Browsing by Author "Middleton, Lyn Elizabeth."

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A social constructionist analysis of talk in episodes of psychiatric student nurse-psychiatric client community clinic based interaction.
(2007) Middleton, Lyn Elizabeth.; Uys, Leana Ria.
The study seeks to explore and to offer a critical account for the 'discursive doings' of student psychiatric nmsing practice as they are jointly constructed in the episodes of conversation between the nmse and client-speakers within the context of the communitybased psychiatric clinic. The study is built around a social constructionist framework and is concerned with the analysis of the discursive activities present within seven (7) transttibed, audio-recordings of student nurse-psychiatric client interactions. A thick and sometimes critical description of three of the contextual forces back grounding/foregrounding the discursive processes of psychiatric nursing is given. These include the public health psychiatric care context, the problem-solving approach of the undergraduate psychiatric nursing curriculum and the assumption and effects of modem psychiatric nursing theory. The first level of analysis is an aspect of the methodology and offers a descriptive and interpretive analysis of the talk in the texts. Various conversational discourse analytic tools were used here to transform talk into text and to develop the starting point for the subsequent positioning theory analysis. The second level of analysis is a positioning theory analysis of happenings within these texts. Some of the textual descriptions generated in the first level of analysis are used to illuminate and to add substance to the accounts of these positioning theory happenings. The analysis has shown that from a social constructionist positioning perspective, the unfolding nurse-client dialogue in these texts operates in four potentially distinct ways - highlighting, herding, hectoring and heeding - with specific effects for their going on together in conditions of relationship. These ways of talking are shown to be contrary to the person-eentered rhetoric of modem psychiatric nursing and more aligned with the bio-medical format of talk in helping contexts. Can these activities be dismissed as non-nursing activities? The implications for a modem psychiatric nursing theory that holds the person-centred approach to be its quintessential essence are considered and a number of ideas for how client-authorised expressions may be jointly manifest in conversations situated in this practice context are offered.
The effects of familiarity on stigma components in potential employers towards people with a serious mental illness in Durban KwaZulu-Natal.
(2010) Smith, Amanda April Heather.; Middleton, Lyn Elizabeth.
AIM The purpose of the research study was to explore and to describe stereotypes associated with serious mental illness and the effects of familiarity on the serious mental illness stigma process in potential employer informants in the greater Durban area, eThekwini district, KwaZulu-Natal. Methods A quantitative non-experimental cross sectional survey relational research design was used to describe firstly, the stereotyping and individual discriminatory behavior (desire for social distance) of potential employers to a person with a SMI, and secondly, the effect of familiarity and other person variables (culture, age and gender) on the stigma components of stereotyping, emotional reaction and individual discriminatory behavior (desire for social distance). The population included potential employers of the SMI person in the greater Durban area, eThekwini District, KwaZulu-Natal. The target population was all students enrolled for a part-time management course at two academic institutions in the Durban central area. Non-randomized, non-probability purposive sampling was used. Demographic data and four self report tools were compiled into one self report questionnaire to collect data. Results The sample was evenly distributed amongst male and female within the various age groups. All cultural groups were represented but this representation was not a perfect fit with national or provincial population statistics. Just less than half of the participants (48% n=55), both genders and across all cultural groups, had intimate and or personal contact with persons with a serious mental illness. Demographic associations suggest that male participants had greater perceptions of dangerousness, unpredictability and incompetence and a greater desire for social distance. The statistical results indicated limited correlations between emotional reactions and desire for social distance, stigmatizing attitudes and desire for social distance, and evidence of no significant relationship between familiarity and other components within the stigmatizing path. Fear was associated with a desire for social distance and with perceptions of limited potential for recovery. Stigmatizing attitudes were most negative towards persons who had a previous admission to a psychiatric hospital and the least negative towards 'bipolar mood disorder'. Stigmatising attitudes were recorded for all serious mental illness labels (including that of bipolar) with 75% of participants scoring closer to the negative polar adjective of stigmatizing attitude. Conclusion and Recommendations In conclusion, the supposed lack of desire for social distance, the dependent variable in this study, may reflect political policy and current ideology but the strength of the negative stereotypes suggests that changing policy is easier than changing attitudes. It is suggested that the stigmatizing stereotype of limited potential for recovery may have more salience in developing countries such as South African than the developed western world. Limited potential for recovery has financial and emotional implication within a developing country and to this extent, desire for social distance and fear are correlated to perceptions of limited potential for recovery. Recommendations include additional research include measures of social desirability bias to clarify the relationship between familiarity, emotional reaction and social distance. Secondly, intervention studies, specifically with potential employers, are required to obtain empirical data related to the combine effectiveness of disconfirming information and contact with people with a serious mental illness. Further, that health departments actively engage in evidence based anti-stigma initiatives. Lastly it is recommended nursing curricula recognise the importance of student psychiatric nurses developing a balanced view of mental health care users assigned the serious mental illness labels through a balanced clinical exposure to recovered, as well as acutely ill mental health care users. That the new undergraduate nursing degree curricula strengthen content related to recovery and psychosocial rehabilitation, specifically nursing interventions / strategies to facilitate rehabilitation in all the areas of study, socialization, community living, and specifically in the area of work.
The effects on familiarity on stigma components in potential employers towards people with a serious mental illness in Durban, KwaZulu-Natal.
(2010) Smith, Amanda April Heather.; Middleton, Lyn Elizabeth.
Aim The purpose of the research study was to explore and to describe stereotypes associated with serious mental illness and the effects of familiarity on the serious mental illness stigma process in potential employer informants in the greater Durban area, eThekwini district, KwaZulu-Natal. Methods A quantitative non-experimental cross sectional survey relational research design was used to describe firstly, the stereotyping and individual discriminatory behavior (desire for social distance) of potential employers to a person with a SMI, and secondly, the effect of familiarity and other person variables (culture, age and gender) on the stigma components of stereotyping, emotional reaction and individual discriminatory behavior (desire for social distance). The population included potential employers of the SMI person in the greater Durban area, eThekwini District, KwaZulu-Natal. The target population was all students enrolled for a part-time management course at two academic institutions in the Durban central area. Non-randomized, non-probability purposive sampling was used. Demographic data and four self report tools were compiled into one self report questionnaire to collect data. Results The sample was evenly distributed amongst male and female within the various age groups. All cultural groups were represented but this representation was not a perfect fit with national or provincial population statistics. Just less than half of the participants (48% n=55), both genders and across all cultural groups, had intimate and or personal contact with persons with a serious mental illness. Demographic associations suggest that male participants had greater perceptions of dangerousness, unpredictability and incompetence and a greater desire for social distance. The statistical results indicated limited correlations between emotional reactions and desire for social distance, stigmatizing attitudes and desire for social distance, and evidence of no significant relationship between familiarity and other components within the stigmatizing path. Fear was associated with a desire for social distance and with perceptions of limited potential for recovery. Stigmatising attitudes were most negative towards persons who had a previous admission to a psychiatric hospital and the least negative towards 'bipolar mood disorder'. Stigmatising attitudes were recorded for all serious mental illness labels (including that of bipolar) with 75% of participants scoring closer to the negative polar adjective of stigmatizing attitude. Conclusion and Recommendations In conclusion, the supposed lack of desire for social distance, the dependent variable in this study, may reflect political policy and current ideology but the strength of the negative stereotypes suggests that changing policy is easier than changing attitudes. It is suggested that the stigmatizing stereotype of limited potential for recovery may have more salience in developing countries such as South African than the developed western world. Limited potential for recovery has financial and emotional implication within a developing country and to this extent, desire for social distance and fear are correlated to perceptions of limited potential for recovery. Recommendations include additional research include measures of social desirability bias to clarify the relationship between familiarity, emotional reaction and social distance. Secondly, intervention studies, specifically with potential employers, are required to obtain empirical data related to the combine effectiveness of disconfirming information and contact with people with a serious mental illness. Further, that health departments actively engage in evidence based anti-stigma initiatives. Lastly it is recommended nursing curricula recognise the importance of student psychiatric nurses developing a balanced view of mental health care users assigned the serious mental illness labels through a balanced clinical exposure to recovered, as well as acutely ill mental health care users. That the new undergraduate nursing degree curricula strengthen content related to recovery and psychosocial rehabilitation, specifically nursing interventions / strategies to facilitate rehabilitation in all the areas of study, socialization, community living, and specifically in the area of work.
An exploration of the nurses perception on causes of and management of in-patient aggression in a psychiatric institution in Botswana.
(2009) Kealeboga, Kebope Mongie.; Middleton, Lyn Elizabeth.
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.
An exploratory-descriptive study of perceived family burden by family members of individuals with a serious mental illness in the uThukela District of KwaZulu-Natal.
(2010) Buthelezi, Tholakele Maria.; Middleton, Lyn Elizabeth.
The global change in the provision of mental health care services from long-term institutionalization to community-based care brought changes in the care giving responsibilities. This approach shifted the responsibility for the care of individuals with serious mental illness from psychiatric hospitals where health professionals were the primary care-givers, to community health care services where the family members are now the primary care-givers and the major sources of psychosocial support for the individuals with serious mental illness (Chamber, et al., 2001; Seloilwe, 2006). The aim of this study was therefore to explore the care giving burden as perceived by family members of individuals with serious mental illness and the association between their coping strategies and the perceived burden. Methodology: An exploratory-descriptive, non- experimental quantitative study was adopted to describe and explore perceptions of care giving burden by family members, and the association between the perceived burden and the family coping strategies. The Zarit Burden Interview (ZBI) was used to collect data on perceived family burden and the Carers Assessment of Management Index (CAMI) to collect data on coping strategies. The questionnaire was self- administered to 120 family members of the individuals with serious mental illness who accompanied their relatives at the clinic and who met the sample inclusion criteria. Findings: The findings revealed that family members in the uThukela District were experiencing great burden while caring for their relative with serious mental illness. The most influencing factors were the worsened condition of a relative with unmanageable behaviour, poverty, lack of resources including knowledge, rehabilitation centres. Over dependency of a relative with serious mental illness on family members was one of the greatest worries of the participants. The situation negatively affects on the social lives of the family members and on their well being. In terms of coping strategies, family members were found to be using both problem-focused and emotional-focused strategies to balance their coping abilities.
On becoming a confident occupational therapist.
(2013) Holland, Kathlyn Elena.; Uys, Leana Ria.; Middleton, Lyn Elizabeth.
This thesis presents and discusses the results of research undertaken to explore the concept 'professional confidence'. The term 'confidence', is frequently to be found In previous research, yet this has not adequately been defined. The conceptions held by occupational therapists were not clear, and the events or circumstances that fostered professional confidence in occupational therapists have not been identified. Each of these aspects was identified as an area for research in the profession. Three studies were undertaken to gain greater insights and to add to the body of knowledge in terms of our understanding of 'professional confidence'. The studies included a concept analysis of the concept of 'professional confidence', a phenomenographic study of the conceptions of professional confidence that novice occupational therapists hold and finally, the sources or determinants of professional confidence beliefs in occupational therapy students were explored using an interpretative methodology. The research undertaken yielded antecedents and attributes or characteristics of professional confidence, and from these a definition was crafted. The conceptions or understanding of professional confidence held by the community service therapists, namely knowing, believing and being, were closely related to the attributes raised in the concept analysis, confirming the findings of the analysis. Final year occupational therapy students highlighted a number of determinants of professional confidence, including events, situations and circumstances within their control, the control of their clinical supervisors and/or the profession. These sources in turn had been confirmed as antecedents in the concept analysis. The research confirmed that professional identity, competence and professional confidence are inter-related and inter-dependent phenomena. Professional confidence involves a dynamic, maturing self-belief closely related to, and informed by both professional identity and competence. As such, equal attention should be given during the educational endeavour and initial employment opportunities, to the fostering of both professional identity and professional confidence while enhancing competencies. The recommendations provided within the research provide a rich source of information from which further research can be undertaken and interventions developed to assist students and novice practitioners to enhance their professional confidence.
A phenomenological study of caring experiences of caregivers caring for mentally ill individuals at home in the Northdale area of Pietermaritzburg.
(2012) Royan, Nelyanne.; Middleton, Lyn Elizabeth.
In the context of recent shifts in South African national health policies that integrate mental health care into primary health care, the family rather than the institution has become the primary site of ongoing care for psychiatric clients. The purpose of this qualitative phenomenological study was to describe how caring is rendered at home for the mentally ill person by family caregivers, living in Northdale, Pietermaritzburg. Purposeful sampling was used to recruit six family caregiver participants from the psychiatric clinic waiting room. These were caregivers who had accompanied their family member with mental illness for treatment on that particular day. Data generated from in-depth interviews with these participants provided personal experiences of their caregiving practices, behaviours, and problems. Data analysis was based on descriptive phenomenology and Colaizzi’s method of data analysis and data representation. Significant statements were extracted and grouped to form larger units or clusters. The clusters were then organised into nine themes, with associated significant statements made by the caregivers: Theme 1: Family as support system. These aspects related to daily maintenance of nutrition, hygiene and grooming for the family member with mental illness. The participants indicated that the maintenance of these activities f daily living were very important in the care of the SMI individual at home. Theme 2: Commitment to care. Evident throughout the interviews were issues of how caregivers perceived and sustained the ongoing responsibilities of home care for the mentally ill. There was a willingness and complete commitment to caring for the SMI family member with all its responsibilities. Theme 3: Disruption to family life. Details emerged from the interviews about how families adjusted to the constant needs of care provision, supervision, and vigilance demanded by home care giving. The participants accepted that problem behaviours were part of caring. Theme 4: Value in contributing to care. The interviews revealed various aspects of how caregivers drew reassurance and a sense of positive accomplishment from successes in teaching, supervising and managing a mentally ill relative at home. There were positive aspects to caring in that the SMI individuals could be of help to the caregivers. Simple tasks such as empting of bins, shopping and dish washing were part of the daily routine which proved beneficial to the caregiver and the family member with mental illness. Theme 5: Maintaining hope. Various implications emerged in the study such as being hopeful, and having a positive outlook as caregiver, despite the behaviour problems and chronic nature of the client’s mental illness. Participants indicated that despite the fact that they have a responsibility to care they are hopeful that one day the family member would be as normal as any other person. Theme 6: Support and Guidance: Ongoing assistance. Several issues emerged in relation to the involvement of the community psychiatric clinic professional staff in giving support and guidance to the individual caregivers, such as provision of information about side effects of medication, especially drowsiness, impaired communication and inactivity, guidance on how to cope with taking of substances by the client, and assistance with preparing for lifelong care of the family member with mental illness. Theme 7: Concern for Continuity of care. There was the need to look at what would be the outcome if the parents were not there to care for the SMI individual. Even though this is something to think about and had been broached at one time with the psychiatrist the family and care giver are hopeful that another family member will step into the caring role should they not be there. Theme 8: Fears and difficulties experienced in caring. Problem behaviours and danger to self and others is always upper most in the minds of the care givers, this resulted in even limiting friends because the SMI individual could be influenced into taking drugs. Care giving involved taking steps to ensure the family member does not hurt himself or herself. Theme 9: Misuse of Social Grant. Financial burdens were experienced by the family of the mentally ill individual. Social grants were being used to maintain the whole family for food, lights and rent. Sometimes the caregivers are forced to hand over the social grant to the MHCU just to ensure that there will be no problems at home if they were refused. Money is used to purchase cigarettes and drugs. Fear that the grant would be stopped results in the family not willing to report the abuse to the clinic staff. Implications for psychiatric nursing practice that the study highlighted included need for intervention by the community psychiatric nurses in regard to side-effects of medication, management of problem behaviours, and education for caregivers concerning the illness and especially its progressive signs and symptoms. Further research might explore current supportive programmes available in the community to keep pace with societal changes, with particular focus on whether. caregivers are included in the visits to the clinic with the mentally ill family member and what attention is given to their needs and problems so that they feel appreciated and valued.
Policy implementation : implication on caregiving experiences of families and persons living with serious mental health problems in Nigeria.
(2012) Jack-Ide, Izibeloko Omi.; Uys, Leana Ria.; Middleton, Lyn Elizabeth.
No abstract available.