. Because of the identification of the multi-dimensional factors, the use of the Modified Biopsychosocial Model (MBPS) was selected as a framework for continued research as it depicts the interrelationship between the factors and their influence on farm women’s depressive symptoms. The MBPS was applied to data from 358 farm women aged 50 and older from a larger cohort study, and a secondary analysis was performed. Multivariable binary logistic regression was used to identify those variables associated with depressive symptoms among farm women. Depressive symptoms were predicted by race/ethnicity, years of education, adequacy of income for vacation, perceived health status, perceived stress score, and active coping score. Significant differences between those farm women with low CES-D score (< 16) and those with high CES-D score (≥ 16) were noted. Race/ethnicity, years of education, adequate income for vacation and retirement, reported health status of fair or better, perceived stress score, active coping score and satisfaction from farm work were all significant between groups. Women who were non-White, had less education, reported income not adequate for vacation or retirement, reported poor health, higher levels of perceived stress, lower levels of active coping and who were not satisfied with farm work were more likely to be in the high CES-D group. A principal component analysis with direct oblimin rotation in a sample population of older farm women (n=458) identified two dominant themes of the JHAC-12: “commitment to hard work” and “self-efficacy.” The instrument component structure reflects the culture of the agrarian society. In the two-component solution, 2 items were removed from the scale after revealing low values of communality (< .3). The item reduction resulted in more refined scale, increasing explained variance by 4.1% with less items. Cronbach’s of the JHAC-12 (α = .78) and JHAC-10 (α = .76) indicated high levels of reliability for both scales. Rotation of the items resulted in a simple structure with high loadings within items, no major-cross-loadings and little correlation between components (r = .29), supporting both convergent and discriminant validity in this population. The ability of the JHAC to encompass the socio-culture aspects of active coping among farm women and obtain a quantifiable result supports the JHAC as an important tool to utilize in future studies of depressive symptoms and farm women with use of the JHAC-10 in future studies of farm women decreasing the burden of the participants. Although there are limitations within each document, each section adds to the science of farm women and depression symptoms and provides directions for future research. The major gaps identified were: 1) the need for current research with stronger study designs, 2) studies of farm women across their life spans, 3) the need for focused studies among minority and migrant women, 4) an understanding of farm women and their leisure time, and 5) a broader application of the MBPS theory to include a large number of social variables shown to be associated with farm women and depressive symptoms that were not available in the dataset.

In 2010, men who have sex with men (MSM) represented 4% of the population in the United States (US) and accounted for 78% of all new Human Immunodeficiency Virus (HIV) infections among Hispanic men. Hispanic men who have sex with men (HMSM) accounted for the third largest number of new HIV infections (6,700 cases). This dissertation explored the effects of age, loneliness, substance use, depression, and social support on high risk sexual behaviors that predispose middle aged HMSM to sexually transmitted infections (STIs) and HIV infection risk. A sample of 150 urban HMSM aged 40 to 65 were surveyed in this study. Singer’s Syndemics Theory (1996) provided this study’s theoretical framework. Data was analyzed using a variety of parametric and non-parametric statistics. Loneliness, social support, depressive symptoms, alcohol/drug use, and sexual risk behaviors were found to have an influence on HIV infection status in this study. Partner status, religious affiliation and age did have an influence on alcohol use in this study’s participants. Also, participants with increased age had increased depressive symptoms in this study. Lastly, depressive symptoms, substance use, social support, and loneliness did have an influence on sexual risk behaviors in this study’s participants, specifically alcohol use and illicit drug use. The findings from this study should be used to assess, diagnose, plan, implement and evaluate prevention strategies geared to reduce STI and HIV infection in this population. Future research should build on these findings and develop tailored risk reduction interventions addressing HMSM, with particular attention to the understudied age group of the middle aged HMSM.

The United States experiences opioid addiction at epidemic levels. In 2012, the National Institute of Drug Abuse reported that 23.1 million Americans were in need of addiction treatment services, although only 2.5 million were enrolled in treatment. Following an amendment to the Drug Addiction Treatment Act of 2000 (Public Law 106-310), advanced practice nurses were qualified as providers who could bridge the healthcare gap in treatment access. The purpose of this project was to determine the interest of advanced practice nurses in (a) prescribing buprenorphine and (b) establishing guidelines that would allow them to do so. This quantitative project used a 10-question Internet-based survey with a convenience sample of 95 nurses (recruited online) who were currently practicing in advanced nursing roles. Social media platforms, including Facebook, were used to recruit participants. The survey included questions about expanding the scope of practice in addiction treatment and establishing guidelines that would allow nursing knowledge and expertise to be used in outpatient opiate addiction treatment. Critical social theory and Kingdon's theory of policy analysis were applied to support the project. The Survey Monkey data analysis tool was used to generate descriptive statistics, which demonstrated respondents' support for an expanded scope of practice. If the recommendations of this project are adopted by national legislation, increased accessibility to addiction treatment services will save millions of dollars in justice system, healthcare system, employment, and societal costs. Nursing policy advocates nationally can apply these results to support efforts to expand scope of practice to include prescribing buprenorphine.

Bakgrund: Psykisk ohälsa hos barn är ett växande folkhälsoproblem. Att upptäcka och sätta in insatser för att förebygga psykisk ohälsa hos barn är ett av barnhälsovårdens mål. Föräldrastödsmetoder för att förebygga psykisk ohälsa är en insats på folkhälsoområdet som lämpar sig väl för ett evidensbaserat förhållningssätt. Familjen är en av de viktigaste faktorerna för att förebygga utvecklingen av psykisk ohälsa hos barn. Syfte: Syftet var att belysa effekten avmanualbaserade föräldrastödsmetoder för prevention av psykisk ohälsa hos barn.Metod: Strukturerad litteraturstudie baserad på 15 vetenskapliga artiklar. Studien inkluderar artiklar där föräldrastödsintervention med metoderna Active parenting, COPE, Komet och Marte Meo utvärderas. Resultat: I resultatet framkom följande effekter: a/ Förbättring för föräldrarna gällande förstärkning av föräldrarollen, psykisk hälsa och ökad tilltro till den egna förmågan i rollen som förälder, selfefficacy. b/ Barnens beteendeproblem förbättrades signifikant. c/ Påverkan på interaktionen mellan förälder och barn visade sig i form av en förbättrad relation.Slutsats: Resultatet från studien kan ligga till grund för att utveckladistriktssköterskans familjefokuserade arbete för prevention av psykisk ohälsa hos barn. Föräldrastödsmetoderna Active Parenting, COPE, Komet och Marte Meo resulterade i goda effekter för förstärkning av föräldrarollen, förbättring av föräldrars psykiska hälsa, förbättring av barns beteende samt förbättrad relation mellan förälder och barn.

Background: Mental health problems in childhood are an increasing problem for public health. A purpose for primary care in Sweden is to screen and prevent mental health problems for children. Parent training to prevent mental health problems is an intervention convenient for an evidence based attitude. The family is one of the most important factors to prevent mental health problems in childhood. Aim: The aim of the study was to illustrate parent training based on manuals as prevention for mental health problems in childhood. Method: A structured literature study based on fifteen scientific articles was performed. The study included articles with evaluation of parent training intervention (Active Parenting, COPE, Komet and Marte Meo). Result: The result showed following categories a/ The parents improved considering the parent-role, the mental health and the self-efficacy. b/ The children significant improved considering behaviour problems. c/ The interaction between parent and child was improved.Conclusion: The results of the study could underlie the work for nurses in primary care to develop family-focused intervention to prevent mental health problems in childhood. Parent training resulted in good effects considering the parent-role and the mental health of the parents.The children improved considering behaviour problems and the relationship between parent and child was also improved.

The purpose of this study was to compare two groups of nurses's attitudes towards the elderly and the knowledge base of the nurses as to signs, symptoms and interventions with depression and dementia in the elderly. The theoretical framework for this study was Oren's (1985) self-care deficit theory. Attitude was measured using the Koan Attitude Toward Old People Scale (Koan, 1961) and knowledge was measured using a scale developed by (Myton, Allen, and Baldwin, 1991).The population studied was registered nurses working at these state hospitals in a midwestern state and agency nurses from four agencies that provide staff coverage at these hospitals. The convenience sample consisted of state nurses (n=65) and agency nurses (n=38). A cover letter explaining confidentiality and voluntary participation was attached to each survey. Completion of the survey constituted consent to participate in the study. There were no identified risks related to participation in the study.The study did not identify significant differences between groups in any of the variables involving attitude toward the elderly, ability to differentiate signs, symptoms, and interventions for dementia and depression in the elderly. Both groups were able to correctly identify signs, symptoms and interventions for dementia and depression about one-half the time. The treatment modalities are different for dementia and depression. The problem is significant because if signs, symptoms and interventions are not identified correctly the patient will not be assisted toward recovery and self-care may decrease. The recommendation for increased inservice education on gerontological nursing are applicable to both groups.
School of Nursing

In the US, one in every eight deaths is due to an obesity-related chronic health condition (ORCHC). More than half of African American women (AAW) 20 years old or older are obese or morbidly obese, as are 63% of menopausal AAW. Many have ORCHC that increase their morbidity and mortality and increase health care costs. In 2013, 42.6 percent of AAs living in South Carolina (SC) were obese. The purpose of this cross-sectional study was to identify the cognitive, behavioral, biological, and demographic factors that influence health outcomes (BMI, and ORCHC) of AAW living in rural SC. A sample of 200 AAW (50 in each of the 4 groups of rurality by menopausal status), 18-64 years, completed the: Menopausal Rating Scale (symptoms); Body Image Assessment for Obesity (self-perception of body); Mental Health Inventory; Block Food Frequency Questionnaire; Eating Behaviors and Chronic Conditions, Traditional Food Habits, and Food Preparation Technique questionnaires – and measures for Body Mass Index. Most rural, and premenopausal AAW were single and not living with a partner. Premenopausal women had significantly higher educational levels. Sixty percent of AAW had between 1 and 5 ORCHC. Most AAW used salt based seasonings, ate deep fried foods 1 to 3 times a week, and ate outside the home 1 to 3 times a month. Few AAW knew the correct daily serving for grains and dairy, and most consumed less than the recommended daily serving of fruits, vegetables and dairy. Morbidly obese AAW used more traditional food preparation techniques than obese and normal-weight AAW. Rural, and menopausal AAW had significantly higher morbid obesity levels, consumed larger portions of meats and vegetables, and reported more body image dissatisfaction than very rural AAW, and premenopausal AAW, respectively. Controlling for socioeconomic factors the relationships between perceptions of body images, psychological distress, and psychological wellbeing remained significant for numbers of ORCHC

As gerontologists may know, there are a great deal of studies and a variety of academic literature on the misuse of alcohol and prescription medication amongst the elderly population. While there is a plethora of information on alcohol and prescription misuse, there is little reported data about the prevalence of other substance misuse experienced by this population. This study aims to help to fill that gap in the data by using quantitative methods to describe the scope of substance abuse of individuals 55-years or older. This study utilizes data from the Treatment Data Set Admission (TEDS-A). The TEDS-A is a public data set which includes admissions data from multiple substance abuse treatment facilities associated with the Substance Abuse and Mental Health Services Association (SAMHSA). This is a regional study, therefore this study focuses only on individuals 55-years or older who have been admitted into substance abuse treatment facilities in the state of California in the year 2014. The TEDS-A is a data set that is supported and conducted by members of SAMHSA. Most of their public data sets, including the TEDS-A, can be accessed on their website (https://www.datafiles.samhsa.gov/study/treatment-episode-data-set-admissions-teds-2014-nid16949). The data available in the TEDS-A involves a number of admission questions, including demographic data, reasons for intake, primary through tertiary substance concerns, questions regarding social status, information on medical insurance, and more. This study looks at the descriptive frequencies of the use of alcohol, crack/cocaine, marijuana/hashish, heroin, other opiates & synthetics, methamphetamine, and other substances. The study includes 13,512 cases, of which 9966 (73.8%) of cases were male, 3539 (26.2%) were female, and 7 (0.1%) were missing and/or invalid. The results of the data suggests that, while alcohol abuse is a problem, those over 55 are admitted into substance abuse clinics for many other reasons, not just alcohol abuse.

Este estudo teve como objetivo verificar as repercussões da violência por parceiro íntimo, ocorrida durante a atual gestação, na saúde mental de mulheres usuárias de um serviço de atendimento pré- natal. Trata-se de estudo observacional, com delineamento transversal, desenvolvido no Centro de Referência da Saúde da Mulher de Ribeirão Preto, São Paulo, Brasil, com 358 gestantes, em acompanhamento pré-natal no serviço, entre maio de 2012 e maio de 2013. A coleta dos dados aconteceu no dia da primeira consulta de pré-natal das gestantes no serviço, por meio de sete instrumentos: i. instrumento de caracterização sociodemográfica, econômica e comportamental; ii. instrumento de caracterização obstétrica; iii. Edinburgh Postnatal Depression Scale; iv. Post-Traumatic Stress Disorder Checklist - Civilian Version; v. Escala de Ideação Suicida de Beck; vi. Inventário de Ansiedade Traço-Estado; vii. Instrumento de identificação e caracterização da violência. Os dados foram analisados no software Statistical Package for Social Sciences, versão 21.0. Utilizamos as análises univariada, bivariada e multivariada dos dados, por meio da distribuição de frequências absolutas e relativas, medidas de tendência central e de variabilidade, os testes estatísticos Qui- quadrado e Teste t, razões de prevalência, razões de chances de prevalência, regressão logística múltipla e regressão linear múltipla. No momento da coleta dos dados, as participantes tinham, em média, 25 anos de idade e 9,5 anos de escolaridade formal. A maioria considerou-se não branca, era solteira, coabitava com o parceiro íntimo, possuía alguma religião, não exercia atividade remunerada e possuía renda familiar mensal média de 2,6 salários-mínimos, sendo o parceiro o principal provedor da família. A maioria não fumou, não consumiu bebidas alcoólicas e não fez uso de drogas ilícitas, durante a atual gestação. A amostra caracterizou-se por mulheres multigestas e nulíparas que, em sua maioria, possuíam filhos vivos e não haviam abortado. A prevalência da violência por parceiro íntimo, durante a atual gestação, foi de 17,6%. As prevalências dos indicativos das presenças de transtorno depressivo, do diagnóstico de transtorno de estresse pós-traumático e de ideação suicida foram de 28,2%, 17,0% e 7,8%, respectivamente. Os escores médios das gestantes nas escalas ansiedade-traço e ansiedade- estado foram de 39,1 e 42,5 pontos, respectivamente. Após se ajustar aos modelos de regressão logística múltipla, a violência por parceiro íntimo, durante a gestação, associou-se com o indicativo da presença de transtorno depressivo, com o indicativo do diagnóstico de transtorno de estresse pós- traumático e com o indicativo da presença de ideação suicida. Os modelos de regressão linear múltipla ajustados evidenciaram que as mulheres em situação de violência por parceiro íntimo, na atual gestação, apresentaram maiores escores dos sintomas de ansiedade-traço e estado do que aquelas que não sofreram esse tipo de violência. Portanto, reconhecer a violência como um fator de risco clinicamente relevante e identificável para a ocorrência de transtornos mentais, durante a gestação, pode ser um primeiro passo na prevenção destes problemas. Idealmente, as respostas devem incluir os setores da saúde, assistência social e justiça, no sentido de cumprir a obrigação do Estado para eliminar a violência contra a mulher
The objective of this study was to verify the repercussions of violence by the intimate partner during the present pregnancy on the mental health of women users of a prenatal care service. This is an observational study, performed with a cross-sectional design, at the Reference Center for Women\'s Health of Ribeirão Preto, São Paulo, Brazil, with 358 pregnant women following prenatal care at the referred service between May 2012 and May 2013. Data collection was performed on the day of the women\'s first prenatal appointment at the service, using seven instruments: i. instrument for sociodemographic, economic and behavioral characteristics; ii. instrument for obstetrical characteristics; iii. Edinburgh Postnatal Depression Scale; iv. Post-Traumatic Stress Disorder Checklist - Civilian Version; v. Beck Scale for Suicidal Ideation; vi. State-Trait Anxiety Inventory; vii. instrument for violence identification and characterization. The data were analyzed using Statistical Package for Social Sciences, version 21.0. Furthermore, univariate, bivariate and multivariate analyses of the data were performed, by absolute and relative frequency distribution, central and variability tendency measures, the Chi-square and T-Test statistical tests, prevalence ratio, prevalence odds ratio, multiple logistic regression and multiple linear regression. At the moment of data collection, the participants\' mean age was 25 years, and they had a mean of 9.5 years of formal education. Most women reported having the following characteristics: skin color different from white; single; living with the intimate partner; having some kind of religion; unemployed; mean monthly family income of 2.6 Brazilian minimum wages; partner was the breadwinner. Most reported not having smoked, consumed alcohol or any illicit drugs during the present pregnancy. Moreover, the sample was characterized by multiparous and nulliparous women, most of whom had living children and without a history of miscarriages. The prevalence rate for intimate partner violence during the present pregnancy was 17.6%. The prevalence rates of probable antenatal depression, probable antenatal post-traumatic stress disorder and probable antenatal suicidal ideation were 28.2%, 17.0% and 7.8%, respectively. The women\'s mean scores on the trait-anxiety and state-anxiety scales were 39.1 and 42.5, respectively. After adjustment using multiple logistic regression models, associations were found between intimate partner violence during the pregnancy and probable antenatal depression, probable antenatal post-traumatic stress disorder and probable antenatal suicidal ideation. The adjusted multiple linear regression models showed that women victims of intimate partner violence in the present pregnancy had higher scores for trait-anxiety and state-anxiety symptoms compared to those who did not endure this type of violence. Therefore, recognizing violence as a clinically relevant and identifiable risk factor for the occurrence of mental disorders during pregnancy may be a first step to prevent these problems. Ideally, the answers should include the health, social work and justice domains so as to meet the duty of the Brazilian State of eliminating the violence against women

O cuidado em liberdade de pessoas cumprindo medida de segurança no contexto de um CAPS III, tema do presente trabalho, inscreve-se num ponto de tensão entre as concepções da Reforma Psiquiátrica brasileira e as questões pertinentes às pessoas em conflito com a lei. O tema não tem acúmulo de conhecimentos, conforme evidenciado pela pesquisa bibliográfica. Este estudo demonstra como um sujeito cumprindo medida de segurança é acompanhado num serviço comunitário de saúde mental e sustenta a argumentação do direito ao cuidado em liberdade. Os objetivos são: conhecer como um CAPS III da Cidade de São Paulo se organiza para cuidar de uma pessoa cumprindo medida de segurança e quais os efeitos do cuidado para a vida dessa pessoa. Trata-se de uma pesquisa qualitativa que utiliza o Estudo de Caso como procedimento metodológico para a apreensão e compreensão dos dados empíricos. O marco teórico que norteia este estudo é a desinstitucionalização como estratégia de produção de direitos. São 13 (treze) os sujeitos do estudo entrevistados utilizando-se a entrevista semi-estruturada. O material empírico submetido à análise temática resultou nas categorias empíricas: 1) Narrativa da história de vida do Emanuel; 2) Processos de Trabalho em Saúde Mental; 3) Dispositivo para o cuidado em liberdade: o CAPS; 4) A Necessária Formação do Trabalhador da Saúde Mental. Resultados: na análise temática dos discursos foram identificados o objeto complexo do cuidado e suas necessidades, os agentes dos distintos processos de trabalho, os instrumentos e as finalidades destes processos de trabalho, ou o objeto transformado, isto é, um sujeito atravessado, tocado e interferido pelo cuidado. O CAPS é o lócus onde os processos de trabalho se organizam para dar conta das necessidades do objeto de cuidado, utilizando como instrumentos de intervenção: escuta, afeto, grupos, pintura, atendimentos individuais, equipe de referência, conhecimentos técnicos, projeto terapêutico singular e o projeto de geração de trabalho e renda na perspectiva da Economia Solidária. Aspectos positivos e negativos do processo de trabalho aparecem nos discursos, que revelam como os sujeitos entendem o CAPS, a constituição do projeto institucional do serviço, como o avaliam, a ações intersetoriais que o caso demandou e as questões da interface com a Justiça. Identificou-se nos discursos dos agentes dos processos de trabalho a necessidade de formação para a prática cotidiana do cuidado e preocupação com a questão da violência: como intervir e como prevenir. As informações específicas das pessoas em conflito com a lei também são abordadas no discurso dos entrevistados que evidenciam grande lacuna nesta área. Depreende-se dos discursos que a construção do Projeto Terapêutico Singular neste serviço pauta-se na construção de estratégias que visam responder às necessidades das pessoas, conforme as diretrizes das políticas públicas de saúde mental e da Reforma Psiquiátrica brasileira. As pessoas em conflito com a lei apresentam uma necessidade que é específica, particular, de agenciamento de possibilidade de defesa. Outros sujeitos podem demandar outras necessidades e os serviços, para serem efetivos, têm que atender todo mundo: têm que saber agenciar recursos para quem chega.
The care of people after a pleading insanity is made in freedom and can be done in a Mental Health Center (CAPS III), that is the theme of this master, and its a tension point at the conceptions of the brazilian Psychiatric Reform and people who have conflicts with the law. Theres no enough and significant accumulation of knowledge about this theme as the bibliography shows. This study can be used to make understandable as a person after the plea of insanity is followed in a treatment system in a community service of mental health. The goals: to know how a Mental Health Center of the city of São Paulo is organized to take care of people after a plea of insanity and what are the effects for this person. Its a qualitative study that uses the Study of Case as methodological procedure for the apprehension and understanding of the empirical data. The theoretical reference that guides this study was the deinstitutionalization as strategy for the production of rights. The 13 (thirteen) people of the study were interviewed, using a interview semi-structured. The empirical material after thematic analyzes showed: 1) Narrative of Emanuels life story; 2) work processes in mental health 3) A service for the treatment in freedom: the CAPS; 4) The necessary graduation of the worker in Mental Health. Results: In the Thematic Analyzes of the speech were identified: the complex object of care and its needs, the agents of the distinct processes of work, the instruments and its purposes of work processes: a person crossed, touched and interfered for the care. The CAPS is the setting where the work processes are organized to give support of the needs of this work object, and it uses instruments for intervention: as the listening, affection, groups, painting, individual consults, reference team, technic knowledge, Individual Therapeutic Projects and a project to generate employment and income in view of the Solidarity Economy. Positive and negatives aspects of the work process are also found in the speeches, what also shows that the people understand the CAPS, and the law of the institutional design of the service, such as assessing, the intersectoral actions demanded that are issues of interface with the justice. Were found in the speeches of the CAPS employees the need of studying to the daily practices of care and the concern with the violence matter: how the make an intervention and prevention. The specific information of people in debit with law are given also in the speeches of people that reveal a big gap in this area. People in conflict with the law have a need that is specific, particular, the possibility of defense. Other people can demand other needs and the services, for been effective, have to attend everybody: they need to be able to give resources for those arriving.

Introdução: O objeto desta tese é a potencialidade educativa do lazer para gerar crítica sobre a ideologia do consumo problemático de drogas. Revisão bibliográfica sobre o lazer em unidades de saúde mostrou que ele é reconhecido como espaço para recreação ou como atividade que ocupa o tempo. A maior parte dos artigos científicos relatava objetivos funcionalistas para o lazer, o que remete ao lazer viciado, conceito cunhado para designar a forma hegemônica do lazer capitalista na área de drogas. Os aplicativos para dispositivos móveis e os jogos educativos sobre drogas analisados não incentivavam a discussão do processo de produção de drogas lícitas e ilícitas, tampouco abordavam o consumo problemático de drogas como consequência de relações sociais alienadas e do mal-estar contemporâneo. Apesar da potencialidade educativa que os jogos e os aplicativos oferecem, as finalidades detectadas reiteravam posições amplamente criticadas no campo da saúde, filiadas ao proibicionismo e à guerra às drogas. Objetivo: Construir arcabouço teórico-metodológico para uma proposta crítica ao lazer viciado da área de drogas. Parte-se da perspectiva da saúde coletiva para compreender os problemas relacionados ao consumo de drogas como determinados socialmente e por isso, intimamente, ligados à totalidade social, expressando-se como sintomas de conflitos, que indivíduos e grupos sociais enfrentam no cotidiano. Método: Realizou-se pesquisa-ação com trabalhadores da saúde mental, por meio de oficinas emancipatórias, coerentes com a epistemologia materialista histórico-dialética. Resultados: As oficinas emancipatórias permitiram transformação de representações cotidianas, assim como, identificação de convicções de trabalhadores da saúde mental. Entre estas estavam: a concepção enraizada da dependência química, da educação sobre drogas como prevenção ao uso e do lazer como atividade terapêutica. São representações ilusórias que tomam o consumo de drogas como doença. Os resultados afirmam a necessidade de construção de práticas críticas à ideologia da doença mental e comportamental do consumo de drogas. Conclusões: Fundamentado na perspectiva da saúde coletiva, o arcabouço teórico-metodológico concebido nesta pesquisa propõe a realização de oficinas emancipatórias de lazer em serviços de saúde e intersetorialmente nos serviços de educação, entre outros, que trabalham com a temática do consumo de drogas, mantida a coerência com o referencial teórico, que propõe a crítica a relações sociais alienadas. Essa estratégia pode se valer de conteúdos lúdicos, esportivos, culturais, entre outros. Advoga-se que o processo educativo tem potencial emancipatório se for radicalmente participativo; e que as formas contemporâneas de vivenciar o tempo de não trabalho, que compõem as estratégias de alívio do mal-estar social na atualidade, podem ser problematizadas. Tal problematização deve iluminar o embate entre projetos de hegemonia no capitalismo, o que é potencialmente fortalecedor para os participantes, na medida em que desnaturaliza a alienação que produz desentendimentos e frustrações. Sugere-se ainda, como material de apoio educativo, o jogo Cidade Dorme: representações cotidianas sobre drogas, legitimado coletivamente nesta pesquisa.
Introduction: The object of this thesis is the educational potential of leisure to develop a critical understanding of the ideology around substance/drug use/consumption. A literature review in the context of health services showed that leisure and the playful are perceived as recreation, as well as an activity to fill-in time such. However, most of scientific articles listed functionalist objectives for leisure, which is associated to hooked leisure, concept coined to designate the hegemonic form of capitalist leisure in the area of drugs. Applications for mobile devices and educational games about drugs do not promote discussion about the legal and illegal drug production process; neither approaches the problematic consumption of drugs as a consequence of alienated social relations and the contemporary malaise. Despite the educational potential that games and apps offer, their purposes reinforced conceptions widely criticized in the health area, being associated with prohibitions and war on drugs. Objective: To develop a theoretical and methodological critical proposal to hooked leisure practices in the field of drugs. The Collective Health approach was adopted to understand the problems related to drug consumption as socially determined; as so they are intimately connected to the social totality, expressing themselves as symptoms of conflicts that individuals and social groups face in their daily lives. Method: An action research was carried out with mental health workers through emancipatory workshops, aligned with the epistemology of historical-dialectical materialism. Results: Emancipatory workshops promoted the transformation of everyday representations, as much as it has promoted the identification of the convictions of mental health workers. Among them there were: a traditional conception of chemical addiction, drug education as prevention of drug use and leisure as a therapeutic activity. Those are illusory representations which presume that all drug consumption is a disease. The results indicate the need to create critical practices that challenge the ideology of drug consumption as mental and behavioral sickness. Conclusions: Based on the perspective of Collective Health, the theoretical and methodological framework for leisure articulated in this research proposes the implementation of emancipatory workshops of leisure in health as well as education services, among others that work with the drug consumption theme as a cross-disciplinary approach, as long as it maintains consistency with the theoretical framework that proposes the critique on alienation. This strategy can use play, sports and cultural contents, among others. These features place leisure activities aligned with the purpose of emancipatory educational processes. It is argued that the educational process has emancipatory potential if it is radically participatory; and that the contemporary ways of experiencing nonworking time, which compose the strategies for alleviating contemporary malaise, can be debated. Such debate will certainly bring light to the battle among hegemonic projects in the capital system, which can be potentially strengthening to participants, as it denatures alienation that produce disagreements and frustrations. It is also suggested, as an educational support material, the game Cidade Dorme: representações cotidianas sobre drogas (City Sleeps: everyday representations on drugs), collectively legitimized in this research.

Through this hermeneutic study I sought to explicate the practice knowledge of nursing on residential adolescent mental health units. I did this by seeking to understand what nurse's and adolescent's stories of nursing, or being nursed, revealed about the knowledge informing practice within that context. Seven nurses and seven young people shared their experiences. Taped and written stories, and survey material, provided texts for analysis and interpretation. As stories centred around specific nurse-adolescent interactions they pointed to the knowledge informing practice within those encounters. Thus, practice knowledge was explicated through interpretation of the actual experiences of nurses and adolescents. Study findings were conceptualised as sub-elements, elements and a meta-element of practice knowledge. Ninety one

INTRODUCCIÓN: El sistema sanitario está apostando por un cambio de paradigma que se orienta hacia la implicación activa de los pacientes en su proceso de salud y; se propone poner énfasis en los pacientes con enfermedades crónicas, grandes consumidores de servicios sanitarios. Por otro lado, la situación actual obliga a repartir los recursos disponibles y, por tanto, es necesario un cambio en el modelo de actuación fomentando la participación de la población y, en este sentido, el ciudadano puede aportar mucho en su autocuidado. Procurar una salud mental positiva se incluye en las acciones saludables y pensamos que el contexto de las consultas de enfermería puede ser un espacio idóneo para ello. Este trabajo se postula en base a las posibilidades de intervención psicosocial de enfermería con pacientes con problemas crónicos y en la relación entre los constructos Agencia de Autocuidado y Salud Mental Positiva. Se planteó una investigación estructurada en dos fases. OBJETIVOS: Fase I: Describir las características sociodemográficas y las condiciones de salud física en pacientes con problemas crónicos de salud y explorar los niveles de Agencia de Autocuidado y de Salud Mental positiva y la correlación entre ambos constructos. Fase II: Evaluar la efectividad de un programa de intervenciones psicosociales de enfermería para potenciar la agencia de autocuidado y la salud mental positiva en personas adultas con problemas crónicos de salud física e identificar la utilidad del programa y la satisfacción del mismo. METODOLOGÍA: Fase I se planteó un estudio transversal, descriptivo, y correlacional. Fase II quasi-experimental, pretest-posttest, con grupo de intervención y grupo control. La muestra estuvo configurada en la Fase I por n=259 y en la Fase II por n= 44 grupos: de intervención (n=22) y control (n=22). En la Fase I se realizó un análisis descriptivo, de todas las variables. Los datos se analizaron con el paquete estadístico PASW-18, con una significación p-valor de <0.05. En la Fase II, para la comparación entre las variables categóricas se utilizó el test exacto de Fisher y para las variables cuantitativas la U de Mann-Whitney. Para determinar si la intervención era significativa se realizó un análisis multivariante (MANOVA) con las diferencias pretest-posttest entre el grupo de intervención y el grupo de control. RESULTADOS: Los instrumentos utilizados, Escala de Agencia de Autocuidado (ASA) y Cuestionario de Salud Mental Positiva (CSM+) obtuvieron una α de Cronbach de 0.73 y 0.91 respectivamente. La correlación entre ambos constructos la correlación fue muy significativa y bidireccional. En el programa de intervención psicosocial de enfermería se comprobó la efectividad del mismo con un aumento significativo en la agencia de autocuidado (ASA) y en la salud mental positiva (CSM+) (F [7,36]=28,51, p<0,0001). CONCLUSIONES: El perfil es el de una mujer de 66-75 años, con una capacidad de agencia de autocuidado medio y una salud mental positiva moderada-alta. Existe una relación bidireccional estadísticamente significativa entre los constructos: agencia de autocuidado y salud mental positiva. El programa de intervención fue efectivo generando un incremento de la agencia de autocuidado y de la salud mental positiva en el grupo de intervención
INTRODUCTION: The health system is committed to a paradigm shift towards the active involvement of patients in their process of health, and the strong emphasis is placed in patients with chronic diseases, who are the large consumers of health services. Conversely, the current situation requires distributing the available resources and consequently a change is necessary in the performance model. Thus, encouraging population participation can be a pathway to achieve this goal, and in this sense, citizens can contribute much to their self-care. Ensure a positive mental health is included in wholesome actions. The hypothesis of this project is based on the possibilities of psychosocial nursing interventions in patients with chronic physical health problems, and the relationship between of Self-Care Agency and Positive Mental Health. A research structured in two phases was designed. OBJECTIVES: In Phase I objectives were: To describe the sociodemographic characteristics and physical health conditions in patients with chronic health problems and explore the levels of the Self-Care Agency and Positive Mental Health, and the positive correlation between the two constructs. In Phase II the objectives were: Evaluate the effectiveness of a program of psychosocial nursing interventions to enhance the Self-Care Agency and positive mental health in adults with chronic physical health problems and identify the program's usefulness and satisfaction. METHODS: For Phase I sectional, descriptive, correlational study and for Phase II quasi-experimental, pretest-posttest studies were proposed, with intervention group and control group. The sample in Phase I included 259 people with chronic health problems; Phase II included 44 people, divided between the intervention (n = 22) and control (n = 22) groups. In Phase I was conducted a descriptive analysis of all variables. Data were analyzed with SPSS-18 statistical package, with a significant p-value of <0.05. In Phase II, Fisher's exact test was used for comparison between categorical variables, and the Mann-Whitney U test for quantitative variables. To determine whether the intervention was significant, multivariate analysis (MANOVA) with pretest-posttest differences between the intervention group and the control group was performed. RESULTS: The instruments used, Appraisal of Self-Care Agency Scale (ASA) and Positive Mental Health Questionnaire (CSM +) obtained a Cronbach α of 0.73 and 0.91 respectively. Analyzing the correlation between both constructs, the correlation was highly significant and bidirectional. The effectiveness of nursing psychosocial intervention program demonstrated a significant increase in self-care agency (ASA) and positive mental health (CSM +) (F [7,36] = 28.51, p <0 , 0001). CONCLUSIONS: The following conclusions were obtained: The profile of the sample studied is that of a woman of 66-75 years, with a moderate capacity in the self-care agency and a moderate medium-high positive mental health. There is a statistically significant two-way relationship between the constructs: self-care agency and positive mental health , so that the more efficient self-care a higher level of positive mental health. The nursing psychosocial intervention program was effective in generating an increase in self-care agency and positive mental health in the intervention group. The usefulness of exercises carried out and participant satisfaction were very high.

Includes bibliographical references
Introduction: Mental health of Ugandans could be improved through mainstreaming the services into primary care systems. Nurses constitute a high percentage of the workforce in health; therefore they can significantly contribute towards several experiences by patients with mental illness. Stigma towards mental illness and individuals living with mental illness is among the major hindrances to effective mental health service delivery amongst healthcare workers. Therefore it is important for stigma to be explored among general nurses as mental health services are being integrated into the primary health care. The aim of this study was to explore stigma among general nurses towards mental illness and individuals living with mental illness. Methods: This was a cross-sectional quantitative study. Self-administered questionnaires were distributed to nurses working in Amolatar district health facilities that measured knowledge, attitudes and behaviour towards individuals living with mental illness, in addition to their familiarity with a person with mental illness. Descriptive statistics were used to determine the extent to which stigma was reported in this population. Bivariate and multivariate analyses were done using linear and logistic regressions to identify the predictors of the knowledge, attitudes and behaviours of nurses regarding mental illness and individuals living with mental illness. Results: Sixty-three general nurses participated in the study. Most of the participants identified schizophrenia as an SMI, however 79% considered stress to be mental illness and only a quarter of respondents scored above 80% on knowledge about mental illness. Most of the participants believed that psychotherapy was the most effective treatment for mental disorders. The nurses were benevolent (mean 3.06, s.d 0.29) and showed acceptance towards mental health services and individuals living with mental illness in the community (mean 3.56, s.d 0.30) however the nurses tended towards authoritarianism (mean 3.74, s.d 0.34) and social restrictiveness (mean 2.98, s.d 0.27). Level of contact with individuals living with mental illness predicted community mental health ideology and authoritarianism. No demographic variables were associated with level of knowledge using MAKS score and intended behaviour using RIBS tool. Conclusion: This study has provided some of the first data on stigma among primary health care nurses towards people with mental illness in Uganda and has added to knowledge of stigma towards people with mental illness by health care providers in LAMIC. Many of the findings were positive and bode well for the planned integration of mental health in primary health care. The negative findings of this study have shown that there are many areas for improvement which could be tackled by interventions such as public and community education, and in-service training regarding causes and management of mental disorders. Further research could be done to understand more about the negative attitudes found in many LAMIC.

Trata-se de uma revisão integrativa da literatura baseada em Cooper, que objetivou conhecer e identificar as ações de redução de danos voltadas para os usuários de drogas em artigos publicados em periódicos científicos. Para a coleta dos dados foram utilizados os descritores redução de danos, políticas públicas e transtornos relacionados ao uso de substâncias, nos idiomas português, inglês e espanhol, nas bases de dados da Literatura Latino-Americano e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO), National Library of Medicine- USA (MedLine) e na Revista Eletrônica Saúde Mental Álcool e Drogas (SMAD). Os critérios de inclusão foram: artigos que contemplem a temática da área de redução de danos, tanto questões teóricas, políticas quanto práticas, completos, disponíveis on-line, gratuitos e publicados no período de 2005 a 2010. Este trabalho evidenciou uma predominância de estudos enfocando questões referentes a prática da redução de danos em contextos diversos, além de ainda existirem muitos entraves e embates éticos, ideológicos e políticos. Os achados foram ordenados em três categorias: Políticas Públicas, Aspectos Teóricos e Éticos e Ações de Redução de Danos, que indicaram alguns aspectos fundamentais resultantes das práticas voltadas para os usuários de drogas, como por exemplo, a promoção do protagonismo e responsabilidade individual, penal, liberdade de escolha, descriminalização, diversificação das modalidades de atendimento, objetivos e direção dos tratamentos, qualificação na interface da saúde e da lei e dispositivos de saúde sócio-culturais (esporte, lazer, cultura, trabalho), no compasso com os princípios e as diretrizes do SUS, ou seja, a flexibilidade desta diretriz de trabalho permitiu um diálogo maior com diferentes instâncias (intersetorialidade), ressignificando e ampliando o debate sobre o tema, pautado pela ética e pelo respeito as subjetividades.
It is an integrative literature review based on Cooper, which aimed to find and identify actions aimed at harm reduction for drug users in articles published in scientific journals. To collect the data descriptors were used to harm reduction, public policies and disorders related to substance use, in Portuguese, English and Spanish, in the databases of the Latin American and Caribbean Center on Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO), National Library of Medicine, USA (Medline) and the Electronic Journal of Mental Health, Alcohol and Drugs (SMAD). Inclusion criteria were: articles that address the thematic area of harm reduction, both theoretical issues, policies and practices, complete, available online, free and published in the period 2005 to 2010. This work showed a predominance of studies focusing on issues concerning the practice of harm reduction in diverse contexts, and there are still many barriers and ethical conflicts, ideological and political. Findings were sorted into three categories: Public Policy, and Ethical Aspects, Theoretical and Actions Harm Reduction, which indicated some key issues arising from practices for drug users, such as promoting individual responsibility and leadership, criminal , freedom of choice, decriminalization, diversification of modes of attendance, objectives and direction of the treatments, qualifying at the interface of health and health law and by socio-cultural (sport, leisure, culture and work), in step with the principles and the guidelines of the SUS, or the flexibility of this work direction allowed a larger dialogue with different bodies (intersectoral) and redefines the expanding debate on the subject, based on ethics and respect for the subjectivity.
Se trata de una revisión integradora de la literatura sobre la base de Cooper, que tuvo como objetivo conocer e identificar las acciones encaminadas a la reducción de daños para usuarios de drogas en los artículos publicados en revistas científicas. Para recoger los descriptores de datos se utilizaron para la reducción del daño, las políticas públicas y los trastornos relacionados con el consumo de sustancias, en Portugués, Inglés y Español, en las bases de datos del Centro Latinoamericano y del Caribe en Ciencias de la Salud (LILACS) y Scientific Electronic Library Online (SciELO), Biblioteca Nacional de Medicina, EE.UU. (Medline) y la Revista Electrónica de Salud Mental, Alcohol y Drogas (SMAD). Los criterios de inclusión fueron: artículos que abordan el área temática de reducción de daños, tanto en cuestiones teóricas, políticas y prácticas, completa, disponible en línea, libre y publicados en el periodo 2005 a 2010. Este trabajo muestra un predominio de estudios centrados en las cuestiones relativas a la práctica de reducción de daños en diversos contextos, y todavía hay muchas barreras y conflictos éticos, ideológicos y políticos. Los resultados fueron clasificados en tres categorías: Políticas Públicas y Aspectos éticos, teóricos y acciones de reducción de daños, lo que indica algunas cuestiones importantes que surjan de las prácticas para los usuarios de drogas, como la promoción de la responsabilidad individual y el liderazgo, penal , la libertad de elección, la despenalización, la diversificación de los modos de asistencia, los objetivos y la dirección de los tratamientos, clasificación en la interfaz de la ley de salud y de la salud y socio-culturales (deporte, ocio, cultura y trabajo), en consonancia con los principios y las directrices del SUS, o la flexibilidad de esta dirección de trabajo permitió un diálogo más amplio con los diferentes órganos (intersectoriales) y redefine el debate ampliar sobre el tema, basado en la ética y el respeto de la subjetividad.

A influência das características laborais sobre a saúde mental dos trabalhadores pode decorrer de inúmeros fatores ou formas de organização do trabalho. Na atualidade, verifica-se os crescentes índices de sintomas psíquicos entre determinadas categorias profissionais, com destaque para os trabalhadores de saúde atuantes em ambiente hospitalar Objetivo: Este estudo objetivou identificar a ocorrência de Transtornos Mentais Comuns (TMC), a ocorrência da síndrome de Burnout, e a associação de ambos os transtornos nos trabalhadores de enfermagem, bem como elaborar propostas de intervenção para redução do desgaste psíquico. Metodologia: Trata-se de um estudo exploratório, transversal com abordagem quanti-qualitativa. A pesquisa foi realizada em Hospital Público Universitário especializado em cardiologia, pneumologia e cirurgias cardíacas e torácicas. A amostra foi composta por trabalhadores de enfermagem que atuam em unidades de terapia semi-intensiva e intensiva pediátrica e neonatal, perfazendo um total de 92 participantes. Para a coleta de dados quantitativos foram utilizados: instrumento de caracterização sócio demográfica, Self-Reporting Questionnaire (SRQ-20), e o Maslach Burnout Inventory (MIB). Para os dados qualitativos, optou-se pela técnica de grupo focal, conduzido por questões norteadoras, com uma amostra de 17 trabalhadores de enfermagem. O período de coleta foi nos meses de junho e julho de 2012. Resultados: A análise dos resultados evidenciou a ocorrência de TMC em 44,60%(41) dos trabalhadores e a ocorrência de Burnout em 8,7%(8) trabalhadores. Houve associação estatística entre os TMC e o Burnout p=0,003, considerando nível de significância de 5%. Em relação aos TMC, as respostas dos trabalhadores foram distribuídas de acordo com os quatro grupos de sintomas avaliados pelo SRQ-20: Grupo somático, Decréscimo de energia vital, Humor depressivo-ansioso e Pensamentos depressivos. Em relação à sindrome de Burnout, os trabalhadores foram avaliados considerando-se a ocorrência de escores alto nas três dimensões (Desgaste Emocional, Despersonalização e Reduzida Realização Profissional) ou em uma delas apenas. Não foi constatada associação entre os transtornos e as variáveis sócio-demográficas. Houve associação entre ambos os transtornos. As sessões de grupo focal evidenciaram propostas de intervenção mediante três temas que emergiram das discussões: Aprender a lidar com a criança cardiopata grave, Receber o reconhecimento profissional e Repensar a gestão de pessoas. Conclusão: Os achados, em conjunto, evidenciam necessidade de medidas protetoras à saúde mental do trabalhador que assiste crianças cardiopatas graves. Palavras-chave: Estresse psicológico, Esgotamento profissional, Equipe de enfermagem, Hospitais públicos, Unidades de terapia intensiva pediátrica, Unidade de terapia intensiva neonatal, Saúde do trabalhador.
The influence of work characteristics on mental health workers may be due to numerous factors or forms of work organization. At present, there is the growing rates of psychiatric symptoms among certain professions, especially health workers working in hospitals Objective: This study aimed to identify the occurrence of Common Mental Disorders (CMD), the occurrence of Burnout, and the association of both disorders among nursing staff, as well as elaborate proposals for intervention to reduce wear psychic. Methodology This is an exploratory study, cross-sectional with quantitative and qualitative approach. The research was conducted in a public University Hospital specialized in cardiology, pulmonology, thoracic and cardiac surgery. The sample consisted of nursing workers of care units, semi-intensive and intensive, pediatric and neonatal, making a total of 92 participants. For quantitative data collection was used: instrument of socio demographic, Self-Reporting Questionnaire (SRQ-20), and the Maslach Burnout Inventory (MIB). For qualitative data, we chose the technique of focal group, conducted by leading questions, with a sample of 17 nurse workers. The collection period was between June and July, 2012. Results The result of the analysis revealed the occurrence of CMD in 44.60% (41) of the workers and the occurrence of Burnout in 8.7% (8) of the workers. There was a statistical association between CMD and Burnout p = 0.003, considering level of significance 5%. Regarding CMD, the answer of the workers was distributed according to the four groups of prognostic evaluated by the SRQ-20: Somatic Group, Decrease of vital energy, Anxious-depressive humor and Depressive thoughts. Regarding Burnout syndrome, workers were evaluated considering the occurrence of high scores in all three dimensions (Emotional Exhaustion, Depersonalization, and Reduced Professional Accomplishment) or only in one of them. There was no association between the disorders and sociodemographic variables. There was an association between both disorders. The focal group sessions revealed proposals for intervention through three issues that emerged from the discussions: Learn to deal with severe heart disease children, professional acknowledgment and rethink people management. Conclusion: Findings, during the sessions, highlight the need for protective measures of mental health for workers who assist children with heart disease

This dissertation consists of three studies to assess nurses’ attitudes toward persons with mental illness. The first study was an integrative review of literature which revealed that surveyed nurses across 20 countries and three continents had mixed attitudes toward people with mental illness. While those attitudes mirrored attitudes of the general public and health providers in the United States, none of the identified studies explored nurses’ attitudes toward people with mental illness in the United States and none included a theoretical framework, showing several gaps in knowledge. Therefore, in the second paper of this dissertation two leading theories regarding stigma were analyzed and compared in order to select the best theoretical framework to guide a survey of psychiatric nurses’ attitudes toward the mentally ill, which comprises the third study of this dissertation. The Modified Labeling Theory (MLT) and the Cognitive Behavioral Models (CBM) were analyzed and evaluated. Since the MLT had strong empirical evidence, it was selected to guide the quantitative study that explored nurses’ attitudes toward people with mental illness. This exploration of 146 mental health workers and registered nurses’ attitudes in a 270-bed psychiatric hospital in New York examined three areas: it assessed respondents’ beliefs about devaluation and discrimination of people with mental illness and factors related to these beliefs; compared respondents’ expressed stigmatizing actions toward patients with schizophrenia or depression versus those with diabetes but no mental illness; and it assessed the extent to which study results were consistent with the theoretical underpinnings of the MLT. In general, respondents expressed the belief that people with mental illness would be devaluated and discriminated and expressed stronger desire for social distance from a person with schizophrenia than depression. Even though the respondents did not express a desire for social distance from a person with depression, they indicated their preference to be closer to a person with diabetes. Finally, the results of the study were consistent with the theoretical underpinnings of the MLT, confirming that the MLT is appropriate for use as a guiding theoretical framework for future research in nursing. Implications for future research, nursing education and practice are discussed.

This dissertation is made up of three distinct parts: 1) A comprehensive, structured literature review 2) a mixed-methods descriptive study and 3) an inductive thematic qualitative analysis. The objective of this dissertation is to explore the concepts of compassion fatigue, compassion satisfaction and burnout as they relate to the practices of narrative medicine among expatriate humanitarian aid workers. Data collected for this research focuses on expatriate healthcare workers who provided direct patient care during the 2013-2016 Ebola response in Sierra Leone, Liberia and Guinea. Findings from these studies support the growing body of evidence and discussion regarding psychosocial support of healthcare workers in humanitarian contexts. To the extent that global health is public health (Fried, 2010), results from this dissertation will contribute guidance in the understanding and management of aid workers in contexts beyond the Ebola response.

Despite nurses having legitimate ethical rights and responsibilities, they are often constrained in practice from acting in ways they believe to be morally correct. This thesis presents a qualitative exploration of factors that influenced eight newly graduated nurses as they endeavoured to practice ethical mental health nursing in New Zealand. Data was gathered from in depth interviews with the participants and analysed using a thematic analysis method. A critical lens was employed to view the data so as to make visible aspects of the social and political context within which the participants were situated. The participants? moral practice was profoundly influenced by a number of relational experiences they had. These relationships were then determinants in their moral development, professional socialization and their ability to practice in accordance to their moral beliefs. Key aspects of these relationships were their experiences with nursing education and the influence of the organisations where they worked. Recommendations are made to both areas to enable and support moral nursing practice for new graduate mental health nurses. New graduate nurses inherently desire to practice in a way that honours the client and is therefore inherently ethical. Moral nursing practice is an everyday occurrence that must be situated in a culture of respect and regard for both clients and nurses. New graduate nurses have much to offer the profession and the tangata whaiora of the mental health services. They must be valued and supported to act in accordance to their moral ideals.

The purpose of the study was to explore the understanding and implementation of the guidelines by nurses to detect mental disorders in Human Immunodeficiency Virus (HIV) management in the Limpopo Province, South Africa. The study aimed to recommend measures to strengthen implementation practices. Qualitative, exploratory and descriptive approach was conducted. Non-probability purposive sampling was used to select primary health professional nurses trained in HIV programme at primary health care facilities in Capricorn District. Data were collected through focus groups and in-depth individual interviews approach using the interview guide. The interviews started with focus group discussions as primary method and in-depth individual interviews as follow-up. Interviews were tape recorded and transcribed. Data were analysed using Creswell’s data analysis steps. Four themes emerged from data: understanding of HIV management guidelines; implementation of the guidelines; strengthening of mental health screening and competencies required for mental health screening. The study revealed that the nurses who did not have psychiatric nursing as an additional qualification lacked confidence and skills to conduct mental health screening in HIV positive infected individuals. However, they used their background nursing knowledge to manage clients. They all experienced challenges with information provided in the guidelines to screen for mental health in HIV management. Based on the results of this study, it was recommended that there should be integration of mental health and HIV and development of practical assessment tools for mental health screening. The study acknowledges the importance of equipping nurses with adequate skills to diagnose altered mental health states among HIV infected individuals.
Health Studies
M.A. (Nursing Science)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs.
Health Science
M.A.(Nursing Science)

This social-cultural history explores the changing context, culture, and identity of psychiatric nurses working in New Zealand public mental hospitals between 1939 and 1972. Primary documentary sources and oral history interviews provided the data for analysis. The thesis is divided into two periods: 1939 to 1959 when asylum-type conditions shaped the culture of the institutional workforce, and 1960 to 1972 when mental health reform and nursing professionalisation challenged the isolation and distinct identity of mental hospital nurses. Between 1939 and 1959 the introduction of somatic treatments did not substantially change nursing practice in mental hospitals. Overcrowding, understaffing and poor resources necessitated the continuance of custodial care. The asylum-type institutions were dependent on a male attendant workforce to ensure the safety of disturbed male patients, and the maintenance of hospital farms, gardens, and buildings. Although female nurses provided all the care and domestic work on the female side, the belief that psychiatric nursing was physically demanding, potentially dangerous, and morally questionable, characterised the work as generally unsuitable for women. Introduction of psychiatric nursing registration which was a move toward professionalisation did little to change the dominance of a male, working-class culture. From 1960 to 1972 psychiatric nurses’ identity was contested. New therapeutic roles created the possibility of the nurses becoming health professionals. Their economic security and occupational power, however, was tied to an identity as unionised, male workers. As psychiatric nurses were drawn closer to the female-dominated nursing profession through health service changes and nursing education reform, both men and women acted to protect both their working conditions and their patients’ welfare. To achieve these ends, they employed working-class means of industrial action. By accepting the notion that psychiatric nurses’ identity was socially constructed, this thesis provides an interpretation that goes beyond the assumption that nursing is a woman’s profession. Instead, it presents psychiatric nursing as a changing phenomenon shaped by contested discourses of gender, class and professionalisation. Nursing in public mental hospitals attracted ordinary men and uncommon women whose collective identity was forged from the experience of working in a stigmatised role.

M. Curr.
Mental health challenges are a worldwide phenomenon, and more people are experiencing these challenges which are related to the life style and psychological stressors facing them. Addressing this burden is a challenge to health care providers, as some are influenced by their perceptions about mental illness in facing the demands made be society. Registered nurses who are not trained in psychiatric nursing do not have the appropriate background information or skill of how to cope with patients with mental health challenges even if they have undergone an introduction into nursing psychology at college. This increases their fears and anxieties when having to interact with these patients. The aim of this study is thus to explore the experiences of registered nurses in interaction with patients with mental health challenges so as to be able to formulate and describe guidelines to facilitate the registered nurses mental health.

Purpose: The purpose of this study was to explore the experiences of forensic nurses when providing care to victims of sexual assault in selected public hospitals of Limpopo province. Methods: A qualitative, explorative, descriptive and contextual research design was employed in this study. A sample of 7 registered nurses was purposively selected to partake in in-depth unstructured interviews. Results: Four themes associated with the experience of providing care to victims of sexual assaults emerged during data analysis. These included (1) psychological experiences of nursing victims of sexual assault, (2) physical challenges associated with implementing the forensic nursing specialty in a clinical setting, (3) psychological coping strategies to deal with challenges experienced, and (4) the experience of managerial support. Conclusion: Participants reported negative psychological and physical experiences of providing care to victims of sexual assault, which resulted to occupational stress. Recommendations of forensic nurses support guidelines and further research were made.
Health Studies
M.A. (Health Studies)

The purpose of this qualitative research project has been to explore what social inclusion means to people with an enduring mental health problem. A review of the general literature on social inclusion revealed that little research has been conducted in relation to mental health, particularly in New Zealand. Even fewer studies have investigated the meanings that people with severe and enduring mental health problems place on their experiences. A life story narrative approach was employed in order to explore the experience of social inclusion and enduring mental health problems. Data were collected by way of unstructured, individual interviews with five users of mental health services living in supported housing in a small rural New Zealand town. Thematic analysis was carried out on the narratives, identifying six major themes. The findings indicated that, for this group of service users, social inclusion means having someone to love, something to do and somewhere to live. They want relationships with family and friends, to engage in recreational or leisure activities, to be employed, to have financial security, and to have safe and comfortable housing. The major barriers to achieving these are stigma and discrimination. New Zealand’s mental health services have adopted a recovery approach to mental health. Whereas social inclusion has a broad political and social focus that places responsibility for reducing social exclusion on society, recovery focuses on individuals’ personal journeys towards mental health and well-being. Despite international recognition of the value of social inclusion, New Zealand’s mental health services have not yet embraced it, although policy advisory organisations such as the Mental Health Commission state its aims as desirable for services. However, the concept of recovery sits within the framework of social inclusion and is an integral part of it. Mental health nurses need to understand what social inclusion means to people who experience it, so that they are able to empower them to make a positive contribution to their community, as citizens, friends, family members, employees and neighbours.