Dissertations / Theses on the topic 'Mental health personnel and patient Australia'

Major mental disorder, with prolonged periods of dysfunction that require long term care, is an issue of concern amongst mental health professionals. Although substantial effort and resources are devoted towards returning mentally ill individuals to the community, one of the most distinctive and consistent features of the persistently mentally ill (PMI) is their high rate of readmission to hospital. Existing studies into discharge planning revealed that no research had been undertaken to determine if this is the case in Western Australia. This study sought to investigate perceptions of discharge planning held by patients, carers, nurses and allied health workers involved in discharge preparation in a major metropolitan psychiatric hospital operated by the Health Department of Western Australia. Eighty one subjects were selected from the four principal groups involved in care in this mental health setting, consisting of patients ( n = 21 ), carers ( n = 20 ), nurses ( n = 22 ) and allied health workers ( n = 18 ). Perceptions of discharge planning of these subjects were evaluated and compared using the Discharge Priorities Rating Scale. Farran, Carr & Maxson's model of goal congruence in discharge planning was used to guide this study. Significant differences were found to exist in the perceptions of discharge planning between patients, carers, nurses and allied health workers. Differences in perceptions are seen to have a detrimental effect on the discharge planning process, resu1ting in unnecessary and frequent readmission to hospital and the perpetuation of institutional dependency. Whilst the results of this study can only be applied to similar institutions, the findings are relevant for the persistently mentally ill who have patterns of frequent readmissions across the public and private mental health service settings. The results obtained indicate that nurses can facilitate effective discharge planning practices by adopting a more assertive role in the hea1th care team, in communicating patients' and their carers' concerns and promoting a more collaborative approach to care.

Thesis (Ph.D.)--University of Wollongong, 2008.
Typescript. Computer optical disc inserted in pocket on p. 195 entitled: Medication alliance core skills demonstration. Includes bibliographical references: p. 147-179.

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb. 15, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. Martha Markward. Vita. Includes bibliographical references.

Background: The interpersonal relationship between nurses and clients is seen as the central element or core activity of mental health nursing. Without this relationship therapeutic alliance cannot take place. Concern has been expressed that nurse prescribing could have a negative impact on the nurse patient relationship and result in the nurse sacrificing nursing skills for the prescribing role. Aim: The aim of this study was to explore the nurse patient relationship in the mental health setting when the nurse is a prescriber. In order to do this a comprehensive literature review was undertaken and views of participants were explored and relationships described. Methodology and methods: Nurse prescribers were sent questionnaires to gather demographic data and basic qualitative data. Focus groups and interviews were undertaken within a large NHS Foundation Trust. A constructivist approach was used with 57 participants including nurse prescribers, pharmacist prescribers, nurse managers, clients and doctors. A discussion guide and an iterative approach were used to clarify findings. Data analysis was guided by a Framework approach. Findings: The majority of clients preferred to have their nurse prescribe for them. Trust was highly valued within the pre-established relationship and clients found nurses easier to talk to about their medication than doctors. Nurse prescribers placed high importance on being able to reduce and discontinue medication for the client, terming this ‘un-prescribing’. Nurse prescribers were uncomfortable with the concept of power, preferring to use the term ‘empowerment’. All groups of participants were unanimous that nurse prescribers continued to provide care and that they had not moved from a traditional ‘caring’ role to a ‘medical’ curing role and importance was placed on the therapeutic alliance between nurse prescribers and clients. Conclusion: Rather than detracting from the nurse patient relationship, results from this study suggest that nurse prescribing enables the mental health nurse prescriber to provide more holistic care than previously. The action of ‘un-prescribing’ may indicate a new culture around mental health nurse prescribing

Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 1989.
A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

Thesis (Ph. D.)--West Virginia University, 1999.
Title from document title page. Document formatted into pages; contains viii, 178 p. Vita. Includes abstract. Includes bibliographical references (p. 158-168).

Thesis (Ph.D.)--Kent State University, 2009.
Title from PDF t.p. (viewed Apr. 28, 2010). Advisor: Donald Bubenzer. Keywords: adolescent sexual offender treatment; adolescent; sexual offender treatment; honesty; clinicians' beliefs. Includes bibliographical references (p. 181-197).

Bakgrund: Psykisk ohälsa och sjukdom är vanligt förekommande i Sverige, tidigare studier har visat att personer med psykisk ohälsa eller sjukdom löper större risk att drabbas av somatiska sjukdomar jämfört med den generella populationen. Det förekommer att dessa patienter upplever stigmatisering i så väl samhället i stort som inom hälso- och sjukvården, vilket kan medföra risk för bristfällig omvårdnad av denna patientgrupp inom den somatiska vården. Syfte: Syftet var att utforska verksamma och blivande sjuksköterskors attityder gentemot patienter med psykisk ohälsa och sjukdom inom den somatiska vården. Metod: Elva vetenskapliga studier inkluderades i en litteraturstudie inom det valda forskningsområdet. Databaserna PubMed, CINAHL och PsycInfo användes för datainsamling. Samtliga artiklar kvalitetsgranskades och besvarade frågeställning och syfte. Resultat: Resultatanalysen resulterade i tre kategorier som beskriver attityder till psykisk ohälsa bland sjuksköterskor och blivande sjuksköterskor. Dessa kategorier är; Positiv attityd, Negativ attityd och Undvikande attityd. Erfarenhet, utbildning och kunskap är några av de viktigaste faktorerna som visat sig ha en inverkan på attityden till att vårda patienter med psykisk ohälsa. Slutsats: Sjuksköterskor och sjuksköterskestuderande har varierande attityder till att vårda patienter med psykisk ohälsa och sjukdom inom somatisk vård. Bristande kunskap och erfarenhet av psykisk ohälsa kan bidra till stigmatiserande och avståndstagande attityder, vilket kan leda till att patienten inte alltid får en optimal och likvärdig vård. Kunskap om dessa attityder kan bidra till att utveckla omvårdnaden för personer med psykisk sjukdom inom somatisk vård.
Background: Mental illness is common in Sweden, previous studies demonstrate that people with mental illness have an increased risk of physical illness compared to the general population. These patients often experience stigmatization generally in society, as well as within health care, which can result in a deficient care of these patients in the somatic care. Purpose: The aim of the study was to explore registered nurses and nursing students’ attitudes towards patients with mental illness in somatic care. Method: Ten scientific studies were included in a literature study of the chosen research field. The databases PubMed, CINAHL and PsycInfo was used for data collection. All the articles reviewed for quality and answered the purpose. Findings: The analysis resulted in three categories that describe attitudes to mental illness among nurses and nursing students. These categories are; Positive attitude, Negative attitude and Avoiding attitude. Experience, education and knowledge are some of the factors that can have an impact on the attitude towards caring for patients with mental illness. Conclusion: Nurses and nursing students express varying attitudes towards caring for patients with mental illness treated in somatic hospital settings. Lack of knowledge and experience of mental illness can result in stigmatization and rejection attitudes towards the patient, as well as an unequal care. Increased awareness about such attitudes can contribute to developing nursing care for these patients.

Bakgrund: Samsjuklighet är vanligt förekommande bland personer med psykisk ohälsa. Samtidigt finns indikationer på att patienter med vanligt förekommande psykiatriska diagnoser riskerar att inte få fullgod behandling av sina somatiska sjukdomstillstånd. Bristande vårdkvalité och tillgänglighet är två orsaker som anses vara bidragande till förlust av levnadsår hos denna patientgrupp. Patienter med psykisk ohälsa har rätt till en vård utan diskriminering, men forskningen visar att det kan förekomma negativa attityder och stigmatisering mot dessa patienter från vårdpersonal. Syfte: Syftet med litteraturöversikten var att belysa upplevelser och erfarenheter hos patienter med psykisk ohälsa av bemötande från vårdpersonal i den somatiska vården. Metod: Litteraturöversikt med 13 vetenskapliga artiklar från sex olika länder hämtades från Cinahl och PsycINFO. Artiklarna analyserades enligt Friberg. Resultat: Fyra huvudteman identifierades: Erfarenheter av att bli marginaliserad, Erfarenheter av bra bemötande, Erfarenheter av att vården inte räcker till och Konsekvenser av negativt bemötande. Diskussion: Med Orlandos teori om det dynamiska förhållandet mellan sjuksköterska och patient som teoretisk utgångspunkt diskuteras resultatet i relation till Orlandos nyckelbegrepp: evidensbaserad vård, dialog och reflektion. Behov av ytterligare kompetens hos vårdpersonal i att vårda patienter med psykisk ohälsa var en sak som lyftes.
Background: Somatic and psychiatric comorbidity are frequent in patients with mental illness. There is a risk that patients with common mental disorders don’t get adequate treatment for their somatic health problems. Lack of care quality and availability to somatic health care are issues considered contributory to years of life lost to these patients. Patients with mental disorders have the right to receive care without discrimination, though research indicates that negative attitudes and discrimination by health-care personnel towards these patients may occur. Aim: The aim of this literature review was to reveal how patients with mental illness experience the encounter with health care personnel in somatic care. Method: A literature review with 13 original research articles from six different countries was retrieved from the databases Cinahl and PsycINFO. The studies were analyzed based on Fribergs method. Results: Four main themes were crystallized: Experiences of being marginalized, Positive experiences of health care, Experiences of health care not being good enough and Consequences of negative attitudes. Discussion: The article result was discussed related to Orlando’s nursing process The dynamic nurse-patient relationship and her key concepts: evidence-based nursing, communication, dialogue and reflection. The need for additional   expertise in caring for patients with mental illness was one of the points raised.

A serious problem confronts the psychologist whose patient threatens, within the privacy of a therapy session, to inflict violent harm upon some third person. Therapists in Texas face a risk of unjust legal liability because of a lack of widely accepted, clearly and fully articulated standards. A questionnaire was submitted to Texas psychologists and Texas judges of mental illness courts. It involved a hypothetical case of a patient who threatened to kill his girlfriend. The hypothesis that no consensus exists at present among psychologists or judges appears to be supported by the data. Comparisons are made of the attitudes of psychologists and judges. Correlations between psychologist attitudes and certain demographic and practice variables are reported. The need for new legislation in Texas concerning legal liability of therapists for the violent behavior of patients is discussed. Proposed legislation for Texas is set out. Among its important features are (1) recognition that continued therapy is itself a protective strategy and (2) establishment of good faith as the standard by which the behavior of the therapist is to be judged.

A Saúde da Família configura-se em uma estratégia de reorientação do modelo assistencial que busca melhor compreensão do processo saúde-doença e a assistência integral e continuada com foco nas famílias de uma área adscrita. Caracteriza-se, ainda, como trabalho complexo, exigindo, dos profissionais, uma construção coletiva. O objetivo desta pesquisa foi avaliar a organização do trabalho, prazer, sofrimento e as estratégias de mediação do sofrimento dos profissionais das equipes de Saúde da Família do Grupo Hospitalar Conceição (GHC). Pesquisa com abordagem quantitativa transversal e qualitativa estruturada a partir da metodologia da Psicodinâmica do Trabalho. A coleta dos dados quantitativos ocorreu de setembro a novembro de 2011, com a aplicação do Inventário de Risco de Adoecimento relacionado ao Trabalho (Itra) junto aos profissionais das equipes de Saúde da Família de 12 unidades de saúde do GHC localizadas em Porto Alegre/RS, Brasil. A partir dos resultados da análise fatorial de correspondência da etapa quantitativa participaram. do estudo qualitativo, três unidades de saúde da família, que obtiveram, com aplicação do Itra, menor, moderado e maior risco de adoecimento relacionado ao trabalho. Para a coleta dos dados qualitativos, foram realizadas observação e entrevistas coletivas semiestruturadas com os profissionais das equipes de Saúde da Família no período de outubro a dezembro de 2012 e, para a análise, utilizou-se a Análise de Conteúdo. O Itra avaliou que o contexto de trabalho das equipes de Saúde de Família apresenta moderado risco de adoecimento relacionado ao trabalho quanto à organização (3,32), condições (3,03) e relações socioprofissionais (2,58) no trabalho. Quanto ao custo humano de trabalho, os custos físicos (2,72) e afetivos (2,66) foram avaliados como críticos, e o cognitivo (3,77) como grave risco de adoecimento relacionado ao trabalho. As vivências de prazer, com os indicadores realização profissional (4,21) e liberdade de expressão (4,21), foram consideradas satisfatórias, enquanto que as de sofrimento e falta de reconhecimento (1,80) foram igualmente avaliadas como satisfatórias. O indicador de sofrimento por esgotamento profissional (3,33) foi avaliado como crítico. Os três fatores da escala de danos relacionados ao trabalho, físico (2,33), psicológico (1,37) e social (0,70) foram considerados suportáveis. Da análise qualitativa emergiram três temas: prazer, sofrimento e estratégias de enfrentamento do sofrimento. Os profissionais avaliam a autonomia, a criatividade e trabalho em equipe com fontes de prazer na organização do seu trabalho. O sofrimento é percebido nas exigências do trabalho, condições da estrutura física e a complexidade do trabalho realizado pelas equipes de Saúde da Família; dizem, ainda, que utilizam estratégias de enfrentamento do sofrimento como o compartilhamento do trabalho e estratégias individuais. Conclui-se que o estudo destaca a importância e a necessidade de os profissionais disporem de espaços de fala e escuta para discutirem e refletirem sobre a organização do seu trabalho, dando potência à subjetividade do trabalho, ou seja, entendendo-o realizado por pessoas com identidade, com história; pessoas que não são somente instrumentos, mas os produzem na relação com características prazerosas para alcance do seu fim, no caso a promoção da saúde. Considera-se que produzir espaços para produção/reflexão do trabalho é ferramenta necessária, a qual contribuirá para a saúde dos profissionais da saúde, auxiliando a compreensão sobre o sofrimento que antecede a formação de sintomas e doenças relacionadas ao trabalho.
The Family Health program configures a strategy that designs the care model with a new guiding outline which looks for better comprehension of the health-disease process as well as the whole and continuous care with focus on families from an restricted area. In addition, it features a complex work that requires a collective construction by the professionals. The objective of this research was to evaluate the work organization, pleasure, suffering and the strategies to mediate the suffering of the professionals from the staffs of the Family Health program of Grupo Hospitalar Conceição (GHC). It is a research with cross-sectional quantitative and qualitative approach structured from the methodology of the Psychodynamics of Work. The collection of quantitative data was carried out from September to November 2011 by applying the Illness Risk Inventory regarding Work (Itra) with professionals of the Family Health staffs from 23 health centers of the GHC located in Porto Alegre/RS, Brazil. From the results of the correspondence factor analysis of the quantitative step, three family health centers participated of the qualitative study that, after application of the Itra, obtained minor, moderated, and higher illness risk in connection with work. For the collection of the qualitative data, observation and semi-structured collective interviews were carried out with professionals from the Family Health staffs in the period from October to December 2012 and for the analysis, the Content Analysis method was utilized. The Itra evaluation evidenced that the working context of Family Health staffs presents moderated illness risk regarding the work as to the organization (3.32), conditions (3.03) and social and professional relations (2.58) in the labor environment. As to the working human cost, physical costs (2.72) and affective costs (2.66) were assessed as critical while cognitive costs (3.77) showed severe illness risk regarding work. Pleasure experiences, with indicators like professional achievement (4.21) and expression freedom (4.21) were considered satisfactory while those like suffering and lack of recognition (1.80) were also evaluated as satisfactory. The suffering indicator due to professional burnout (3.33) was evaluated as critical. The three factors of the scale for damages in connection with work, i.e., physical (2.33), psychological (1.37) and social (0.70) were considered tolerable. From the qualitative analysis, three themes have emerged: pleasure, suffering and strategies to face suffering. Professionals evaluated autonomy, creativity and team work with sources of pleasure in their working organization. Suffering is perceived within working requirements, physical structure conditions and the complexity of the work carried out by the Family Health staffs; they say, yet, that they utilize strategies to face suffering like sharing work and individual strategies. The conclusion drawn is that the study points out the importance and the professionals´ need of speaking and listening spaces in order to discuss and to reflect about their work organization, by giving power to the work subjectivity, that is, by understanding it as done by people with identity, history; namely, by people who are not only tools, but who produce them within a relationship with pleasing characteristics in order to achieve their goal, namely, health promotion. Designing spaces in order to produce and to reflect about work is considered a needed tool which will contribute for the well-being of healthcare professionals by helping them to understand suffering that occurs before the rise of symptoms and diseases in connection with work.
El programa Salud de la Familia configura una estrategia de reorientación del modelo asistencial que busca mejor comprensión del proceso salud-enfermedad así como la asistencia integral y continuada con foco en las familias de un área adscrito. Se caracteriza, aún, como trabajo complejo, exigiendo, de los profesionales, la construcción colectiva. El objetivo de esta investigación fue evaluar la organización del trabajo, el placer, el sufrimiento y las estrategias de mediación del sufrimiento de los profesionales de los equipos de Salud de la Familia del Grupo Hospitalario Conceição (GHC). Se trata de una investigación con planteamiento cuantitativo transversal y cualitativo estructurado desde la metodología de la Psicodinámica del Trabajo. La recopilación de los datos cuantitativos se realizó de septiembre a noviembre de 2011, con la aplicación del Inventario de Riesgo de Enfermedad relacionado al Trabajo (Itra) junto a los profesionales de los equipos de Salud de la Familia de 12 unidades de salud del GHC localizadas en Porto Alegre/RS, Brasil. A partir de los resultados del análisis factorial de correspondencia de la etapa cuantitativa participaron del estudio cualitativo, tres unidades de salud de la familia, que obtuvieron, a través de la aplicación del Itra, menor, moderado y mayor riesgo de enfermedad relacionado al trabajo. Para la recopilación de los datos cualitativos, se realizaron observación y entrevistas colectivas semi-estructuradas con los profesionales de los equipos de Salud de la Familia en el período de octubre a diciembre de 2012 y, para el análisis, se utilizó el Análisis de Contenido. El Itra concluyó que el contexto de trabajo de los equipos de Salud de la Familia presenta moderado riesgo de enfermedad relacionado al trabajo en cuanto a la organización (3,32), condiciones (3,03) y relaciones sociales y profesionales (2,58) en el trabajo. En cuanto al consumo humano de trabajo, el consumo físico (2,72) y lo afectivo (2,66) fueron evaluados como críticos, mientras lo cognitivo (3,77) como grave riesgo de enfermedad relacionado al trabajo. Las experiencias de placer, con los indicadores realización profesional (4,21) y libertad de expresión (4,21), fueron consideradas satisfactorias, mientras las de sufrimiento y falta de reconocimiento (1,80) fueron igualmente evaluadas como satisfactorias. El indicador de sufrimiento por agotamiento profesional (3,33) fue evaluado como crítico. Los tres factores de la escala de daños relacionados al trabajo, físico (2,33), psicológico (1,37) y social (0,70) fueron considerados soportables. Del análisis cualitativo emergieron tres temas: placer, sufrimiento y estrategias de enfrentamiento del sufrimiento. Los profesionales evalúan la autonomía, la creatividad y el trabajo en equipo con fuentes de placer en la organización de su trabajo. El sufrimiento es percibido en las exigencias del trabajo, en las condiciones de la estructura física y en la complejidad del trabajo realizado por los equipos de Salud de la Familia; dicen, aún, que utilizan estrategias de enfrentamiento del sufrimiento como el compartimento del trabajo y estrategias individuales. Se concluye que el estudio destaca la importancia y la necesidad de que los profesionales dispongan de espacios de habla y escucha para que discutieran y reflejaran acerca de la organización de su trabajo, dando potencia a la subjetividad del trabajo, o sea, entendiéndolo realizado por personas con identidad, con historia; personas que no se vean solamente como instrumentos, pero que los produzcan en la relación con características placenteras para alcanzar su fin, es decir, la promoción de la salud. Se considera que producir espacios para producción y reflexión del trabajo es herramienta necesaria, la cual contribuirá para la salud de los profesionales de la salud, auxiliando la comprensión sobre el sufrimiento que antecede la formación de síntomas y enfermedades relacionadas al trabajo.

This research program on burnout and work environment perceptions in personnel working directly with unemployed individuals in Australia is reported in three studies. Using a survey methodology and taking a quantitative approach, burnout was investigated using the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1986) on two occasions, before and after the privatisation of Australia's employment services industry (Job Network). The most widely accepted survey instrument measuring burnout (Lee & Ashforth, 1996), the MBI defines this stress related syndrome in terms of three subscales, Emotional Exhaustion, Depersonalisation and Personal Accomplishment. Perceptions of the work environment experienced by employment service staff were concurrently surveyed using the Real form of the Work Environment Scale (Moos, 1994). Heeding advice of researchers from the job stress area (e.g., Mccrae, 1990), this program of research also concurrently investigated the personality trait Neuroticism, the disposition to perceive and report negative experiences. In 1995, burnout in two groups of public sector personnel engaged in assisting individuals experiencing unemployment were compared. Staff employing a case management style of service delivery and staff engaging in an over-the-counter production-line style of service were surveyed and their responses on the MBI, the WES and the Neuroticism subscale of the revised short form edition of the Eysenck Personality Questionnare (EPQR/ s; Eysenck & Eysenck, 1991) compared. As hypothesised, case managers reported significantly higher burnout scores on all three subscales of the MBI, and perceptions of higher work pressure. The personality trait Neuroticism was found to account for significant variance in the burnout scores of the public sector respondents. The second study was conducted in 1999 after the full privatisation of the Australian employment services industry. At this time (T1 ), burnout in case managers throughout Australia was investigated with a postal survey which sampled 86 case managers from 38 different private sector organisations providing case management services to the long-term unemployed. The same respondents were surveyed again after six months (T2}. Study 2 demonstrated that case manager burnout levels in the new Job Network were significant. The design also allowed for the prediction of future burnout (T2) from personality and work environment data collected at an earlier time (T1) to be correctly modelled. As hypothesised Neuroticism was a significant predictor of all three MBI subscales both at T1 and T2. In what amounts to a comparison of public and private sector personnel, the third study compared the burnout levels and work environment perceptions of case managers surveyed in 1995 with the responses of case managers surveyed in 1999. Case managers from the public and private sector reported similar high levels of Emotional Exhaustion and Depersonalisation. Private sector case managers also reported significantly higher mean Personal Accomplishment scores, corresponding to a lower mean burnout level, and significantly higher levels of involvement and commitment to their work than public sector case managers. The results of these studies addressed a significant gap in the burnout literature which had hitherto failed to report investigations into employment service personnel, and highlighted the importance of considering the personality trait of Neuroticism in future burnout research. Results were discussed in the contexts of the evaluation of the current Job Network and the process model of burnout (Leiter, 1993).

This study investigates two facets of the relationship between mental health and religion. The first is an investigation into the effects of psychologist's and psychiatrist's religious belief on their assessments of a religious client. Previous research has argued that non-religious mental health workers display bias against their religious clients (Houts and Graham, 1986; and Jones, 1994). Other research has suggested that extrinsically religious indivi~uals and indiscriminately religious individuals tend to be more prejudiced than non-religious or intrinsically religious individuals (Donahue, 1985; and Richards and Bergin, 1997). The second facet of this study is an investigation into the differences between ministers of religion and mental health workers (psychologists and psychiatrists) in their assessment of a religious client. The DSM IV (APA, 1994) suggests that mental health workers should consider the cultural appropriateness of an individuals "symptoms" or behaviours before diagnosing them. It is argued here that psychologists and psychiatrists do not give due regard to the cultural appropriateness of their client's religious beliefs and the ministers of religion offer a gauge of what is culturally appropriate. To investigate these questions a group of mental health workers (consisting of 19 psychologists and 9 psychiatrists) and a group of Christian ministers of religion (consisting of 13 Pentecostal ministers and 17 mainstream ministers) was asked to complete a questionnaire based on a hypothetical case study. The hypothetical case study was constructed to have ambiguous religious characteristics, to allow the respondents to interpret the information according to their own biases. The questionnaire included Allport and Ross's Religious Orientation Scale (ROS) (Wulff, 1991). Data were analysed using Mann-Whittney U-tests and Kruskal Wallis H-tests. Significant differences were found between ministers of religion and mental health workers on most variables, with the greatest differences being evidenced between Pentecostal ministers of religion and psychiatrists. This suggests that mental health workers perceive religious clients as more mentally ill than ministers of religion do. However, no differences were found between mental health workers of different religious orientations according to the ROS and other measures of religiousness. This implies that mental health workers are not biased based on their own religious faith, but all mental health workers may be indiscriminately biased against religious individuals.
Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

This study explores how formal and informal social networks and decision making about resources in the hospital setting are related. Over the last few years, tensions between new public management of hospitals and increased demands has led to an increase in bottlenecks, stagnation of patient flow, and overcrowded emergency departments. These problems have led to an increase in access block for patients attempting to access the public hospital system. The introduction of Patient Flow Units has instigated the formalisation of a nurse manager function to coordinate patient flow. Nurses in such a pivotal position and who greatly influence hospital operations, tend to have special characteristics and use these to “get things done”. This thesis investigates interpersonal associations between professional (e.g. doctors and nurses) and functional groups (e.g. clinicians and managers), when making clinical and operational decisions when transferring a patient from the emergency department to a ward bed. By employing a mixed methodology, this thesis first sought to establish a snapshot of organisational culture in three hospitals. Drawing on Degeling et al. (1998) and Fitzgerald (2002), an organisational cultural survey was distributed to a total of 1750 participants. The response rate was 11.65% This survey particularly addressed five cultural constructs including a sense of organisational commitment, perceptions of managerial role characteristics, perceptions of currently pursued organisational goals, perceptions of orientation to work values when choosing a job, and interactions with various professional constituencies. In addition, 18 interviews were conducted and a total of 150 hours of observation of work processes, interactions between staff and environmental conditions were studied. This investigation largely confirmed earlier studies by Degeling (2002) and Fitzgerald (2002) that professional groups believed that their organisation primarily exhibited an Elite style of management, that financial viability is the most important goal their organisation is pursuing, and staff welfare was a low priority. In addition, it found significant differences in cultural footprints between the small hospital, which had a more integrated culture, and the large hospital, which was more fragmented in nature. However, the major contribution of this investigation is demonstrated in the qualitative chapter. This thesis found that the role of “who matters the most” in relation to decision making about patient flow, changes depending on the stage of the decision making process. It also found that non-managerial nursing staff with no formal power or legitimacy could affect urgency. The thesis comprises eight chapters. Following the introductory chapter, Chapter 2 considers the literature associated with the public health system in Australia with a focus on public hospitals in NSW. Chapter 3 critically examines the literature describing organisational culture, with an emphasis on subcultures. Chapter 4 contains a review of professional identity and roles, networks and alliances, social capital, deep smarts, and stakeholder theory. Description and justification of the research method selected to explore the thesis proposition follows in Chapter 5. Chapter 6 contains an outline of the findings concerning the analysis of the survey questionnaire to determine a cultural footprint of the three hospitals studied. Chapter 7 considers the different roles of professional groups (doctors, nurses, and others) and functional groups (clinicians and managers) in the operational phase of patient flow and in doing so contributes to knowledge. Finally, in Chapter 8, a discussion summarises the thesis findings, describes the implications, acknowledges limitations of the study and identifies avenues for future research.
Doctor of Philosophy (PhD)

Inpatient aggression in mental health settings is a significant concern because it compromises the quality of care provided by health care workers. Nurses are one of the groups most affected by inpatient aggression because they are usually the client's first contact on admission. A number of studies have found that nurses are the most frequently assaulted professional group both inside and outside of the hospital setting, are more frequently assaulted than doctors and most are likely to experience some form of aggression in their career. The causes of inpatient aggression are frequently conceptualised as multidimensional and involving factors internal to the client e.g. age, factors relating to the environment such as inflexible ward routines and factors relating to the quality of the interaction between nursing staff and clients. Research studies suggest that nurses generally respond reactively and rely heavily on physical control strategies rather than on interpersonal strategies in managing inpatient aggression. Contemporary literature suggests that the perceptions nurses hold about aggression and its causes influences their management of the event and that this process is mediated by a number of client, environment and nurse-related variables including age, education, gender, nursing experience, perceptions of aggression and its causes. Although the causes and management of inpatient aggression in nursing is well documented in the United Kingdom and some other West European countries, this is not the case for Africa and in the case of this study, for Botswana. No studies have attempted to find the nurses' perception, perception on the cause, and management of inpatient aggression in Africa and more so in Botswana. Aim: The purpose of the study was to explore how nurses' demographic characteristics, their perceptions of aggression and its causes, influence the management of inpatient aggression by nurses in the main psychiatric institution in Botswana. Method: A descriptive, exploratory non-experimental design was used. Perception of inpatient aggression was captured by a Perception of Aggression Scale (POAS) and the perception on the cause and management of inpatient aggression was collected with Management of Aggression and Violence Attitude Scale (MAVAS).The sample comprised of 71 nurses, 48 of whom were females and 23 males. The mean age of the nurse respondents was 36 years. Of the 71 respondents 50 were registered nurses only while 20 were psychiatric registered nurses. More than two thirds of the respondents had a diploma in nursing, one had a masters degree and the remainder, a degree in nursing. The average nursing and psychiatric nursing experience of the respondents were 12.1 and 6.87 years respectively. ANNOVA test and t-tests were done to find the associations between the nurses' demographic variables, their perception, perception on the cause and management of inpatient aggression. Findings: The respondents In this study perceived inpatient aggression as both negative and positive. There was an overall agreement with the perception of aggression as always negative and as an action of physical violence against a nurse (81.73%). Nurses saw the cause of inpatient aggression as emanating from the internal, external and situational/interactional factors. The use of traditional methods of aggression dominated as shown by a high mean score of 80.5 as compared to interpersonal management with a mean score of 60.5. A statistical difference was found between gender, perception of aggression and perception of aggression and the traditional management of aggression while age, nursing and psychiatric nursing experience were statistically associated with the use of interpersonal management of aggression. Conclusion: The study provided insight into the nurses' perceptions, perceptions on the cause and management of inpatient aggression in a mental institution in Botswana. Nurses in this study hold predominantly negative perceptions of aggression and generally favour traditional management strategies. However, older, more experienced nurses tended to favour interpersonal techniques. Recommendations for nursing practice, education and research to address this issue centre around further and targeted education and training in mental health and specifically, in the comprehensive management of aggression which includes communication skills, use of de-escalation, use of medication and cautious physical restraint.
Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2009.

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

No
It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over pound50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.

The experiences of working in an acute psychiatric unit were investigated in this research using multiple qualitative methodologies, particularly Reflective Topical Autobiography and Participatory Action Research. The Participatory Action Research was undertaken in an acute psychiatric unit of a major public hospital in Melbourne. The collaborative design focused on bringing staff and consumers of psychiatric services together with an aim to develop new work practices for mental health practitioners. Four consumer consultants including a Koori representative participated in this study. Consumer consultants and staff, working in collaboration with the researcher, informed the fluid and iterative research process. Data included thirty eight interviews with psychiatric health professionals (2 psychiatrists, 2 managers, 6 psychiatric registrars and 28 nurses, including two charge nurses). Horizontal violence, and its impact on the capacity for reflexive work practices, became a strong emergent theme. Other emergent and important themes included workplace hierarchy, values, power, and the impact of critical incidents and supervision. Ego-state theory was utilised to better understand the psychology of staff members, and Organisational Egostate theory was presented as an original concept to explore the psychiatric unit as an organism having its own personality characteristics. It was concluded that for there to be permanent and iterative change to the organisation that engrained automatic responses of the organisation need to be identified and new responses developed. The research resulted in a number of new work practice recommendations, including the establishment of non-discriminatory review processes where work practices that are viewed as inappropriate by staff and consumers can be assessed with consideration to the importance of all stakeholders. Specific insights and conclusions have been suggested in relation to the treatment of aboriginal (Koori) people in the psychiatric unit. A central conclusion from this study was that psychiatric staff and consumers need more inclusion in the design and review of work practices.

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research.
thesis (BPsychology(Hons))--University of South Australia, 2004.

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007.
Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6595. Adviser: Arch I. Carson. Includes bibliographical references.

Mental health professionals are continually asked to determine whether an individual is safe to reside in society without restraint. However, early research on the ability of mental health professionals to assess dangerousness has produced discouraging results. A clinician’s ability to process and recall clinical material may significantly be influenced by patient characteristics. Clinicians are not immune to gender biases, and research assessing such differences between male and female clinicians -- including how their attitudes toward women influence their clinical judgment-- have yielded mixed results. This dissertation will assess the impact of clinician attitudinal factors, specifically gender biases, on perceptions of dangerousness. Furthermore, this dissertation will also examine themes that emerge regarding gender bias, racial bias, and attitudes toward women within the assessment of dangerousness.

PhD (Advanced Nursing Science)
Department of Advanced Nursing Science
iii Abstract The Mental Health Act is the law which sets out when you can be admitted, detained, and treated in hospital against your wishes. It is also known as being “sectioned”. For this to happen, certain people must agree that you have a mental disorder that requires a stay in hospital. In South Africa, the Mental Health Act of 1973 was noted to have many gaps. Due to all the shortcomings, in 2004 the Mental Health Care Act No. 17 of 2002 came into being in order to protect human rights of the mental health care users. This study sought to determine the knowledge and explore the experiences of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002. Secondly, based on the findings, to develop a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors in Vhembe District. The population of this study consisted of all medical doctors working in Vhembe District Hospitals with mental health units and at a specialized mental health hospital as well as all documents completed by medical doctors during admission, care and discharge of mental health care users were purposively sampled. The study was conducted in two phases. In phase 1, where quantitative and qualitative designs were followed to do situational analysis. In phase 2, the programme was developed using results from phase 1, the theoretical framework and approaches outlined by Dickoff, James and Wiedenbach (1968); Chinn and Krammer (1999); Walker and Avant (1995). Individual in-depth interviews and questionnaires checklist were used to collect data which was analysed through opened coding method and SPSS. The findings of this study indicate that medical doctors have knowledge and skills deficit regarding implementation of the Mental Health Care Act No. 17 of 2002 during the admission, care, and discharge of mental health care users. Based on these, a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors during admission, care and discharge of mental health care users was developed. The study concludes that this is a significant contributor in supporting the vision of the National Department of Health to ensure improved mental health for all in South Africa. The study recommends a longitudinal study, tracking the impact of a developed programme, the knowledge of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002, and its contribution to the improvement of mental health for all should be conducted over a period of 5 (five) to 10 (ten) years

MCur
Departrment of Advanced Nursing Science
In mental health, a Maximum-Security Ward is a special setting for care of patients who are unique and exceptional. People who have committed crimes due to their mental conditions are admitted for care, treatment and rehabilitation. Patients admitted in this ward are verbally and physically aggressive, violent, unpredictable, unmanageable and at times manipulative. Professional nurses working in the Maximum-Security Ward are at risk of suffering from occupational stress, burnout, lack motivation and are anxious. The aim of this study is to investigate the experiences of professional nurses working in the Maximum-Security Ward at Hayani hospital. A qualitative approach using a descriptive, exploratory and contextual design was used. A purposive, convenient sampling was used to sample professional nurses working in the Maximum-Security Ward of Hayani hospital. In-depth interviews were used to collect data. A voice recorder was utilised to record all data and the researcher being the main instrument for data collection. Dependability, confirmability and transferability were upheld to ensure trustworthiness of the findings. Data was analysed using Tech’s eight steps approach. Three themes with their categories and subcategories emerged after data analysis. The themes were as follows: the participants’ views on type of patients admitted in the ward, participants’ views on safety in the ward and participants’ views on staff interaction. The study recommended the following: Emotional counselling and debriefing sessions to be conducted at regular intervals or after a traumatic incident. Motivational and team building activities to be organised for professional nurses. Safety of professional nurses must be of significant value. More support is needed in times of emotional difficulties. Development of a model to support professional nurses.
NRF

The experiences of working in an acute psychiatric unit were investigated in this research using multiple qualitative methodologies, particularly Reflective Topical Autobiography and Participatory Action Research. The Participatory Action Research was undertaken in an acute psychiatric unit of a major public hospital in Melbourne. The collaborative design focused on bringing staff and consumers of psychiatric services together with an aim to develop new work practices for mental health practitioners. Four consumer consultants including a Koori representative participated in this study. Consumer consultants and staff, working in collaboration with the researcher, informed the fluid and iterative research process. Data included thirty eight interviews with psychiatric health professionals (2 psychiatrists, 2 managers, 6 psychiatric registrars and 28 nurses, including two charge nurses). Horizontal violence, and its impact on the capacity for reflexive work practices, became a strong emergent theme. Other emergent and important themes included workplace hierarchy, values, power, and the impact of critical incidents and supervision. Ego-state theory was utilised to better understand the psychology of staff members, and Organisational Egostate theory was presented as an original concept to explore the psychiatric unit as an organism having its own personality characteristics. It was concluded that for there to be permanent and iterative change to the organisation that engrained automatic responses of the organisation need to be identified and new responses developed. The research resulted in a number of new work practice recommendations, including the establishment of non-discriminatory review processes where work practices that are viewed as inappropriate by staff and consumers can be assessed with consideration to the importance of all stakeholders. Specific insights and conclusions have been suggested in relation to the treatment of aboriginal (Koori) people in the psychiatric unit. A central conclusion from this study was that psychiatric staff and consumers need more inclusion in the design and review of work practices.