2.5 Demands and Challenges Associated with Caring for Institutionalised Mentally Ill Patients
2.5.1 Shortage of Staff
Joubert and Bhagwan (2018) found that nurses are globally confronted by huge difficulties and significant challenges. A study by Chikudu (2016) reveals that the nursing profession currently suffers a globally severe shortage. He further mentions that the shortage of professional nurses continues to be a huge problem for both public and private mental ihealth institutions worldwide and that South Africa is included in this difficulty. This is consistent with the current study, which reveals the shortage of staff as a serious problem in the three MHIs. The WHO estimates that there is a shortfall of over 43 million nurses, midwives, doctors, and other healthcare workers. The quality and sustainability of health systems globally are threatened by a global shortage of these medical experts, according to Aluttis et al. (2014). Zarea et al. (2012) agree, saying that the shortage of staff has been found to be a challenge amongst psychiatric nurses. The same opinion is held by Ngako et al. (2012), who also point out that there is a severe shortage of nursing staff in acute mental hospitals, which makes it difficult for nurses to care for patients who are severely sick.
According to the South African National Council (2013), as cited in Van Graan et al.
(2016), the current proportion of nurse to patient is enough proof that there are
25 shortages of nurses. Currently, nurses are overburdened as there are ordinary too many patients per nurse. The problem intensifies when nurses are unavailable from work, or are on lengthy leave such as maternity leave (SANC, 2013). Shortage of personnel is a hurtful reality to psychiatric nursing. According to Zarea et al. (2012), some nurses are often pressurised by their management to work within the psychiatric units against their will owing to low personnel numbers. Sometimes nurses use aggressive behaviour towards the patients with the aim of pushing them away so that they are able to do the other duties that have to be done. A study by Bimenyimana et al.
(2009) found that shortage of personnel, inadequate management support, a lack of cooperation from multidisciplinary team members, and a lack of systematic and thorough orientation.
A study by Marie et al. (2017) reports that shortage of staff is a challenge to healthcare professionals and results in overworked nurses. Personnel shortages have resulted in high workloads for mental health nurses, and while there is a nurse’s shortage in all areas of nursing, there is a severe shortage of nurses in the psychiatric setting. (Zarea et al., 2012). They also state that shortage of personnel usually led to strenuous workloads for psychiatric nurses. In addition, increased staff turnover, personnel absenteeism, and the performance of non-nursing duties also led to high workload.
According to Bimenyimana et al. (2009), the lack of personnel causes exhaustion amongst mental health nurses which, in turn, results in fatigue and job displeasure.
Gradually, these nurses become dismayed and resort to not going to work as a way of being heard. This predicament farther and farther diminishes the already overworked staff, causing more fear and tension for those on duty (Bimenyimana et al., 2009).
Longer, more frequent, and more intense patient contact, using oneself, and susceptibility to stress all contribute to fatigue, which is the end result of a progressive and accumulative process.
Booyens et al. (2015) claim that, with the assistance of rehabilitative professional therapists in the healthcare system, healthcare workers make up the majority of the front-line and referral health teams in South Africa. All types of healthcare workers, particularly doctors, but also paramedics, dentists, nurses, physiotherapists, and
26 occupational therapists, are in serious short supply in South Africa. Additionally, South Africa faces an 80,000-professional shortfall in the field of healthcare, which creates significant obstacles for the provision of high-quality healthcare in the state services.
Due to a staffing shortfall, new categories of healthcare workers, such as clinical associates, have been established (Booyens et al., 2015).
The scarcity of pharmacists makes it difficult for nurses to provide care (Larson, 2006).
Medication delivery can be hampered when there is a shortage of pharmacists.
Furthermore, due to a shortage of pharmacists to meet the needs of a hospital, nurses may have to wait longer to collect and administer medication to their patients. Larson (2006) goes on to say that when other staff members are unavailable, nurses may be called upon to help out. This can slow down the delivery of patient care and may contribute to the already growing discontentment that several nurses are articulating about their working conditions (Larson, 2006). Hlongwa and Sibiya (2019) agree, adding that many clinics cited a lack of staff, particularly psychiatric nurses, psychiatrists, and advanced psychiatric nurses, as the main impediment to integrating mental health care into primary care. They also state that there is no residential psychiatrist in any clinic, that a psychiatrist only visits once a week, and that a general practitioner sees all patients, including those in MHCUs.
Vergunst (2018) highlights the unequal distribution of mental health human resources between rural and urban sectors in South Africa. For example, there are 3.6 times as many psychiatrists in or around the largest city as there are in the entire nation. It is unknown how many mental health nurses work in rural and urban hospitals. In South Africa, it is typical for rural areas to lack psychiatrists and psychologists, therefore medical professionals, occupational therapists, and nurses are typically the primary providers of mental health therapies. Typically, patients are directed to the nearest city, which can present transportation challenges for those in need of a psychologist or psychiatrist (Vergunst, 2018). According to Ngako et al. (2012), staff shortages make it difficult to provide MHCUs with essentials like careful monitoring and emotional support.
According to Booyens and Bezuidenhout (2014), staff shortages can be attributed to the following factors: pension, resignation, a desire for new adventures, a higher level of job
27 discontentment, and outstanding job offers in terms of rewards or good salaries.
According to Chikudu (2016), the main motivation for staffing shortages is financial independence; many nurses suffer financially. A large number of nurses are in debt and are compelled to perform extra shifts to supplement their already pitiful pay (Mokoena, 2017). Salary disparities between people with similar qualifications and job experience working for different hospitals are enormous and unjust. Chikudu (2016) found that the majority of nurses also leave because of high levels of crime. He adds that unsatisfactory working circumstances are a further factor in nurses leaving their existing positions to work in other industries. Additionally, it is challenging for nurses to feel enthusiastic and motivated about their work because of the lengthy and uncomfortable work hours.
According to research, the lack of employees is a contributing factor to absenteeism and burnout (Garcia et al., 2015). There are many people that miss work for various reasons. Singh (2012) asserts that there are three general categories into which absenteeism can be divided: authorised absenteeism, unexcused absenteeism, and absenteeism due to illness. Unauthorised absence is any absence that is not included in sickness absence or approved absence; it occurs when an explanation is not supplied for the absence or when the employer does not approve the excuse. Sickness absenteeism is when an employee appears to be absent due to illness. According to Nyathi and Jooste (2008), absenteeism causes a high workload for nurses who fill in for colleagues who are absent, which can lead to a lack of motivation among nurses and a reduction in the quality of patient care. Furthermore, personal and organisational factors, as well as managerial and working conditions, can all contribute to workplace absenteeism.
They go on to say that nursing leaders may face difficulties in modifying timetables and redistributing nursing services of those who are not present to nurses who are present to ensure patient care in the facility continues. Absenteeism may be directly related to work challenges, reflecting on the quality and productivity of the nursing profession as well as its personal life. Absenteeism has become a source of concern for organisations, and it has a negative impact on nursing as a profession as it reflects on
28 the quality of care. The absenteeism among nurses disrupts teamwork and impart the quality of patient healthcare (Huber, 2008).
Burnout is a prevalent psychological phenomenon among nurses. Burnout is associated with exhaustion, frustration, anger, and depressive symptoms (Maila, 2019). Burnout is defined as regular exposure to an stressful, emotional, stressful, and maladaptive occupational conditions, by which challenging and interesting duties turn into depressing and pointless ones (Khamisa et al., 2015). Burnout is seen as global phenomenon and influences people working in different professions (Moodley, 2010).
Healthcare professionals in psychiatry are more likely than any other professionals to experience burnout, according to Garcia et al. (2015). Sadly, this has a negative effect on their productivity and results. According to Bimenyimana et al. (2009), burnout has negative effects on the entire facility as well as the mental nurses that work there.