D.Cur. / Lifecare, like any other corporate business, in the current environment, has to change all the time. Companies need new customers, innovative products, expanded market and cutting edge technologies. The Company has the potential to shape the behaviour, reinforce common beliefs, and encourage members to apply their efforts to accomplish important Company objectives of providing care for chronic mentally ill patients. The psychiatric nurses are therefore an essential requirement for the success of the Company in a competitive environment. On the other side, psychiatric nurses face the difficult task of confronting the challenges involved in the nature of care required among chronic psychiatric patients. Whilst striving for quality patient care, they find themselves faced with some breakdowns within the environment in which they are interacting, resulting in their resorting to negative media publicity. This type of publicity can lead to damaging the Company’s reputation and can retard the Company’s growth strategy, which the psychiatric nurses might not seem to understand. There was also high staff turnover which hampered quality patient care. This could also affect the Company in terms of what affects the competitiveness of the quality care which the Company aims to deliver. The researcher believes that for clinical care to take place, psychiatric nurses need to be in sound mental health and understand the dynamics within the Company in order to deal with it in an effective way. The following research questions posed were addressed in this research: • What are the psychiatric nurses’ experiences whilst being employed by the Company? • In what way can the formulation of the model be of assistance in the promotion of the psychiatric nurses’ mental health as an integral part of health? The research objectives were: • To explore and describe the experiences of the psychiatric nurses whilst employed by Lifecare.• To use the results to generate the concepts for the model that would serve as a framework for the psychiatric nursing specialist to facilitate the implementation of guidelines that would assist the psychiatric nurses to be in a sound mental state. • To describe the guidelines that would serve as a framework for operationalising the model in nursing education, psychiatric nursing practice and nursing research. Methods to ensure trustworthiness were ensured throughout this research. Ethical consideration as outlined in the Position Statements published by the Democratic Nursing Association of South Africa (1998: 2-21), was adopted. The researcher utilized the assumptions of the Theory for Health Promotion in Nursing in this research. This theory focuses on the whole person, that is, the mind, body and spirit as well as on the parameters of nursing and the beliefs about the person, health, illness and nursing. The emphasis in this theory is on mental health promotion of the psychiatric nurses within the Company. This research consisted of three stages as follows: In stage one a qualitative design was used to explore and describe the psychiatric nurses’ inner world experiences of the Company’s culture. Indepth semi-structured interviews were utilized to obtain data from these psychiatric nurses. These interviews were conducted by an independent interviewer, and were audio-taped. These were transcribed and were analysed by the researcher. Tesch (1990) in Cresswell (1994: 154) outlined eight steps, which are referred to as decontextualisation and contextualisation, which were adopted in analyzing the results. A description of the results was given. This was followed by literature control which highlighted the similarities to and contributions to this research. Themes that emerged highlighted the experiences that the psychiatric nurses had of the Company culture which affected their mental health. In stage two the research design and theory generation was employed to formulate a model which could be used in nursing education, nursing research and nursing practice. The model formulated was based on the resultsobtained on the inner world experiences of psychiatric nurses. A combination of stages of theory generation by Chinn and Kramer (1991:79-104) and Dickoff, James and Wiedenbach (1968: 431-434) were employed by the researcher to identify the central concepts that guided the identification of the main theme. A tentative model was formulated and was submitted to the independent experts for consultations and clarification. The model was named and presented in its final form to the independent experts. In stage three the researcher formulated the guidelines for operationalising the implementation of the model in clinical practice, nursing education and recommendations were made for further research.

D.Cur. (Psychiatric Nursing Science) / The researcher was involved in the clinical accompaniment of student nurses working with mentally challenged individuals during their psychiatric nursing practical training. In her role as advanced psychiatric nurse educator, she noticed that student nurses experienced working with mentally challenged individuals as a challenging working context. It created intense emotional discomfort for the student nurses, especially during their initial exposure to the relevant individuals. During the student nurses' last day of working with these individuals, they reflected with the advanced psychiatric nurse educator on their emotional growth and enrichment and how this experience had changed their views of life. Ineffective management of emotional discomfort may lead to emotional exhaustion or burnout and reflect negatively on a person's mental health. The main purpose of this research was to explore and describe the experiences of student nurses working with mentally challenged individuals. Subsequently, to develop, describe and write guidelines to operationalise and evaluate a model for the advanced psychiatric nurse educator to facilitate the mental health of student nurses working with mentally challenged individuals. A qualitative, explorative, descriptive, contextual and theory-generating research design was utilised to achieve the abovementioned purpose. The development of the model comprised four steps. Step one consisted of a concept analysis including identification and definition of central concepts in the model. A concept analysis was done by exploring and describing the experiences of student nurses working with mentally challenged individuals. Two focus groups, naive sketches, reflective journals, a reflective letter and field notes were used to explore their experiences. Focus groups were audiotaped as well as videotaped. Verbal consent was given by the student nurses to be videotaped and a letter of consent was signed to give permission for audiotaping of the focus groups. The audio tapes were transcribed verbatim. The video tapes were only used by the transcriber when she could not hear the sound on the audio tapes clearly. An independent coder utilised Tesch's method of open-coding to code and analyse the data. A consensus was reached between the researcher and the independent coder with regard to the themes and catogories represented by the data. During the concept analysis, engagement on a deeper emotional level was identified as the central concept. Step two consisted of the relationship statements of the model. During step three, a model for the facilitation of a process of engagement on a deeper emotional level for student nurses working with mentally challenged individuals was described. The structure of the model clarified the purpose, assumptions and context. The central concepts were defined and the relationship statements between the central and essential concepts were explained. The structure of the model focused on the relationship-, workingand termination phases within the process of engagement on a deeper emotional level. In step four guidelines were described to operationalise the model in practice. The model, as framework of reference for the advanced psychiatric nurse educator, focused on the facilitation of a process of engagement on a deeper emotional level for student nurses working with mentally challenged individuals. The process description of the model differentiated between three phases: the relationship phase, the working phase and the termination phase. Guidelines for the operasionalisation of the model focused on the objective of each phase as well as the strategy of actions for each different phase.

M. Curr. / Mental health challenges are a worldwide phenomenon, and more people are experiencing these challenges which are related to the life style and psychological stressors facing them. Addressing this burden is a challenge to health care providers, as some are influenced by their perceptions about mental illness in facing the demands made be society. Registered nurses who are not trained in psychiatric nursing do not have the appropriate background information or skill of how to cope with patients with mental health challenges even if they have undergone an introduction into nursing psychology at college. This increases their fears and anxieties when having to interact with these patients. The aim of this study is thus to explore the experiences of registered nurses in interaction with patients with mental health challenges so as to be able to formulate and describe guidelines to facilitate the registered nurses mental health.

D.Cur. (Psychiatric Nursing) / Please refer to full text to view abstract

M.Cur. (Psychiatric Nursing) / Psychiatric nursing forms part of basic nursing education in South Africa which is done in four years, either at diploma level or degree level. The psychiatric nurses are only trained in basic psychiatric nursing and are not well equipped to work effectively with children. Even though psychiatric nurses do not have enough skills and knowledge, it is expected of them to work in child psychiatric wards without adequate knowledge and skills. This creates discomfort to the internal environment of a nurse and the situation can be stressful to the nurse. Psychiatric nursing has two important components which are: supporting people at a reasonable level of functioning which they cannot maintain independently; and facilitating a higher level of functioning in people for whom this is possible. Child psychiatry is one of the specialities in the psychiatric division. ‘The description of the practice of the professional nurse in the field of child psychiatry in South Africa is vague and undeveloped and there are only a few nurses in South Africa with knowledge and skills to set guidelines for this area of practice (Makhele, 2006:36)’. Psychiatric nurses working in psychiatric hospitals undergo different experiences on a daily basis. In this research study, the researcher wondered as to what psychiatric nurses working with children diagnosed with mental illness, experience on a daily basis. The researcher then asks the following questions: 1. What are the lived experiences of psychiatric nurses working with children diagnosed with mental illness? 2. What can be done to assist the psychiatric nurses, working with children diagnosed with mental illness, in order to facilitate their mental health? This research study was done to: 1. To explore and describe the lived experiences of psychiatric nurses, working with children diagnosed with mental illness; and 2. To formulate guidelines in order to facilitate these psychiatric nurses’ mental health. In order to explore and describe the lived experience of psychiatric nurses who work with children diagnosed with mental illness, the researcher used a qualitative design. The researcher utilised phenomenology, in order to explore and describe the experiences of these psychiatric nurses in the context of their working environment. Purposive sampling method was used. In-depth phenomenological interviews were used to collect data. Tesch’s method in Creswell (2011: 113) of open coding was utilised for the analysis of the data. The results were re-contextualised within the literature. The findings of this study provided the detailed content of professional psychiatric nurses’ experience when working with children diagnosed with mental illness. Two themes which were identified are: 1. Theme 1 A challenging experience associated with tensions inherent to the contextual demands of psychiatric nurses working with children diagnosed with mental illness. 2. Theme 2 Psychiatric nurses experience of contextual demands which requires a process of continuous adjustment Guidelines on how to promote the mental health of psychiatric nurses working with children diagnosed with mental illness were derived from the research findings. In conclusion, presently psychiatric nursing training appears to rely upon individual training institutions putting into practice government policy in a fragmented fashion with no cohesive strategy. Where psychiatric nurses receive good quality training which includes child psychiatry, it is clear that good quality and appropriate interventions to children with mental illness and emotional problems can be achieved.

The literature has indicated that nurses perceive more occupational stressors than do other professional groups. HIV is a new stressor which has impacted on society, in particular on people caring for HIV/AIDS patients. The availability of antiretroviral treatment (ART) which is accessible at wellness clinics has improved the quality of life of people with HIV and greatly prolonged the lives of many infected people. Wellness clinics are out-patient clinics where HIV positive patients receive their ART. This study has explored and described the occupational stressors perceived by nurses working in wellness clinics in Nelson Mandela Bay. The study was conducted using a qualitative research approach. Convenience sampling was used consisting of voluntary registered female nurses. The data were collected by means of semi-structured interviews. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using Tech’s method. The nurses who participated in this study reported their perceptions of occupational stressors in wellness clinics where they worked. The occupational stressors perceived by the nurses included the working environment, interpersonal relationships and the organizational structure. However, they also reported that they experienced satisfaction from their jobs despite the perceived stressors.

Professional nurses working at a campus health service have to cope with challenges such as staff shortages and budgetary constraints associated with working in a complex environment providing primary health care. The aim of primary health care includes promoting health, preventing disease and the early detection and treatment of illness. Mental health services form an integral part of the integrated primary health care package as implemented in the campus health service. Students attend the Campus Health Service for help related to their health. Health care is provided by professional nurses and counsellors through a comprehensive primary health care service which serves students as well as staff. Some students may state that they experience feelings of being stressed or depressed. Other students may complain of physical symptoms such as headache or upper backache. Upon further investigation emotional problems may be identified as the cause of the psychosomatic symptoms. The professional nurses working in the campus health service verbalised that it is sometimes difficult to identify a mental illness or mental distress as there is no effective assessment tool that they can use. Management of conditions is also problematic as there are no protocols indicating the therapeutic interventions that can be taken. The research question in this study was therefore: What information should be included in a protocol to assess and manage a student experiencing mental distress that can be used by professional nurses working in a Campus Health Service? The aim of this study is to develop a mental health care protocol for campus health service professional nurses to assess and manage university students who are experiencing mental distress. The research design of this study was qualitative, explorative, descriptive, explanatory and contextual. In this study the Delphi research technique was used to create an instrument to standardise mental health care in a campus health service. The Delphi technique is a series of sequential questionnaires or “rounds” interspersed with controlled feedback that seeks to gain the most reliable consensus of opinion of a group of experts. A questionnaire was developed based on an extensive literature review. The research population of this study consisted of two groups: professional nurses with knowledge of student health care needs and expert psychiatric nurses. The study was conducted at the Campus Health Service at a university in the Eastern Cape. The data collection and analysis was done utilising the Delphi technique. Trustworthiness was ensured by using the Lincoln and Guba Model utilising the criteria of credibility, applicability, dependability and conformability. In this study the ethical principles of beneficence, non-maleficence, justice and self determination were applied to ensure that participants are treated with respect and consideration and ensured high ethical standards. Informed consent was obtained from the participants in this study. The findings of this research were utilised to assist the researcher in developing a protocol for mental health care of students in campus health service settings.

Educating staff nurses is pivotal in the evolving healthcare environment. Two staff development models used in the healthcare setting are unit-based and centralized. Unit-based education is a staff development model that places educators on individual units. These educators direct the educational development of staff nurses on their assigned units. Centralized education meets generalized learning needs and provides nursing departments with scheduled education sessions or impromptu meetings regarding changes to policies and procedures. In addition, centralized educators are assigned to address the learning needs of the nurses on several units with universal orientation (Cummings & McCaskey, 1992), coordinate and implement intravenous and blood transfusion therapy courses, physical assessment courses, professional update programs, and universal workshops and conferences (Cummings & McCaskey, 1992). In contrast, unit-based educators are more familiar with the unit's practices and staff nurses while providing more individualized staff education than the centralized model. This research was conducted to explore the association between the type of staff development model and staff nurses' evaluations of their clinical educators, their anxiety, and their clinical reasoning. The researcher used a quantitative descriptive comparative, cross-sectional, intact group design. The sample included staff nurses (N = 86) from a tertiary care medical center in New York City. The staff nurses were from two units with a unit-based educator and two units with a centralized educator. Data were collected from the first week of September 2022 to the first week of December 2022. Two reports are described below that are based on this research, which included administering four different scales. Not all respondents completed all four scales. The first report concerns the findings on two instruments that measured the staff nurses' evaluation of clinical educators. The Clinical Educator Evaluation Questionnaire (CEEQ), developed for this study, measured nurses' perceptions of the extent to which their staff educators' methods were consistent with Malcolm Knowles's Adult Learning Theory. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) measured staff nurses' perceptions of their current staff educators as clinical educators. An exploratory factor analysis was conducted on the CEEQ questionnaire developed by the researcher, a Pearson’s correlation analysis between the two surveys, the CEEQ and the NCTEI, and a Chi-square analysis and independent t test was conducted to compare demographic variable among the unit-based and centralized education groups was also conducted. In addition, differences between group responses for independent sample comparisons were examined using t tests. There were significant differences between the groups, t(100) = 3.31, p = .001, on the CEEQ. The 59 participants in the unit-based group scored higher (M = 119.76, SD = 19.62) than the 43 participants in the centralized group (M = 106.86, SD = 19.17) on perceptions of their instructors' methods as consistent with the adult learning theory. The groups also differed on the perceived effectiveness of their nurse educators as clinical instructors, t(94) = 2.66, p = .009, on the NCTEI. The 55 participants who represented the unit-based group (M = 250.5, SD = 70.34) had higher means than the 41 participants in the centralized group (M = 212.8, SD = 66.14). The second report concerns staff nurses' anxiety during staff education as measured using the State Anxiety Inventory (SAI) and staff nurses' self-report of their clinical reasoning as measured by the Nurses Clinical Reasoning Scale (NCRS). Differences between the group responses for independent sample comparisons were examined using t tests. The anxiety of the 48 participants in the unit-based group (M = 35.7, SD = 11.47) was compared to the anxiety of the 38 participants in the centralized group (M = 37.2, SD = 11.35). No statistically significant differences were found, t(84) = -.633, p = .528. Similarly, there was no significant difference between the groups on the NCRS, t(85) = -.188, p = .852. The 48 participants who represented the unit-based group (M = 59.1, SD = 6.61) did not differ from the 39 participants in the control group (M = 59.3 SD = 6.80) on clinical reasoning. Findings showed that the staff nurses evaluated the unit-based educators more highly but that the two models did not differ regarding their effects on anxiety and clinical reasoning. This is the first study to examine staff nurses’ evaluations of their clinical educators. Findings indicate that staff nurses reported more effectiveness for unit-based educators than centralized educators regarding practices that aligned with Malcolm Knowles’s Adult Learning Theory. In addition, this is also the first research study to examine the relationships of staff development models to anxiety and clinical reasoning during staff education. Although the two models did not differ on their effect on anxiety and clinical reasoning, additional research is recommended to explore other variables that may further justify the investment in unit-based education.

M.Cur. / Violence and aggression in psychiatric hospitals are a worldwide known phenomenon. South Africa is no exception to the rule. Previous researches conducted in psychiatric institutions have mainly focused on the patients, leaving everyone to guess how this violence affects nurses who are in contact with the patients on a daily basis and who are key role-players in the care, treatment, and rehabilitation of the patients under their responsibility. The research aimed to explore and describe the lived experience of aggression and violence by the registered nurses in a Gauteng psychiatric institution, the essence of this violence, and how nurses cope with this violence, in order to formulate guidelines and recommendations that could assist them to manage violence. A qualitative, explorative, descriptive, and contextual study design was utilised. Data was collected by means of semi-structured interviews, and naïve sketches. Tesch’s method was used for data analysis, here and an independent coder was utilised. The uniqueness of this study was to bring to the surface the other side of violence as it is perceived and lived by the nurses. The findings show that the nurses face violence on a daily basis. Among the contributing factors there are: the type of patients admitted in the hospital; the staff shortage; the lack of support among the members of the multidisciplinary team (MDT); and the lack of structured and comprehensive orientation. The consequences of this violence to the nurses are emotional, psychological, and physical and take the form of: fear, anger, frustration, despair, hopelessness and helplessness, substance abuses, absenteeism, retaliation, a development of an “I don’t care attitude”, injuries, and damage to personal properties such as clothes, and spectacles.

The study sought to gain an in-depth understanding of the knowledge and skills regarding rehabilitation of mental health care users of nurses who work at a psychiatric rehabilitation centre, in order to design a continuing professional development plan for registered and enrolled nurses. The researcher used a qualitative, exploratory descriptive design to explore the knowledge and skills of nurses who practise in a psychiatric rehabilitation centre dealing with the rehabilitation of mental health care users. Four themes emerged from the data that were collected from four focus groups: knowledge of the rehabilitation process; the need for continuing professional development; nursing skills required for the implementation of psychiatric rehabilitation and means of communication within psychiatric rehabilitation. The researcher devised a continuing professional development plan, including topics on the management of the mentally ill, the problems associated with mental illness and rehabilitation appropriate to the mental illness. / Health Studies / M. A. (Health Studies)