Perceptions of nurses at a public mental healthcare establishment in the North West Province on factors limiting presence

Abstract

Healthcare establishments in South Africa place emphasis on the improvement of quality of healthcare through improving caring attitudes. Presence is a way through which caring attitudes and values can be experienced. Presence is when nurses holistically avail themselves to patients. Such an approach creates inner healing and promotes quality of life. Presence helps nurses to gain self-awareness, improve their well-being, apply their unique strengths in caring for patients, and bring about healing. However, certain factors exist that limit presence, especially in mental healthcare establishments. The purpose of this study was to address the knowledge gap regarding factors that limit the presence of nurses working in a mental healthcare establishment through exploring and describing the perceptions of nurses working in a public mental healthcare establishment in the North West Province on factors limiting presence. In order to achieve the purpose, the research project followed a qualitative descriptive inquiry design by means of individual semi-structured interviews which were audio-recorded to explore the perceptions of nurses working at a public mental healthcare establishment. A purposive sampling method was used and the sample consisted of ten nurses: n=2 auxiliary nurses and n=8 professional nurses, with different work experience and qualifications. They were purposively selected from a population of N=58 nurses. The researcher personally transcribed each semi-structured interview recording verbatim. Field notes were taken directly after each interview. Both the co-coder and the researcher analysed the transcribed interviews using content analysis. Strategies for trustworthiness were followed by applying the principles of credibility, dependability, confirmability, and transferability. The researcher also adhered to different international and national health research ethics guidelines to ensure and maintain integrity throughout the process of research study. Meaningful findings emerged during data analysis. These findings describe the views, understanding and opinions of nurses working at a mental healthcare establishment in the North West Province of how they perceive mental healthcare users, and of circumstances, facts and influences that limit, restrict and hinder them to know the mental healthcare users, to know their needs and to provide good care. Perceptions on their own needs in relation to providing good care are also described. These findings could be grouped into the following three themes: perceptions of mental healthcare users, how to get to know the mental healthcare users, and providing good care to mental healthcare users. These three themes, with eight sub-themes are discussed and are supported by relevant data obtained from literature and direct quotes from data. The descriptions provided a deeper understanding of the perceptions of nurses at a public mental healthcare establishment in the North West Province on factors limiting presence in this context. The conclusions of the study on the perceptions of nurses in the public mental healthcare establishment in the North West Province of factors limiting presence further guided the formulation of recommendations for nursing practice, education, and research. The conclusions are that presence is limited due to nurses’ inner conflict, namely their view of mental healthcare users as dangerous and unpredictable leading to a need to maintain a distance from the mental healthcare users for their safety, in contrast with their wish to maintain caring relationships with mental healthcare users and being advocates for them. Presence is furthermore limited when nurses, to ‘get to know’ mental healthcare users, are focused on obtaining ‘information about’ the mental healthcare users. Additionally, circumstances such as language barriers, lack of trust, distorted cognition in the mental healthcare user and staff shortages are seen as factors that limit ‘getting to know’ mental healthcare users. Good care is perceived to be providing in the basic needs of mental healthcare users. Environmental difficulties are perceived to limit good care and are experienced as demotivating, and nurses are in need of support and encouragement. Also, a need is identified that nurses be equipped to provide good care through presence, which involves connecting, knowing self and others, overcoming ‘distance’, and negotiating for the needs of others and themselves. Nurses need to be prepared to negotiate for their own needs to be met and to focus their attention on the needs of the patients through communication and building a trusting relationship with mental healthcare users.