Within the framework of ethnography, an inquiry was made into the many dimensions of psychological treatment and training in a psychiatric hospital, with particular reference to State Patients. Ethnography is the study of an intact cultural or social group based mainly on observations over a prolonged period of time in which the researcher is a participant. The multicultural aspects of the therapeutic community were also inquired into. Ethnographic data was collected and processed over a period of 16 years in three psychiatric hospitals, the main source of data gathered from Weskoppies Hospital in Pretoria. The ecosystemic psychotherapeutic perspective was used as a meta-model to describe eight therapeutic approaches in which intern-psychologists were trained. The hospital is described as a therapeutic community in which rehabilitation is a multi-professional responsibility. Each profession, or sub-culture, has its own framework and culture in which it works within the broader system of the psychiatric hospital. Ethical considerations and recommendations are levelled at the academic and practical aspects of clinical psychology, hospital management, and different levels of government. / Psychology / D.Litt. et Phil.

Thesis (MCur)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: No clear description exists in S.A. of the role and functions of a forensic psychiatric nurse. The researcher conducted a research project based on more than 20 years of practice experience to define and describe the role and functions of the forensic nurse practitioner. A non-experimental descriptive study was done. Questionnaires and checklists were compiled to determine the perceptions of forensic psychiatric patients/clients (n =24) and nursing staff (n = 15) .The nursing activities in a selected forensic psychiatric unit was evaluated through nonparticipative observation. Results indicated that: • Patients experienced their environment as isolated and has a need for better support by the nursing staff; • Nursing staff indicated their need for more specific training in forensic psychiatric nursing; and • A need exists for specific protocols and procedures to guide his/her practice. The recommendations are made that: • A special training program for forensic psychiatric nursing needs to be planned and implemented; and • Procedures and guidelines must be established to guide the practice of the nurse practitioner. / AFRIKAANSE OPSOMMING: Daar bestaan in S.A. geen duidelike omskrywing van die rol en funksies van die forensiese psigiatriese verpleegkundige nie. Die navorser het gegrond op meer as 20 jaar praktykervaring 'n navorsingsprojek gedoen om die rol en funksies van die verpleegpraktisyn te definieer en te omskryf. 'n Nie-eksperimentele, beskrywende studie is gedoen. Vraelyste en kontrolelyste is opgestel om die persepsies van forensiese psigiatriese pasiënte/kliënte (n=24) en verpleegpersoneel (n=15) te bepaal. Die verpleegaktiwiteite in 'n geselekteerde forensiese psigiatriese eenheid is deur nie-deelnemende observasie geëvalueer. Resultate het daarop gedui dat: • Pasiënte hulle omgewing as geïsoleerd ervaar en het 'n behoefte aan beter ondersteuning deur die verpleegpersoneel; • Verpleegpersoneel het aangedui dat hulle 'n behoefte het aan spesifieke opleiding in forensiese psigiatriese verpJeging;en • Daar 'n behoefte is aan spesifieke protokolle en prosedures om sy/haar praktyk te rig . Die aanbevelings word gemaak dat: • 'n Spesiale opleidingsprogram vir forensiese psigiatriese verpleging beplan en geïmplementeer word; en • Prosedures en riglyne daargestel moet word om die praktyk van die verpleegpraktisyn te rig.

Within the framework of ethnography, an inquiry was made into the many dimensions of psychological treatment and training in a psychiatric hospital, with particular reference to State Patients. Ethnography is the study of an intact cultural or social group based mainly on observations over a prolonged period of time in which the researcher is a participant. The multicultural aspects of the therapeutic community were also inquired into. Ethnographic data was collected and processed over a period of 16 years in three psychiatric hospitals, the main source of data gathered from Weskoppies Hospital in Pretoria. The ecosystemic psychotherapeutic perspective was used as a meta-model to describe eight therapeutic approaches in which intern-psychologists were trained. The hospital is described as a therapeutic community in which rehabilitation is a multi-professional responsibility. Each profession, or sub-culture, has its own framework and culture in which it works within the broader system of the psychiatric hospital. Ethical considerations and recommendations are levelled at the academic and practical aspects of clinical psychology, hospital management, and different levels of government. / Psychology / D.Litt. et Phil.

In South Africa, mental health care is being integrated into primary health care services. The integration of services was aimed at increasing the accessibility and availability of all health care services at primary health care level. The integration was well intentioned, and it was hoped that mentally ill clients would benefit from having a service near their homes. However, the process of integration is fraught with challenges, for instance, staff shortages, which lead to ineffective nursing management of mentally ill clients at the primary health care clinics. As a result, one professional nurse is often allocated to manage the clinic services on a daily basis with the assistance of an enrolled nurse or auxiliary nurse. The professional nurses therefore experience high levels of stress due to gross staff shortages and lack of time to conduct proper nursing assessments. This led to the research question: “What are the experiences of professional nurses with regards to the nursing management of mentally ill clients in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape?’’ The proposed objectives of the study were to explore and describe the experiences of professional nurses working in rural primary health care clinics with regard to the nursing management of mentally ill clients. The researcher thereafter made recommendations to the district managers regarding effective nursing management of mentally ill clients in rural primary health care clinics. A qualitative, exploratory, descriptive and contextual design was used. The research population comprised of professional nurses working in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape. Purposive sampling was used to identify participants and the sample number was determined by data saturation. Unstructured interviews and observation notes were used to collect data. The eight steps of data analysis suggested by Tesch were utilized to analyze the data. The researcher conducted an in-depth literature review in order to identify research gaps pertaining to the study. To ensure that a high level of validity and reliability was exercised throughout the study, the researcher conformed to Lincoln and Guba’s model of trustworthiness. The study was conducted in an ethical manner and ethical principles were adhered to. Findings: Three themes with subthemes emerged. The study showed that professional nurses experienced challenges related to the nursing management of mentally ill clients. These challenges included shortage of staff, a heavy workload, and lack of resources, lack of in-service training and workshops related to mental health issues coupled with lack of support from the supervisors. Due to the challenges, the mentally ill clients were not getting quality nursing care leading to complications and relapse. Conclusion: It emerged from the study that matters pertaining to mental illness and mental discomfort were still a serious problem in rural areas. The problems were related to the challenges which prevented professional nurses from providing quality nursing care to mentally ill clients with subsequent complications and relapse. Recommendations: Recommendations were made as an effort to ensure that the nursing management of mentally ill clients in rural primary health care clinics is improved. These recommendations were categorized as related to nursing practice, nursing education and nursing research.

Human Immunodeficiency Virus (HIV) positive patients are at increased risk for developing mental health problems when compared with the general population. The identification and management of symptoms of mental illness in HIV-positive patients is thus crucial in reducing the risk to developing severe mental illness. The severe mental illness may lead to poor adherence to anti retro-viral drugs resulting in increased morbidity and mortality. The primary health care nurses are largely responsible for managing the treatment of HIV-positive patients as they spend the greatest degree of their time with these patients as compared to other health care professionals. Consequently it is important for primary health care nurses to identify symptoms of mental illness. However, it was unclear to the researcher, a professional psychiatric nurse, as to the level of knowledge among primary health care nurses concerning symptoms of mental illness in HIV-positive patients. Therefore, the aim of this study was to determine the knowledge of primary health care nurses regarding symptoms of mental illness in HIV-positive patients attending primary health care services. In addition, recommendations were developed for primary health care nurses for the purpose of improving their competence in the identification of symptoms of mental illness in HIV-positive patients attending primary health care services. The researcher has utilised quantitative, explorative, descriptive and contextual design. Bloom’s Taxonomy was used as a theoretical lens, to explore the primary health care nurse’s knowledge regarding symptoms of mental illness in HIV-positive patients. The study was conducted in the primary health care services situated in the Nelson Mandela Metropolitan area. The research population consisted of the primary health care nurses working with HIV-positive patients in these primary health care services. The researcher utilised census survey to recruit participants. A structured questionnaire, with 3 sections was used in this study. The necessary principles of reliability and validity were exercised to ensure research of the highest quality. The data was analysed by using descriptive and inferential statistics. All ethical considerations pertaining to beneficence, maleficence, justice, autonomy and obtaining permission from relevant structures to conduct the study were strictly adhered to.

M.Cur. / Die idee waarmee hierdie studie 'n aanvang geneem het, het ontstaan vanuit my waarneming dat al hoe meer polisiebeamptes opgeneem word in die psigiatriese kliniek waar ek, die navorser werksaam is. Hierdie polisiebeamptes vertel 'n storie van blootstelling aan talle traumatiese situasies in die beoefening van hul beroep, waar geweld, misdaad, lewensgevaar en die dood vir hulle bekende verskynsels is. Maar dit lei dikwels tot depressie, alkoholmisbruik en aggressie by die polisiebeamptes. Hierdie probleme word, volgens polisiebeampes, dikwels vererger deur 'n autokratiese bestuurstelsel in die SAPD, swak salarisse, 'n lae status in die gemeenskap en ontoereikende fasiliteite. Die winde van politieke verandering wat sedert 2 Februarie 1990 deur Suid-Afrika waai, verg van polisiebeamptes om sekere fundamentele aanpassings te maak en 'n nuwe benadering tot polisiering te volg. Hierdie aanpassings word dikwels as moeilik ervaar. Die gesinne van polisiebeamptes word dikwels direk geaffekteer deur al die genoemde faktore, in die sin dat, die polisiebeampte se manier van "dink en wees" as polisiebeampte, sy interaksie met sy gesin beInvloed. Ek het dus gewonder hoe die gesinne van polisiebeamptes dit beleef wanneer 'n lid van die gesin werksaam is as 'n polisiebeampte in 'n hoe-risiko metropolitaanse area in Gauteng. Geen studie is voorheen hieroor uitgevoer nie. Om hierdie vraag te beantwoord, het ek van 'n verkennende, beskrywende, kontekstuele en kwalitatiewe navorsingsontwerp gebruik gemaak in die uitvoering van hierdie studie. Semigestruktueerde, fenomenologiese onderhoude is gevoer met agt vroue van polisiebeamptes, werksaam by 'n geIdentifiseerde polisiestasie in Gauteng. Die vroue is volgens die sneeubalmetode geselekteer. Dit is gedoen nadat die nodige ingeligte toestemming van hulle verkry is. Stappe is deurgaans deur die studie geneem om vertrouenswaardigheid te verseker, volgens Guba se model. Daar is ook verseker dat hierdie studie op 'n etiese wyse uitgevoer is, deurdat ek myself laat lei het deur die Suid-Afrikaanse Verpleegstersvereniging se standaarde vir verpleegkundige navorsers. Die meta-teoretiese aannames wat hierdie studie rig, is verkry uit die Verplegingsteorie vir Mensheelheid, waarvolgens die mens 'n geestelike wese is wat op 'n gentegreerde, biopsigososiale wyse binne die gesin en gemeenskap funksioneer. Data is ontleed volgens die metodes van Tesch en die dienste van 'n onafhanklike kodeerder is verkry. Sodoende is ooreenstemming bereik oor die kategoriee en subkategoried van temas wat die storie van die vroue so akkuraat as moontlik sou kon beskryf. Die resultate het daarop gedui dat gebroke interaksie dikwels in die gesinne van polisiebeamptes vookom. Hierdie interaksie word gekenmerk deur oppervlakkige, konkrete kommunikasie, aggressie en fisiese, sowel as emosionele afwesigheid van die polisiebeampte in die gesin. Die vrou neem dikwels sekere rolle in die verhouding aan en ervaar emosies van pyn, alleenheid, woede, verwerping, vrees en onsekerheid. Riglyne is beskryf wat moontlik kan lei tot die ondersteuning van die gesinne van polisiebeamptes, deur die psigiatriese verpleegspesialis. Voorstelle vir die aanwending van die resultate in die verpleegonderwys, -praktyk en —navorsing is gemaak. Daar word tot die gevolgtrekking gekom dat die verkenning en beskrywing van die beleweniswereld van die gesinne van polisiebeamptes, die psigiatriese verpleegspesialis instaat kan stel om die gesinne te ondersteun in die mobilisering van hulpbronne en die gesin te fasiliteer in die bevordering, handhawing en herstel van gesinsgeestesgesondheid as 'n integrale deel van gesondheid.

Human Immunodeficiency Virus (HIV) positive patients are at increased risk for developing mental health problems when compared with the general population. The identification and management of symptoms of mental illness in HIV-positive patients is thus crucial in reducing the risk to developing severe mental illness. The severe mental illness may lead to poor adherence to anti retro-viral drugs resulting in increased morbidity and mortality. The primary health care nurses are largely responsible for managing the treatment of HIV-positive patients as they spend the greatest degree of their time with these patients as compared to other health care professionals. Consequently it is important for primary health care nurses to identify symptoms of mental illness. However, it was unclear to the researcher, a professional psychiatric nurse, as to the level of knowledge among primary health care nurses concerning symptoms of mental illness in HIV-positive patients. Therefore, the aim of this study was to determine the knowledge of primary health care nurses regarding symptoms of mental illness in HIV-positive patients attending primary health care services. In addition, recommendations were developed for primary health care nurses for the purpose of improving their competence in the identification of symptoms of mental illness in HIV-positive patients attending primary health care services. The researcher has utilised quantitative, explorative, descriptive and contextual design. Bloom’s Taxonomy was used as a theoretical lens, to explore the primary health care nurse’s knowledge regarding symptoms of mental illness in HIV-positive patients. The study was conducted in the primary health care services situated in the Nelson Mandela Metropolitan area. The research population consisted of the primary health care nurses working with HIV-positive patients in these primary health care services. The researcher utilised census survey to recruit participants. A structured questionnaire, with 3 sections was used in this study. The necessary principles of reliability and validity were exercised to ensure research of the highest quality. The data was analysed by using descriptive and inferential statistics. All ethical considerations pertaining to beneficence, maleficence, justice, autonomy and obtaining permission from relevant structures to conduct the study were strictly adhered to.

Workplace violence directed at student nurses in training in psychiatric institutions is a significant concern as it negatively affects the quality of learning and causes the students to have a negative perception of nursing as a profession. The absence of scientific data describing the perceptions of student nurses about workplace violence and their clinical learning outcome motivated the researcher to conduct the study. Quantitative, descriptive research was conducted to explore the influence that workplace violence will have on clinical learning outcomes of student nurses who are studying psychiatric nursing at psychiatric institutions in KwaZulu-Natal, in South Africa. Data was gathered using a 71 question questionnaire, which was adapted from the one used by Hewett (2010). With the necessary permission from the health authorities, the campus principals and the nursing students, a group of 4th year student nurses (n=163) from 6 campuses of the KwaZulu-Natal College of Nursing (KZNCN) who have worked in psychiatric units for at least 3 months and longer participated in the study. The study highlighted the types of workplace violence encountered by student nurses, the effects of workplace violence on students’ academic performance and the barriers to the reporting of workplace violence encountered by the student nurses. The study revealed that there is a large amount of non-physical, some physical and a few incidents of sexual violence directed towards the student nurses at the psychiatric institutions, and that it has a negative impact on student learning. The recommendations emanating from the study support the idea of a shared responsibility between healthcare and education institutions and the focus is on preparing and equipping the student psychiatric nurses to confront, withstand and break the cycle of workplace violence. / Health Studies / M.A. (Nursing Science)

The purpose of the study was to explore and describe the lived experiences of general nurses working at Standerton hospital medical wards which also admit psychiatric patients. A qualitative, descriptive phenomenological approach was used for the study. The study population consisted of seven general nurses working in medical wards at Standerton hospital. Purposive sampling was used to select participants who met the inclusion criteria. Researcher used in-depth face to face interviews to collect data until data saturation was achieved. Tesch’s method of qualitative data analysis was utilised to identify themes. Three themes and five sub-themes emerged from the study: theme1: perceived danger due to aggression sub-themes stress for medical patients, stress for medical patients’ families and stress for nurses. Theme 2: lack of skills in dealing with psychiatric patients’ sub- theme use of restrains. Theme 3: self fulfilling prophecy subtheme reported incidences. The study findings demonstrate the plight of general nurses who are not trained to work with psychiatric patients but continue to do so. Findings further accentuate what is already known about the labelling that goes with psychiatric patients and aggression as a resultant effect. Recommendations were made for future research, policy makers, nursing education and practice. / M.A. (Health Studies)

M.Cur. / The purpose of this study is to describe guidelines for a Community Based Curriculum in Psychiatric Nursing Science for a nursing college in KwaZulu Natal. The study consists of 4 phases. To reach the purpose of the study, a situational analysis was done in 3 phases to identify the principles for a Community Based Curriculum in Psychiatric Nursing Science. In Phase I - a document analysis of relevant government policies and legislation was conducted to obtain the principles of mental health care. In Phase H - the statistics of the psychiatric diagnoses of patients from two community psychiatric clinics and one psychiatric hospital admission unit were collected. From the prevalence of the mental disorders, the mental health needs and problems were identified. These were the principles of Phase II. Phase III - was the focus group interviews with the psychiatric nurse educators of a nursing college in KwaZulu Natal to ascertain their viewpoints on a Community Based Curriculum in Psychiatric Nursing Science. From the findings of the focus group interviews, a literature control and conceptual framework were done. Thereafter, the principles of mental health care from this phase were identified. The principles of Phase I, II and III were used to formulate Phase IV, which was the guidelines for the operationalisation of Community Based Curriculum in Psychiatric Nursing Science. The outcomes based approach was used in the Community Based Curriculum in Psychiatric Nursing Science in accordance with the National Qualifications Framework of the South African Qualifications Authority. Recommendations concerning nursing practice, nursing education and further study were made at the end of the study including the limitations affecting the study