Exploring nursing presence as an approach to prevent relapse of discharged mental health care users

Abstract

The aim of this study was to explore and describe primary healthcare nurses' (PHC nurses) perceptions of the factors that influence nursing presence as an approach to prevent the relapse of a discharged mental healthcare user. Relapse of mental healthcare users is one of the major contributing factors to the high burden of mental illness in South Africa. One of the standard components of a strategy to prevent relapse is good compliance to treatment by a mental healthcare user (MHCU) after being discharge from the psychiatric institution at an identified down-referral primary healthcare facility. The challenges that professional nurses in primary healthcare experience with respect to follow-up treatment include a high workload, lack of adequate time to cater for people with mental disorders, and a lack of support and supervision to undertake their tasks with confidence. Nursing presence should be considered an approach used by PHC nurses to build a trust relationship with the mental healthcare user to detect any signs and symptoms of relapse at an early stage so that they can mobilize appropriate resources and can design nursing interventions unique to the specific MHCU. However, no studies could be found specifically on nursing presence to limit the relapse of a discharged MHCU, and little is known about PHC nurses' perceptions of nursing presence with regard to limiting relapse of a discharged MHCU. Purpose: The purpose of the study was to explore and describe the perceptions of PHC nurses on nursing presence to prevent relapse of discharged MHCUs. Design and method: The research project followed a qualitative descriptive design. The population consisted of professional nurses from various PHC clinics in a district rendering mental healthcare services to discharged MHCUs. Participants were selected by means of purposive sampling with the assistance of a mediator in the person of the provincial mental healthcare coordinator. Four semi-structured focus group interviews were conducted to collect data. The sample size was determined by data saturation. Data were captured on a digital audio recorder and transcribed verbatim. The researcher and co-coder analysed the data independently and six main themes were identified after the researcher and the co-coder reached consensus. Results and conclusions: The main themes correlated with the attributes of nursing presence as defined by Finfgeld-Connet (2006:711).The sub-themes describe the participants' specific views on these attributes as they relate to preventing relapse of a MHCU. The conclusions that were reached are also applicable to the attributes of nursing presence namely: attentiveness and sensitivity, holism, intimacy, vulnerability, uniqueness, and limiting relapse. This study reveals that PHC nurses are willing to provide holistic care and to practice nursing presence to prevent relapse in discharged MHCUs, but so many challenges limit their efforts to do so. These challenges include a lack of resources, lack of training and running multiple programmes. This leads to burnout and eventually a 'don't care' attitude as a defence mechanism. It is also important to note that despite these challenges, some PHC nurses are really eager to learn more about mental health. They are willing to participate in any training on the topic of mental health despite workplace adversities and their perceived lack of support from their employer. Recommendations were formulated for nursing education, nursing research and nursing practices, focusing on supporting and empowering PHC nurses with respect to nursing presence to prevent the relapse of a discharged MHCU.