Magister Scientiae (Occupational Therapy) - MSc(OT) / Return to work is a recognised goal of rehabilitation by the occupational therapy discipline that is addressed through vocational rehabilitation as a key feature of work practice. Programmes that fall under the umbrella of vocational rehabilitation include work preparation and training, work hardening and supported employment. In the case of mental health care users (MHCU), meaningful employment contributes to their sense of identity and the prevention of relapse. Vocational rehabilitation is thus important in preparing MHCU for self-employment or employment in the community after they are discharged from the hospital. There is however a dearth of literature pertaining to how vocational rehabilitation programmes particularly in a rural setting, is experienced by MHCU in South Africa. Therefore, the aim of this study was to explore the experiences and perceptions of MHCU regarding the usefulness of the vocational rehabilitation programme at a rural hospital in enhancing their worker roles. A qualitative research approach and exploratory descriptive research design was utilised. Purposive sampling was used to select participants for the study. Semi-structured interviews were conducted with ten MHCU participants as well as two focus groups. Semi-structured interviews were furthermore conducted with two key informants. All interviews and the focus group discussion were audio-recorded, transcribed verbatim and analysed through thematic data analysis. Strategies implemented to ensure trustworthiness included member checking and peer review. Ethics clearance was obtained from the UWC Research Committee and permission to conduct the study at the hospital was requested from the Mpumalanga Provincial Health Ethics Committee and hospital management. Three themes originated from the findings of this study. Theme one describes the barriers experienced by people with mental illness while returning to work. Theme two describes the programme factors that influence return to work in respect of work habits, work skills, and community re-integration. Theme three captures the value of participating in the work programme as experienced by the participants. The findings of the study is related to the Model of The Ecology of Human Performance (EHP) to show how the vocational rehabilitation programme effected the MHCU’s return to work. The findings show that the context as well as the person’s skills and abilities are very important factors in reintegrating the user back to work. The study illuminated recommendations for the further development of the vocational rehabilitation programme.

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

Magister Scientiae (Occupational Therapy) - MSc(OT) / Return to work is a recognised goal of rehabilitation by the occupational therapy discipline that is addressed through vocational rehabilitation as a key feature of work practice. Programmes that fall under the umbrella of vocational rehabilitation include work preparation and training, work hardening and supported employment. In the case of mental health care users (MHCU), meaningful employment contributes to their sense of identity and the prevention of relapse. Vocational rehabilitation is thus important in preparing MHCU for self-employment or employment in the community after they are discharged from the hospital. There is however a dearth of literature pertaining to how vocational rehabilitation programmes particularly in a rural setting, is experienced by MHCU in South Africa. Therefore, the aim of this study was to explore the experiences and perceptions of MHCU regarding the usefulness of the vocational rehabilitation programme at a rural hospital in enhancing their worker roles. A qualitative research approach and exploratory descriptive research design was utilised. Purposive sampling was used to select participants for the study. Semi-structured interviews were conducted with ten MHCU participants as well as two focus groups. Semi-structured interviews were furthermore conducted with two key informants. All interviews and the focus group discussion were audio-recorded, transcribed verbatim and analysed through thematic data analysis. Strategies implemented to ensure trustworthiness included member checking and peer review. Ethics clearance was obtained from the UWC Research Committee and permission to conduct the study at the hospital was requested from the Mpumalanga Provincial Health Ethics Committee and hospital management. Three themes originated from the findings of this study. Theme one describes the barriers experienced by people with mental illness while returning to work. Theme two describes the programme factors that influence return to work in respect of work habits, work skills, and community re-integration. Theme three captures the value of participating in the work programme as experienced by the participants. The findings of the study is related to the Model of The Ecology of Human Performance (EHP) to show how the vocational rehabilitation programme effected the MHCU’s return to work. The findings show that the context as well as the person’s skills and abilities are very important factors in reintegrating the user back to work. The study illuminated recommendations for the further development of the vocational rehabilitation programme.

Magister Curationis - MCur / Background: The integration of mental health into primary health care meant that patients were admitted into a less restrictive environment. They received treatment for mental illness in their communities, therefore, averting unnecessary hospitalisation in psychiatric hospitals. However, given that patients with mental illnesses were admitted to district hospitals as involuntary mental health care users (MHCUs), this setting was purported to be fraught with challenges for both staff and patients. Aim and objectives: The aim of this study was to explore and describe the experiences of professional nurses, working at selected district hospitals in the Western Cape metropole, where 72-hour assessments of involuntary mental health care users are conducted. The objectives of this study were to determine how the 72-hour unit functioned in the general ward, the experiences of professional nurses regarding the integration of the 72-hour assessment units in the general ward and suggested improvements. Methodology: A qualitative research approach, with a descriptive phenomenological design, was used to collect data through semi-structured interviews from eight (8) professional nurses, working in the two selected district hospitals in the Cape Town metropole area. Purposive sampling was employed to select the participants. Data were analysed using Tesch’s method of qualitative data analysis. Four themes, namely, patient management process affected the functioning of the ward, patient management challenges in rendering patient care, burden of caring on the Self, and staff and patient support to create a therapeutic environment, emerged during data analysis, which encapsulated the nurse's experience of working in 72-hour assessment units in selected district hospitals. Findings: The findings of this revealed that the district hospitals were ill prepared for the admission of involuntary mental health care users. There were challenges, in terms of resources, namely, infrastructure to create a therapeutic environment, knowledgeable and skilled staff to care for the MHCUs. The MHCUs were contained in the district hospitals for longer than was legislated, rather than receiving therapeutic interventions at psychiatric facilities. Needs were identified to improve the functioning of the 72-hour assessment units, which included education and training of personnel, Discussion: The non-therapeutic environment had a negative impact on the staff working in the 72-hour assessment units. Nursing staff were burdened with caring for patients in an environment where they, as well as the MHCUs, were stigmatised due to the diagnosis of mental illness. However, the participants internalised their own experiences, as they prioritised the MHCUs well-being. The findings supported previous studies, which revealed that the objectives of the Mental Health Care Act (No. 17 of 2002), which supported the integration of mental health into primary health care, were not realised after more than a decade of implementation. Recommendations: Given the limited scope of this thesis, replications of this study in other district hospitals are recommended, in order to ascertain whether the objectives of the MHCA (2002), regarding 72-hour assessments, have been realised. A therapeutic environment, which includes infrastructure and resources to ensure that MHCUs receive care, treatment and rehabilitation within the district hospitals, is required. The recruitment and retention of adequate, skilled permanent staff is crucial, to ensure that MHCUs receive care, treatment and rehabilitation. Finally, the training and education of all personnel (including security) working in the selected district hospitals should be mandatory, in order to address patient care and stigma related to mental illness.

Magister Curationis - MCur / Mental health care for adolescents is currently provided in a range of settings world-wide. These include the pediatrics units, general hospitals and specialized in-patient units for adolescents. However, care in these specialized units has hitherto not been evaluated. A phenomenological approach as a method and design was chosen to enable participants to describe and explore the lived experiences of nurses caring for adolescents in specialized psychiatric units of the selected psychiatric hospital. A purposive sampling method was used to select respondents. In-depth interviews were conducted with nurses caring for adolescents with mental health problems. Data saturation was reached with seven respondents. Interviews were recorded with a tape recorder that was only accessible to the researcher. Data analysis followed Collazi’s style that included listening to the recorded data, transcribing, coding, and intuition, reflection, reducing and interpreting the data. Ethical clearance was obtained from University of the Western Cape Higher Degrees Committee. The researcher requested permission to conduct the study at selected Psychiatric hospital from the Medical Superintendent and research ethics committee. Informed consent was also sought for those who agreed to participate in the study. Participants remained anonymous as their identity was not revealed. Only information related to the study was collected. Anonymity was assured by omitting names from transcripts as participants were given numbers only rather than using their names. The in-depth interviews were conducted in a quiet office to ensure privacy and confidentiality.

Thesis (M. Sc.) Nursing Sciences)) -- University of Limpopo, 2016

Providing mental health care to involuntary mental health care users (MHCUs) is challenging and an ethical adversity nurses often have to deal with. The literature, in general, indicates that nurses might possess coping and resiliency in the work environment where they are often faced with adversities. However there is a paucity of information regarding the resilience of nurses providing mental health care (MHC) to involuntary MHCUs. Therefore the research objectives explored the resilience of nurses using the Connor-Davidson scale (CD-RISC), to explore and describe how nurses cope and strengthen their resilience in providing MHC to involuntary MHCUs and to formulate guidelines to strengthen the resilience of these nurses to provide quality nursing care in the work environment where MHCUs are often involuntarily admitted. To achieve these objectives, the research followed both a qualitative and quantitative approach and an exploratory and descriptive design which was contextual in nature. A convenience sampling method was used to achieve a sample size of 28 participants, who were handed questionnaires to complete, containing demographical information, the CD-RISC and a narrative. A response rate of 85.7% was reached. Quantitative data was analysed by using the SPSS programme while data from narratives, for the qualitative data, were grouped and themed. The results in the first phase indicated that resiliency was high amongst participants, as the mean score of the CD-RISC was 79.9 out of a total score of 100; whilst only one participant scored below 50. The mean for the highest scores was on item 25 (pride in your achievements) (3.8) and item 10 (best effort no matter what) (3.6) and two critical aspects which scored low were item 18 (make unpopular or difficult decisions) and item 19 (can handle unpopular feelings) (2.3) amongst participants. Interestingly, the majority of participants (66.7%) do not have training in psychiatric nursing. In the second phase, two themes were identified from the questions. The first theme “Coping mechanisms” identified four methods to cope with involuntary MHCUs. These subthemes are “support system”, “knowledge, skills and experience”, “nurse-patient relationship” and “spirituality and selfcare”. The second theme “Resilience strategies” brought forth five subthemes as follows: “support”, “trained staff”, “security measures and safety”, “teamwork” and “in-service training and education”. Conclusions suggest that nurses are resilient to provide MHC for involuntary MHCUs. Furthermore, they take pride in their achievements and have passion for their work. On the contrary, they find it difficult to make unpopular decisions which affect others and to handle unpleasant feelings. This is indicative of internal conflict and difficulty in being assertive. Nurses take pride in their achievements and want to give nursing care that’s in the best interest of the MHCUs whilst they feel that they might not always be able to do so due to the involuntary nature of the MHCUs admission and treatment. Recommendations for nursing practice, namely guidelines to strengthen the resilience of nurses providing mental health care to involuntary MHCUs could be developed from the research findings. Facilitating assertiveness and a supportive environment might strengthen resilience and should be addressed by management and supervisors. Recommendations for nursing education and further research were also formulated. / MCur, North-West University, Potchefstroom Campus, 2015

Providing mental health care to involuntary mental health care users (MHCUs) is challenging and an ethical adversity nurses often have to deal with. The literature, in general, indicates that nurses might possess coping and resiliency in the work environment where they are often faced with adversities. However there is a paucity of information regarding the resilience of nurses providing mental health care (MHC) to involuntary MHCUs. Therefore the research objectives explored the resilience of nurses using the Connor-Davidson scale (CD-RISC), to explore and describe how nurses cope and strengthen their resilience in providing MHC to involuntary MHCUs and to formulate guidelines to strengthen the resilience of these nurses to provide quality nursing care in the work environment where MHCUs are often involuntarily admitted. To achieve these objectives, the research followed both a qualitative and quantitative approach and an exploratory and descriptive design which was contextual in nature. A convenience sampling method was used to achieve a sample size of 28 participants, who were handed questionnaires to complete, containing demographical information, the CD-RISC and a narrative. A response rate of 85.7% was reached. Quantitative data was analysed by using the SPSS programme while data from narratives, for the qualitative data, were grouped and themed. The results in the first phase indicated that resiliency was high amongst participants, as the mean score of the CD-RISC was 79.9 out of a total score of 100; whilst only one participant scored below 50. The mean for the highest scores was on item 25 (pride in your achievements) (3.8) and item 10 (best effort no matter what) (3.6) and two critical aspects which scored low were item 18 (make unpopular or difficult decisions) and item 19 (can handle unpopular feelings) (2.3) amongst participants. Interestingly, the majority of participants (66.7%) do not have training in psychiatric nursing. In the second phase, two themes were identified from the questions. The first theme “Coping mechanisms” identified four methods to cope with involuntary MHCUs. These subthemes are “support system”, “knowledge, skills and experience”, “nurse-patient relationship” and “spirituality and selfcare”. The second theme “Resilience strategies” brought forth five subthemes as follows: “support”, “trained staff”, “security measures and safety”, “teamwork” and “in-service training and education”. Conclusions suggest that nurses are resilient to provide MHC for involuntary MHCUs. Furthermore, they take pride in their achievements and have passion for their work. On the contrary, they find it difficult to make unpopular decisions which affect others and to handle unpleasant feelings. This is indicative of internal conflict and difficulty in being assertive. Nurses take pride in their achievements and want to give nursing care that’s in the best interest of the MHCUs whilst they feel that they might not always be able to do so due to the involuntary nature of the MHCUs admission and treatment. Recommendations for nursing practice, namely guidelines to strengthen the resilience of nurses providing mental health care to involuntary MHCUs could be developed from the research findings. Facilitating assertiveness and a supportive environment might strengthen resilience and should be addressed by management and supervisors. Recommendations for nursing education and further research were also formulated. / MCur, North-West University, Potchefstroom Campus, 2015

The purpose of the study was to investigate the lived experiences of young people living with mental healthcare users (MHCUs) in order to gain insight into their needs and how their daily coping can be maximised. A qualitative, descriptive phenomenology study was undertaken, with face-to-face, audiorecorded individual in-depth interviews conducted with 10 participants aged between 19 and 23 years, at their homes. Participants were recruited from one of the local health clinics in Dikgale area, Limpopo province, where the MHCUs collect medication and attend follow-up medical reviews. Non-probability purposive sampling technique was used to select the sample size. The following were the objectives of the study:  To explore and describe the lived experiences of young people living with MHCUs.  To determine the coping strategies of young people living with MHCUs. Five themes and 12 sub-themes emerged from the study. The findings of the study revealed that young people were faced with psychological effects, caring demands and responsibilities, effects on their schooling performance, and lack of coping and support. The study results informed recommendations to the psychiatric nursing services on the needs and support to be provided to these young people in order to ensure maximum coping in their life situation. / Health Studies / M.A. (Nursing Science)

See the attached abstract below