ORIGINAL RESEARCH

 

Psychiatric nurse practitioners' experiences of working with mental health care users presenting with acute symptoms

 

 

Jacobs K. Ngako^I; Elsie S.J. van Rensburg^II; Sanah M.L. Mataboge^III

^IDepartment of Nursing Science, University of Pretoria, South Africa. Alcohol and Drug Abuse Research Unit, South African Medical Research Council, South Africa
^IIDepartment of Nursing Science, University of Pretoria, South Africa
^IIIDepartment of Nursing Science, University of Pretoria, South Africa

Correspondence

 

 

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ABSTRACT

Psychiatric nurse practitioners (PNPs) working with mental health care users presenting with acute symptoms work in a complex environment. This environment is characterised by mental health care users who may present with a history of violence, sexual assault and substance misuse.
The objectives of this study were twofold: firstly, to explore and describe the experiences of PNPs working with mental health care users (MHCUs) presenting with acute symptoms; and secondly, to make recommendations for the advanced PNPs to facilitate promotion of the mental health of PNPs with reference to nursing practice, research and education.
A qualitative, explorative, descriptive and contextual design was used. The target population was PNPs working with MHCUs presenting with acute symptoms in a public mental health care institution in Gauteng. Data were collected by means of four focus group interviews involving 21 PNPs. The researcher made use of drawings, naïve sketches and field notes for the purpose of data triangulation. Data were analysed in accordance with Tesch's method of open coding.
The three themes that emerged were: PNPs experienced working with these MHCUs as entering an unsafe world where care became a burden; they experienced negative emotional reactions and attitudes towards these MHCUs that compromised quality nursing care; and they made a plea for a nurturing environment that would enhance quality nursing care.
The PNPs suggest skills and competency development, organisational support, and a need for external resources. Creation of a positive environment and mobilisation of resources as well as the identification and bridging of obstacles are essential in the promotion of the overall well-being and mental health of PNPs.

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References

Babbie, E. & Mouton, J., 2001, The practice of social research.: Oxford University Press, Cape Town, South Africa.         [ Links ]

Bimenyimana, E., Poggenpoel, M., Myburg, C. & Van Niekerk, V., 2006, 'The lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution', Curationis, 32(3), 4-13.         [ Links ]

Björkman, T., Angelman, T. & Jönsson, M., 2008, 'Attitudes towards people with mental illness: A cross-sectional study among nursing staff in psychiatric and somatic care', Scand Journal of Caring Science, 22, 170-177. http://dx.doi.org/10.1111/j.1471-6712.2007.00509.x, PMid:18489686        [ Links ]

Bowling, A., 2002, Research methods in health: Investigating health and health services, 2nd edn., Open University Press, Philadelphia.         [ Links ]

Brennan, G., Flood, C. & Bowers, L., 2006, 'Constraints and blocks to change and improvement on acute psychiatric wards: lessons from the city nurses project', Journal of Psychiatric and Mental Health Nursing, 13, 475-482. http://dx.doi.org/10.1111/j.1365-2850.2006.00956.x, PMid:16965464        [ Links ]

Burns, N.A. & Grove, K.S., 2005, The practice of nursing research: Conduct, critique and utilisation, 5th edn., W.B. Saunders, Philadelphia.         [ Links ]

Carlsson, G., Dahlberg, K. & Drew, N., 2004, 'Encountering violence and aggression in mental health nursing: A phenomenological study of tacit caring knowledge', Issues in Mental Health Nursing 21(5), 533-545.         [ Links ]

Chaplin, R., McGeorge, M. & Lelliott, P., 2006, 'The national audit of violence: In-patient care for adults of working age', Psychiatric Bulletin 30, 444-446. http://dx.doi.org/10.1192/pb.30.12.444        [ Links ]

Chen, S.C., Hwu H.G., H. & Williams, R.A., 2005, 'Psychiatric nurses' anxiety and cognition in managing psychiatric patients' aggression', Archives of Psychiatric Nursing 19(3),143-149.         [ Links ]

Clearly, M., 2003, 'The challenges of mental health care reform for contemporary mental health nursing practice: Relationships, power and control', International Journal of Mental Health Nursing 12, 139-147. http://dx.doi.org/10.1046/j.1440-0979.2003.00280.x, PMid:12956025        [ Links ]

Creswell, J.W., 2003, Research design: Qualitative, quantitative and mixed methods approach, 2nd edn., Sage Publication, London.         [ Links ]

Currid, T., 2009, Experiences of stress among nurses in acute mental health settings, Nursing Standard 23(44), 40-46.         [ Links ]

Deacon, M., Warne, T. & McAndrew, S., 2006, 'Closeness, chaos and crisis: The attractions of working in acute mental health care', Journal of Psychiatric Mental Health Nursing 13, 750-757. http://dx.doi.org/10.1111/j.1365-2850.2006.01030.x, PMid:17087679        [ Links ]

De Vos, A., Strydom, H., Fouché C.B. & Delport, C.S.L., 2005, Research at grass roots for the social sciences and human service professions, 3rd edn., Van Schaik Publishers, Pretoria.         [ Links ]

Fourie, W.J., McDonald, S., Connor, J. & Barlett, S., 2005, The role of the registered nurse in an acute mental health inpatient setting in New Zealand: Perceptions versus realit, International Journal of Mental Health nursing 14, 134-141. http://dx.doi.org/10.1111/j.1440-0979.2005.00370.x, PMid:15896261        [ Links ]

Higgins, A., Barker, P. & Begley, C. M., 2008, 'Clients with mental health problems who sexualize the nurse-client encounter: The nursing discourse', Journal of Advanced Nursing 65(3), 616-624. http://dx.doi.org/10.1111/j.1365-2648.2008.04899.x, PMid:19222659        [ Links ]

Humpel, N. & Caputi, P., 2001, 'Exploring the relationship between work stresses, years of experience and emotional competency using a sample of Australian mental health nurses', Journal of Psychiatric and Mental Health Nursing 8 399403. http://dx.doi.org/10.1046/j.1365-2850.2001.00409.x, PMid:11882159        [ Links ]

Jenkins, R. & Elliott, P., 2003, 'Stressors, burnout and social support', Journal of Advanced Nursing 48(6), 622-631. http://dx.doi.org/10.1111/j.1365-2648.2004.03240.x, PMid:15548253        [ Links ]

Kindy, D., Petersen, S. & Parkhust, D., 2005, 'Perilous work: Nurses' experiences in psychiatric units with high risks of assault', Archives of Psychiatric Nursing, 19(4), 169-175. http://dx.doi.org/10.1016/j~.apnu.2005.05.002, PMid:16088855        [ Links ]

Mackay, I., Paterson, B. & Cassels, C., 2005, 'Constant or special observation of inpatients presenting a risk of aggression or violence: Nurses' perception of the rules of engagement', Journal of Psychiatric and Mental Health Nursing, 12, 464-471. http://dx.doi.org/10.1111/j.1365-2850.2005.00867.x, PMid:16011502        [ Links ]

Moran, A., Cocoman, A., Scott, P.A., Matthews, A., Staniuliene, V. & Valimaki, M., 2009, 'Restrain and seclusion: A distressing treatment option?', Journal of Psychiatric and Mental Health Nursing, 16, 599-605. http://dx.doi.org/10.1111/j.13652850.2009.01419.x, PMid:19689553        [ Links ]

Munro, S. & Baker, J.A., 2007, 'Surveying the attitudes of acute mental health nurses', Journal of Psychiatric and Mental Health Nursing, 14, 196-202. http://dx.doi.org/10.1111/j.1365-2850.2007.01063.x, PMid:17352783        [ Links ]

Nijman, H., Bowers, L., Oud, N. & Jansen, G., 2005, 'Psychiatric nurses' experiences with inpatient aggression', Aggressive Behaviour, 31, 217-227. http://dx.doi.org/10.1002/ab.20038        [ Links ]

Nyati, Z. & Sebit, M.B., 2002, 'Burden of mental illness on family members, care-givers and the community', East African Medical Journal, 79(4), 206-209. http://dx.doi.org/10.4314/eamj.v79i4.8880, PMid:12625678        [ Links ]

Parahoo, K., 2006, Nursing research: Principles, process and issues, 2nd edn., Palgrave Macmillan, New York.         [ Links ]

Polit, D.F. & Beck, C.T., 2008, Nursing research: Generating and assessing evidence for nursing practice 8th edn., Lippincott, Williams & Wilkins, Philadelphia.         [ Links ]

Richards, D.A., Bee, P., Barkham, M., Gilbody, S.M., Cahill, J. & Glanville, J., 2006, 'The prevalence of nursing staff on adult acute psychiatric in-patient wards: A systematic review', Social Psychiatry and Epidemiology, 41, 34-43. http://dx.doi.org/10.1007/s00127-005-0998-7,PMid:16341829        [ Links ]

Robinson, J.I., Clements, K.L. & Land, C., 2003, 'Workplace stress among psychiatric nurses: Prevalence, distribution, correlates and predictors', Journal of Psychosocial Nursing, 41(4), 33-41.         [ Links ]

Sadock, B.J. & Sadock, V.A., 2007, Kaplan & Sadock's synopsis of psychiatry: Behavioural Sciences/Clinical Psychiatry, 10th edn., Lippincott & Wilkins, London.         [ Links ]

Soanes, C., Hawker, S. & Elliott, J, 2006, Oxford English Dictionary., 2006, 6th edn., Oxford, Oxford University Press.         [ Links ]

South African Government. Mental Health Care Act, No. 17 of 2002. Government Printer, Pretoria.         [ Links ]

Terre Blance, M. & Durrheim, K., 1999, Research in practice, University of Cape Town Press, Cape Town.         [ Links ]

Theodoridou, C., Bowers, L., Brennan, G., Gilbert, D. & Winship G., 2009, 'The measurement of psychotic acuity by nursing staff', Journal of Psychiatric and Mental Health Nursing, 16, 234-241.http://dx.doi.org/10.1111/j.13652850.2008.01338.x, PMid:19291151        [ Links ]

Uys, L. R. & Middleton, L., 2010, Mental health nursing: A South African perspective, 5th edn., Juta, Cape Town.         [ Links ]

University of Johannesburg, 2009, The Theory of Health Promotion, Department of Nursing Science Paradigm, University of Johannesburg, Auckland Park.         [ Links ]

Waldheter, E.J., Nicole, T., Johnson, E.R. & Penn, D.L., 2005, 'Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness', The Journal of Nervous and Mental Disease, 193(9), 609-618. http://dx.doi.org/10.1097/01.nmd.0000177788.25357.de, PMid:16131944        [ Links ]

Zauszniewski, J.A., 2009, 'Mentoring our next generation: Time to dance', Journal of Advanced Psychiatric Nursing, 22(3), 113-114.         [ Links ]

 

 

Correspondence:
Jacobs Ngako
P.O. BOX 1751, Silverton
0127, South Africa
Email: Kgalabi.ngako@mrc.ac.za

Received: 17 Aug. 2011
Accepted: 18 Dec. 2011
Published: 30 May 2012