As stated earlier, nurses are essential in the treatment of patients with mental illnesses.
All nations' comprehensive plans for mental health need to acknowledge its role and include it. In order to design policy, plans, laws, and service programs, nurses should be fully involved. The nurses who took part in this study grumbled about the hospital administration's lack of support. This result is in line with Sherring and Knight's (2009) results, which highlight the fact that nurses who felt underappreciated and unsupported lost motivation and experienced burnout.
Social support is characterized as interdependent relationships and ties that help people cope with challenging circumstances in their lives. Social support mitigates the negative impacts of job demands, lessens feelings of weariness, and lessens the severity of these stress elements. Poor social support is one of the major workplace characteristics linked to psychiatric diseases and employee absenteeism in the United Kingdom,
46 according to Michie and Williams' 2003 study. According to a study by Mohadien (2008), 50% of nurses reported feeling underappreciated and that their extra efforts in a dangerous workplace went unrecognized. To bolster this claim of a lack of support from hospital authorities, one participant stated that there were no debriefing sessions in place to assist staff members who had been traumatized as a result of a patient assault.
Another female participant stated that she received adequate support from her coworkers after being assaulted by a female patient (Sobekwa & Arunachallam, 2015).
Considering the challenges mentioned in this study, it is evident that PNs need support programmes. Several studies have come up with support progrmmes that will ease the caring burden. In addition, support programmes such as mentorship programmes, peer support, stress management, group supervision and debriefing are crucial to ease the caring burden of nurses. According to Arvidsson et al. (2000), group supervision in nursing care influences their professional competence. They go on to say that the goal of group supervision in nursing care is to comprehend nurses' experiences in real-world care settings and structure them in a professional and personal context.
Mentorship programmes are recommended by Block et al. (2005) as a way of enhancing nursing satisfaction that ultimately improves patient recovery. A programme called Resilience in Stressful Events (RISE) was created at the Johns Hopkins Hospital in Baltimore, USA, with the aim of providing support for nurses who experience emotional distress (Edrees et al., 2016). According to Foster et al (2018)'s research, nurses can gain from resilience education that gives them the cognitive, emotion regulation, and relational skills they need to handle challenges at work. This education should be combined with any accessible external supports and resources. The findings of this study were that many staff had encountered a shocking adverse incident, and preferred support from their peers. Peer support is also perceived as one of the most effective programmes for primary care nurses.
According to Hasan (2017), a stress management approaches programme is particularly successful in helping psychiatric nurses deal with work-related stress that could have a negative impact on their well-being. Moreover, this programme helps them to employ more effective problem-solving coping strategies. With the main goal of
47 reducing work-related causes of stress, Madu and Mamomane (2003) advise that there should be stress management programs, training on coping mechanisms, and the creation and execution of techniques for the enhancement of work circumstances and the surroundings for nurses in the remote regions.
There are studies that recommend support programmes for nurses. Land and Hudson (2002) reveal that the provision and implementation of detailed workplace support programmes is needed for nurses. A research by Mavundla (2000) on professional nurses' perspectives of caring for mentally ill patients in a general hospital setting makes recommendations for improving nurses' knowledge and abilities as well as providing them with counseling for emotional support. It was advised that departmental managers provide regular emotional assistance to their staff in relation to issues encountered in their departments. In addition, support groups can also be helpful as nurses are able to express and ventilate their emotions.
Participants in a study conducted by Ngako et al. (2012) requested organizational support in the form of emotional support for staff via debriefing or verbal acknowledgement that they had done a good job. Furthermore, participants stated that they needed mentoring because they believed they lacked the necessary knowledge and skills to work with MHCUs. Emotional exhaustion and social support may play an important role in mediating the relationship between job stress and depression and anxiety. Strategies such as reducing emotional exhaustion, increasing social support in the workplace, and reducing job stressors would be beneficial in preventing depression and anxiety among young nurses.
Participants in a study by Chen et al. described the need for emotional support from management in the form of debriefing (2005). According to one participant, emotional support would help professional nurses maintain their mental health: The necessity for treatment to assist them deal with the difficulties of dealing with MHCUs was also mentioned by participants: Chen et al. back up the requirement for psychological assistance for PNs (2005). According to Chen et al. (2005), debriefing, a sort of psychological support, will help PNs deal with violent occurrences when dealing with MHCUs.
48 According to Sobekwa and Arunachallam (2015), given that nurses perceive the acute admission wards to be strenuous and demanding, with a heavy workloads that results in some nurses experiencing symptoms of emotional exhaustion and burnout, there is a clear need to implement debriefing consultations for nursing staff. This is critical because they work in such difficult settings with a difficult patient population. After reviewing the literature on personal resilience in nursing, Jackson et al. (2007) recommend that resilience in nurses be strengthened through strategies and mentorship programs. These programs should strive to foster positive and nurturing professional relationships, as well as to promote positivity, emotional insight, life balance, spirituality, and personal reflection (Lu et al., 2015).
The religious and humanitarian roots of the profession demonstrate that religion and spirituality have always been significant in nursing practice (Carson, 1989). Many individuals place a high value on religion, and the nursing literature is full with statements about how crucial it is for nurses to attend to their patients' spiritual needs (Greenstreet, 1999; Baldacchino & Draper, 2001). Previous studies in Uganda have discovered that nurses try to deal with issues at work by transferring care to carers, relying on social support, and practicing their faith (Harrowing & Mill, 2010; Nderitu, 2010). Worldwide, nurses use several adaptive coping mechanisms such social support, self-care, counseling, and religion / spirituality (Ablett & Jones, 2007; Glass &
Rose, 2008; Shinbara & Olson, 2010). Additionally, the literature on coping and self- care for professionals emphasizes the importance of nurses taking care of their own physical, mental, spiritual, and social wellbeing (van den Tooren & De Jonge, 2008).
Ugandan nurses providing universal healthcare have described faith in God as a coping method (Nderitu, 2010). Without elaborating on the various ways in which this faith is detailed in order to deal with work obstacles, he continued by citing that faith in God was highlighted as a means of coping. Religiosity has reportedly been shown to play a protective function in Swedish oncology nurses, enhancing ability to cope at work (Ekedahl & Wengstrom, 2010). In the United States, it has been demonstrated that spirituality is advantageous to nurses' daily life and helps them deal with bereavement (Shinbara & Olson, 2010). Religious meaning may be essential in dealing with stressful
49 situations as the foundation for one's aims and values (Park, 2013). It has an impact on how stressors are perceived and the types of coping mechanisms employed to lessen their consequences. The advantages of religious coping with stress in the face of life's problems have been demonstrated through stress studies conducted worldwide. (Hodge
& Roby, 2010; Koenig, 2009) 2.8 Concluding Remarks
Chapter 2 reviewed literature regarding the history of mental health care delivery, the nature of chronic mental illness, phenomenological experiences of professional nurses, demands, challenges associated with caring for institutionalised mentally ill patients, nurses’ coping strategies and lastly, nurses’ support structures and programmes. In the following chapter, the researcher presents the theoretical framework utilised in the study.
CHAPTER THREE THEORETICAL FRAMEWORK 3.1 Introduction
According to Lederman and Lederman (2015) a theoretical framework comprises the theory created to project, explain, and understand phenomena and, in many cases, to critique and broaden existing knowledge within the boundaries of critically bound preconceptions. A theoretical framework is the beginning of conceptualisation at the foundation of a research study, which integrate certain beliefs and ideas that are linked to the phenomena being studied (du Plooy-Colliers et al., 2014). A practice-oriented theoretical framework was used to guide and direct this study. The researcher adopted the practice-oriented theory of Dickoff et al. (1968) as a lens through which to develop a support programme for nurses caring for patients with chronic mental illness.