M.Cur. / The purpose of this research study was to describe guidelines to facilitate a “reflective learning environment” for student nurses in a psychiatric clinical setting. In view of existing problems, such as inadequate preparation of professional nurses for the role of a psychiatric clinical facilitator, inability of student nurses to reflect on their learning and integrating theory into practice, nursing education is faced with a greater need to change from traditional teaching-learning approaches to current student-centred approaches that advocate self-directed learning in student nurses. To achieve this goal in a psychiatric clinical setting, it is necessary to shift the emphasis from instructional teaching to facilitation of reflective learning that results in autonomy and self-reliance in student nurses. Klopper (1994, Monograph 2:24) indicates that the clinical facilitator’s guidance to deep holistic learning is not sufficient on its own. The clinical facilitator should be a reflective practitioner and intentionally facilitate a reflective learning environment for student nurses in a psychiatric clinical setting. The research questions that emerged were: • What is a “reflective learning environment” in a psychiatric clinical setting? • How can a “reflective learning environment” be facilitated for student nurses in a psychiatric clinical setting? To realise the purpose of this research, the following objectives were formulated: • to clarify the concept “reflective learning environment” in a psychiatric clinical setting; • to explore and describe the perceptions of student nurses and clinical facilitators with regard to how a “reflective learning environment” could be facilitated for student nurses in a psychiatric clinical setting; and • to describe guidelines to facilitate a “reflective learning environment” for student nurses in a psychiatric clinical setting. The paradigmatic perspective for this research is adopted from the Theory for Health Promotion in Nursing (RAU 2002:4). The functional approach of Botes (1995:13) was used in this study, since it implies application of knowledge. The research design and method used were qualitative, exploratory, descriptive and contextual in nature. The design was divided into two phases. Phase One involved two steps. Step One included the concept analysis of a reflective learning environment through a literature search of all relevant international and national literature on a reflective learning environment. The method of data collection involved a library search – CD-Rom, the Internet, journal articles, books and subject dictionaries - that were used to arrive at attributes that clarified the concept “reflective learning environment” in a psychiatric clinical setting. Concept analysis was done according to the steps described by Wilson (in Walker & Avant, 1983:39). Content analysis of literature was done using deductive, inductive reasoning strategies, synthesis, and inference as described by Chinn & Kramer (1995:63-67), Mouton (1996: 71, 80, 168) and Walker and Avant, (1983:58-62). Theoretical validity was ensured (Mouton, 1996:117). Step Two included the exploration and description of perceptions using agenda focus group interviews held with student nurses and clinical facilitators. The student nurses and clinical facilitators were selected from a psychiatric clinical setting. Both samples were purposively selected. The results of concept clarification conducted gave direction to the agenda focus group interviews that were held with the student nurses and clinical facilitators during the perception survey. The question for the agenda focus group interview with the student nurses was as follows: What are your perceptions with regard to how a reflective learning environment can be facilitated for student nurses in a psychiatric clinical setting? The question for the clinical facilitators was as follows: What are your perceptions with regard to how you can facilitate a reflective learning environment for student nurses in a psychiatric clinical setting? An audiotape was used to record the interviews for later verbatim transcription. Communication techniques, observation and field notes were used during the data collection. Data from both the student nurses and clinical facilitators were analysed according to the qualitative content analysis, as described by Miles and Huberman (1994:241-243). An independent coder, who was purposively selected, was used independently from the researcher in the categorisation of attributes of a “reflective learning environment” that emerged. To ensure trustworthiness in this qualitative research, Lincoln and Guba’s model (1985:290-314) was used throughout the study to ensure the rigor of the study. Ethical considerations were maintained throughout the research study (Denosa, 1998: 1-6; Burns & Grove, 1993:98-104; De Vos, 1998:27-28). Phase Two consisted of conceptualisation of findings from Phase One. Guidelines were formulated based on concluding statements from conceptualisation of the findings. An evaluation of the study was made. Recommendations related to nursing education, nursing practice and nursing research were indicated accordingly. The study was conducted contextually and no generalisations should necessarily be made.

M.Cur. / Please refer to full text to view abstract

D.Cur. / The purpose of this research study was to describe a model to facilitate collaboration between the institutions of higher education and psychiatric health care services in order to promote psychiatric clinical nursing education, with guidelines to operationalise the model. In spite of the calls by statutory bodies and contemporary legislation for collaboration between institutions of higher education and psychiatric health care services, there are few instances where formalised collaborative ventures exist to promote psychiatric clinical nursing education. Since the move of nursing education from hospital-based schools to colleges and universities, there was no attempt to redefine the most appropriate roles for nurse educators and clinical facilitators regarding student teaching and learning, given this realignment. The consequence was that the relationship between these institutions is characterised by territoriality; a lack of integration of knowledge and expertise of nurse educators and clinical facilitators; a lack of sharing the necessary resources to facilitate cooperative teaching thus increasing the existence of academia-service gap and/or theory-practice gap to develop. There was therefore a need to develop a model with guidelines for operationalisation of the model to facilitate collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education. The research questions that emerged were: • What is the meaning of collaboration between institutions of higher education and psychiatric health care services within psychiatric clinical nursing education? • How can collaboration between institutions of higher education and psychiatric health care services be facilitated to promote psychiatric clinical nursing education? To realise the aim of this research, the following objectives are formulated: • to explore and describe the meaning of the concept “collaboration” between the institutions of higher education and psychiatric health care services within a psychiatric clinical educational context (theoretical and empirical perspectives); • to explore and describe the perceptions of nurse educators, nurse managers, and (i) clinical facilitators with regard to how collaboration between institutions of higher education and psychiatric health care services can be facilitated to promote psychiatric clinical nursing education; • to conceptualise the identified concepts of the model for collaboration to facilitate psychiatric clinical nursing education; • to describe the model to facilitate collaboration between institutions of higher education and psychiatric health care services, evaluate the model and describe guidelines for its operationalisation. The study was conducted in four phases. Phase One of the study involved an exploration and description of the meaning of collaboration within psychiatric clinical nursing education in accordance with Rodgers and Knafl’s evolutionary method of concept analysis (Rodgers & Knafl, 1993:77-90) and empirical meaning description from the participants’ perspective. Integration of the theoretical and empirical meaning of collaboration formed the basis on which a conceptual map was designed. Content analysis of literature was done using deductive and inductive reasoning strategies, synthesis, and inference and derivation as described by Chinn & Kramer (1995:63-67), and Walker and Avant, (1983:58-62). Theoretical validity was ensured (Chinn & Jacobs, 1987:208). A conceptual map constituting the four phases of collaboration was described.

M.Cur. / Please refer to full text to view abstract

published_or_final_version / Education / Master / Master of Education

The purpose of this study is to gain a richer understanding of the experiences of moral distress for nursing students within the context of psychiatric-mental health clinical placements, examine strategies students use to effectively manage distress, and explore student and instructor roles as agents of change to reduce the negative impact of moral distress. Nursing students and instructors engaged in semi-structured interviews and focus groups, respectively, to examine the complexities of this phenomenon. This study utilized second-person action research based on Jürgen Habermas’ Theory of Communicative Action. Findings indicated that nursing students experience moral distress when they are powerless and lack role models to follow in taking action to address situations that are “not right”. Nursing instructors acknowledge their responsibility to prepare students for practice, but are also powerless as “guests” within the practice setting and are powerless to effect change on a hierarchical medical system. Findings indicate that both nursing education and health care institutions must make changes in their approaches to practice if they wish to empower nursing professionals to provide safe, competent, and ethical care to patients. / vii, 139 leaves ; 29 cm

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

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

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