5.3 Themes and Sub-Themes
5.3.3 Theme 3: Challenges Experienced by Professional Nurses
5.3.3.2 Sub-Theme 2: Lack of Social Support
127 Another challenge is that one of shortage of staff. We also bathe patients as professional nurses because we don’t have enough nurses. We are not enough at all. Aniri, some of our patients are bedridden, we have to turn them time and again, so the other nurses cannot do it alone, we help them. (Participant 2, age 27, female).
The above extracts suggest that professional nurses encounter enormous challenges while providing care to patients with chronic mental illness. They provide care for patients. Nurses are expected to do more nursing, and non-related nursing duties because of the shortage of staff. They are expected to provide optimal care to patients with a low number of staff, which increases their stress levels and makes the caring duties not easy. Consequently, these nurses feel overwhelmed and tired, which ultimately has a negative impact on patient care. Based on the above extracts, it is clear that the shortage of staff is a massive problem in nursing practice.
128 they become stable, ready to go home but there is no custodian to receive them. The following excerpts exemplify this specific sub-theme:
Because in most cases we are not only dealing with the patient alone. We are also dealing with family rejections, ja, most of them are rejected by their families.
So, now is the thing of, a patient has been here and have not seen the family for a long time. Wena, you will do your part and give medication and stuff but at the end of the day they need support and be reunited with their families. (Participant 4, age 36, male).
Relatives, family of these patients are a problem. They don’t want to visit them;
they don’t care about them. (Participant 5, age 51, female).
The family is the one that gives us challenge because most of them they don’t want these patients. Some of them they qualify to get LOA, but they don’t want them. (Participant 14, age 40, female).
In addition, there are many patients in institutions who have being admitted for many years. They are mentally stable but there is no family member willing to take them home, which results in a shortage of space in the ward. These patients are occupying a space of someone who is mentally ill and needs assistance. This is supported by the following comments from participants:
Some over 30 years; some of them were here before I was even born (she laughs). (Participant 16, age 29, female).
We have many patients here who have not seen their relatives in many years.
Others maybe over 10 years. We call them but they don’t come. (Participant 5, age 51, female).
129 You may find that the patient has been admitted in the 1990s or vho 2000 and they didn’t even have a visitor. (Participant 11, age 56, female).
Most of these families reject the patients because of what they did prior to admission.
The PNs think the rejection emanates from the kind of offences the patients have committed. Maybe the families are afraid of their loved ones. See the extracts below:
Cases like murder, rape all those kinds of cases. So, if ever he has murdered his own father or someone within the family, they are scared of him. So is very difficult to accept him back. (Participant 20, age 28, male).
The challenges here that we have is the problem of relatives sometimes. Some of the relatives reject those patients. I think they are afraid of what they have done, eeee. They reject them; even if we do home visits, some of them don’t want to be with the patients. (Participant 11, age 56, female).
Some patients are rejected by their families. We will want to discharge the patient, the patient is fine and he can go home but when we call the family, they don’t want him. Others can even tell us that they don’t want him. (Participant 6, age 35, male).
5.3.3.2.2 Community Rejection
The findings of this study indicate community rejection as another challenge for PNs.
PNs interviewed in this study stated that most community members tend to reject patients with chronic mental illness. Like family rejection, community rejection is sometimes caused by fear and anger towards patients with chronic mental illness. The community display fear and anger towards these patients owing to the crimes they committed before their admission to a mental health institution. Consciously or subconsciously, these community members still think these patients are capable of committing the same offence and even worse offences. This is congruent with the excerpts below:
130 Some have been here for 20 years, others 15 years or 10 years. It all depends on the families if they want them or not. Remember our communities don’t accept that they have mental illness.
(Participant 8, age 35, female).
There are those the community no longer wants; so, they just have to remain here; they will not be going home. (Participant 7, age 29, female).
And some we can see that these are stable but due to family rejection and community rejection, some are rejected by the community, they don’t want them back based on what they did prior coming here. (Participant 20, age 28, male).
Looking at the above extracts, lack of social support is a serious challenge for nurses.
Most families and relatives are not supporting patients. They often distance themselves from them and expect the nurses to be the only ones rendering social support to patients. Family and community health awareness projects should be made a priority to alleviate the stigma around mental illness.