Dissertations / Theses on the topic 'Psychiatric nurses' mental health'

Suicide is a major health concern worldwide. Nurse practitioners must possess suicide assessment skills and treatment knowledge to ensure appropriate identification of persons with suicidal ideation. The purpose of this project was to assess psychiatric nurse practitioners' knowledge of suicide prevention in rural Kentucky. The conceptual framework was Orlando's nursing process theory, which emphasizes the importance of nurse-patient interaction. A 13-item survey of suicide-related knowledge and skills was administered to 10 psychiatric nurse practitioners in rural Kentucky. Only 3 participants responded correctly to a question related to suicidality in persons with borderline personality disorder. Regarding competency and support for assessing suicide, 100% of participants reported that they were comfortable asking direct and open-ended questions regarding suicide. Nine of the 10 respondents assessed their knowledge and skills as sufficient to engage effectively with patients contemplating suicide, which indicates that psychiatric nurse practitioners may overestimate their ability to identify and treat persons with suicidal ideation. Healthcare providers in all specialties can benefit from this project by improving competencies and guiding continuing education to bridge any gaps in knowledge for adequately assessing suicide. Further education is needed for psychiatric nurse practitioners to promote positive social change for suicidal persons, their families, and their communities.

Magister Curationis - MCur
Professional nurses, with additional training in mental health, report attitudes and perceptions of mental health nursing that are more positive, whilst those with less training report more negative attitudes and perceptions to mental health nursing. The primary aim of this research study was to describe the attitudes and perceptions of professional nurses towards the mentally ill in a psychiatric hospital in the Cape Metropole. The objectives of the study were: to explore the attitudes and perceptions of professional nurses towards the mentally ill; to identify common factors that influence the professional nurses’ attitudes and perceptions towards the mentally ill; to compare the attitudes and perceptions of professional nurses who have completed the Regulation 425, Regulation 808 and Regulation 212 training in mental health nursing towards the mentally ill. A quantitative, exploratory, descriptive design was employed and cross-sectional survey was carried out. Participants comprised all permanent professional nurses (n=60) at a governmental Associated Psychiatric Hospital in the Cape Metropole. Participants completed a demographic questionnaire and two self-report questionnaires, measuring attitudes to and perceptions of mental health problems. Nurses with a diploma report significantly higher role competency than those nurses with a degree. The ethnicity of nurses played a role in the stereotyping of the mentally ill. No significant differences were evident between those professional nurses who had completed the advanced mental health course and those whom had not. However, the combined effects of learning the appropriate course and experience in the practical field of the mentally ill are necessary for the task of impacting positively on the attitudes of the nurses towards the mentally ill.

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

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

Magister Curationis - MCur
Research reported that it is very challenging for mental health care users to quit smoking and the risk of relapsing after quitting is high. However, tobacco dependence treatment is possible and potentially lifesaving for people. The delivery of tobacco dependence treatment by nurses is influenced by a variety of factors, including lack of knowledge and skills, limited professional leadership, and smoking within the profession. There is a strong link between mental illness and smoking-related diseases, including cancer, respiratory diseases and heart diseases that are linked with depression. There is a high incidence of cancer in people with bipolar mood disorder and schizophrenia due to smoking. In spite of this, smoking is regarded as part of the culture of psychiatric institutions and tobacco is seen as “necessary self- medication for the mentally ill”.

Psychiatric recovery-oriented care is aimed at improving patients' quality of care while increasing the efficiency of health care providers. Despite the benefits of recovery-oriented care, this approach is often lacking in health care settings. The purpose of this project was to implement a recovery-oriented training on psychoeducational groups on a 26-bed psychiatric unit. The Iowa model of evidence-based practice and adult learning theory provided the framework for the project. The objectives were to (a) assess training needs, (b) evaluate barriers for recovery-oriented psychiatric nursing, (c) develop strategies to address barriers, (d) train staff in psychoeducational approaches, and (e) evaluate the training effectiveness. Information on knowledge, confidence, training needs and barriers in conducting psychoeducational groups was collected from 24 nursing staff. Open-ended interviews were conducted to ascertain staff perceptions on training needs and barriers. Interview responses were analyzed for common themes. Staff expressed a need for training and perceived a lack of knowledge and time as barriers in conducting psychoeducational groups. A questionnaire was used to collect data on knowledge (8 items) and confidence (5 items) pre and post training. Pre/post responses were analyzed using descriptive statistics and paired sample t test. Results showed a significant increase in staff knowledge, but not confidence in conducting psychoeducational groups from pre to posttest. Results may be used by psychiatric nursing staff to improve the quality of recovery-oriented care, patient satisfaction, and efficiency of the care delivery system. Recovery-oriented psychiatric care implicitly changes social norms by helping individuals with mental health problems integrate back into their communities.

Workforce shortages are a major concern of health care and the creation of a positive workplace is central to the attraction and retaining of employees where employees are motivated to be loyal towards their employer by a positive work experience rather than by financial rewards (Manion, 2009:XIII). This positive work experience can include the providing of workplace support that is tailored to the specific experiences and wishes of psychiatric nurses working at a private mental health care setting. Work demands encountered by psychiatric nurses can vary from personal stresses related to the interpersonal nature of working with the challenging behaviour of mental health care users, to environmental stresses related to an environment reflecting inadequate workplace support. Stuart and Laraia (2005:11) described the role of the psychiatric nurse in any mental health care setting as depending on certain factors in the organisation. This include the philosophy, goals, prevailing understanding of mental health, the needs of the mental health care users, number of available personnel, communication structure, understanding of their individual roles, available resources and the presence of effective nurse mentoring. As a professional psychiatric nurse, I identified the need for effective workplace support to psychiatric nurses working in a private mental health care setting by observing signs of burnout in psychiatric nurses and by listening to employees verbalising their need for workplace support. The purpose of the research was to conduct an Appreciative Inquiry in order to generate an in-depth understanding of the experiences and wishes of psychiatric nurses regarding workplace support in a private mental health care setting. The objectives of the research were to explore and describe the experiences of psychiatric nurses regarding workplace support, to explore and describe the wishes of psychiatric nurses regarding workplace support in a private mental health care setting and to propose recommendations regarding workplace support. Proposed recommendations will have reference to psychiatric nursing research, psychiatric nursing education, psychiatric nursing management and psychiatric nursing practice, in order to facilitate more effective means to provide workplace support and to facilitate the promotion of the mental health of psychiatric nurses. I decided to use an Appreciative Inquiry framework in order to explore the experiences and wishes of psychiatric nurses regarding workplace support. The importance of Appreciative Inquiry lies in the appreciation of the behaviour and the responses of individuals instead of focusing on their problems. Appreciative Inquiry identifies that which is positive in any system and connects to or builds on it in order to “heighten energy, vision and action for change” (Cooperrider, Whitney&Stavros, 2008:XV). The meta-theoretical perspective that guided this researcher was the Theory for Health Promotion in Nursing. The essential purpose of this theory is health promotion for an individual, group, family or community (University of Johannesburg, 2009:4). The individual is in interaction with the environment, which consists of an internal and external environment. The internal environment comprises the body, mind and spirit dimensions of the individual. The external environment comprises the physical, social and spiritual dimensions of the individual. The interactions of these dimensions in the environment of the individual influence the health status of the individual on a continuum (University of Johannesburg, 2009:5). The experiences and wishes regarding the providing of workplace support pertaining to the internal and external environments of the psychiatric nurse were examined in order to facilitate the promotion of the mental health of the psychiatric nurse. The theoretical and methodological perspective that guided this research was Appreciative Inquiry. Appreciative Inquiry uses a process known as the 4-D cycle, which is the process that is employed to facilitate change or to generate the power of Appreciative Inquiry (Whitney&Trosten-Bloom, 2003:6). For this research on workplace support, I employed the first two phases of Appreciative Inquiry, namely the discovery phase and the dream phase as part of the data collection. The discovery phase involves the appreciation or discovering of that which is positive, life giving or effective and the dream phase involves the imagining of new possibilities. As a unique paradigm, Appreciative Inquiry questions traditional approaches to problem solving by accepting organisational challenges using an affirmative approach. An affirmative approach includes an appreciation of the positive by focussing on successes, strengths and potential (Cooperrider, Whitney&Stavros, 2008:433). Appreciative Inquiry views organisations as an individual centre of immense imagination and possibilities, intended to function as solutions (Cooperrider, Whitney&Stavros, 2008:16-17). I used a qualitative design, which was exploratory, descriptive and contextual. I integrated an Appreciative Inquiry approach into this design. I used purposeful sampling, which Polit and Beck (2007:763) define as a sampling method where participants are selected based on who will be the most informative regarding the topic of the research, namely workplace support in this research. The data collection methods used was naïve sketches, small core group inquiries and individual interviews with members of nursing management. The small core group inquiries included written answers on the interview schedule from the one-on-one interviews, transcribed feedback from the discussion phase, the positive core map, the nominal group technique, field notes and reflective interviews. The small core group inquiries were structured around one-on-one interviews that participants conducted with each other in groups of two, using an interview schedule. During the data analysis phase, I used two different techniques in order to analyse the available data, namely the nominal group technique and open coding. I used a tree as symbol for workplace support at this mental health care setting. The roots of the tree symbolised the willingness of management to provide workplace support to their employees. The trunk of the tree symbolised the holistic approach to workplace support. The branches of the tree symbolised the identified themes. I represented the discovery phase categories as the green leaves of the tree. I represented the dream phase categories as pink buds. I proposed recommendations relating to psychiatric nursing research, psychiatric nursing education, psychiatric nursing management and psychiatric nursing practice. The aim of these recommendations was to facilitate more effective means of providing workplace support, from a holistic perspective, in order to facilitate the promotion of mental health of psychiatric nurses working at this mental health care setting.
AFRIKAANS : Tekorte in die arbeidsmag is ʼn bron van groot besorgdheid vir gesondheidsorg, en die skep van ʼn positiewe werkplek is sentraal tot die aantrekking en behoud van werknemers in gevalle waar werknemers deur middel van ʼn positiewe werkservaring, eerder as ʼn finansiële vergoeding, gemotiveer word om lojaal teenoor hul werkgewer te wees (Manion, 2009:XIII). Hierdie positiewe werkservaring kan die verskaffing van werkplekondersteuning, wat op die spesifieke ervarings en wense van psigiatriese verpleegspraktisyns wat in ʼn privaat geestesgesondheidsomgewing werk, geskoei is, insluit. Werkseise wat psigiatriese verpleegspraktisyns teëkom kan wissel van persoonlike stres verwant aan die interpersoonlike aard van om met die uitdagende gedrag van geestesgesondheidsgebruikers te werk, tot omgewingstres verwant aan ʼn omgewing wat ontoereikende werkplekondersteuning bied. Stuart en Laraia (2005:11) beskryf die rol van ʼn psigiatriese verpleegspraktisyn in enige geestesgesondheidsomgewing as afhanklik van sekere faktore in die organisasie. Dit sluit die filosofie, doelwitte, heersende begrip van geestesgesondheid, die behoeftes van die geestesgesondheidsgebruikers, die aantal beskikbare personeel, die kommunikasiestruktuur, begrip vir die individuele rolle, beskikbare hulpbronne en die teenwoordigheid van effektiewe verpleegsbegeleiding in. As ʼn professionele psigiatriese verpleegspraktisyn het ek die behoefte aan effektiewe werkplekondersteuning vir psigiatriese verpleegspraktisyns wat in ʼn privaat geestesgesondheidsomgewing werk, waargeneem toe ek na tekens van uitbranding by die psigiatriese verpleegspraktisyns opgelet het, en na die werknemers geluister het wanneer hulle hul behoefte aan werkplekondersteuning verwoord het. Die doel van hierdie studie was om ʼn Waarderende Ondersoek te loods ten einde ʼn indiepte begrip van die ondervindings en wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning in ʼn privaat geestesgesondheidsomgewing te bewerkstellig. Die doelstellings van die studie was om die ondervindings van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning te beskryf ten einde die wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning in ʼn privaat geestesgesondheidsomgewing te ondersoek en te beskryf en om aanbevelings te maak met betrekking tot werkplekondersteuning. Voorgestelde aanbevelings verwys na psigiatriese verpleegsnavorsing, psigiatriese verpleegsopleiding, psigiatriese verpleegs-bestuur en psigiatriese verpleegspraktyk, om meer effektiewe metodes te fasiliteer ten einde werkplekondersteuning te voorsien en die geestesgesondheid van psigiatriese verpleegspraktisyns te bevorder. Ek het besluit om ʼn Waarderende Ondersoekraamwerk te gebruik te einde die ervarings en wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning te ondersoek. Die belangrikheid van ʼn Waarderende Ondersoek lê in die waardering van die gedrag en terugvoer van individue, in plaas van om op hul probleme te fokus. Waarderende Ondersoek identifiseer dit wat positief is in enige stelsel en sluit daarby aan of bou daarop om energie, visie en aksie vir verandering te verhoog (Cooperrider, Whitney&Stavros, 2008:XV). Die meta-teoretiese perspektief wat die navorser gelei het, was die Teorie vir Gesondheidsbevordering in Verpleging. Die hoofdoel van hierdie teorie is die gesondheidsbevordering van ʼn individu, groep, gesin of gemeenskap (Universiteit van Johannesburg, 2009:4). Die individu is in interaksie met die omgewing, wat uit ʼn interne en eksterne omgewing bestaan. Die interne omgewing sluit die liggaamlike, verstandelike en geestelike dimensies van die individu in. Die eksterne omgewing sluit die fisiese, sosiale en geestelike dimensies van die individu in. Die interaksies van hierdie dimensies in ʼn individu se omgewing beïnvloed die gesondheidstoestand van die individu op ʼn kontinuum (Universiteit van Johannesburg, 2009:5). Die ervarings en wense met betrekking tot die voorsiening van werkplekondersteuning wat met die interne en eksterne omgewings van die psigiatriese verpleegpraktisyn verband hou, is ondersoek ten einde die bevordering van die geestesgesondheid van die psigiatriese verpleegpraktisyn te fasiliteer. Die teoretiese en metodologiese perspektief wat hierdie studie gelei het, was Waarderende Ondersoek. Waarderende Ondersoek gebruik ʼn proses wat as die 4-D siklus bekend staan. Hierdie proses word gebruik om verandering te fasiliteer of om die krag van Waarderende Ondersoek te verseker (Whitney&Trosten-Bloom, 2003:6). Vir hierdie navorsing oor werkplekondersteuning het ek die eerste twee fases van Waarderende Ondersoek, naamlik die ontdekkingsfase en die droomfase, as deel van dataversameling gebruik. Die ontdekkingsfase sluit die waardering of ontdekking van wat positief, lewegewend of effektief is, in, en die droomfase sluit die verbeelding van nuwe moontlikhede in. As ʼn unieke paradigma, bevraagteken Waarderende Ondersoek tradisionele benaderings tot probleemoplossing deur organisatoriese uitdagings met ʼn regstellende ingesteldheid te benader. ʼn Regstellende benadering sluit die waardering van die positiewe in, deur op suksesse, sterkpunte en potensiaal te fokus (Cooperrider, Whitney&Stavros, 2008:433). Waarderende Ondersoek sien organisasies as ʼn individuele sentrum met onmeetlike verbeelding en moontlikhede, met die voorneme om met oplossings vorendag te kom (Cooperrider, Whitney&Stavros, 2008:16-17). Ek het ʼn kwalitatiewe ontwerp, wat verduidelikend, beskrywend en kontekstueel van aard was, gebruik. Ek het ʼn Waarderende Ondersoekbenadering met hierdie ontwerp geïntegreer. Ek het doelbewuste steekproefneming, wat Polit en Beck (2007:763) definieer as ʼn steekproefnemingsmetode waar deelnemers gekies word op grond van wie die meeste inligting oor die tema van die navorsing sal verskaf, wat in hierdie navorsing werkplekondersteuning is. Die dataversamelingsmetodes wat ek gebruik het, was naïewe sketse, klein kerngroep-ondersoeke en individuele onderhoude met lede van die verpleegsbestuur. Die klein kerngroep-ondersoeke het geskrewe antwoorde op die onderhoudskedule van die een-tot-een onderhoude, getranskribeerde terugvoer van die besprekingsfase, die positiewe kernkaart, die nominale groeptegniek, veldnotas en reflektiewe onderhoude ingesluit. Die klein kerngroep-ondersoeke was gegrond op een-toteen onderhoude wat die deelnemers met mekaar, in groepe van twee, gevoer het, deur van ʼn onderhoudskedule gebruik te maak. Tydens die dataontledingsfase het ek twee verskillende tegnieke gebruik om die beskikbare data te ontleed, naamlik die nominale groeptegniek en oopkodering. Ek het ʼn boom as simbool vir werkplekondersteuning in hierdie geestesgesondheidsomgewing gebruik. Die wortels van die boom het die bestuur se vrywilligheid om werkplekondersteuning aan hul werknemers te bied, gesimboliseer. Die stam van die boom het die holistiese benadering tot werkplekondersteuning gesimboliseer. Die takke van die boom het die geïdentifiseerde temas gesimboliseer. Die kategorieë van die ontdekkingsfase is deur die groen blare voorgestel, en die kategorieë van die droomfase deur pienk botsels. Ek het aanbevelings gemaak met betrekking tot die psigiatriese verpleegsnavorsing, psigiatriese verpleegsopleiding, psigiatriese verpleegsbestuur en psigiatriese verpleegspraktyk. Die doel van hierdie aanbevelings is om meer effektiewe metodes vir die verskaffing van werkplekondersteuning, uit ʼn holistiese perspektief, te fasiliteer, ten einde die geestesgesondheidsbevordering van psigiatriese verpleegpraktisyns wat in hierdie geestesgesondheidsomgewing werk, te fasiliteer.
Dissertation (MCur)--University of Pretoria, 2011.
Nursing Science
unrestricted

The aim of this study was to determine the ability and proficiency of the newly qualified professional nurses in utilising psychiatric nursing skills at Chris Hani District Psychiatric Health Care Services in the Eastern Cape, South Africa. The research method was a qualitative, phenomenological approach. A purposive sample of newly qualified professional nurses and supervisors participated in the study. The data were collected through interviews and focus group discussions, using semi – structured interview guides. Interviews responses were recorded on the interview guide. Data were analysed using the computer software Atlas ti and manually. Positive and negative themes were identified. Ethical considerations were ensured by means of privacy, anonymity and confidentiality. Ethical clearance was obtained from the University of Fort Hare and permission from the Provincial Department of Health and Chris Hani District Health and Mental Health Institution at Queenstown was sought. The findings revealed that newly qualified professional nurses performed well, according to the perception of their supervisors. Newly qualified professional nurses were faced with challenges such as shortage of resources, mental illness not considered as a priority and lack of skills development. The study also revealed that newly qualified professional nurses focussed on the curative aspect of ailments, rather than preventive care. However community health workers (CHW) focussed on the preventive aspect of care. Limitations and recommendations based on the findings of the study are presented.

Xhosa psychiatric nurses stand unique at the interface between Western mental health care and indigenous healing in South Africa. They stem from a cultural history that is embedded within traditional health care discourses and yet are trained and work within a Western psychiatric model. In embodying the intersection between these two paradigms, they are faced with the challenge of making sense of such an amalgamation. These nurses' views are thus valuable in reflecting this intersection and illustrating many of the central concerns that surround it. This study explicates the views of these nurses toward traditional healers and their potential role in mental health care in South Africa. In addition, it illuminates some of the cultural dynamics at work amongst these subjects as they struggle to make sense of their unique cultural position. Using a questionnaire-based methodology, the views of Xhosa psychiatric nurses in a psychiatric hospital in the Eastern Cape, toward traditional healers and their role in mental-health care, were examined. The findings reveal that the vast majority of these nurses believe in traditional cosmology, involve themselves in traditional ritual practices and regularly visit traditional healers as patients. In suggesting ways in which indigenous healing and Western mental health care can work together, 75% of the nurses were in favour of a general referral system between the hospital and traditional healers, most (77%) agreed that certain patients would be better off being treated by both the hospital and traditional healers than they would if they were only being treated by the hospital alone, and 85% of the subjects agreed that patients who are already seeing traditional healers should check if psychiatric medication might help them. These findings indicate that these nurses operate across two healing systems which are at this point not conceptually compatible. This results in deep cultural tension for the nurses. In being entangled in the dialectical tension created in this context, the nurses manage the incongruencies in three general ways: a) Most, in one form or another, incorporate beliefs from both systems into an integrative model, b) some assimilate their cultural belief system into the Western mental health paradigm, throwing off their beliefs in traditional healing, and c) others remain ambivalent in the dialectic between traditional and Western health care discourses. Although this may suggest that these nurses reside within a cultural milieu that is somewhat unhealthy, at another level, in managing and containing the incompatibility between the two systems, these nurses ensure a space for on-going and healthy critique of the underlying assumptions involved in this health care malaise.

Magister Curationis - MCur
Background: Psychiatric observation units are the units where 72-hour psychiatric observations are conducted in the district and in some of the regional hospitals. These hospitals were selected under the Mental Health Care Act No. 17 of 2002 (MHCA 2002) to admit patients suspected to be mentally ill, ascertain the cause of symptoms, exclude medical illness as a cause of the symptoms, treat and rehabilitate these patients; and at times transfer the patients to tertiary psychiatric hospitals. These units are often overcrowded as only about 30% of patients are transferred to the tertiary psychiatric hospitals. These units are fraught with challenges such as shortage of crucial facilities like seclusion rooms, specialised staff, resources and minimal budget is allocated to these units. Nursing staff in these units are faced with a number of challenges such as shortage of staff, patient overflow, prolonged patient stay, psychologically disturbed patients who can be agitated and violent, and are working long hours. Therefore, Compassion Satisfaction may be affected and these nurses are prone to Compassion Fatigue, which can lead to low Professional Quality of Life. Aim & objectives: The aim was to investigate Professional Quality of Life among nurses working in psychiatric observation units in Metropole District Health Services in the Western Cape Metropole. The objectives were to measure Compassion Satisfaction, to measure levels of Burnout and determine levels of Secondary Traumatic Stress among nurses working in psychiatric observation units in the Metropole District Health Services. Method: A quantitative research approach using a descriptive design was used to determine the Professional Quality of Life of nurses working in psychiatric observation units in the Metropole District Health Services. A self-administered survey using a structured questionnaire, the Professional Quality of Life version 5 (ProQoL 5) was used to collect data from an all-inclusive sample of 175 nurses, yielding a response rate of 93% (n=163). Data was analysed using the Statistical Package of Social Services (SPSS) version 24. Findings: The findings of this study showed that respondents experienced moderate Compassion Satisfaction, moderate Burnout and high Secondary Traumatic Stress. Advanced psychiatric nurse practitioners and registered nurses reported lower Compassion Satisfaction, higher Burnout and higher Secondary Traumatic Stress than enrolled nurses and enrolled nursing assistants. Recommendations: Qualitative research studies need to be conducted on nurses working in psychiatric observation units in order to understand experiences and factors affecting Professional Quality of Life among nurses. Qualitative research studies need to be conducted in order to understand factors affecting Professional Quality of Life of advanced psychiatric nurse practitioners and general registered nurses in psychiatric observations units.

Magister Curationis - MCur
The provision of mental health care, treatment and rehabilitation of the acutely ill mental health care users (MHCUS) poses a major challenge to the nurses working in acute units. Nurses spend long hours ensuring that acutely ill psychiatric patients receive quality patient care in acute admission units in different psychiatric hospitals in South Africa. With few studies showing a rise in the prevalence of mental disorders in the South Africa and the Western Cape Province, acute psychiatric inpatient units across the province have experienced intense pressure and persistent rise in the number of acute patient admissions. Dealing with this group of patients is a difficult task particularly for nurses who spent prolonged hours caring for them. Despite the continuing provision of care to MHCUS by nurses in acute admission units, very little is known about the lived experiences of nurses in acute admission units. The aim of this study was to explore and describe the lived experiences of nurses who care for the acutely ill MHCUS in an acute male admission unit at a psychiatric hospital in the Western Cape. Acutely ill MHCUS in acute psychiatric units show severely disturbed behaviour at times, aggression, hostility, acute psychotic symptoms and many other symptoms related to psychiatric illness. Methods: a qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of nurses who care for acutely ill patients in an acute admission unit. A purposive sample of eight nurses was selected. Individual, semi structured phenomenological interviews were used to collect data from nurses caring for MHCUS in an acute admission unit. Data saturation was reached after carrying out the eight interviews. These interviews were audio taped and transcribed verbatim and Collaizi’s (1978) seven steps method of qualitative data was applied to analyse the collected data. Findings: The study found that nurses in the acute admission unit experienced several challenges while caring for MHCUs. Nurses reported both negative and positive experiences. Positive experiences included MHCUs recovery, teamwork and passion for caring while negative experiences were feeling unappreciated and unsupported by authorities. Furthermore, they reported physical assault by MHCUs which led to fear. Challenges experienced included shortage of staff and increased workload which led to burnout amongst nurses in acute admission units.

Human Immunodeficiency Virus (HIV) positive patients are at increased risk for developing mental health problems when compared with the general population. The identification and management of symptoms of mental illness in HIV-positive patients is thus crucial in reducing the risk to developing severe mental illness. The severe mental illness may lead to poor adherence to anti retro-viral drugs resulting in increased morbidity and mortality. The primary health care nurses are largely responsible for managing the treatment of HIV-positive patients as they spend the greatest degree of their time with these patients as compared to other health care professionals. Consequently it is important for primary health care nurses to identify symptoms of mental illness. However, it was unclear to the researcher, a professional psychiatric nurse, as to the level of knowledge among primary health care nurses concerning symptoms of mental illness in HIV-positive patients. Therefore, the aim of this study was to determine the knowledge of primary health care nurses regarding symptoms of mental illness in HIV-positive patients attending primary health care services. In addition, recommendations were developed for primary health care nurses for the purpose of improving their competence in the identification of symptoms of mental illness in HIV-positive patients attending primary health care services. The researcher has utilised quantitative, explorative, descriptive and contextual design. Bloom’s Taxonomy was used as a theoretical lens, to explore the primary health care nurse’s knowledge regarding symptoms of mental illness in HIV-positive patients. The study was conducted in the primary health care services situated in the Nelson Mandela Metropolitan area. The research population consisted of the primary health care nurses working with HIV-positive patients in these primary health care services. The researcher utilised census survey to recruit participants. A structured questionnaire, with 3 sections was used in this study. The necessary principles of reliability and validity were exercised to ensure research of the highest quality. The data was analysed by using descriptive and inferential statistics. All ethical considerations pertaining to beneficence, maleficence, justice, autonomy and obtaining permission from relevant structures to conduct the study were strictly adhered to.

Background: The use of the Dynamic Appraisal of Situational Aggression (DASA) in acute psychiatric settings to identify aggressive and/or violent patients upon admission. Objective: Determining nurses' perception of the usefulness of the Dynamic Assessment of Situational Aggression (DASA) in a psychiatric emergency room setting. Theoretical Background: Langley, Nolan, Nolan and Provost’s (2009) Model for Improvement, which incorporates Deming’s Plan-Do-Study-Act (PDSA) cycle, was utilized as the theoretical framework to guide this DNP project. Setting: An adult psychiatric emergency room in urban Phoenix, Arizona. Measurement: A six-item survey questionnaire measured on a five-point Likert scale ranging from "Strongly Disagree" (1) to "Strongly Agree" (5) describes and measures nurses' perception on the usefulness of the DASA. An additional question explored the influence of static nursing factors (gender, years of experience, level of education, years at the facility), on nurses' perception of the usefulness of the DASA. Results: Overall, nurses (90%) of the study participants perceived the DASA to be effective in identifying aggressive violent patients and 70% of the participants would like to continue to use the DASA. Static nursing factors showed no difference in nurses' perception of usefulness. Limitations: Further exploration in similar settings such as regular emergency departments and psychiatric emergency and crisis settings are recommended. In this study only nursing perception was explored. Analysis of the validity of the DASA tool in the psychiatric emergency room setting in addition to nursing perceptions would be more beneficial in determining the DASA’s true usefulness. Conclusion: The results of this DNP project demonstrate that nurses at the SAUPC perceive the DASA to be a useful addition to their admission assessment. Overall nursing response was positive and the SAUPC seclusion and restraint committee recommended incorporating the DASA into the triage nursing admission assessment.

Depression is often difficult to diagnose in the elderly. Elders and their families may misinterpret symptoms of depression as symptoms of co- morbid medical illnesses. These illnesses may include: diabetes, stroke, heart disease, arthritis, Parkinson's or Alzheimer's disease (National Mental Health Association, 1996). The Diagnostic and Statistical Manual of Mental Disorders (DSM- IV -TR) assists the health care provider in the diagnosis of depression. These include: Major Depressive Disorder (MDD), Depressive Disorder NOS, Bipolar I and II, and Mood Disorder due to General Medical Conditions. The elderly experience of depression involves loss, including: loss of interest in activities, decrease in energy, loss of control of their life, difficulty with concentration, difficulty with memory and the ability to make decisions (National Mental Health Association, 1996). In fact, one study found that depressive symptoms in the elderly are an important risk factor for developing cognitive impairment and triggering functional decline (Bassuk, Berkman, & Wypij, 1998.) This paper will concentrate on the loss of the decision -making ability in elders that is due to their diminished capacity and the knowledge and skills the Psychiatric Mental -health Nurse Practitioner (PMhNP) offers in assisting families and other providers to help depressed elders.

Nurses are an integral part of the health care system and their job encompasses a wide range of responsibilities including the promotion of health, prevention of illness and care for physically, mentally ill and disabled people. Nurses have a mandate to be responsible and accountable to the public they serve. For these reasons, it is crucial that nurses possess attitudes that allow them to provide optimal care in a supportive manner for patients. Despite the fact that considerable research on the experiences of nurses caring for the mentally ill in general hospitals has been done globally, none has been conducted in the Eastern Cape, South Africa. Additionally, no studies could be obtained from anywhere in the world on the experiences of non-psychiatric trained nurses caring for mental health care users on 72 hour observations. Studies indicated that nurses have different experiences when caring for mental health care users. It was therefore considered necessary to find out how non-psychiatric trained nurses perceive the caring of mental health care users during the 72 hour observations. The research design used to explore and describe their experiences was qualitative, descriptive, explorative, phenomenological and contextual in character. Semi-structured interviews were conducted with eight (8) participants who were purposively selected. This was done after necessary permission from the Department of Health and informed consent from the research participants. Steps were taken throughout the course of the study to ensure trustworthiness. Data were analysed using Tesch’s methods and the services of an independent coder were used. The results indicate that there are different experiences with regard to the caring for mental health care users during the 72 hour observations. The major themes identified are: feelings experienced by these nurses, lack of knowledge, challenges and strategies used for coping with a violent user, need for support from security staff and lack of policies. v Guidelines as a supportive action are suggested. From the results of the study recommendations are made in the areas of nursing education, nursing practice and nursing research. It is concluded that for non-psychiatric trained nurses to provide optimal care to mental health care users, the nurses need knowledge and skills in order to facilitate the promotion, maintenance and restoration of mental health of these patients as an integral part of health.

Magister Curationis - MCur
There is a growing burden of disease associated with mental disorders especially in low and middle-income countries. This growing burden is accompanied by an increase in psychotic disorders and has increased the demand for antipsychotic medication. The increase in the use of antipsychotic medication has resulted in the increase in side-effects that have a detrimental effect on the health of the mental health care user. Antipsychotic medication side-effects have been classified as the primary indicator for medication non-adherence. There is a relationship between psychiatric nurses’ knowledge and attitudes towards the use and the non-adherence of antipsychotic medication.

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.

Magister Curationis - MCur
The South African health care system shifted the focus of treating psychiatric disorders from institutional care level mental health services to facilitate this process of integration into the Primary Health Care (PHC) settings. All the provinces were thus engaged in improving mental health care services at community level by providing training for professional nurses in mental health at PHC settings. Consequently, mental health nursing has also changed considerably by shifting the focus of mental health care to the primary care level. It is however, suggested that the current revolving door syndrome experienced at psychiatric institutions was partly due to inadequate community-based psychiatric services. It was also suggested that the attitudes and knowledge of health professionals towards mental illness has a major impact on service delivery, treatment and outcome of mental illness. The aim of this research study was to assess the attitude of nursing staff working at a Community Health Centre (CHC) towards the mental health care user. A CHC was chosen that renders 24 hour services. The inclusive sample included all the different categories of nurses permanently employed at this CHC. The Attitude Scale for Mental Illness questionnaire was used to collect the data. Descriptive statistics: means, median and standard deviations were calculated for the following variables: separatism; stereotyping; restrictiveness; benevolence; pessimistic prediction and stigmatization. In conclusion it can be said that the nursing staff with more experience irrespective of category of nurse has less of a stereotyping attitude towards mental illness. The longer the nurse worked at the setting and irrespective of their nursing qualification the more positive their attitude towards the MHCU became.

People living with a mental health issue is elevated both nationally and internationally, and the likelihood of a person interacting with someone who has a mental health issue is high. It is even higher for those who work in the health care profession, so understanding their attitudes on this matter is important. As a review of current literature reveals, there is not only stigma in the health care system, but there is also stigma among health care professionals and students. One of the groups of students that has not been researched to a great extent is nursing students and the degree of stigma they have for caring for those with mental health issues. A cross-sectional survey was conducted to assess the degree of stigma among these individuals. A voluntary online survey was done was administered to undergraduate nursing students at a university in the southeastern part of the United States using the twenty item Opening Minds Scale for Health Care Providers (OMS-HC). The results indicated that mental illness stigma did exist within the student nurse community with no association between gender, classification, and mental health nursing course completion and total score on the OMS-HC scale.

The present thesis was carried out in part fulfilment of the Doctorate in Clinical Psychology at the University of Edinburgh. It is presented in portfolio format, comprising of two individual papers although a total thesis abstract provides an overview of the entire thesis. The first paper is a systematic review of existing empirical research. It explores the predictive validity of risk assessment tools for imminent (short-term) violence and aggression in forensic psychiatric settings. The second paper is an empirical study exploring how frontline nursing staff both predict and emotionally cope with experiencing violence and aggression in a high-security setting. Paper one was prepared for Aggression and Violent Behavior and paper two for The International Journal of Forensic Mental Health; so, follow their respective author guidelines. Mental health, and forensic mental health nurses have been identified as being at particular risk of experiencing patient perpetrated violence and aggression (PPVA). There is relatively little research investigating how nursing staff predict and cope with more immediate, imminent inpatient violence and aggression, specifically within secure (forensic) settings. Negative outcomes of PPVA are widely accepted and demonstrated within empirical literature, including increased anxiety and stress for staff, fractures to the therapeutic relationship between patients and staff, and difficulties with staff retention and absenteeism for the organization. Due to the extensive negative outcomes associated with PPVA, a wealth of research has focused on developing the area of violence risk assessment. Despite this, there remains limited understanding regarding the utility of existing risk assessment tools for predicting and assessing violence risk over brief time frames (i.e. days to weeks). Therefore, a systematic review was conducted to explore the predictive validity of violence risk assessment tools for imminent, short-term risk in inpatient forensic psychiatric settings. Findings demonstrated that multiple tools had decent predictive validity, however quality scores were impacted by small sample sizes. The Dynamic Appraisal of Situational Aggression- Inpatient Version was the most effective tool with the highest mean quality score. The main limitations were the small number of studies assessing some of the included tools and the level of ambiguity between studies regarding the definition of imminent, short-term violence. Developing a shared understanding of what constitutes short-term risk and improving the number and quality of studies on the largely neglected tools, should therefore be research priorities. How nurses actually recognize and predict inpatient violence and aggression in forensic psychiatric settings, and how they emotionally cope with the aftermath, are poorly explored and understood processes. A social constructivist grounded theory approach was used to analyze the transcripts from 12 interviews with frontline nursing staff from an inpatient high-security setting. A model was constructed integrating nurses' beliefs and assumptions about subtypes of violence, their efforts to use observation skills in order to aid risk prediction, and their resultant emotional experiences following PPVA. Nurses emotional coping seemed to be affected by several factors relating to the culture of the organization and the accessibility of support. Seemingly, knowing the patient helped nurses to better identify underlying needs leading to violent behavior. This understanding helped nurses to implement targeted, needs-led interventions to address these unmet needs, and so reduce recurrent and cyclical violence. Recommendations are made to build upon, and utilize nursing skills in risk prediction and management, and to help better support the emotional impact of experiencing PPVA within forensic psychiatric settings.

In a Department of Veterans Affairs hospital on the East Coast of the United States, behavioral outbursts result in 2 out of 10 veterans dismissed from a posttraumatic stress disorder (PTSD) unit prior to completing the 6-week program. The purpose of this evidence-based quality improvement project was to create a clinical practice guideline (CPG) based on social cognitive theory (SCT) to provide new strategies for managing veterans with PTSD and to improve the confidence of the nurses in managing outbursts. The Star Model guided the project development with the Delphi method to achieve participant consensus, the AGREE II to assess the CPG quality, and the Generalized Self-Efficacy (GSE) scale to measure the change in participant knowledge and confidence. The literature was searched, compiled, assessed, and shared with 10 participants, registered nurses on the PTSD unit. Through the Delphi process, the participants achieved consensus (8/10) for the CPG, with two neutral participants. The GSE was administered pre- and post-test and analyzed using a paired t test to measure the mean differences of the GSE scores. The data was normally distributed to different scores to gauge the impact of the CPG development process on improving nursing knowledge and confidence was normally distributed [t(9) = -4.188, p < 0.05, &, t(9) = -2.714, p =0.003]. The data indicated a significant increase in participant knowledge about role of SCT, and confidence toward implementing the CPG into clinical practice. This project contributes to positive social change as nurses identified a clinical practice problem, transferred evidence about strategies from the literature into their clinical practice through a CPG, and implemented the CPG with the knowledge and confidence to impact patient care.

The prevalence of mental health disorders in the United States is estimated at 1 in 5 persons in any given year, with a lifetime prevalence of approximately 50% (National Institute of Mental Health, 2016a, 2016b). Despite scientific progress towards effective behavioral and psychopharmacological treatment, nearly 50% of Americans with mental illness do not receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). This project will identify key geographical and logistical factors restricting recruitment and retention of psychiatric providers (MD or NP) for an underserved region in California. The results of the study will be used to develop a model for effective partnerships aimed at a “grow your own” approach to addressing the shortage of psychiatric providers. In California, the Mental Health Services Act (MHSA) was approved by the voters as Proposition 63 in 2004, funding expansion of mental health resources and specifically, workforce development (California Department of Health Care Services [DHCS], 2017). National funding also supports the expansion of PMHNP training and capacity through Health Resources and Service Administration (HRSA) and SAMHSA. Despite administrative and funding resources from MHSA and HRSA, the shortage of psychiatric providers continues in rural and remote areas. While few national studies have included nurse practitioners in the findings, a growing body of evidence suggests that nurse practitioners can serve similar if not the same function as physician colleagues (DiCicco-Bloom & Cunningham, 2014; National Governors Association, 2012; Newhouse et al, 2011). Barriers to mental health services in rural communities include challenges around a) availability, b) accessibility, c) affordability, and d) acceptability (Wilson, Bangs, & Hatting, 2015). Using a descriptive design, this project explores these factors necessary for patient access to psychiatric services in rural areas. A logic model is used to create a summary of the findings, which will be used to propose a clinical training partnership between an urban university-based PMHNP education and a rural clinic-based training to be completed upon conclusion of the project.

O objetivo deste estudo foi analisar a convivência do adolescente doente mental com sua família através do relato dos pais. Foram realizadas entrevistas semi estruturadas com pais de adolescentes em acompanhamento no ambulatório do Serviço de Psiquiatria da Infância e Adolescência do HCFMUSP (SEPIA), no período de março a maio de 2006. Participaram cinco mães e três pais. Utilizou-se a análise de conteúdo, elegendo para este estudo a análise temática, segundo MINAYO. Foram identificadas cinco categorias: “Sentimentos gerados na família ao receber o diagnóstico”; “Mudanças no relacionamento familiar e social no convívio familiar com a doença mental”; “Sentimentos que surgiram no convívio com o transtorno mental”; “Descrença quanto ao tratamento”; “Caminhada do desconhecimento ao conhecimento”. Evidenciou-se que os familiares têm dificuldade em aceitar o diagnóstico de uma doença mental em um de seus filhos. A presença desta provocou alterações na dinâmica familiar, acarretando mudanças, não só no convívio da família nuclear, mas afetando os demais componentes da família. O relacionamento na rede social também sofre modificações, em especial com professores e vizinhança. O conhecimento sobre a doença, por parte dos familiares, levou a uma melhor aceitação dessa. Essa constatação mostra, mais uma vez, que as famílias são carentes de orientação e apoio por parte da equipe de saúde que cuida de seus filhos. Apesar de se preconizar, no modelo vigente de saúde mental, o atendimento também às famílias, isto ainda acontece de maneira tímida em determinados locais, sendo a família considerada apenas como fonte de informação. A compreensão do que a família experimenta no seu caminhar com a doença mental, destacada nesse estudo, evidenciou a necessidade de programas de educação em saúde para que possa enfrentar suas dificuldades com mais segurança. Este estudo possibilitou entender um pouco do mundo do adolescente e de seus familiares, enfatizando a importância do profissional Enfermeiro em seu papel de educador. Com base nos resultados desta pesquisa e em resultados de outras, a implantação de programa psicoeducacional aberto, se mostra como possível recurso eficaz coadjuvante para sanar a falta de conhecimento e orientação. Este já se configura como um desdobramento do presente estudo, enfeixando o ensino, pesquisa e assistência.
The aim of this research was to analyze the mentally sick adolescent’s acquaintance with his family through the parents report. Semi-structured interviews with the adolescents’ parents who have been treated in the ambulatory of the Child and Adolescent Psychiatric Service of HCFMUSP (SEPIA) were done, from March to May, 2006. Five mothers and three fathers participated. The content analysis was used, electing for this research the thematic analysis according to MINAYO. Five categories were identified: “Feelings begot in the family at the moment of the diagnostic “; Changes in the family and social relationship living together with the mental disease”; “Feelings that emerged when living together with the mental disorder”; Faithlessness to the treatment”; “Walk from the unknown to the knowledge”. It became evident that parents have difficulty in accepting the mental disorder diagnostic in one of their children. This presence created modification in the family dynamic bringing changes not only to the core of the living together family, but affecting the other components of the family. The relationship in the social area also suffered modifications, especially with teachers and neighborhood. The knowledge about this disease brought a better acceptation. This shows, one more time, that families are poorly informed and supported by the health team that takes care of their children. Despite the fact the current mental health model praises also an attending for the family, this still happens in a shy way in certain places, the family is considered only as a source of information. The comprehension of what the family experiments during the journey in the mental disease stood out in this research showed the necessity of health educational programs, so that they can face their difficulties safely. This study helped understand a little the adolescents and family’s world, emphasizing the importance of the Nurse professional in his educational role. Based on the results of this and other researches, it is suggested the establishment of an open educational program as an efficient co adjuvant resource to clear out the lack of knowledge and orientation. This is a display of the present research, tying together : teaching, research and assistance.

Depuis l’initiation du processus d’ouverture des hôpitaux psychiatriques sur la ville en 1960, le travail des soignants de la psychiatrie publique hospitalière a fait l’objet de profondes transformations. A partir d’un travail d’observation directe au long cours de la vie quotidienne des équipes de soin à l’hôpital psychiatrique et d’un matériau qualitatif complémentaire composé d’entretiens et de documents d’archives, cette thèse décrit la pratique infirmière en psychiatrie. L’héritage de métier des infirmiers de la psychiatrie publique hospitalière peine à s’exprimer dans la pratique des soignants. Les principes, les références et les pratiques qu’ils ont intégrés au cours de leur socialisation professionnelle sont remis en cause par un double processus de déprofessionnalisation et de déspécialisation de la psychiatrie. En 1992, le diplôme protégeant les frontières du groupe professionnel des infirmiers de la psychiatrie est supprimé au profit d’une formation associant ses membres au groupe plus large des infirmiers généraux. Dans le même temps, les réformes hospitalières récusent la spécificité de la filière de soin psychiatrique et soumettent les soignants de la psychiatrie aux mêmes injonctions que celles pesant sur les autres filières de l’hôpital public. Enfin, le passage de la psychiatrie à la santé mentale transforme le rôle de l’hospitalisation en psychiatrie. Autrefois lieu unique de la prise en charge du mal-être, l’hôpital psychiatrique est aujourd’hui le dernier recours pour des patients en crise aigüe ne pouvant être traités au sein des dispositifs extrahospitaliers de santé mentale. Le recentrement sur les pathologies les plus lourdes et sur la gestion de la crise aigüe, l’injonction à la performance et à la qualité et la remise en cause des savoirs au fondement du métier d’infirmier en psychiatrie traduisent la reformulation du mandat accordé aux soignants de la psychiatrie. Aujourd’hui tributaires d’un mandat d’ex-compagnement, les infirmiers de la psychiatrie publique hospitalière sont chargés de soigner les patients et de les raccompagner au plus vite vers la sortie de l’établissement. Ce mandat paradoxal induit de nouvelles pratiques. Dans le quotidien des unités de soin, les infirmiers chargés à la fois de vider les lits et de prendre soin des patients mobilisent les outils thérapeutiques au service de la gestion des flux de patients. Ils participent ce faisant à la création d’un quotidien aux règles strictes et à l’imposition d’un rôle de patient particulièrement exigeant. Ne pouvant accorder du temps à l’ensemble des patients, ils procèdent à la sélection de quelques malades méritants et se désinvestissent collectivement des patients indignes de leur engagement. Face aux contraintes managériales et gestionnaires, les infirmiers de la psychiatrie sont loin d’être démunis. Ils parviennent par leurs résistances à lutter contre la colonisation de la politique du chiffre et à protéger leur métier. Leur maîtrise de l’art du braconnage leur confère un pouvoir leur permettant de subvertir les instruments de pouvoir issus du New Public Management et de renverser les effets de la dominance professionnelle des médecins. Profession subalterne dans la hiérarchie hospitalière, les infirmiers en psychiatrie se présentent aujourd’hui, au regard de leur pratique professionnelle, comme les principaux artisans du quotidien de la psychiatrie
Since the initiation of psychiatric hospitals opening process in 1960, care work in the public hospital psychiatry has been the subject of profound transformations. From a direct observation work of the daily life of care teams in the mental hospital and an additional qualitative material composed of interviews and archive documents, this thesis describes the nursing practice in psychiatry.The skilled nursing heritage of public psychiatric hospital hardly expresses itself in the practice of nursing. The principles, references and practices they have built during their professional socialization are challenged by a double process of de-professionalization and de-specialization in psychiatry. In 1992, the diploma protecting the borders of the professional group of nurses in psychiatry is deleted in favor of a training involving its members in the wider group of the general nurses. Meanwhile, hospital reform rejects the specificity of the psychiatric care sector and submits caregivers of psychiatry to the same injunctions as those imposed on the other sectors of the public hospital. Finally, the shift from psychiatry to mental health transformed the role of psychiatric hospitalization. Formerly unique place in the treatment of ill-being, the psychiatric hospital is now the last resort for patients in acute crisis that cannot be treated in the mental health-hospital devices. The refocusing on the most serious diseases and the management of acute crisis, the injunction to performance and quality and the questioning of the basis of the knowledge of the nursing profession in psychiatry reflect the restatement of the mandate given to caregivers of psychiatry. Today dependent on an ex-companying mandate, nurses in the hospital public psychiatry are responsible for patients’ care and have to accompany them quickly towards the hospital exit. This paradoxical mandate induces new practices. In the daily care units, nurses responsible both for emptying the beds and taking care of patients mobilize therapeutic tools for the management of patient flow. They participate thereby in the creation of strict rules in everyday life and in the imposition of a particularly demanding patient role. Unable to give time to all the patients, they proceed to the selection of some deserving patients and divest collectively patients who are unworthy of their commitment. Faced with managerial and managerial constraints, psychiatry nurses are far from weak. By their resistance, they manage to fight against the colonization of numbers policy and to protect their profession. Their mastery of the art of poaching gives them a power enabling them to subvert the instruments of power from the New Public Management and to reverse the effects of professional dominance of physicians. Subaltern profession in the hospital hierarchy, psychiatric nurses stand today, in terms of their professional practice, as the main architects of the daily psychiatry

Atualmente, vários estudos são encontrados na área de enfermagem psiquiátrica e saúde mental que descrevem o descompasso entre o ensino e a prática da enfermagem psiquiátrica e saúde mental e desses com as políticas nacionais de saúde mental. Este cenário é um dos fatores que colabora para a formação de profissionais acríticos e pouco atuantes politicamente dentro de um contexto de Reforma Psiquiátrica. Acresce-se o fato de estarmos inseridos em uma sociedade pós-moderna, em constante transformação, na qual as tradicionais práticas educativas já não sustentam ações para atender as necessidades contemporâneas. A percepção de que os professores ao formularem seus planos e objetivos, para o ensino, acreditam que estão formando enfermeiros competentes para a prática assistencial em saúde mental, conforme os princípios da Reforma Psiquiátrica, porém, sem definição do referencial pedagógico que sustente este processo ensino-aprendizagem, motivou este estudo que teve por finalidade confrontar o referencial da pedagogia das competências com o referencial pedagógico dos educadores, sujeitos da pesquisa. Os objetivos foram os de analisar a representação dos sujeitos da pesquisa (docentes e enfermeiros de campo) sobre competência; identificar os conhecimentos necessários e as habilidades que devem ser desenvolvidas pelo enfermeiro para a construção das competências; identificar limites e possibilidades para a construção de competências, para o ensino da prática de enfermagem psiquiátrica e saúde mental. Os elementos teóricos que fundamentaram esta investigação teve como base a \"pedagogia das competências\" e o referencial teórico-filosófico do materialismo histórico-dialético. Para conhecimento do objeto foram definidas as categorias analíticas práxis e relações sociais de produção. A coleta de dados realizou-se a partir de grupos focais com os sujeitos da pesquisa (docentes e enfermeiros de campo) e a análise se baseou na técnica de análise de discurso. Foram identificadas as categorias empíricas \"Competência: saber administrar uma situação complexa\"; \"Competência e a mobilização de recursos pessoais e do meio\" e \"Agir com competência\". A investigação revelou que os enfermeiros têm diversas compreensões sobre competência, mas também, aproximam-se do conceito pedagógico de competência (mobilização de recursos pessoais e do meio para agir eficazmente em um determinado contexto). Os depoentes revelaram uma insatisfação com o modelo pedagógico aplicado na formação geral do enfermeiro e estão num processo de mobilização, de busca de outros modelos. Não conseguiram superar os paradigmas tradicionais, mas, estão em movimento. Pode-se afirmar que o ensino de enfermagem psiquiátrica e de saúde mental não vem formando para competência; embora alguns discursos já incorporem as novas tendências pedagógicas. Sugere-se que a superação das contradições identificadas no processo passe pela adoção de um modelo fundamentado nos pressupostos da pedagogia das competências.
Nowadays there are many studies in the psychiatric nursing and mental health field that describe the out of proportion reality between the psychiatric nursing/mental health learning and practice besides their divergence with the national mental health politics. This stage is one of the factors that collaborate to the formation of non-critical and little politically active professionals in a Psychiatric Reform context. Furthermore there is the fact that we are inserted in a pos-modern society, in constant transformation, in which the traditional educative practices don\'t sustain actions anymore to meet the contemporary needs. There was the perception that the teachers, while formulating their plans and objectives to teach, believe that they are forming capable nurses to the practice of assistance in mental health, according to the principles of the Psychiatric Reform. Nevertheless, there isn\'t a definition of the pedagogical reference that sustain this teaching-learning process. Such situation has motivated this study and its goal is to face the reference of pedagogy of competences with the educators pedagogical reference and considering that educators were search subjects. The goals were to analyze the representation of the search subjects (teachers and nurses with practice) about competence; to identify the needed knowledge and the abilities that must be developed by the nurse to the construction of the competences; to identify limits and possibilities to the construction of competences to the psychiatric nursing and mental health practice learning. The theoretical elements that substantiate this investigation has had as basis the \"pedagogy of the competences\" and the theoretical-philosophic reference of the historical-dialectic materialism. In order to know the goal the analytical categories praxe and social relations of production were defined. The collection of data was done from focal groups with the search subjects (teachers and nurses with practice) and the analysis have based in the technique of speech analysis. The empirical categories were identified: \"Competence: to know how to deal with a complex situation\", \"Competence and the personal and environmental resources mobilization\" and \"To act with competence\". The competence revealed that the nurses have diverse comprehensions about competence, but they also approach the pedagogical concept of competence (personal and environmental resources mobilization to act efficiently in a determined context). The deponents have revealed a dissatisfaction with the pedagogical model applied in the general formation of the nurse and they are in a mobilization process, searching other models. They couldn\'t overcome the traditional paradigms but they are in movement. It is affirmed that the psychiatric nursing and mental health teaching hasn\'t been forming nurses for competence; although some speeches have already incorporated the new pedagogical tendencies. It is suggested that the overcome of the contradictions identified in the process become a measure of adoption of a model based in the presupposition of the pedagogy of competences.

Bakgrund: Rapporter och studier belyser utvecklingsbehovet inom hälso- och sjukvården avseende salutogena förhållningssätt. Få systematiska hälsofrämjande arbetsmetoder existerar samt att ett helhetsperspektiv där den enskilde patientens resurser tillgodoses, bör vara centralt. Denna studie avser att skapa ökad kunskap om hur arbetet med patientens resurser ser ut. Syfte: Syftet var att undersöka hur specialistsjuksköterskan i psykiatrisk vård identifierar, värderar och använder sig av resurser hos patienter med psykisk ohälsa. Metod: Kvalitativ design valdes för att ge svar på syftet. Datainsamlingsmetoden var intervju där sex specialistsjuksköterskor inom psykiatrisk vård deltog. Forskningsfrågorna besvarades via frågor av öppen karaktär. Datamaterialet analyserades enligt kvalitativ innehållsanalys, induktiv ansats. Resultat: Informanterna beskrev att patientens resurser identifierades i alliansskapande möten, kartläggande samtal samt motiverande samtal. Vad informanterna värderade som resurser resulterade i kategorierna interna respektive externa resurser. Exempel på betydelsefulla resurser är att ha ett socialt nätverk, att ha insikt över sin situation samt motivation att göra förändringar i sin tillvaro. Att formulera resursdiagnoser och att interagera dem med åtgärderna i omvårdnadsplanen, beskrevs som ett effektivt verktyg för att förvalta patientens resurser. Samtliga informanter upplevde påtagliga förbättringsområden avseende resurshanteringen, till exempel saknades ett gemensamt språk angående hur resurser skall tillvaratas, arbetet upplevdes alltför probleminriktat samt önskades ett processmässigt tankesätt istället för att endast det akuta åtgärdas. Diskussion: Studiens resultat diskuterades gentemot Antonovskys salutogena perspektiv, vilken understryker vikten av att se det friska hos patienten och vilka resurser som bidrar till hälsa. Flera studier lyfter fram att det salutogena perspektivet och begreppet KASAM kan användas i praktiken samt ha betydelse i återhämningsprocessen mot psykisk hälsa.
Background: Studies show a need for development in mental health service for salutogenic approaches. Few systematic health promoting activities exist and a holistic perspective, where the patient’s individual resources are catered, should be the focus. This study intends to provide a better knowledge of how the work with the patient’s resources look like. Aim: The aim of this study was to examine how psychiatric nurses identify, value and use the resources of patients with mental illness. Method: A qualitative design was chosen. The data collection was done by interviews, in which six psychiatric nurses participated. Open-ended questions were used to answer the research questions. Data was analyzed according to qualitative content analysis, using an inductive approach. Results: The participants described that the patient’s resources were identified in sessions where the emphasis was laid on building a therapeutic alliance, information gathering and motivational interviewing. The resources that the participants valued resulted in two categories, internal versus external resources. To have a social network, to have awareness of one’s situation and motivation to change were all examples of meaningful resources according to the participants. To formulate resource diagnosis and to integrate these with the interventions in the care plan were described as effective tools in order to look after the patients’ resources. All participants experienced significant improvements in terms of managing their resources. For instance, there was no agreed understanding of how to utilize resources, the work was perceived as too problem focused and a preference for a more process focused way of thinking was expressed. Discussion: The study’s results were discussed against Antonovsky’s salutogenic         perspective, which emphasises the importance of viewing the healthy aspects in patients as well as the factors that contributes to good health. Many studies highlight that the salutogenic perspective and KASAM can be applied in practice and is useful for the recovery process in mental health.

In South Africa, mental health care is being integrated into primary health care services. The integration of services was aimed at increasing the accessibility and availability of all health care services at primary health care level. The integration was well intentioned, and it was hoped that mentally ill clients would benefit from having a service near their homes. However, the process of integration is fraught with challenges, for instance, staff shortages, which lead to ineffective nursing management of mentally ill clients at the primary health care clinics. As a result, one professional nurse is often allocated to manage the clinic services on a daily basis with the assistance of an enrolled nurse or auxiliary nurse. The professional nurses therefore experience high levels of stress due to gross staff shortages and lack of time to conduct proper nursing assessments. This led to the research question: “What are the experiences of professional nurses with regards to the nursing management of mentally ill clients in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape?’’ The proposed objectives of the study were to explore and describe the experiences of professional nurses working in rural primary health care clinics with regard to the nursing management of mentally ill clients. The researcher thereafter made recommendations to the district managers regarding effective nursing management of mentally ill clients in rural primary health care clinics. A qualitative, exploratory, descriptive and contextual design was used. The research population comprised of professional nurses working in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape. Purposive sampling was used to identify participants and the sample number was determined by data saturation. Unstructured interviews and observation notes were used to collect data. The eight steps of data analysis suggested by Tesch were utilized to analyze the data. The researcher conducted an in-depth literature review in order to identify research gaps pertaining to the study. To ensure that a high level of validity and reliability was exercised throughout the study, the researcher conformed to Lincoln and Guba’s model of trustworthiness. The study was conducted in an ethical manner and ethical principles were adhered to. Findings: Three themes with subthemes emerged. The study showed that professional nurses experienced challenges related to the nursing management of mentally ill clients. These challenges included shortage of staff, a heavy workload, and lack of resources, lack of in-service training and workshops related to mental health issues coupled with lack of support from the supervisors. Due to the challenges, the mentally ill clients were not getting quality nursing care leading to complications and relapse. Conclusion: It emerged from the study that matters pertaining to mental illness and mental discomfort were still a serious problem in rural areas. The problems were related to the challenges which prevented professional nurses from providing quality nursing care to mentally ill clients with subsequent complications and relapse. Recommendations: Recommendations were made as an effort to ensure that the nursing management of mentally ill clients in rural primary health care clinics is improved. These recommendations were categorized as related to nursing practice, nursing education and nursing research.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Enfermagem
Tem-se verificado, nas últimas décadas, um aumento da tentativa de suicido ao nível da população mundial, com números preocupantes no que concerne à prática ou tentativa de colocar um fim à própria vida. A enfermagem na área da Psiquiatria, num contexto multidisciplinar, quer ao nível clínico, quer hospitalar, surge como uma via importante de prevenção, identificação e encaminhamento dos pacientes que, por diversos motivos, possam proceder ao suicídio, ou pelo menos à sua tentativa. Perante este contexto, o objectivo geral desta monografia passar por fazer um estudo de investigação sobre a temática “Tentativa de suicídio – Perspectiva dos Enfermeiros de Psiquiatria”, assente numa base exploratório-descritiva com análise qualitativa dos dados, cujos objetivos principais preconizados são aprofundar os saberes e aptidões oriundos da área de investigação de campo; enriquecer o conhecimento sobre a temática em estudo, através da análise critico-reflexiva de artigos científicos; dar cumprimento a uma exigência curricular servindo de instrumento de avaliação da disciplina de Projeto de Graduação do 4º ano da licenciatura de Enfermagem e servir de guia orientador para a elaboração de futuros trabalhos de investigação. There has been, in recent decades, an increase in attempted suicide at the world's population, with numbers concern regarding the practice or attempt to put an end to his life. Nursing in Psychiatry, in a multidisciplinary context, both at clinical or hospital, emerges as an important route for prevention, identification and referral of patients who, for various reasons, are able to suicide, or at least the attempt. Against this background, the overall aim of this thesis to go through a research study on the topic "Attempted suicide - Perspective of Nurses in Psychiatry", based on an exploratory and descriptive qualitative data analysis, whose main objectives are recommended deepen knowledge and skills derived from the area of field investigation; enrich knowledge on the subject under study, through critical analysis and reflective papers; satisfy a curricular requirement serving as a tool for assessing the discipline of Project Graduation 4th year degree of Nursing and serve as a guide for guiding the development of future research.

Mestrado em Enfermagem, Área de especialização: Enfermagem de Saúde Mental e Psiquiátrica
Estima-se 827.000 cuidadores informais em Portugal. Os cuidados requerem esforço contínuo a nível cognitivo, emocional e físico levando a um aumento de stress e sobrecarga no cuidador informal. Da evidência e realidade profissional emergiu o problema: Quais as intervenções terapêuticas do Enfermeiro Especialista em Saúde Mental e Psiquiátrica com o cuidador informal em sobrecarga, na UCC? Realizou-se uma Revisão Integrativa da Literatura integrando-a na Metodologia de Projeto. O objetivo principal foi refletir sobre a importância da intervenção terapêutica do enfermeiro especialista em saúde mental e psiquiátrica no âmbito do cuidado de enfermagem com o cuidador informal em sobrecarga. A evidência revelou a que a oportunidade para expressar necessidades/acolher sentimentos do cuidador informal é um estímulo para (enfermeiro-cuidador) planearem intervenções terapêuticas eficazes na gestão da sobrecarga. Identificámos intervenções terapêuticas como: psicoeducação, aconselhamento psicoterapêutico individual e partilha em grupo.
An estimated 827,000 informal caregivers in Portugal. Care requires continuous effort at the cognitive, emotional, and physical level leading to increased stress and overload in the informal caregiver. From the evidence and professional reality emerged the problem: What are the therapeutic interventions of the Specialist Nurse in Mental and Psychiatric Health with the informal caregiver in overload, in the UCC? An Integrative Review of Literature was carried out integrating it in the Project Methodology. The main objective is to reflect on the importance of the therapeutic intervention of the specialist nurse in mental and psychiatric health in the scope of nursing care with the informal caregiver in overload. Evidence has shown that the opportunity to express needs/welcome feelings of the informal caregiver is a stimulus for (nurse-caregiver) to plan effective therapeutic interventions in the management of the burden. We identified therapeutic interventions as: psychoeducation, individual psychotherapeutic counseling and group sharing.

Bakgrund: Tidigare forskning visar att patienter som kommer i kontakt med psykiatrin eftersuicidförsök ofta upplever känslor av skam och rädsla. Det första mötet med sjuksköterskan är ofta avgörande för hur vårdtiden av patienten utvecklas. Upplever patienten sig inte tagen på allvar, sedd eller hörd kan detta leda till flyktkänslor eller att man drar sig undan. Syfte: Syftet med studien är att utifrån vetenskaplig litteratur beskriva patienter och sjuksköterskors upplevelser av att få samt ge vård efter ett suicidförsök. Metod: Kvalitativ forskningsöversikt inkluderat åtta vetenskapliga studier från databaserna CINAHL och PsychINFO. Data har analyserats med stöd av Evans fyrstegsanalys. Resultat: Resultatet visar att patienter har ett behov att känna sig tagna på allvar för att lindra lidande. Resultatet visar även att sjuksköterskan upplever svårigheter i mötet med den suicidala patienten. Sjuksköterskans bemötande och engagemang i patienten har en central roll för patientens möte med psykiatrisk vård efter ett suicidförsök. Diskussion: Mötet mellan patienten och sjuksköterskan avspeglar sig i sjuksköterskans bemötande och engagemang i patienten, genom att ta patienten på allvar kan lidande lindras och patientens välbefinnande kan ökas. Genom engagemang stöttas patienten och genom eliminering av negativa upplevda känslor kan sjuksköterskan nå patienten på ett sätt som gör att patienten kan inspireras att förändra sin livssituation.
Background: Previous researches shows patients who come in contact with a psychiatric ward after suicide attempt often experience feelings of shame and fear. The first meeting is determined by how the time at the ward develops. If a patient experience not being taken seriously or heard it usually leads to feelings of escaping or withdrawing. Aim: The purpose of the study is based on scientific literature describing patients and nurses' experiences in receiving and providing care after a suicide attempt. Method: Qualitative research review included eight scientific studies from the databases CINAHL and PsychINFO. Data were analyzed with the aid of Evans four steps analysis. Results: The results show that patients have a need to feel that they are being taken seriously in order to alleviate suffering. The result also shows that nurses are experiencing difficulties in meeting with the suicidal patient. The nurse's attitude and commitment to the patient has a central role in the patient's encounter with psychiatric care after a suicide attempt. Discussion: The meeting between the patient and the nurse is reflected in the nurse's attitude and commitment to the patient, by taking the patient seriously suffering can be alleviated and the patient's well being can be increased. Through dedication supported the patient and by the elimination of negative emotions experienced nurse can reach the patient in a way that allows a patient to be inspired to change their lives.

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.

Nursing specialization involves focusing on nursing practice in an identified specific area within the entire field of professional nursing. A defined specialty scope of practice statement and standards of professional practice, with accompanying competencies, are unique to each nursing specialty. These documents help assure continued understanding and recognition of nursing’s diverse professional contributions. The purpose of this article is to demystify the process for specialty nurses who are creating or revising their specialty nursing scope and standards of practice. We provide best practices for the developmental process based on our recently published scope and standards of specialty nursing practice. The conclusion provides strategies to disseminate scope and standards documents to appropriate stakeholders.

O crescente envelhecimento da população e as várias alterações ocorridas nas últimas décadas, tanto a nível da estrutura social como familiar, vieram despoletar novas necessidades, implicando perda de autonomia e acarretando uma maior solicitação de apoios. Apesar das reais transformações, a família continua a ser a principal fonte de ajuda e de suporte. Contudo, a prestação de cuidados requer um esforço contínuo ao nível físico, psicológico, social e económico, originando quase sempre sobrecarga. Com base nesta premissa, considerámos pertinente e necessária a intervenção junto dos cuidadores informais, de modo a percecionar o bem-estar do prestador informal de cuidados e qual o impacto no desempenho desse papel. O objetivo geral do projeto passou por identificar as intervenções terapêuticas de Enfermagem de Saúde Mental e Psiquiátrica eficazes na promoção e proteção da saúde mental de cuidadores informais. Sendo desenhada uma intervenção individual efetuada através de visitas domiciliárias aos cuidadores informais em estudo. A nossa opção metodológica situa-se na Metodologia de projeto, permitindo um processo contínuo e reflexivo. Os instrumentos utilizados para a recolha de dados foram a entrevista semiestruturada e a Subescala – Bem-estar Psicológico do Mental Health Inventory. As intervenções psicoterapêuticas procuraram dotar os indivíduos mais vulneráveis, de estratégias de coping eficazes e de capacidade de resiliência. A relação interpessoal enfermeira – utente é base para a manutenção e/ou recuperação da saúde, pelo que todas as intervenções realizadas tiveram como base este pressuposto; ABSTRACT: “Burden associated with caregiving: the importance of well-being in the caregiver” The increasing aging of the population and the various changes that have occurred in recent decades, both in terms of social and family structure, have triggered new needs, implying loss of autonomy and leading to a greater demand for support. Despite the real transformations, the family continues to be the main source of help and support. However, the provision of care requires a continuous effort at the physical, psychological, social and economic level, almost always causing overload. Based on this premise, we considered it pertinent and necessary to intervene with informal caregivers to perceive the well-being of the informal care provider and the impact on the performance of this role. The overall objective of the project was to identify therapeutic interventions Mental Health Nursing and Psychiatric effective in promoting and protecting the mental health of informal caregivers. An individual intervention was drawn through home visits to informal caregivers under study. Our methodological option is in the Project Methodology, allowing a continuous and reflective process. The instruments used for the data collection were the semi-structured interview and the Subscale - Psychological Well-being of the Mental Health Inventory. Psychotherapeutic interventions have sought to make individuals more vulnerable, coping strategies effective, and resilience. The nurse – patient interpersonal relationship is the basis for the maintenance and/or recovery of health, so all the interventions performed were based on this assumption.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Enfermagem
No âmbito da unidade curricular do Projeto de Graduação e Integração Profissional da Licenciatura em Enfermagem da Universidade Fernando Pessoa, foi proposta a realização de uma investigação relacionada com o tema escolhido pelo aluno dos propostos pelo professor. O tema escolhido foi: As vivências dos Enfermeiros como Cuidadores de Doentes com Perturbações Obsessivo-compulsivas. Para a realização desta investigação foi utilizado o método qualitativo. Esta investigação pretende analisar e conhecer as vivências dos enfermeiros como cuidadores de doentes com perturbações obsessivo-compulsivas e de que forma é que essas vivências podem contribuir para a evolução da prática da enfermagem, bem como no desenvolvimento pessoal e profissional dos enfermeiros. O instrumento de colheita de dados foi a entrevista, realizada a uma amostra de três enfermeiros especialistas de Saúde Mental e Psiquiátrica do Hospital Magalhães Lemos no Porto. Conclui-se que as vivências dos enfermeiros passam pela visualização de alguns comportamentos destes doentes, aos quais os enfermeiros tiveram a oportunidade de se defrontar, desde o início da sua atividade profissional, e que essas vivências contribuem também para um crescimento pessoal dos enfermeiros com todas as experiências que acumulam de cada vez que estão com um doente com perturbação obsessivo-compulsivo.
As part of the course of Graduation Project and Professional Integration of the Degree in Nursing at the University Fernando Pessoa it was proposed to carry out an investigation relating to the theme chosen by the student and proposed by the teacher. The theme chosen was: The Experiences of Nurses as Caregivers of Patients with Obsessive-compulsive Disorders. In carrying out this research it will be addressed the qualitative method. The research aims are to analyze, know and understand the nurses’ experiences as caregivers of patients with obsessive-compulsive disorders and how could these experiences contribute to the evolution of nursing practice, as well as their personal and professional development. The data collection instrument was the interview, conducted on a sample of three Mental and Psychiatric Health experts working at Hospital Magalhães Lemos, Oporto. It was concluded that the nurses’ experiences include visualizing some patients’ behavior, whom the nurses had the opportunity to face from the beginning of their professional activity, and that this involvement also contributes to the nurses’ personal growth with all the experiences that accumulate each time they are with a patient with an obsessive-compulsive disorder.

This study explores the subjective wellbeing and subjective experience of mental health problems in UK mental health nurses using a mixed methods approach. It aimed to understand the relationships between mental health nurses' own mental health and their subjective wellbeing, and to explore the ways in which mental health nurses managed their own mental health and wellbeing and how they negotiated for and use their experiences both within and outside of their work. The mixed methods design had two phases. In phase one an online survey was sent to mental health nurses via their national professional bodies, the Royal College of Nursing and the Mental Health Nurses Association. The survey comprised three measures of subjective wellbeing, questions about personal and familial mental health history and questions about the impact of these experiences on mental health nursing work. 237 survey responses were included in the final statistical analysis. In the second phase 27 semi structured interviews were undertaken with a purposive sample of survey respondents who had both subjective experience of mental health problems and high subjective wellbeing. A major finding of the study was that mental health nurses critically appraised their experience of delivering and receiving mental health care from the expert perspectives of both being a nurse and having their own experience of mental ill health. Personal experience of mental illness was found to influence nursing practice in a number of ways: first, through overt disclosure and negotiation of professional boundaries; second, through the ‘use of the self as a tool’, the emotional labour of nursing; third, through the formation and development of professional nursing identity. This was in the context of a broader canvas of life experiences which participants considered to influence the development of their nursing identity, the use of self and self disclosure in their work. Mental health nurses in this study had a relatively low subjective wellbeing. Low subjective wellbeing was associated with having current mental health problems, and with having past experience of mental health problem. Personal experience of living with someone with mental health problems was associated with relatively higher subjective wellbeing. This study has implications for occupational health and human resources policy within healthcare organisations. The findings suggest that mental health nurses who present to primary care or occupational health services should be offered care and treatment commensurate with their expertise and experience. Employers’ ‘staff happiness strategies’ and occupational health promotion activities should address work life balance and what nurses could do outside of their work to be well, as well as addressing the effects that team and management changes have on staff wellbeing.

Bullying hurts – even many years later

This thesis indicates that bullying by peers in school during childhood is associated withmental health problems in adulthood; almost50 per cent of the 160 psychiatric outpatients reported bullying by peers.

As adults, those bullied in childhood demonstrated higher psychiatric symptom levels, lower self-esteem and more external locus of control. They also reported more bulimianervosa. In addition, they were often singles, and, they had lower levels of education.Bullying by peers was also associated with other types of maltreatment in childhood. Male outpatients bullied by peers in school often grew up without biological fathers. Victimized female outpatients bullied in school reported more childhood abuse and neglect. Overprotective fathers were more common in outpatients with bulimia nervosa, and long-term associations were found between overprotective mothers and poor self-esteem.The findings in this thesis reveal that bullying in childhood is far from harmless and may have destructive long-term consequences.

Paper I and IV reprinted with kind permission Elsevier, sciencedirect.com

Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.