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

Bakgrund: Hot och våld i psykiatrisk slutenvård är ett vanligt förekommande fenomen. Hot och våld uppstår av en rad olika anledningar. Det är ett störande moment i sjuksköterskans arbete och väcker negativa känslor, vilket kan avspeglas i sjuksköterskornas interaktioner med patienterna. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda hotfulla och våldsamma patienter i psykiatrisk slutenvård. Metod: En intervjustudie genomfördes med åtta sjuksköterskor på två psykiatriska kliniker vid ett större sjukhus i en storstadsregion i västra Sverige. Materialet analyserades genom kvalitativ innehållsanalys. Resultat: Fyra kategorier framkommer. Den första är olustkänslor med underkategorierna att känna oro och ångest, att känna stress, att känna sig ledsen samt att känna sig kränkt. Den andra kategorin är rädsla, med underkategorierna rädsla för den hotfulla patienten samt att känna rädsla för andras skull. Den tredje kategorin är maktlöshet med underkategorierna att förlora kontrollen, att känna frustration samt att arbeta med en tickande bomb. Den fjärde kategorin är trygghetsskapande strategier med underkategorierna att sätta sig in i patientens situation samt att våga stå kvar. Slutsats: Ofta kan det aggressiva beteendet hos patienterna associeras till sjukdomsbild och/eller missbruksproblematik, vilket bekräftades i vår studie. I de flesta fall har sjuksköterskorna en djupare förståelse för patientens beteende och har därmed högre tolerans för hot och våld. Sjuksköterskorna betonar att det är viktigt att alltid vara tillgänglig för patienterna, då det skapar trygghet för båda parter samt är en förutsättning för en god vårdande relation. / Background: Inpatient aggression is common as a phenomenon in psychiatric inpatient care. Inpatient aggression arises for several reasons. It disturbs the nurses in their work assignments and causes negative emotions, which can be reflected in the interaction with the patients. Aim: To describe nurse's experiences of caring for aggressive patients in psychiatric inpatient care Method: An interview study was conducted with eight nurses at two psychiatric clinics at a hospital in a big town in Western Sweden. The material was analysed through qualitative content analysis. Results: The analysis resulted in four main categories. The first category is uneasiness, with subcategories: to feel anxiety, to feel stress, to feel sad and to feel offended. The second category is fear, with subcategories: to feel fear for the aggressive patient and to feel fear for others sake. The third category is powerlessness, with subcategories: to lose control, to feel frustration and to work with a ticking time bomb. The fourth category is work to create security policies with subcategories: understanding the patients' situation and courage to remain in an aggressive encounter. Conclusion: Inpatient aggression is often associated to symtoms and/or drug abuse, which also was confirmed in our study. In most scenarios the nurses had a deeper understanding for the patients behavior and thereby a higher tolerance towards inpatient aggresion. The nurses claimed that beeing available to the patients was very important, since that created an atmosphere of security for both parties and it was assumed a presumtion for a good caring relationship.

Bakgrund: Substansmissbruk är ett globalt problem och leder till negativa konsekvenser både för personen och samhället. Antal patienter som vårdats för substansmissbruk inom hälso- och sjukvården i Sverige har ökat de senaste åren. Tidigare forskning visar att substansmissbruk kan grundas i och leda till lidande. Psykiatrisjuksköterskor ger ofta omvårdnad till patienter som har substansmissbruk. Kommunikation mellan psykiatrisjuksköterska och patient sker vanligen via samtal. Forskning har visat att vårdande samtal kan lindra lidande. Syfte: Studiens syfte var att beskriva psykiatrisjuksköterskors erfarenheter av vårdande samtal med patienter som har ett substansmissbruk. Metod: Semistrukturerade narrativa intervjuer via telefon utfördes med elva psykiatrisjuksköterskor. Data analyserades med kvalitativ innehållsanalys. Resultat: Analysen mynnade ut i elva subkategorier och fyra kategorier. Kategorierna var drogfrihet som ambition, följsam närvaro, genuin människokärlek och att möta och lindra lidandets olika skepnader. Slutsats: Vårdande samtal kan ha potential att lindra patientens lidande samt tillfrisknande från substansmissbruk. Psykiatrisjuksköterskan behöver ha ett professionellt och personcentrerat förhållningssätt. Det vårdande samtalet beskrivs vara ett samtal mellan två människor vilket för psykiatrisjuksköterskan innebär utmaning i balans mellan närhet och distans till patienten. / Background: Substance abuse is a global problem that leads to negative consequences both for the person and for society. Healthcare in Sweden has the last couple of years taken care ofan increasing number of patients with substance abuse. Research shows that substance abuse can both lead to and caused suffering. Psychiatric nurses often give nursing care to patients who have substance abuse. Communication between the psychiatric nurse and the patient is often done by conversation. Research has shown that caring conversations can alleviate suffering. Aim: The aim of the study was to describe psychiatric nurses’ experiences of caring conversations with patients who have substance abuse. Method: Semi-structured narrative interviews were conducted by phone with eleven psychiatric nurses. Data is analyzed according to qualitative content analysis. Results: The analysis resulted in eleven subcategories and four categories. The categories were drug freedom as ambition, compliant presence, genuine human love and to meet and alleviate the various forms of suffering. Conclusion: Caring conversations can have the potential to alleviate the patient's suffering as well as recovery from substance abuse. The psychiatric nurse needs to have a professional and person-centered approach. The caring conversation is described as a conversation between two people, which for the psychiatric nurse means a challenge in balancing closeness and distance to the patient.

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)

Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

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)

M.Cur. (Psychiatric Nursing) / The psychiatric nurse, as a member of the multiprofessional mental health team, utilises a goal directed approach to assist the psychiatric patient to mobilise resources to promote, restore and maintain his mental health as an integral part of his quest for wholeness. This goal directed approach is the nursing process which comprises assessment, planning, implementing and evaluation. All four steps of the nursing process and the nurse's interaction wi th the patient are dependent upon therapeutic communication between the nurse and the patient to elicit the necessary information so as to be able to formulate the nursing diagnosis, nursing actions and the patients' outcomes. Therapeutic communication remains important as the core of all nurse-patient interactions. Lack of therapeutic communication with the patient can cause conflict in the patient's internal and external environments since he will be unable to communicate his needs and problems and this will delay the mental health promotion, restoration and maintenance phases. Currently much attention is paid to the pharmacological treatment of the patient as more and more sophisticated psychotropic drugs are produced, and yet the other aspect of the patient's treatment which is equally important is neglected, namely his communication during hospitalisation, especially with the psychiatric nurse as she is the person in direct contact with him and should spend most of her time interacting with him.

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.

Psychiatric nurse practitioner (NP) turnover is a significant cost to healthcare employers. Psychiatric NP turnover due to private practice creation is not well understood. The purpose of this study was to better understand the transition of Psychiatric NPs as they moved from ambulatory/outpatient employment to private practice. Using a hybrid Grounded Theory approach, 17 Psychiatric NPs in private practice were interviewed from October - December 2023. Facilitating factors to private practice creation were: The COVID-19 pandemic, changes to telehealth regulation during the pandemic, increased demand for psychiatric services and decreased supply of providers, and progress within the NP full practice authority movement. While employed, NPs reported experiencing burnout, high patient load, poor schedule, poor compensation, increased administrative tasks not budgeted within the NP workday, and rampant disrespect of the NP role. NPs reported being managed by inappropriate supervisors from other disciplines, and reported little opportunity for growth. Most participants voiced an initial reluctance to enter private practice, and reported being “pushed” to entrepreneurship out of concern for their long term wellbeing. These factors combined contributed to poor NP job satisfaction and NP turnover. Strategies to improve the job satisfaction of employed psychiatric NPs were recommended.

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