Dissertations / Theses on the topic 'Secure psychiatric'
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Watson, William. "Haven of change : the history of a secure psychiatric hospital." Thesis, University of Cambridge, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.259691.
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Bartlett, A. E. A. "Power without glory : the culture of a secure psychiatric hospital." Thesis, University of Cambridge, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.596433.
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Smithtown is a Special Hospital. It is designed to detain and treat individuals with a combination of mental disorder and dangerous antisocial behaviour. This is the first anthropological study of ward life in such a setting in the UK. The tensions generated by undertaking an anthropological project within a institution, whose daily practice and research rely heavily on a medical model of inquiry, are exposed. These tensions are encapsulated in the multiple social identities of the author. Their relevance to the fieldwork and to the creation of the anthropological "other" are discussed. It is then argued, from this specific case that, while at ease with the subjectivity of a social identity, anthropology needs to incorporate more individual elements of the anthropological "self" into contemporary fieldwork. This requires theoretical development of the relationship aspects of fieldwork. The study moves on to describe and compare the social relations and social practice on three wards, two male and one female, within Smithtown. The study was undertaken at a time when there was a mandate for organisational change; managers running the hospital perceived the culture of Smithtown as a problem in itself. The thesis uses ward-based ethnographic material on social relations and social practice to consider the adequacy of anthropological and managerial understandings of culture. Neither ideational or observable anthropological concepts of culture are sufficient, in isolation, for the Smithtown situation. Within Smithtown there is an easily observed social hierarchy, reliant on the primary social categories of staff and patient. It is argued that managerial emphasis on staff fails to acknowledge the interdependence and ambiguity of staff and patient identities. Correspondingly, there has been a neglect of the significance both of patient roles and values, and the importance of the built environment, for ward based social identities and related social practice.
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Garman, Gavin. "Violence, self harm and absconding in a secure psychiatric service." Thesis, University of Reading, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.414723.
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Dickens, Geoff. "Nursing in secure and forensic psychiatry : contexts, contributions and concepts." Thesis, University of Northampton, 2011. http://nectar.northampton.ac.uk/8854/.
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Wilkes, Victoria Louise. "Predicting length of stay in a male medium secure psychiatric hospital." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3772/.
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This thesis examines factors associated with length of hospital stay for mentally disordered offenders, detained within the medium secure psychiatric estate. Following an introduction, Chapter two presents a systematic literature review examining the current literature on factors that predict length of stay for patients detained in medium secure hospitals. Mixed results were found. There was limited convergence across clinical and forensic variables investigated, but greater consensus on what is not associated with length of stay. The limited research available and inconsistencies found indicates the need for further research. Chapter three comprises an empirical research study, investigating which variables within a population of male mentally disordered offenders predict length of stay within a regional, medium secure psychiatric hospital. Preliminary analyses revealed statistically significant relationships between length of stay and nine variables. Effect sizes were small to medium. Logistic regression revealed a statistically significant relationship between length of stay of two years or more and having a diagnosis of schizophrenic disorder. Chapter four presents a critical review of the Historical, Clinical, Risk–20 Violence Risk Assessment (HCR-20) (Version 2), a widely adopted risk assessment framework utilised within forensic psychiatry and the standardised measure used within the empirical study. The review explores the literature on the reliability and validity of the HCR-20, and considers its strengths and limitations. A discussion of the work presented concludes the thesis.
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Parkinson, John. "Black Caribbean men in high secure psychiatric care : a descriptive-interpretative analysis." Thesis, Anglia Ruskin University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248823.
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Over-representation of black men in psychiatric detention is a matter of concern. At Rampton Hospital in the nineteen nineties thirty percent of male mentally ill admissions were Black Caribbean, increasingly born in the United Kingdom. Effects of this have been recorded and discussed by inquiries into secure psychiatric care. Research into the perceptions of treatment of Black Caribbean users of mental health services has been recommended. Adopting a sociological perspective has been urged especially methods that seek to understand participants in their own terms. The present study adopts an inductive phenomenological approach to reflect the beliefs of this population; and their views concerning effects of race, illness, treatment and punishment. All consenting members of the population were interviewed and this data audiotaped and transcribed. Reflexive analysis utilised Ethnograph, a program for qualitative analysis. A classification of types of qualitative analytic theory in relation to the use of qualitative analysis programs helped define theoretical claims for the analysis. Analytic techniques based on Grounded Theory were used to develop an organising system from the reduced data. Validation of transcripts and coding included both participants and independent experts. Stage One involved four interviews; followed by revision of the interview schedule. Stage Two involved nine further interviews. This data was combined with participant feedback from validation. The organising system of clearly defined coded categories and their relationships was used in executing an analytic strategy of matrix and network displays, which enhances analytic transparency. This first produced displays and narratives for each participant; data reduction, which then supported cross-case analysis of important emerging themes and an analysis of causal streams. These streams were combined in a causal model from which propositions were derived. This research is innovative with this population and in the methods of analysis adopted. Relationships of race, beliefs, identity, treatment and punishment to mode of detention, adaptation and compartmentalisation have emerged and been examined.
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LeMay, Carrie C., Jill D. Stinson, Lydia L. Eisenbrandt, Courtney Smith, and Megan Quinn. "Polypharmacy Among Psychiatric Inpatients With Serious Mental Illness in Secure Forensic Care." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7951.
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Polypharmacy is broadly defined as the administration of more than one medication in a single patient, with the most commonly used definition indicating the concurrent use of five or more medications. Polypharmacy occurs in most clinical settings, particularly inpatient settings and treatment settings for persons with chronic illness and the elderly. Reasons for receiving more than one medication include ineffective treatment with monotherapy, targeting specific but varied symptoms, treating two distinct but co-morbid illnesses, addressing unremitting symptoms, and treating extrapyramidal side effects. Research indicates that each medication added to the patient’s regimen increases the likelihood of an adverse outcome, as well as the risk of adverse drug reactions, drug-to-drug interactions, cumulative toxicity, medication errors, patient non-compliance, patient morbidity, and patient mortality. The current study seeks to investigate the rates of polypharmacy and related characteristics predictive of polypharmacy within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101), African American (40.1%, n=73), and Hispanic (2.2%, n=4), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). Of those currently taking medications, 99.2% have been prescribed more than one type of medication, with 93.1% of those individuals being prescribed four or more. Polypharmacy was observed in 91% of participants. Of those diagnosed with a mood or psychotic disorder, an average of 3.6 different types of psychotropic medications were prescribed. Co-morbidity of mental illness was predictive of polypharmacy trends, F(1,181)=5.28, p<.05. Additionally, individuals with at least one chronic illness also were subjected to polypharmacy practices, with rates increasing for those with more than one chronic illness. As a measure of onset and severity of symptoms, age at first hospitalization and age of onset of aggressive behaviors were measured, and, interestingly, both measures were predictive of polypharmacy within these patients, F(1, 181)=13.45, p<.01. Results indicate that perceived severity of symptomology, aggression, and complex health problems all contribute to polypharmacy practices among prescribing physicians. The high rates of polypharmacy observed are concerning because of the potential for increased aversive health outcomes. Understanding the predictive factors, rates, and trends of polypharmacy has valuable implications for the future treatment and rehabilitation of individuals residing in a forensic psychiatric setting.
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Gallagher, Martin. "Implementing computer assisted cognitive remediation in a high secure forensic psychiatric setting." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/14237.
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Introduction This thesis has two aims. The first was to systematically review the literature on the effect of computer assisted cognitive remediation (CACR) for schizophrenia on psychosocial functioning, with a focus on methodological quality and efficacy. The second aim was to evaluate the implementation of CACR in a high secure forensic setting. Method Database searches and hand searches returned 16 randomised controlled trials of CACR that included a functional outcome measure. These were reviewed against predefined quality criteria and effect sizes were calculated. In addition, an uncontrolled pre-post test design was used to evaluate the implementation of CACR in a high secure forensic hospital. Attrition rates, predictors of attrition, and participant feedback were evaluated, along with symptom and functional outcomes. Results The systematic review found a range of methodological limitations. Studies that did not share these limitations did not provide evidence that CACR improves psychosocial functioning. However, CACR may be effective in improving functional outcomes when delivered alongside interventions targeting functional skills. The experimental study found a high attrition rate; poor adherence to the treatment protocol; no clinical, risk or demographic factors to distinguish treatment completers from those dropping out during treatment; and few improvements to performance on treatment activities or functional outcome measures. Conclusion The systematic review indicates that more methodologically rigorous research is required. Future studies with a general psychiatric population should examine the effect of CACR delivered in conjunction with interventions that aim to develop functional skills. Motivational deficits may have undermined the outcomes of the experimental study and it will be important to ensure the delivery of CACR in forensic psychiatric settings is designed to incorporate strategies for enhancing motivation. In addition, using CACR to target functional outcomes may be inappropriate within a high secure forensic setting. The role of CACR as in managing risk and enhancing the outcomes of other interventions should be explored.
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Chabinska, Joanna. "Burnout, depression and job satisfaction in acute psychiatric and secure mental health settings." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/23570.
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Chapter 1: Objective: The systematic review aimed to review the literature on burnout and its relationship to depression within the acute in-patient mental health services: psychiatric units and specifically, secure forensic mental health services. Methods: The review process included a systematic search across five databases (Medline, PsychINFO, Cinahl Plus, EMBASE and SCOPUS). Eligible studies included a cross-sectional design, using validated measures on burnout and depression. Results: A strong relationship between depression and emotional exhaustion was found. The relationship between depression and two other burnout dimensions (personal accomplishment, depersonalisation) was weaker and better explained in the context of other predicting (anxiety) and mediating (transformational leadership) variables. While depression severity across the studies was mostly mild with average burnout, service-specific variations were observed. Chapter 2: Objective: The empirical study aimed to explore any direct relationships of subjectively perceived understanding, predictability, control (job demands) with burnout and job satisfaction, and direct/in-direct effects of social support, psychological mindedness and psychological inflexibility (external and internal resources) on these relationships. Methods: Data was collected among Scottish National Health Service (NHS) employees (n=198) working in secure mental health services; forensic (58.65%) or intellectual disability (41.35%). Data gathered from the final sample of 141 nursing staff was analysed using t-tests, bi-variate correlations, hierarchical regressions and a series of mediation, moderation and moderated-mediation analyses. Results: The empirical study revealed that individual burnout dimensions were predicted by different job demands. Social support appeared as predictor rather than a moderator of job satisfaction and emotional exhaustion while psychological inflexibility was a mediator for job demands and burnout. Overall Conclusions: Concluding remarks for both, systematic review and empirical study, identify the need for further research, especially within the forensic mental health speciality. Both highlight that direct and in-direct effects may be important in explaining burnout while the empirical study makes further suggestion with regards to likely individualised pathways and two important resources of social support and psychological flexibility.
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Sandy, Peter Thomas. "Exploration of psychiatric nurses' attitudes towards service users who self-harm in secure environments." Thesis, Bucks New University, 2011. http://bucks.collections.crest.ac.uk/9632/.
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The literature is clear that self-harm is a serious and widespread behaviour among people with mental health problems, often causing distress to the individuals involved. This issue rightly causes concern among healthcare professionals, whose role it is to safeguard people with mental health problems. Noted in the literature is an apparent differential perception between professionals and service users of the underlying motives for self-harming behaviours in mental health services. This gulf in perception appears to have an impact on the relationship between service users and healthcare professionals, and the care received by the former. What is less clear from the literature is healthcare professionals` experience of self-harm in secure psychiatric settings. This study attempts to fill this knowledge gap by investigating the attitudes and perceptions of healthcare professionals toward self-harm in secure settings. This research, which adopted a multi-method phenomenological approach, was conducted just over four years. The study was conducted in a range of secure environments within a large mental health Trust in southern England. It involved 25 individual interviews and six focus groups to uncover the perceptions of healthcare professionals toward this phenomenon. The data were analysed using Interpretative Phenomenological Analysis according to the procedure recommended by Smith et al (2009). The chief finding is that healthcare professionals have mixed attitudes towards self-harm, but mainly negative ones, which in the main relate to the impact of self-harm and to limited knowledge and skills. This knowledge and skill deficit has implications for effective care provision and recommendations are made to improve this. Routine education about self-harm should be provided for healthcare professionals in secure settings in order to develop their confidence and competence in care provision and communication. Additionally, formal supervision should focus on self-harm management, and staff meetings conducted for the sharing of ideas about how to address challenges. A range of strategies are used by healthcare professionals to cope with the impact of self-harm. Apart for seeking knowledge, staff meetings and supervision, teamworking and blaming service users approaches were also utilised. This is the first study to investigate self-harm within secure settings using this methodology. Its findings provide much needed information.
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Samson, Carly A. "The relationship between self-esteem, narcissism, psychopathy and aggression in a high secure psychiatric population." Thesis, University of Surrey, 2016. http://epubs.surrey.ac.uk/812312/.
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The purpose of this study is to explore the relationship between self-esteem, narcissism, psychopathy and aggression to aid our understanding of personality factors that precipitate aggression. Further research into factors associated with aggression is urgently required due to the huge economic and personal costs of this behaviour. This is the first time these relationships have been explored in a unique and hard to treat population who are at high risk of harming others. Fifty inpatients of a high secure psychiatric hospital completed self-report measures of personality traits and completed a computerised task measuring implicit self-esteem. Information regarding previous and institutional aggression was obtained from patients’ medical files. Self-esteem fragility did not predict high levels of physically aggressive behaviour. However the findings suggest that narcissism and explicit self-esteem may play a role in institutional aggression. A profile of high explicit and high implicit self-esteem was found for Factor 1 psychopathy, and high explicit self-esteem was associated with adaptive narcissism. These findings suggest that narcissism and psychopathy have different self-esteem profiles. Alternative measures of implicit self-esteem in high secure populations are required to further test hypotheses relating to self-esteem fragility and aggression.
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Melzer, David. "Clinicians' perceptions of factors influencing admission to medium secure psychiatric care in England and Wales." Thesis, University of Cambridge, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.614235.
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Goddard, Lucie. "How are outcomes and recovery for patients treated in the secure psychiatric hospital system defined and conceptualised?" Thesis, University of Oxford, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.510421.
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LeMay, Carrie, Jill D. Stinson, and Megan Quinn. "THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES, MENTAL HEALTH OUTCOMES, AND POLYPHARMACY AMONG PSYCHIATRIC INPATIENTS IN SECURE FORENSIC CARE." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/168.
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Persons exposed to adverse childhood experiences (ACEs) are at increased risk of developing long-term negative health consequences. ACEs have a cumulative negative impact on mental health outcomes in particular. Evidence suggests that those in forensic psychiatric settings are disproportionally exposed to ACEs, lending to potentially greater complexity in the relationship between ACEs, psychiatric comorbidity, and behavioral problems. Additionally, within this population a common intervention for mental health symptomology includes pharmacology, particularly as health issues compound. As a medication regimen becomes more complex, the risk for negative consequences – including drug interactions, side effects, and even death – increases.
Limited empirical research describing associations between ACEs, mental health outcomes, and polypharmacy is available. Furthermore, no published studies to date have examined these relationships in forensic inpatient mental health populations, despite the evidence that these populations are disproportionately exposed to maltreatment and household dysfunction in childhood, frequently have higher rates of physical and mental health problems, and are usually treated with multiple forms of medications in response to health and behavioral needs. To address gaps in existing research, the relationship between ACEs, mental health outcomes, and prescription practices will be examined within a forensic inpatient sample.
The current study seeks to investigate the impact of ACEs on mental health outcomes and the relationship to polypharmacy practices within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101) or African American (40.1%, n=73), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132).
It is expected that greater experiences of childhood maltreatment and household dysfunction will result in greater negative mental health outcomes and associated behaviors. This relationship is expected to contribute to polypharmacy practices among prescribing physicians. Because high rates of polypharmacy yield a potential for increased aversive health outcomes, understanding the association between ACEs and other predictive factors and polypharmacy practice has valuable implications for the treatment and rehabilitation of persons in forensic mental health settings.
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Campbell, Lisa. "Do scores on the HCR-20 and FAM predict frequency of self-harm in females within a secure psychiatric hospital?" Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7698/.
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The thesis consists of two volumes. Volume 1: This volume consists of three chapters. The first chapter is a literature review examining whether there is a link between psychopathy and self-harm. The second chapter is a quantitative study investigating whether scores on the HCR-20 and FAM risk assessment tools predict frequency of self-harm in females within a secure psychiatric hospital. The third chapter comprises a public domain briefing document which provides a plain language summary of the literature review and empirical paper. Volume 2: This volume consists of five Forensic Clinical Practice Reports (FCPRs). The first details the case of a 63-year-old man with depression and paranoid schizophrenia, formulated from both cognitive and psychodynamic perspectives. The second is a service evaluation examining whether scores on the HCR-20 and HoNOS decrease over time for patients detained within a secure psychiatric hospital, and whether individuals’ scores on these measures reflect the level of security in which they reside. The third FCPR documents the case of a 34-year-old man experiencing offence-related anxiety, shame and depression. The fourth FCPR is a single-case experimental design investigating the effectiveness of a trauma-focussed cognitive-behavioural intervention for offence-related PTSD. The fifth FCPR is an abstract of an oral case presentation of a 14-year-old girl experiencing school anxiety. Pseudonyms have been used throughout to ensure anonymity.
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Stinson, Jill D., Carrie C. LeMay, Kelcey L. Hall, and S. Mersch. "Developmental and Clinical Predictors of the Onset of Offending and Behavioral Problems: A Comparison Between Adult Offenders in a Secure Psychiatric Hospital and Youth Offenders in Residential Treatment." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7957.
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Turcan, Maja. "One amongst several : working as a member of a multidisciplinary team in a medium secure psychiatric setting : how do we understand, organise and communicate our experiences?" Thesis, University of Essex, 2011. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.548577.
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Sheets, Willard A. "The Process People with Schizophrenia or Schizoaffective Disorder Use to Return to or Initialy Secure Eemployment Following Diagnosis." Ohio University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1241734324.
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SAUX, ANNE-MARIE. "Secret medical et psychiatrie : legislation actuelle." Toulouse 3, 1989. http://www.theses.fr/1989TOU31279.
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Soares, Mesquita Mirka. "Aux frontières de l'autisme infantile précoce et de la psychose infantile : la place d'importance de la psychanalyse dans le champ de la psychiatrie de l'enfant." Paris 13, 2012. http://scbd-sto.univ-paris13.fr/secure/ederasme_th_2013_soares_mesquita.pdf.
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La présente étude trouve son point de départ dans un phénomène actuellement observable dans le champ pédopsychiatrique : le rejet de la psychanalyse et du terme de psychose infantile au nom d’une « psychiatrie scientifique ». Nous partons de l’hypothèse que ce double escamotage donne place à l’utilisation exacerbée du concept d'autisme et de son association aux facteurs purement biogénétiques, remarquable depuis quelques décennies. Nous considérons que ces changements représentent un vrai danger à la pratique diagnostique et thérapeutique car, l’autisme comme la psychose, étant mis dans un « même sac », seront confrontés à des prises en charge essentiellement médicamenteuses et éducatives. La présente étude soutient donc l’élaboration d'une clinique différentielle entre ces deux positions subjectives. Pour ce faire, nous nous appuyons sur trois optiques distinctes, mais tout de même complémentaires : une historique, où nous cherchons à comprendre les liens de parentalité entre les concepts d’autisme et psychose, ainsi que celui entre pédopsychiatrie et psychanalyse ; une structurale qui nous permet de mieux cerner la nature des phénomènes observables de ces deux positions subjectives ; et une clinique qui illustre nos questions autour de la confusion symptomatologique entre l’autisme et la psychose infantile. Nous concluons ainsi qu’un retrait autistique peut être présent chez des enfants dont les entraves suivent plutôt une logique structurale psychotique. L’importance de cette étude porte donc sur la reconnaissance de l’écoute épurée à la parole du sujet comme élément essentiel à toute prise en charge de la souffrance psychique chez l’enfantThis study finds its starting point in a phenomenon currently observed in the psychiatric field: the rejection of the term infantile psychosis and psychoanalysis in the name of "scientific psychiatry". We hypothesize that this double retraction gives room for heightened use of the concept of autism and its association with purely biogenetic factors, remarkable for several decades. We believe these changes represent a real danger to the diagnostic and therapeutic practice because autism as psychosis, put in a "lumped", will face with primarily medicine and education supports. This study therefore supports the development of a differential clinic between these two subjective positions. To do this, we rely on three distinct opticals, but still complementary : historical, where we discuss the link between the concepts of autism and psychosis, as well as between psychiatry and psychoanalysis ; structural, which allows us to better understand the nature of the observable phenomena of these two subjective positions ; and clinical which illustrates our questions around the symptomatic confusion between autism and childhood psychosis. We conclude that autistic withdrawal may be present in children which barriers rather follow a structural psychotic logic. The importance of this study therefore is the focus on the recognition of the purified listening to the speech of the subject as an essential element of any management of mental suffering in children
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TRUONG, MINH TUAN. "Confiance, confidences et conscience : quelques reflexions sur la notion de secret medical." Amiens, 1990. http://www.theses.fr/1990AMIEM047.
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Patel, Gita. "Violent thoughts and fantasies in a high secure mentally disordered offender group : an exploratory study." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29445/.
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There is a well-established association between thinking and doing and so it is no surprise that thinking about violence can be associated with risk of violent behaviour. Violent thoughts are recognised as a treatment target in many offender treatment programmes, yet given the multi-faceted nature of violent cognition and absence of integrating theory of violent offenders’ cognition it can sometimes be difficult to assess and treat the cognition that is associated with violent behaviour. This research project aims to explore Violent Thoughts and Fantasies (VTF) in a clinical and forensic client group. The thesis begins with a review of violent cognition and related constructs. A systematic review then highlights the role of violent cognition at various stages in the offending process. The main empirical study uses qualitative methodology to explore VTF amongst a sample of mentally disordered offenders detained within a high secure hospital. The thematic analysis yielded four super-ordinate themes which included ‘part of who I am’, ‘emotional regulation’, ‘aware of the need to be careful’ and ‘thinking to doing, to thinking, to doing’. Violent thoughts and fantasies appeared to be integral to one’s self concept and functioned to sustain the individual in some way, depending on individual need. A range of functions of VTF were identified using functional analysis and these included: emotional regulation, dealing with provocation and using VTF to plan or guide violent offending. Consequently, there continues to be a need to carefully assess and manage these experiences as the link between thinking about violence and acting in a violent way continues to be a likely possibility. Clinical implications are directed towards a thorough assessment of VTF, with particular emphasis on assessing the underlying function of VTF and supporting offenders to find alternative ways of addressing the need that the fantasy currently fulfils.
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Jacob, Jean Daniel. "Fear and power in forensic psychiatry: Nurse-patient interactions in a secure environment." Thesis, Université d'Ottawa / University of Ottawa, 2009. http://hdl.handle.net/10393/32599.
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This research project was situated at the crossroads of two distinct disciplinary fields: nursing and criminology. It sought not only to situate nursing practice in an extreme environment, but also to explore a professional practice in a context where the probability of nurses becoming victims of interpersonal violence is considered to be high, and where fear becomes a perceptible variable that shapes nurse-patient interactions. The goal was to describe and comprehend how fear as a dynamic process influences nursing interactions with patients. This understanding of the relationship between nurses and patients required that fear, the central concept in this project, be examined within the context of the total institution where nurses are both objects and subjects of power. To accomplish this, a qualitative design, which incorporates explorative and descriptive attributes, was thought to be an appropriate choice for this research project. Given the embryonic state of research regarding fear in forensic psychiatric nursing, and given the nature of the research question, grounded theory was considered to be the research method of choice for this project. Once the methodological groundwork was completed, introduction into the research setting permitted the direct observation of nursing routines as well as the completion of eighteen (18) semi-structured interviews. In keeping with an inductive methodological framework, the analysis of the data produced four mutually exclusive categories: 1.) Context, 2.) Nursing Care, 3.) Fear, and 4.) Othering. The fourth category (Othering) that emerged from the data analysis is the core category, because it is the site of a basic social process, and represents the site where all other categories converge. In brief, the results from this research indicate that the environment in which nurses practice is extremely constraining. Within this highly regimented context, nurses are socialized to incorporate representations of the patient population as being potentially dangerous, and, as a result, distance themselves from idealistic conceptions of care. In effect, the heightened awareness and suspicion that a few patients may evoke creates an environment in which trust is difficult to develop. Moreover, the research results emphasize the implication of fear in nurse-patient interactions and particularly how fear reinforces nurses' need to create a safe environment in order to practice. A constant negotiation between space, bodies and security takes place where nurses are forced to scrutinize their actions (self-discipline) in order to avoid becoming a victim of violence. As a result, security is a factor that needs to be present in order for care to be provided. If the environment is considered to be unsafe, then interventions to secure the space are inevitable. In parallel, participants also described how being able to identify with patients enabled positive (read ''therapeutic'') interventions to take place. Casting the patient in the role of the other (sick and/or vulnerable) enabled the nurse to create a rapport with the patient and to use the relationship in a transformative way (self-governance). However, exposure to the patient's criminal history, as well as the inability to rationalize the patient's behaviours within a sickness model, fostered a negative differentiation process wherein nurse-patient interactions became difficult. Along these lines, demonstrating "potential" was also described as an essential motivator for nurses to invest themselves in therapeutic relationships. The tension generated by (a)potential individuals disrupts the normal nursing process, because nurses experience difficulty in finding meaning in nursing care. Finally, participants also highlighted the presence of gender dynamics and social norms that implicitly and explicitly governed work divisions and the presentation of the self in the forensic psychiatric units. Incorporating the masculine standards (being fearless) was seen as a socially desirable attribute. Overall, this research project suggests that the need for safety (both at the individual and collective levels) will always cast a dark shadow over the ideals of care. When nurses feel threatened, security will take precedent over care.
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Dhaliwal, Ranjit. "Examining social problem solving programmes with mentally disordered and intellectually disabled offenders in secure hospital settings." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/47343/.
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This thesis examines the effectiveness of social problem solving programmes and the efficacy of an assessment tool designed for mentally disordered offenders (MDOs) and intellectually disabled (ID) offenders in secure hospital settings. Firstly, a systematic review concluded that all studies reported benefits of the social problem solving programmes with MDOs. Several studies also identified that shorter revised programmes had lower drop-out rates, and were more cost-effective. Methodological limitations were identified and suggested further research is needed. Secondly, Interpretative Phenomenological Analysis (IPA) was utilised to explore the meanings ID offenders in a secure hospital attribute to their experience of the Thinking Skills Offender Programme (TSOP). Five themes emerged and participants’ conveyed a sense of hope in relation to their treatment, discussed challenges they faced, identified the impact the TSOP had on factors contributing to their offending behaviour, and wanted to share their experiences with a wider audience. Further research to develop effective programmes for ID offenders is discussed. Thirdly, an assessment and treatment of an adult male violent offender with ID and Autistic Spectrum Disorder (ASD) who undertook the TSOP in a medium secure unit is examined. The findings highlighted the difficulties in assessing and treating such patients using conventional methods and the need for standardised assessments and interventions for this population is discussed. Finally, the reliability and validity of the Novaco Anger Scale and Provocation Inventory (NAS-PI) is examined with MDOs and ID offenders. Its clinical utility in inpatients settings and limitations are also discussed. This thesis has highlighted the benefits of social problem solving programmes with MDOs and ID offenders, difficulties of conducting research with this population, and the need for further rigorous research into assessments and interventions.
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Aubat, Thierry. "Collaboration psychiatre et S. A. M. U. - S. M. U. R. 34 face aux troubles aigus du comportement." Montpellier 1, 1988. http://www.theses.fr/1988MON11221.
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Jenkinson, Julia. "Exploring recovery in women diagnosed with personality disorder in a secure setting." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10341/.
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Section A consists of a literature review which explores the concept of recovery and its relevance for women who have been detained in a secure setting and diagnosed with a personality disorder. Section B presents the findings of a study to explore the concept of recovery in women diagnosed with personality disorder in a secure unit. Six semi- structured interviews, conducted with women diagnosed with personality disorder and experience of being detained in secure accommodation, were analysed using Interpretative Phenomenological Analysis. Analysis of the transcripts revealed five master themes: recovering; centrality of relationships; assuming responsibility for own care; evolving an identity; understanding of the mental health experience. The study concludes that, as far as is consistent with a secure setting, women should be given maximum opportunity to participate in decisions about their own care. Staff should be creative in providing opportunities for the women to engage in meaningful activities that promote a positive identity. Education with respect to personal recovery and the presentation and aetiology of personality disorder may support more caring and hopeful relationships between staff and service users, within which recovery can be facilitated. Section C involves a critical appraisal of the study.
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Taylor, Vikki. "An exploration into service users' and staff experiences of a medium secure setting." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/15019/.
Full textAbstract:
Despite a growing literature base related to both compassionate care and work-related stress in healthcare settings, there is a lack of empirical studies investigating the relationship between these concepts, particularly in medium secure settings. This mixed methods study explored the relationship between compassion (The Compassion Scale) and work-related stress (The HSE Management Standards Toolkit) from the self-report of 51 members of staff in a medium secure setting, including semi-structured interviews with 12 participants. On the quantitative measures, the relationship between self-reported compassion and work-related stress on the quantitative measures was found to be statistically non-significant. However, elements of compassion were found to significantly predict subscales of work-related stress such that high levels of elements of compassion were found to predict higher levels of subscales of work-related stress. Participants constructed several meanings of compassion and its role in the care of the patients they worked with. Several consequences of occupational demands were cited including an increase in work-related stress and less time to build therapeutic relationships or to develop compassion towards patients. The findings of this study can be used to inform the development of staff interventions. Increased consistency of staff groups, increased debriefing opportunities and a review of paperwork responsibilities within staff teams have also been recommended.
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Millar, Hayleigh. "Recovery approaches with women with a diagnosis of personality disorder in secure care." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10263/.
Full textAbstract:
A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.
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Moser, Michele R. "Trauma Focused Cognitive Behavioral Therapy (TF-CBT): Healing the Effects of Child Sexual Abuse, the Secret Epidemic." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/4998.
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Delaporte, Sophie. "Le discours médical sur les blessures et les maladies pendant la première Guerre Mondiale." Amiens, 1999. http://www.theses.fr/1999AMIE0002.
Full textAbstract:
La grande guerre a contribue a modifier de maniere considerable la perception par le monde medical de la blessure et de la maladie. Les projectiles ont penetre les tetes, les ventres, les poitrines et les membres des hommes qui avaient la charge de combattre, leur infligeant d'effroyables traumatismes. Les blessures mais aussi les maladies imposerent aux combattants la decheance de leur propre corps. Les reponses therapeutiques apportees par les medecins pendant la grande guerre revelent un bouleversement dans les attitudes medicales. L'interventionnisme therapeutique precoce s'imposa dans la plupart des cas, a l'exception de la chirurgie des membres, ou c'est le conservatisme qui s'imposa, rejetant au detriment de l'interventionnisme a outrance. Les medecins se trouverent confrontes a deux grandes epidemies : le paludisme et la grippe, et a deux phases longues de maladies : la tuberculose et les atteintes par les gaz. Les contenus des traitements mis en oeuvre par le monde medical mettent en evidence que ce sont les methodes + classiques ;, existant deja avant la guerre, qui ont domine, assurant ainsi une certaine continuite avec l'avant-guerre. Si la guerre a montre aussi la persistance de certains + archaismes ; therapeutiques, elle a aussi favorise quelques innovations, dont la diffusion resta pour l'essentiel fort limitee et dont la medecine de l'apres-guerre n'a pas toujours su tirer partiThe great war contributed to change in a considerable way the perception of the injury and illness by the medical world. The projectiles penetrated the head, the stomachs, the chest and the limbs of the men who had the responsability of fighting, inflicting appalling traumatisms to them. The therapeutics answers brought by the doctors during the great war reveal a disruption in the medical stands. The early therapeutic interventionism imposed itself in most cases, except in the one of the limb surgery for which conservatism imposed itself, thus rejecting the excessive interventionism. The doctors found themselves confronted to two big epidemics : malaria and influenza, and two long phases of illness : tuberculosis and gas attacks. The therapeutic contents implemented by the medical world bring to the fore that the classical method which already existed before the war dominated, thus allowing some continuity with pre-war years. The injuries but also the illness imposed to the fighters the degeneration of their bodies. The pre-war years revealed also the persistency of some therapeutic archaisms, it also brought out some innovations whose spreading remained very limited for its greatest part, and from which the pre-war years did not always beneficit
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LIN, TAI-HUA, and 林岱樺. "Secret Garden In Ruins：I stay in the Psychiatric Chronic Ward." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/scuh2z.
Full textAbstract:
碩士輔仁大學
心理學系
103
Abstract In May, 2012, something bombed right into my heart, and left it badly damaged. I, with tears shedding, breast milk pouring out, rose from my ruin breastfeed my daughter. Everyday, I stroke my breasts, recalling how the breasts had once brought shame on me in adolescence. This memory and the time had been frozen in the ruin. And, in the devastated area, neither you nor I could measure the flow of time. However, as my tear wandered in the thirsty land, it channeled water into the frozen time. A rose has grown up. Come, come! Let me show you the secret garden in the ruin. The journey of reflecting my own crazy experience is, on one hand, facing toward the others; on the other hand, walking through my rites of passage from girlhood to womanhood. While I took practicum, I also took my role as an action researcher. With this methodological assumption, I conducted the field study in the chronic psychiatric ward, inviting dialogue, responding to feedback, making self-reflective enquiry. In this back-and-forth action, my own problematic, the perspective to see the nature of question, has undergone a paradigm shift. My conceptual framework was expanded from individualism to collectivism, moving from the individualized experience of madness to the others, for instance, the disable I served in my first job after graduating. And in the ward, the others I encountered include psychiatric patients, clinical psychologists, social workers, occupational therapist, psychiatrist, the constitution of medical profession, and, the last but not the least, I myself in practicum. I started to understand the difference between diagnosis and caring. All my field study and reflection in chronic psychiatric ward pivoted on this differentiation to reexamine the national policy on psychiatry and how it impact patients as well as workers. I initiated my research in three directions. First, I initiated a three-month field observation in chronic ward. Secondly, I started conversation with nurses who was working in the ward. Thirdly, I had a featured report in the department of psychiatry to share my field study with mental health professionals. How the above three directions showed reciprocal influences would be illustrated in the following. With regard to my field observation, I intended to contrast my study with Erving Goffman’s in mental hospitals (1961). Erving Goffman (1961) described how people transform in the process of being adapted to mental hospitals. They were humiliated, abandoned, ashamed, and held in contempt. At the end, patients gave away their subjectivities, receiving unjust stigma. Goffman’s record helped me to identify my lived experience of madness which was evoked by patient situation in my field study. As I faced with mental illness patients, they functioned as a mirror to shine upon my past, my shame toward my female body across adolescence along with my fear of being diagnosed with panic disorder. Inspired by Goffman’s writing, I gave a featured report from my own situated affective experience. However, my report failed to recognize the complicated political structure in which the department of psychiatry located, so it was critically challenged. This setback, instead of holding me back, spurred me on further observation and dialogue making. To do so, I recorded what a typical day is like for nurses and care workers; I interviewed nursing team, the head nurse, a father who took care of his son with mental illness, and also the first chief in the department of psychiatry. It is through the circle of planning, action, and fact-finding about the result of action that I turn my vision into the history of the department of psychiatry in which every participant has constructed his/her own interpretation and experience. The ways that different professionals chose to work with patients are not only determined by his/her position in the structure of mental health system, but also intertwined with his/her survival strategies. During the process of research, I always thought dialectically about my subjective experience and objective truth. Finally, I recognized how student trainees are powerless in the power relationship of hospitals. In this sense, I liken myself to patients in psychiatry. This is a thesis illustrating how a counseling psychologist in practicum took the role of action researcher to reexamine her position in the hospital. Key words：action research , psychiatry , psychiatric chronic ward , counseling psychology intern , internship in psychiatry.