Guidelines to enhance patient centred care for mental health care users in community psychiatric clinics in uMgungundlovu District, KwaZulu-Natal

Abstract

The implementation of the Mental Health Policy Framework and Strategic Plan 2013-2020 promotes the integration of mental health into the general health care stream, intending to reduce the stigma and discrimination associated with mental health disorders. The policy on the integration of services suggests a more holistic and patient-centred approach to nursing mental health care users (MHCUs) in community psychiatric clinics. A substantial amount of research has been done on the integration of services and patient-centred care (PCC) in South Africa. No studies have been found that were conducted specifically with professional nurses and the provision of guidelines on enhancing PCC for MHCUs in the community psychiatric settings taking into consideration the integration of services. Aim The aim of the study was to identify the extent to which mental health has been integrated into the general health stream and ultimately develop guidelines to enhance patient - centred care for MHCUs in community psychiatric clinics in the uMgungundlovu District, KwaZulu Natal (KZN). Methodology A convergent parallel mixed-methods approach was used in the current study. The professional nurses and operational managers who met the inclusion criteria were purposely included in the sample. Data collection was achieved through three phases, namely; by observation using an observation checklist, surveys in the form of individually structured questionnaires and one -on - one interviews guided by a list of pre-set questions. Data from phases one and two were analysed using the Statistical Package for Social Sciences (SPSS) Software Version 25. Descriptive statistics were used to summarise and describe the analysed data and the findings were also presented in the form of tables and graphs. Inferential statistics were applied to identify significant trends. Data from the one-on-one interviews were coded and analysed until relevant themes and sub-themes were realised. Findings Professional nurses reported that the integration of services was in line with the prescripts of the ideal clinic. The policy on the integration of services was implemented although professional nurses expressed that it was not effective due to MHCUs temperament. Professional nurses that were in direct contact with MHCUs daily tried to give off their best to MHCUs and practice PCC. They reported that open communication, teamwork, appropriate nurse-patient relationships, adequate and updated in-service on PCC were essential components in the delivery of PCC. However professional nurses also faced barriers that prevented the successful implementation of PCC; namely: staff shortages, time constraints, and large numbers of patients, impatient patients and inexperienced nurses. The findings of all three phases were triangulated with the integration of the Neuman’s Systems model which guided this study to assist in the development of the proposed guidelines to enhance PCC.