M.Cur. (Psychiatric Mental Health Nursing) / Injuries suffered by nursing personnel as a result of aggression by mental health care users are on the increase. The psychiatric nurses and assistant nurses working in a psychiatric institution may suffer physical trauma, which gets healed over time with proper treatment, but the emotional scars are not attended to, hence some of the psychiatric nurses and assistant nurses working in a psychiatric institution do not cope. The impact of this trend is enormous and it is reflected in the health care service. The main purpose of this research study is to explore and describe the experiences of psychiatric nurses and assistant nurses who have been exposed to aggression by mental health care users while working in a psychiatric institution, in order to formulate guidelines to promote the mental health of these psychiatric and assistant nurses to. A qualitative, exploratory, descriptive and contextual research design was utilised in this study. There were two phases to the research, whereby phase one included the description and exploration of experiences of nurses who have been exposed to aggression by mental health care users in a public psychiatric hospital in Gauteng. In phase two, guidelines were formulated to promote the mental health of the nurses in this context. A purposive sampling method was used, since it provides information-rich cases for in-depth study. One-on-one in-depth phenomenological interviews were utilised to gather data. Lincoln and Guba’s approach to trustworthiness was adopted, and I employed the services of an independent coder - an experienced psychiatric nursing specialist - to assist. Thereafter a consensus discussion was held. Ethical principles were adhered to throughout the study. The findings of the research were discussed in the light of literature relevant to this research study and similar studies will be used to verify the findings. Tesch’s method of data analysis was utilised in analysing the data of this research study. The findings revealed that participants experience significant emotional distress as a result of both verbal and physical aggression by mental health care users. Aggressive behaviour was recognised by the participants as being the outcome of interplay between numerous interactional and contextual factors. Participants may at times, experience conflict between their job mandate – to care for the mental health care users – and their need for personal safety. This often results in a sense of ambivalence towards those they care for, as well as towards their job. The participants were of the opinion that they should be offered counselling or debriefing services by management after exposure to aggressive incidents in order to recuperate from the anxiety-provoking situation they encountered. They also mentioned that they do not receive enough training in handling aggressive mental health care users, hence at times they feel demotivated. Guidelines to facilitate the mental health of nursing personnel who have been exposed to aggression by mental health care users, were formulated and recommendations were made to psychiatric nursing practice, psychiatric nursing education and psychiatric research. Evaluation of the study was done and the role of an advanced psychiatric nurse in mobilising resources to facilitate the mental health of psychiatric nurses and assistant nurses working in a psychiatric institution who have been exposed to aggression by mental health care users, was outlined.

Bipolar disorder is the sixth leading cause of disability in the world among people aged 15-44. Bipolar disorder is a chronic psychiatric disorder with a significant impact on patients’ social, occupational, and general functioning well-being. Patients who are diagnosed with bipolar type 1 disorder are usually admitted to a psychiatric hospital as an involuntary patient which means that they will be cared for in a closed unit. In a critical analysis of the literature it was noted that not much is known of the experiences of patients in psychiatric wards. The researcher used a qualitative approach, with a phenomenological research strategy. An explorative, descriptive and contextual design was utilized to gain more insight into female patients’ lived experiences during their admission and stay in a tertiary level psychiatric institution. The research population was female patients who were diagnosed with bipolar disorder and who had recently experienced being admitted to and treated at a tertiary level psychiatric facility where they were treated for this condition. Purposive sampling was utilised to obtain the sample for the study. A pilot study was conducted before the study commenced to ensure the trustworthiness of the findings. The researcher obtained the data via semi-structured interviews as well as field notes and reflective journals. Data was analysed by using Tesch’s method as adopted by Creswell. Once the data had been analysed, a literature control was done in accordance with the findings. Guba’s model of trustworthiness was utilized to ensure that this study was trustworthy and credible. The researcher implemented ethical principles to ensure that no harm was done to the participants during the research study. Finally, guidelines were developed to assist professional nurses to manage patients optimally during their admission and stay in a closed unit of a tertiary psychiatric facility.

Submitted in fulfillment of requirements for the Degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introducion Mental health nurses face challenging positions in practice. They are required to support and care for people hospitalised for treatment of mental illnesses on their recovery journeys but are also expected to manage ward administrative tasks, admit patients, attend meetings, dispense medication and communicate with patients (Gunasekara, Pentland, Rodgers and Patterson 2014: 101; Fourie, Mc Donald, Connor and Bartlett 2005: 135). It has been suggested that mental health nurses spend more time managing the ward environment and staff matters resulting in little time to develop and maintain therapeutic patient relationships (Fourie et al. 2005: 135). Problem Statement Research conducted in other countries identified the roles of the psychiatric nurse and mental health care nurses as attending to patients’ basic needs, assistance with self-care activities, monitoring and administering medication, ensuring safe environments in the health care setting and health education (Rungapadiachy, Madill and Gough 2004; Bowers 2005; Seed, Torkelson and Alnatour 2010). Although there is evidence of studies in psychiatric and mental health nursing locally, little is known about the roles of registered nurses and psychiatric nurses at in-patient facilities. OBJECTIVES • To explore which mental health problems are most commonly seen amongst psychiatric patients at these facilities. • To investigate the challenges faced by psychiatric nurses when caring for psychiatric patients. • To investigate what specialized knowledge and skills are required when nursing such patients. • To investigate whether their education and training prepared them adequately to deal with psychiatric patients and suggest guidelines to strengthen nursing education. METHODOLOGY The study utilized a quantitative non-experimental descriptive design to survey registered nurses and psychiatric nurses at in-patient psychiatric facilities in KwaZulu-Natal. A census was utilized in this study as the entire population was sampled. Data were collected using survey questionnaires. Phase two of the study, qualitative content analysis of Psychiatric nursing curricula strengthened the survey findings. FINDINGS Findings of this study showed that 98.4% of respondents believe psychiatric nursing care is an important aspect of holistic nursing practice. Respondents agree that challenges are commonly encountered in psychiatric nursing practice and that they are prepared to deal with these patients. However the aspects most frequently identified as needing greater attention in the Psychiatric nursing curricula were The Mental Health Care Act no 17 of 2002 and practical management of aggression, violence and de-escalation / M

MCur / Departrment of Advanced Nursing Science / In mental health, a Maximum-Security Ward is a special setting for care of patients who are unique and exceptional. People who have committed crimes due to their mental conditions are admitted for care, treatment and rehabilitation. Patients admitted in this ward are verbally and physically aggressive, violent, unpredictable, unmanageable and at times manipulative. Professional nurses working in the Maximum-Security Ward are at risk of suffering from occupational stress, burnout, lack motivation and are anxious. The aim of this study is to investigate the experiences of professional nurses working in the Maximum-Security Ward at Hayani hospital. A qualitative approach using a descriptive, exploratory and contextual design was used. A purposive, convenient sampling was used to sample professional nurses working in the Maximum-Security Ward of Hayani hospital. In-depth interviews were used to collect data. A voice recorder was utilised to record all data and the researcher being the main instrument for data collection. Dependability, confirmability and transferability were upheld to ensure trustworthiness of the findings. Data was analysed using Tech’s eight steps approach. Three themes with their categories and subcategories emerged after data analysis. The themes were as follows: the participants’ views on type of patients admitted in the ward, participants’ views on safety in the ward and participants’ views on staff interaction. The study recommended the following: Emotional counselling and debriefing sessions to be conducted at regular intervals or after a traumatic incident. Motivational and team building activities to be organised for professional nurses. Safety of professional nurses must be of significant value. More support is needed in times of emotional difficulties. Development of a model to support professional nurses. / NRF