Another theme that the current study identified is the coping strategies that PNs use to cope with the caring burden. Roets et al. (2018) claim that psychiatric nurses used a variety of stress-reduction techniques. Some of the coping mechanisms employed by these nurses include effective time management, prearranged team meetings, support systems, and improved communication routes both within and between professional specialties and sections. This study discovered that PNs apply both maladaptive (negative) and adaptive (positive) coping mechanisms to manage their caring burden.
The coping mechanisms that these PNs use are prayer, faith or belief in God, teamwork, self-counselling, and absenteeism. The findings of this study revealed that most of the PNs seem to use positive coping mechanisms to deal with their caring duties and responsibilities. These positive coping mechanisms are prayer, faith or belief
172 in God, teamwork, and self-counselling. Absenteeism was the only negative coping mechanism that a few PNs reported using to cope with their caring burden. All the coping mechanisms that the PNs presented with are outlined underneath.
6.5.1 Prayer
The PNs participating in this study reported using prayer as a way of coping with their caring duties and their problems. Most of PNs use prayer to cope with the challenges that they come across because they are Christian. Prayer has been found to be a commonly used coping mechanism in most Christian PNs. Consistent with the findings of this study, Koen et al. (2011) discovered that healthy lifestyle and spirituality are coping mechanisms used by nurses. Nurses use their inner strength and spiritual resources to deal with their fears, uncertainties, and inquiries, according to Monareng (2012). Others even go to the extent of praying with their family members to manage and solve their problems.
6.5.2 Faith in God
Believing in God was also discovered to be one of the coping mechanisms that PNs used in the current study. The participant’s faith in God served assisted the nurses to accept their circumstances, and simultaneously giving a source of meaning in life.
Numerous researchers agreed with this concept that nurses practising a religion, spirituality and faith have greater coping abilities (Cameron & Brownie 2010; Zander et al, 2010; Zheng et al. 2017). The participants said that they found the strength and capacity to deal while at work through religious activities such as personal prayer and meditation, as well as group prayer with other nurses. All the nurses participated in this study were actively religious people, at the time of the interview. All of these nurses mentioned that religious standards influenced their performance in a positive manner, enabling them to find meaning amid catastrophe. Faith in God was also found to be one of the coping mechanisms utilised by the PNs interviewed in this study. These nurses believe strongly that their faith in God assists them to cope well with their caring burden.
The PNs revealed that they get their strength to care for patients with chronic mental illness from God.
173 6.5.3 Teamwork
One of the other adaptive coping strategies that PNs in these three mental health institutions use is teamwork. A large number of PNs emphasised that working as a team was important to support them in making patient related decisions and assisting them manage their problems. These PNs are of the opinion that working together, or unity, is power. Furthermore, they indicated that having a good working relationship with colleagues helps them to offer good care to patients. Since they have a good working relationship with each other, they are able to cover and stand in for each other when a need arises. Ramalisa et al. (2018) share the same view by indicating that teamwork between colleagues, multidisciplinary members, and supervisors improved participant’s resilience. They further indicated that working as a team provided them the bravery to share cases with managers and boosted their morale. Social support from colleagues was seen a positive attitude in these PNs, which included habit of going to others for communication, advice and comfort.
For nurses and healthcare professionals, the literature review chapter has identified a variety of social support systems. Both at home and at work, specifically from family members, spouses, and friends, were sources of social support. Support at work came from supervisors, colleagues, and coworkers. Support comes from a family, a personal support system, other coworkers, and an organization, according to Ramalisa et al.
(2018). The organisation's and coworkers' support is essential to the direct delivery of treatment since poor collaboration can compromise patient care. Amarneh et al. (2010) looked into how Jordanian hospital nurses' job performance was affected by social support from their coworkers. The study's conclusions showed that perceived social support from coworkers increased job performance, lowered working stress, and increased commitment to one's employment.
6.5.4 Self-Counselling
Self-counselling was highlighted as another adaptive coping mechanism used by PNs to maintain their psychological health while rendering professional service. Since they have studied basic psychological counselling as part of their modules, they decided to use what they had learnt and to counsel themselves when they have problems. These
174 PNs also mentioned that the other reason for self-counselling is that the psychological services in these hospitals are mainly for patients, not for staff. The reasons for not seeking psychological services are unavailability of psychological practitioners, fear of discussing their personal issues with a colleague, and poor relationships between the nursing and psychology department. This concept of self-counselling was adopted as a coping strategy by nurses after realising and accepting their work challenges.
6.5.5 Adaptation
Adaptation has been discovered as one of the methods that PNs use to cope with their caring burden. Adaptation is defined as the human ability to adapt to different situations.
Lints (2012) agrees by stating that in generally, adaptation as a process is possibly about changing something can be itself, others, the sounding so that it would be extra convenient for certain reason than it would have otherwise been. Furthermore in psychology, adaptation is interested in how people mentally cope with different life changes. From the feedback given by nurses interviewed in this study, some nurses adapt to the situation, in this case the caring burden, as a coping mechanism. This coping mechanism is often used after acceptance of the situation. According to these PNs, after realising that they cannot fix most of their challenges, they decided to adapt to the situation.
6.5.6 Absenteeism
The results of the current investigation also showed that employee weariness and absenteeism were caused by a staffing shortfall. According to a study by Garcia et al., this is accurate (2015). There are many people that miss work for a variety of reasons.
According to Singh (2012), absenteeism has been seen to predominate among PNs working with chronic mentally ill patients. Nurses use absenteeism as a way of coping with work demands. PNs reported being tired because they are working too much, which results in absenteeism. Many of them mentioned that they take sick leave and do not go to work as a way of coping with their caring burden. According to the nurses, this negative coping mechanism is perpetuated by the shortage of staff and by financial problems that are prevalent in these institutions.
175 6.6 Support Structures and Programmes Available to PNs
Another theme of the current study is support structures and programmes available to assist the nurses with their caring duties and responsibilities. The researcher found it essential to determine the support structures and programme for nurses in order to develop a support programme for them if none was available. The reason for this inclusion is to check whether nurses have support structures and how effective those structures are before developing a support programme. The responses gathered in this study revealed that not all institutions and wards have support structures and programmes. The majority of the PNs from the three MHIs indicated that they do not have formal and functional support structures and programmes. The support structures and programmes available in these institutions are mostly for patients, not for nurses.
In addition, PNs indicated that they do not have support from most multidisciplinary team members (MDT). Procedurally, patients with chronic mental illness were supposed to consult with 90 per cent of the MDT members but in these institutions it is not like that. In these institutions, nurses and doctors are the ones who are consistently consulting with patients and caring for them. Consequently, patients end up not receiving holistic treatment. PNs stated that the involvement of other MDT personnel is crucial to optimal patient care and overall treatment.
However, a minority of PNs reported having some form of support structures in place for nurses. These support structures include union forums, support visits from their supervisors, and other nursing-related meetings. All these support structures are aimed at addressing the challenges that PNs experience while caring for patients with chronic mental illness. It is like a venting session of some sort. These meetings are usually held once a month. The target group is all the nurses with their operational managers and matrons. Sadly, the result of this study revealed that a large number of PNs participating in the present study do not have functional formal support structures and programmes, which necessitates the development of a support programme. Functional support structures and programmes are a must-have and are critical in that they will allow the nurses to share their experiences and to find healthy ways of coping with their caring
176 duties and responsibilities. The PNs recommended the following support programme to assist with their caring duties and responsibilities.