[Identification and management of violence in psychiatry: Nurse and patient perceptions of safety and dangerousness]. / Identification et gestion de la violence en psychiatrie: perceptions du personnel infirmier et des patients en matiére de sécurité et dangerosité.

This paper reports the results of a study on the identification and management of violence on a psychiatric ward and in the psychiatric emergency of a Quebec hospital. The purpose of this exploratory and descriptive study was to examine patients' and nurses' perceptions and strategies for identifying and managing patient aggression and violence. Results show that the type of setting influences the way aggressive behaviour issues are perceived and managed. The types of behaviours deemed aggressive or risky also vary between the two units. Moreover, patients and nurses are similarly described by all participants as susceptible to being violent and to being a victim of violence. Prevention of aggression and violence remains a significant challenge in psychiatric nursing, where administrative and environmental constraints, the growing complexity of clinical profiles, divergent interprofessional approaches to care, and collective feelings of apprehension and vulnerability interact.

Building life around foster home versus moving on: the competing needs of people living in foster homes.

OBJECTIVE: This article reports findings on the competing needs of people living in psychiatric foster homes in Montreal, Canada. METHODS: Semi-structured interviews were conducted with 33 residents. Consumers describe the tensions associated with foster home life. RESULTS: Two overall competing needs emerged: the need to build their lives around the foster home and the need to build life beyond the foster home. Residents describe their need for security and support versus their need for greater personal autonomy, the dilemmas associated with communal living, and their struggle to envisage a positive future. CONCLUSIONS: These findings have important implications for mental health professionals mandated to dismantle foster homes for more autonomous housing.

From the real frontline: the unique contributions of mental health caregivers in Canadian foster homes.

This article reports the findings of a qualitative study on the contribution of foster home caregivers for people with serious mental illness. Traditionally, social workers have played a key role in the supervision of foster homes. Little is known about how the help caregivers provide is similar to, or different from, that provided by mental health professionals. Twenty semistructured interviews were conducted with caregivers operating foster homes in Montreal, Canada. With no preset theoretical framework, data analysis was inductive and ongoing, involving the identification of categories and themes. Overall findings revealed that caregivers consider themselves the real frontline workers. They claim to be available 24 hours a day, seven days a week to combine egalitarian and affective relationships with their residents and to provide them with personalized care. Caregivers are well positioned to respond immediately to crises. Caregivers also believe that their intimate and thorough familiarity with their residents allows them to assess residents differently than could social workers. These findings have implications for mental health professionals. The combined skills and expertise of nonprofessional caregivers and social workers are essential in promoting the residents' reintegration into the community.

The values and qualities of being a good helper: a qualitative study of adult foster home caregivers for persons with serious mental illness.

BACKGROUND: Canadian foster homes for adults with serious mental illness are operated by non-professional caregivers, usually women, whose mandate is to support residents and reintegrate them into the community. While mental health professionals recognize that adult foster homes are an important service for this population, there is little understanding of how caregivers impact on the lives of their residents. AIMS AND OBJECTIVES: This article draws on the findings of a larger study which examined both caregiver and resident perspectives on the helping relationship in adult foster homes. Caregiver perspectives on the values and qualities required to help people living in foster homes are reported. DESIGN AND METHODS: With no pre-set theoretical framework, this qualitative study employed an inductive approach within a naturalistic paradigm. Semi-structured interviews were conducted with 20 caregivers. Data analysis was an ongoing, 2-year process, involving the identification of categories and themes through several distinct stages. SETTING: The study included Montreal adult foster homes (n=242) for persons with serious mental illness, supervised by two university-affiliated psychiatric hospitals. PARTICIPANTS: Twenty caregivers, selected according to years of experience and number of residents in the home, were diverse in terms of age, cultural background, family composition, education and occupational background. RESULTS: Caregivers possess a clearly articulated value system, and 21 specific qualities which reflect the attributes of both professional and informal helpers. These values and qualities provide caregivers with a "professional" or "vocational" orientation. CONCLUSIONS: A deeply held system of values and qualities is critically important to caregiver effectiveness and job satisfaction. Findings suggest that caregivers are highly motivated, and should be recognized as full participants in the mental health system at both policy and practice levels.