D.Cur. / In South Africa, mood disorders, specifically depression, accounts for the most psychiatric related hospital admissions. The total cost (overt and hidden) of mood disorders that result from lost productivity, can be estimated at billions of rand per year. In addition to economic costs, depression can carry great personal costs because of the social stigma associated with the diagnosis and treatment of a 'mental illness'. This stigma likely plays a big role in women' reluctance to seek, accept and adhere to treatment. The potential savings to be derived from the appropriate treatment of women suffering from depression are socially and economically significant. The focus in this thesis has been on women suffering from depression as it is estimated that at least twenty five percent of women will suffer from a major depressive episode in their life. Based on the problem statement that was included in this thesis, the researcher asked the following questions: 'What is the phenomena that constitutes the restoration process of women suffering from depression? Which processes contribute to the restoration process of women suffering from depression and facilitate these women's quest for mental health as an integral part of wholeness? How can an approach to provide quality care to women suffering from depression be described?" The primary purpose of this thesis was thus to explore and describe the processes contributing to the restoration process of women suffering from depression, in order to develop a mental health nursing approach that will provide quality care to women suffering from depression in their continuous quest for mental health. The psychiatric nurse specialist then developed and described guidelines to operationalise the approach that contributes to quality care of women suffering from depression in mental health nursing. The paradigmatic basis of this study was based on the Nursing for the Whole Person Theory (Oral Roberts University, Anna Vaughn School of Nursing, 1990:136-142) as used by the Rand Afrikaans University. This theory is based on a Judea-Christian philosophy.

Abstract The study describes adult patients' experiences of psychosis and being helped in an inpatient setting. The method is qualitative and the approach phenomenological. The study was carried out at the psychiatric clinic of a Finnish university hospital in 1998. The participants were men and women aged 23-57 coping with different types of psychosis. The data consists eight people's interviews (n=14), which were tape-recorded (except one). The data was analysed using the method developed by Amedeo Giorgi and Juha Perttula. Patients experienced psychosis as an uncontrollable sense of self, which included emotional and physical feelings of a change and a loss of control over one's self. Uncontrollable sense of self increased sensitivity with self, others, the significant others were important and meaningful and coping with daily life was difficult and varied individually. The onset of psychosis was experienced situational, the progress of psychosis as holistic and exhaustive, and the admission into the treatment as difficult but inevitable. The care was experienced as helpful but unstructured. The care should be based on patients' experiences of psychosis with self, others and life. When patients have uncontrollable sense of self the care should be protection from vulnerability to more integrated inner world supporting individual empowerment and coping. / Tiivistelmä Tutkimuksessa kuvaillaan aikuisten potilaiden kokemuksia psykoosin ja autetuksi tulemisen todellisuudesta psykiatrisen sairaalahoidon aikana. Tutkimuksen lähestymistapa on fenomenologinen. Keräsin tutkimusaineiston yliopistosairaalan psykiatrian klinikassa avoimilla haastatteluilla vuonna 1998. Tutkimukseen osallistuneet olivat erilaisia psykooseja kokeneita ja niistä selviytyneitä tai selviytymässä olevia, 25-57-vuotiaita naisia ja miehiä. Tutkimusaineistona on kahdeksan erimuotoista psykoosia kokeneen potilaan haastattelut (n=14), jotka nauhoitettiin (yhtä lukuun ottamatta). Analysoin aineiston Amedeo Giorgin kehittämällä ja Juha Perttulan Giorgin analyysimenetelmään liittämän muunnelman mukaan. Potilaat kokivat psykoosin hallitsemattomana minuutena, mikä tarkoitti emotionaalista ja fyysistä minän muuttumisen ja itsehallinnan menetyksen tunnetta. Hallitsematon minuus merkitsi herkistyneisyyden lisääntymistä itsen ja muiden suhteen, omaisten ja ystävien tärkeyttä ja vaihtelevaa vaikeutta selviytyä jokapäiväisestä elämästä. Elämäntilanteeseen liittyvä hallitsematon minuus oli kokonaisvaltainen ja uuvuttava kokemus. Tällöin sairaalahoito koettiin vaikeana, mutta välttämättömänä. Autetuksi tuleminen oli helpottavaa ja välttämätöntä, mutta hoito jäi jäsentymättömäksi omaan sisäiseen tilanteeseen, hoitotoimintojen ja minuuden hallitsemattomuuden / hallinnan suhteen. Autetuksi tuleminen tarkoitti potilaiden kokemana haavoittuvuudelta suojaamisesta eheytyneemmäksi tuloa siten, että yksilöllistä voimaantumista ja selviytymistä tuetaan.

Bakgrund: Vårdrelationen är ett samspel och består av all kommunikation som sker i   vårdsituationerna med hållning, samtal och handlingar. Det finns forskning som visar att upplevelsen av vårdrelationen är betydande för patienters tillfrisknande inom psykiatrisk omvårdnad. Samtidigt finns skildringar om hur utmanande psykiatrisjuksköterskor kan uppfatta vårdrelationen. Sjuksköterskans förmåga till närvaro beskrivs som essentiellt i vårdrelationen. Medveten närvaro innebära att genom riktad uppmärksamhet bli medveten om ögonblicket här och nu. Forskning pekar på att träning i medveten närvaro verkar gynnsamt för sjuksköterskor genom att ge ökad fokus och utrymme för reflektion, en större acceptans och empati. Därtill finns studier på patienter som indikerar en större tillfredställelse i kommunikationen med sjuksköterskor som praktiserar medveten närvaro. Vårdrelationen beskrivs som essentiell i psykiatrisk omvårdnad varför en fördjupad förståelse för hur medveten närvaro påverkar båda dess parter anses betydelsefullt att utforska. Syfte: Beskriva sjuksköterskors erfarenheter av medveten närvaro och dess betydelse för vårdrelationen inom psykiatrisk omvårdnad.  Metod: Kvalitativ design med semistrukturerade intervjuer.  Informanterna var sju sjuksköterskor verksamma på mottagningar inom psykiatri och beroendevårdens öppenvård. Som analysmetod användes kvalitativ innehållsanalys. Resultat: Resultatet pekar på att när sjuksköterskor är medvetet närvarande i vårdrelationen påverkas båda parter positivt.  Aspekter som påverkade patienten var att bli sedd och lyssnad på, att bli bemött i nuet, att inte dömas och att bli betraktad som en hel människa. När sjuksköterskorna var medvetet närvarande gynnades färdigheter som att stanna upp och observera samt bidrog till ökad flexibilitet och sensibilitet i vårdrelationen. Medveten närvaro beskrevs därtill som hjälpsamt för den personliga utvecklingen och gjorde det lättare att vara autentisk i vårdrelationen. Förhållningssättet beskrevs som återhållsamt, motsatsen till att fixa eller lösa patientens svårigheter. Detta gjorde upplevelsen av vårdrelationen för sjuksköterskorna som mer givande, roligare och tryggt istället för en känsla av börda eller att ta över patientens ansvar och elände. Diskussion: Resultatet diskuterades utifrån Jean Watsons teori för mänsklig omsorg samt relevant forskning.

M.Cur. / In a changing South-Africa new challenges regarding multiculturality emerge. In psychiatric nursing the psychiatric nurse also faces new challenges. During a cultural discussion, the personnel of a private psychiatric clinic realised that culture has numerous different meanings. (that numerous different meanings may be attached to culture). Culture has an interesting nature and certain expectations exist around culture. I have described this discussion in order to present a qualitative, descriptive, singular case study, within the paradigm of the Theory for Health promotion in Nursing. The data was processed according to the recommendations of Tesch (in Creswell, 1994:155). The discussion is presented according to certain themes. No guidelines have been set, but I have made certain recommendations that may be utilised in training of psychiatric nurses as well as in practise and research in the field of psychiatric nursing. The discussion was important because the participants were able to develop a sensitivity toward culture. This lead to the promotion of co-operation, productivity, and mutual understanding and respect within the context. The importance of the description of the discussion lies in the information that has been generated. This information will be available and will be incorporated as part of the body of knowledge in psychiatric nursing.

D.Cur. (Psychiatric Nursing Science) / The overall goal of this research study was to explore and describe strategies in order to promote the mental health of married couples throughout the ante- and postnatal period. The majority of research on the transition to parenthood has found that as couples become parents, there is a dramatic decrease in positive marital interchanges, a dramatic increase in marital conflict and a precipitous decline in marital satisfaction (Belsky & Kelly, 1994; Belsky & Pensky, 1988: 133-156; Belsky, Spanier & Rovine, 1983: 567-577). The transition to parenthood is viewed as instigating a shift in the marriage whereby most couples are expected to experience a qualitative change in their relationship that is relatively abrupt (Pancer, Pratt, Hunsberger & Gallant, 2000: 253-280). Becoming a new parent poses challenges for nearly every married couple (Curran, Hazen, Jacobvitz & Feldman, 2005: 189). Becoming a parent is a major developmental transition of adulthood (Harwood, McLean & Durkin, 2007: 1). Individuals often have optimistic expectations about parenthood, yet this transition also presents a number of challenges (Harwood et al, 2007: 1). The questions that arose was what are the stories of married couples throughout the ante- and postnatal period of their first child, and what can be done by an advanced psychiatric nursing practitioner to promote the mental health of married couples based on their story. The researcher utilised a qualitative, explorative, descriptive and contextual study design as described in Babbie (2010: 92). This research study was carried out in four phases. During the first phase of this research study, the researcher explored and described the stories of married couples throughout the ante- and postnatal period of their first child according to the quest narrative method described by Frank (1997: 115). The results were discussed within relevant literature. iv In the second phase of this research study the researcher developed a conceptual framework on the basis of the empirical data. The conceptual framework was developed according to the concepts as proposed by Dickoff, James and Wiedenbach (1968: 435). The researcher described strategies, to promote the mental health of married couples throughout the ante- and postnatal period of their first child, in the third phase of this research study. These strategies were described according to a relationship phase, a working phase and a termination phase as part of the facilitation process. These three phases were discussed as part of a proposed facilitation process that forms part of the developed conceptual framework. In the fourth phase of this research study, the developed strategies were subjected to expert assessment according to the criteria stated by Chinn and Kramer (2011: 196-205). The findings of the research study are applicable to psychiatric nursing practice, research and psychiatric nursing education.

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

M.Cur. (Psychiatric Nursing) / Burnout has severe consequences for the psychiatric nurse as individual and for the mental health delivery system because of an increase in staff turnover and a decrease in the quality of patientcare. Psychiatric nurses suffering from burnout have the potential to experience job satisfaction, if job satisfaction can be facilitated. Job satisfaction of the psychiatric nurse will promote the mental health for her as individual, her patients, colleagues, family and the community. The following aims were set for the research project: Exploring and describing the aspects which cause and promote burnout amongst psychiatric nurses at a private psychiatric hospital; and to formulate guidelines for the psychiatric nursing specialist to facilitate job satisfaction of psychiatric nurses, as an integral part of mental health by means of mobilisation of resources. Nursing for the Whole Person Theory was used as the theoretical framework for this qualitative,contextual study. Botes' Model (1995:4-9) for Nursing Research was used to structure theresearch. The measures which were used to ensure reliability,validity and credibility of the research, were that of Guba (inKrefting, 1991:214-222).A pilot study was conducted to prevent obstacles during gathering and analysis of data. Specific criteria were set for selectionof participants. After conducting a pilot study, fiveparticipants were purposively selected from the target populationat a private psychiatric clinic.Individual focus interviews were recorded on tape and latertranscribed. Data gathering and data analysis were divided in two phases. Three questions were asked during -Phase 1 regarding burnout, and one during - Phase 2- regarding guidelinesfor the prevention of burnout. Data was analyzed systematicallyand descriptive, combining Tesch's (in Creswell, 1994:115) and Kerlinger's (1986:479) methods.

M.Cur. (Nursing Science) / People play a major role in each other’s lives and this is because they rely on one another for survival. Many studies have been done on families and how they experience having persons challenged with mental illness but little has been done on couples and how they experience a relationship where one is challenged with mental illness or on the facilitation of the mental health of couples in a relationship where one is challenged with mental illness. The purpose of this study is to explore and describe the lived experience of couples in a relationship where one is challenged with mental illness in order to describe guidelines to facilitate the mental health of the couples. A qualitative, explorative, descriptive and contextual research design was utilised. The research was done in two phases. Phase one focused on an exploration of the lived experiences of couples in a relationship where one is challenged with mental illness. Phase two focused on guidelines to facilitate the mental health of the couples as a framework for the advanced psychiatric nurse practitioner. Purposive sampling was employed in selecting participants for the research study. The criteria were set out to be: couples in a relationship where one is challenged with mental illness with the willingness to participate and above the age of eighteen years. Phenomenological interviews were conducted and field notes gathered. Tesch’s method of data analysis was applied to analyse the data. Themes and categories were identified and a consensus was reached with the independent coder. Measures to ensure trustworthiness were considered and the criteria for ensuring rigour included truth value, applicability, consistency and neutrality. Ethical principles were also adhered to and those included: autonomy, non-maleficence, beneficence and justice to protect the human participants. Findings have shown that both partners in a relationship where one is challenged with mental illness, experience challenges in the relationship. They experience the relationship as different to what it was before there was mental illness. The couples experience a change in their social roles, as the partner with mental illness cannot work, provide, or fulfil his or her role in the relationship. The partner without mental illness carries more responsibility than before because of the demands which the mental illness imposes in the relationship. There is also emotional upheaval experienced by both partners because being in the relationship for both of them is overwhelming. They also experience interpersonal distance linked to unhealthy relational patterns characterised by constant fights and drifting apart. The couples also experience a changed relationship with the self, and financial challenges as the mental illness cost them a great deal. The partners with mental illness experience rejection and feel undeserving of spousal support, whereas the partners without mental illness experience a burden due to the increased responsibility that they have to assume and that is both socioeconomic and household roles. Guidelines based on the findings as described by the couples were described in Chapter Four in order to facilitate the mental health of couples in a relationship where one is challenged with mental illness. Recommendations for mental health nursing practice, mental health nursing education and mental health nursing research were made. The study was evaluated and limitations were outlined.

M.Cur. (Psychiatric Nursing) / Caring for intellectually disabled people can be demanding for student nurses who are still novices in the profession. To ensure optimal nursing care is received, student nurses must have both an understanding of and a positive attitude towards intellectually disabled people. Nursing intellectually disabled people is a challenge that can have an impact on a person‟s body, mind and spirit therefore, student nurses need to have the ability to deal with stressful situations and environments. Student nurses need to be prepared to care for patients with long-term challenges, such as intellectual disabilities. These patients require a caring relationship that facilitates an enhanced awareness of life and health experiences. The caring relationship also facilitates health and healing processes as it involves the authentic and genuine needs of patients. This research aimed to explore and describe lived experiences of student nurses caring for intellectually disabled people in a public psychiatric institution, and to formulate guidelines for the facilitation of mental health of these student nurses. A qualitative, exploratory, descriptive and contextual design was used. Data were collected through individual in-depth interviews, focusing on the question “How was it for you to be working at this institution?” Thematic analysis was used to analyse the collected data and a consensus discussion was held with the independent coder. Ten participants were interviewed and five, who were not comfortable with interviews, wrote naïve sketches. Trustworthiness was assured by adhering to Lincoln and Guba‟s principles, that is, credibility, transferability, dependability, and confirmability. Four ethical principles were demonstrated throughout the research namely, principles of respect for autonomy, non-maleficence, beneficence, and justice. Three themes emerged from the data. Firstly, student nurses experience a profound unsettling impact on their wholistic being when caring for intellectually disabled people. iv Secondly, they develop a sense of compassion and a new way of looking at life, and lastly they require certain educational, emotional and spiritual needs to be met. Guidelines were formulated to facilitate the mental health of student nurses caring for intellectually disabled people in a public psychiatric institution.

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.