Abstract
M.Cur.
Community mental health nurses working in mental health units attached to
general health facilities, like all trained psychiatric care providers in the mental
health care services, have hopes and expectations about a well-running
decentralised and integrated mental health care service. Their hopes and
expectations will be seen to have been realised when general health care
workers at all levels, cooperate and show a positive attitude towards mental
health and mental health services by being involved in mental health services.
Unfortunately the situation is probably the opposite, such that a number of
community mental health nurses have left mental health services since the
beginning of integration, to join other health sectors or other institutions. They
probably could not cope with the decentralization and integration of mental health
services into the general health care delivery system. This led to the researcher
developing an interest to undertake a research study on the community mental
health nurses' experience of decentralised and integrated psychiatric-mental
health care services. A qualitative, exploratory, descriptive and contextual research design was
undertaken to find out what the community mental health nurses are
experiencing due to decentralization and integration of the psychiatric-mental
health care services into the general health care delivery system.
Permission was obtained from the gatekeepers. A pilot phenomenological
interview was conducted with a community mental health nurse who met the
selection criteria, to test and refine the interview question. The
phenomenological in-depth interviews were conducted with twelve community
mental health nurses who were purposively selected. Ethical measures were
adhered to. Steps were taken to ensure trustworthiness of results. Data were
analysed following methods suggested by Tesch (in Creswell, 1994:155).
Follow-up interviews were conducted with one group of community mental health
nurses. A literature control was undertaken to compare the findings.
The results demonstrated that community mental health nurses working in
mental health units attached to general health facilities are frustrated,
discouraged, disappointed, unhappy, demoralised, have lost interest in mental
health work and confused, because of uncooperativeness, lack of being
appreciated, lack of interest, lack of support, rejection of mental health
responsibility and generally a negative attitude of general health care workers
(general nurse, medical practitioner, nursing management, immediate
supervisors, administrators and higher authorities) towards mental health, mental
health services and personnel.
Guidelines for the advanced psychiatric nurse to assist community mental health
nurses to cope with decentralization and integration of psychiatric-mental health
care services have been described. The recommendation and application of the
results of the research in nursing practice, nursing education and nursing
research have been highlighted. Community mental health nurses working in the decentralised and integrated
mental health care services need support from advanced psychiatric nurses in
order to facilitate the promotion, maintenance and restoration of their mental
health as an integral part of health. This will influence their ability to facilitate the
promotion of patients' health.