Daily experiences of non‐psychiatric nurses in acute psychiatric wards

Abstract

Aim

To explore and describe the daily experiences of non‐psychiatric nurses working in selected acute psychiatric wards in South Africa.

Design

A qualitative explorative and descriptive study design was used.

Methods

Individual face‐to‐face semi‐structured interviews were used to gather data from fifteen non‐psychiatric nurses with a minimum of one month of experience working in acute psychiatric wards in Limpopo Province, South Africa. Data were analysed using eight Tech techniques. The study is reported following consolidation criteria for reporting qualitative research.

Results

Findings on non‐psychiatric nurses' daily experience revealed three themes: (1) Unsafe working environment, (2) Managing difficulties due to lack of skills and (3) Strategies to support non‐psychiatric nurses in acute psychiatric wards.

Findings suggested institutional and managerial interventions in the form of orientation, in‐service training and workshops and resource provision. Future studies should be done to develop a model for supporting non‐psychiatric nurses in Limpopo Province, South Africa's acute psychiatric wards.

1. INTRODUCTION

In several hospitals, non‐psychiatric nurses (i.e., registered general nurses (RN), registered staff nurses (RSN) and registered auxiliary nurses (RAN)) find themselves allocated in acute psychiatric wards caring for people with mental disorders. These circumstances are common across various regions. Non‐psychiatric nurses are nurses registered by SANC under section 31(1) of Nursing Act No 33 of 2005 who are not psychiatrically trained and who practice nursing according to their scope of practice in R786 as stipulated by SANC under section 58(1) (a) on Nursing Act, 2005 of 2005, as amended (South African Nursing Council (SANC), 2005). They lack academic training on mental disorders and skills to render care treatment and rehabilitation to MHCUs in acute psychiatric wards. Non‐psychiatric nurses should be sufficiently acquainted with mental disorders and the medication that is prescribed. For them to be able to manage MHCUs in acute psychiatric units, they needed to demonstrate clinical mental health nursing skills.

It was discovered that non‐psychiatric nurses struggle to provide care to people with mental disorders as they are not qualified. They lack communication skills, preventive strategies for suicide and strategies to prevent potential violence and aggression, which are standards for psychiatric nurses. The inability to identify the risk of possible aggression and lack of therapeutic communication skills by non‐psychiatric nurses leads to delays in effective treatment, decreased quality of care and potentially poorer health outcomes for persons with mental disorders (Harwood, 2017).

In turn, providing high‐quality healthcare depends on the availability of qualified and devoted healthcare workers, particularly nurses. The majority of healthcare professionals at psychiatric facilities are nurses. The primary objectives of nursing care in these institutions are to offer people high‐quality care that will speed up their recovery and support their return to their everyday lives. As a result, high‐quality nursing care services in psychiatric wards may speed up people' recovery to everyday life. However, there aren't enough nurses to give mental care. According to the World Health Organization, there was one psychiatrist per 200,000 people in psychiatric settings in 2016. This indicates a chronic scarcity of health professionals who can provide mental healthcare (Samari et al., 2019).

It is crucial to understand their viewpoints to completely comprehend non‐psychiatrically nurses' daily experiences in the clinical setting. This will give rise to the development of a model to support non‐psychiatric nurses in acute psychiatric wards. For instance, non‐psychiatric nurses experienced difficulties due to a shortage of resources, with an ineffective managerial approach leading to emotional exhaustion, negative attitude towards the profession, decreased and poor‐quality care, high staff turnover and early retirement among nurses (Ghavidel et al., 2019). Still, non‐psychiatric nurses experience stress, feel unsafe and face difficulties managing people with mental disorders (Netshakhuma, 2016). This study focused on the daily experiences of non‐psychiatric nurses rendering care to mental healthcare users (MHCUs) in acute psychiatric wards.

1.1. Background

The experiences of non‐psychiatric nurses are explained as stressful when caring for people with mental health problems in acute psychiatric wards. Mental health problems are prevalent globally. Around one in eight people worldwide suffer from a mental illness. With age and sex, distinct mental issues are more or less familiar. Anxiety disorders and depressive disorders are the most prevalent in men and women. One in every 6 years living with a disability (YLD) worldwide is caused by mental disorders, which are the leading cause of YLDs. Also highly underserved are conditions related to mental health. Important information and research, governance, resource and service shortages and inequities are present throughout the world's mental health systems (World Health Organization (WHO), 2022).

Mental disorders are the third leading cause of disease burden in South Africa. The burden of mental problems is important, and it is anticipated that the epidemiological transition to chronic and noncommunicable diseases may increase. Mental disorders rank third in contribution to the burden of diseases in South Africa. Approximately 1 in 6 South Africans are likely to experience a mental disorder such as depression, anxiety, or a substance use disorder (Pillay & Barnes, 2020). Treatment and care of mental‐related disorders are provided in different settings. There are three primary settings: hospital inpatient, residential and outpatient (Halter, 2014). People with mental disorders are admitted to an acute psychiatric ward for nursing care, treatment and rehabilitation according to the Mental Health Care Act 17 of 2002.

Nurses of all categories are allocated in acute psychiatric wards to manage (MHCUs), that is, psychiatric nurses and non‐psychiatric nurses (i.e., registered staff nurses [RSN] and registered auxiliary nurses [RAN]). Both nurses should follow necessary procedures in the acute psychiatric wards while rendering care to MHCUs according to Mental Health Care Act 17 of 2002. Nurses are the key frontline care providers in most mental healthcare facilities; they are with service users 24 hours a day in some care settings and provide care to service users daily (Figueroa et al., 2019).

In acute psychiatric wards, skilled and competent nurses render specialized care according to their scope of practice (SANC, 2005) to ensure that people with mental disorders receive care treatment and rehabilitation according to legislation. Non‐psychiatric and psychiatric nurses are allocated to the same group in acute psychiatric wards. In addition, Bowers et al. (2017) mentioned that a variety of healthcare providers, including psychologists, occupational therapists, consultant psychiatrists and trained and untrained nurses, work in acute psychiatric units. According to MHCA 17 of 2002, mental health professionals must provide MHCUs with treatment and rehabilitation with the necessary care (MHCA, 2002).

However, caring for people with mental illnesses and working in a challenging environment led to many challenges among non‐psychiatric nurses. Specific psychiatric nursing knowledge and skills are essential for nurses in psychiatric mental health settings; however, little is known regarding the lived experiences of non‐psychiatric nurses in acute psychiatric wards in Limpopo Province, South Africa.

Furthermore, Gutierrez (2019) commented that while rendering care to MHCUs, due to a lack of specialized psychiatric knowledge and training, non‐psychiatric nurses develop attitudes based on misconceptions such as the fear of mentally ill people who are aggressive and violent. These perceptions contribute to discrimination acts by non‐psychiatric nurses and heighten stigma. This fear causes a sense of caution and guard, which interferes with their ability to be practical nurses.

Few studies have focused on non‐psychiatric nurses' experiences in general wards providing mental health care; little is known about non‐psychiatric nurses' daily experiences in acute psychiatric wards in Limpopo Province. In Limpopo Province, South Africa, Netshakhuma (2016) indicated that when taking care of MHCUs general wards, non‐psychiatric nurses experienced burnout due to a lack of knowledge about the care of the people with mental disorders, and they feel endangered as they are not psychiatrically trained. Non‐psychiatric nurses further indicated a lack of support from hospital authorities; no counselling is offered when MHCUs injure a nurse.

Currently, hospitals in South Africa allocate non‐psychiatric nurses in psychiatric wards, and there is no information about the everyday experiences of non‐psychiatric nurses providing inpatient care to MHCUs in acute psychiatric wards. Non‐psychiatric nurses did not receive psychiatric training, which means they do not have the expertise to render care to MHCUs. Lack of knowledge might lead to the provision of poor‐quality care to MHCUs, placing the community in danger as MHCUs might not be rehabilitated, which may lead to litigation by the community members. However, the researchers believe that non‐psychiatric nurses' daily experiences in acute psychiatric wards must be understood as this may assist in supporting them while in acute psychiatric wards. Therefore, the present study aimed to explore and describe the daily experiences of non‐psychiatric nurses in acute psychiatric wards in Limpopo Province, South Africa. To further comprehend how nursing may sustainably contribute to MHCUs' mental health, a better understanding of the nature and conditions for rendering care to MHCUs in acute psychiatric wards from the daily experiences of non‐psychiatric nurses is required. The current study's findings will reveal what they have experienced and the essential measures as are necessary for non‐psychiatric nurses' orientation and staff development that would decrease their stress in acute psychiatric wards.

2. METHODS

2.1. Design

The researcher used an in‐depth description of phenomena to attain the study's objectives as it described the daily experiences of non‐psychiatric nurses. The orientated phenomenological research method described by Husserl was used as it described the participant's lived experience (Heotis, 2020). This phenomenology method addresses the objectives of Husserl, which states that the knower's internal reality is what arises in their consciousness. Husserl argued that characteristics of a lived experience of an incident were shared by those who had also experienced it (Neubauer et al., 2019). Non‐psychiatric nurses described their daily lived experiences rendering care to MHCUs in acute psychiatric wards. The researchers set aside their experiences, bracketing their dimensions during the data collection and analysis. Semi‐structured interviews are used as they are the best, according to Husserl's philosophy.

Phenomenology is a qualitative research method that is especially well‐suited to assist with this study. The goal of phenomenological research is to understand the nature of people by focusing on their daily experiences (Polit & Beck, 2017). Researchers used qualitative explorative, descriptive and contextual designs to conduct the study. The qualitative research method described and analysed human experiences. It has been chosen as it seeks to understand the meaning and interpretations of human experiences interacting with events or situations. Qualitative research occurs in natural settings, where human behaviour and events occur. Qualitative research focuses on participants' perceptions and experiences and how they make sense of their lives (Creswell, 2016).

Upon approval from all Institutional Review Boards, all female researchers recruited participants face‐to‐face and informed them about the reason for conducting the study by the researchers. With the greatest possible flexibility in terms of their job experience, educational background and professional rank, they were purposefully chosen. The inclusion criteria for the study were as follows: (1) non‐psychiatric nurses allocated in acute psychiatric wards (2) participants had worked in an acute psychiatric ward for at least 6 months and above. (3) ability to share experiences and a history of providing care and treatment to MHCUs in acute psychiatric wards (4) holds a nursing licence issued by the South African Nursing Council. Participants in the study had to have worked at the ward for at least 6 months to be eligible to participate.

During the recruiting phase, the unit manager was contacted physically, acted as gatekeeper and forwarded the information to all the staff at acute psychiatric wards during report giving, after which those non‐psychiatric nurses interested in participating in the study then contacted the first author or the unit manager, and an interview time and date were arranged. The only exclusion criterion was the refusal of a non‐psychiatric nurse to participate in the study.

This study utilized purposive sampling to include 15 non‐psychiatric nurses who were allocated in acute psychiatric wards caring for MHCUs. A non‐psychiatric‐ nurse is a nurse who does not have qualifications in psychiatric nursing science. For this study, non‐psychiatric nurses refer to registered staff nurses and registered auxiliary nurses allocated in an acute psychiatric ward. All non‐psychiatric nurses with a minimum experience of 1 month working and above in the acute psychiatric ward were invited to participate in semi‐structured interviews. The purpose and objectives of the study were explained to non‐psychiatric nurses, who were also provided with the information sheet in preparation for participation. Those who agreed to form part of the study were included. Fifteen participants took part in the study. Semi‐structured interviews were used to explore and describe the daily experience of non‐psychiatric nurses in three selected public hospitals with acute psychiatric wards in Limpopo Province, South Africa. Non‐psychiatric nurses were also informed that the interview would be audio‐recorded for a research study, and they gave consent. The authors told potential participants, both in writing and verbally, about the different uses of interview data, the goal of the study and its voluntary confidentiality. In our work, we followed (COREQ) consolidation criteria for reporting qualitative research by Tong et al. (2007) (see File S1).

2.2. Data collection

From June to December 2022, two PhD researchers who are lecturers with a background in mental health nursing and qualitative research methodologies developed a guide with central questions pretested with three non‐psychiatric nurses to test the research questions, a gadget used for recording if working correctly. Interview questions were formulated being guided by the PEO framework, P‐population being studied (non‐psychiatric nurses), E‐exposure to pre‐existing condition (MHCUs in acute psychiatric wards) and O‐outcome of interest (mental health nursing skills and knowledge) (Barroga & Matanguihan, 2022). The researchers conducted individual, semi‐structured, responsive interviews at the participants' workplaces. To get more information from four participants and to clear up certain ambiguities from their initial interviews, they were interviewed twice; hence, the other 11 participants were interviewed once during the data generation process. According to Creswell (2016), semi‐structured interviews are helpful if the researcher needs to obtain more information from participants because semi‐structured interviews are guided by the situation being investigated. The interviews were audio‐recorded; 15 non‐psychiatric nurses (registered staff nurses and registered auxiliary nurses) were interviewed (four males and 11 females) in a private room in the researcher's presence only until the data reached saturation, and no new information emerged.

The researchers generated field notes during each individual interview. The interviews ranged in length from 20 to 45 minutes. The open‐ended questions were followed by probing, paraphrasing, clarifying and other communication skills. The questions were: What are your daily experiences when rendering care to MHCUs in acute psychiatric wards? What can be done to overcome your daily experiences in acute psychiatric wards? The final number of participants was 15, depending on the data saturation. Data saturation was reached when participants provided no new information but only a repetition of previously collected data. Data saturation was reached by the 13th participant. However, the data collection continued until the 15th participant, which was done to ensure that nothing new came up. We conducted member checking by doing individual follow‐up interviews with participants. Participants' transcripts were returned for comments, and they provided feedback on the findings. All participants indicated that we accurately captured their daily experiences in acute psychiatric wards.

Researchers maintained the confidentiality of the data and the study participants' privacy throughout. Participants were assured that they had a right to withdraw from the study. Dependability was maintained by reporting and consulting with the research team. To increase credibility, researchers conducted debriefings and member checking to provide feedback to the non‐psychiatric nurses. Biographical information was obtained to ensure transferability and a dense description of the research methodology and the findings were provided. A memory stick of the voice recorded was preserved to ensure conformability. Data was kept on a laptop, cloud and voice recorder for safety. In our work, we followed (COREQ) consolidation criteria for reporting qualitative research by Tong et al. (2007).

2.3. Data analysis

Two PhD. researchers with expertise in qualitative methods transcribed individual verbatim responses from a tape recording and analysed them separately using Tesch's eight data analysis steps (Creswell, 2016).

The thematic analysis employed Tesch's eight phases, as Creswell (2016) outlined, in the following order: a thorough reading of the dataset was carried out to provide a general understanding of the data. After that, a more thorough review was conducted to start the coding procedure. According to Creswell (2016), coding is the process of taking a large amount of data and dividing it into smaller components before giving it meaning. These smaller segments were named after the open coding methodology, which involves labelling or renaming data set segments to identify and classify shared meanings. The participants' most intriguing answers were chosen, and their underlying significance was investigated. A list of topics that had been discussed repeatedly by various participants emerged. Rereading the participant responses led to the creation of new categories. These were further developed and categorized based on shared meanings, producing a list of final categories that emerged as themes and subthemes.

The formal analysis was the responsibility of the second author, and all authors addressed each step. Codes, themes and sub‐themes were generated and refined after collaborative discussion. The researchers and the independent coder discussed the themes and sub‐themes and reached a consensus.

2.4. Ethical consideration

Institutional Research Ethics Committees granted this study's ethical approval, IREC number: FHS/22/PDC/O6/2104. Informed consent was sought from participants at the beginning of the interviews regarding the purpose of the study, confidentiality of the study data, voluntariness of participation and audio recording of the interviews.

3. RESULTS

A total number of 15 non‐psychiatric nurses were interviewed, of which 11 were females and only four were males. Participants' work experiences in the acute psychiatric ward range from 6 months to 15 years. Some non‐psychiatric nurses with 15 years of experience have basic knowledge they acquired in the ward as psychiatric nurses teach them; however, those trained in elective psychiatry were excluded from the study participation. The sample recruited involved six registered staff nurses and nine registered auxiliary nurses. Most participants (n = 11) were female, aged 24 to 56. The educational background of the participants is a certificate from nursing school. The participating nurses' work experience ranged from 6 months to 15 years (Table 1).

TABLE 1.

Features of the participants.

Participant number	Gender	Age (years)	Professional category	Work experience
1	Female	28	Registered Auxiliary Nurse	6 months
2	Female	46	Registered Staff Nurse	12 months
3	Female	48	Registered Staff Nurse	5 years
4	Male	51	Registered Auxiliary Nurse	10 years
5	Male	24	Registered Auxiliary Nurse	12 months
6	Female	38	Registered Staff Nurse	2 years
7	Female	56	Registered Auxiliary Nurse	2 years
8	Female	36	Registered Auxiliary Nurse	7 months
9	Female	32	Registered Staff Nurse	7 months
10	Female	44	Registered Auxiliary Nurse	12 months
11	Female	38	Registered Auxiliary Nurse	6 months
12	Male	40	Registered Staff Nurse	3 years
13	Male	56	Registered Auxiliary Nurse	15 years
14	Female	43	Registered Auxiliary Nurse	4 years
15	Female	49	Registered Staff Nurse	2 years

The emerging themes were unsafe working environments, managing difficulties due to lack of skills and strategies to overcome experienced challenges. Themes and sub‐themes are illustrated with quotations.

3.1. Theme 1: Unsafe working environment

Three sub‐themes were identified and will be discussed in detail with supporting quotes. Most non‐psychiatric nurses described what makes them feel unsafe in acute psychiatric wards.

3.1.1. Sub‐theme 1.1: MHCU's uncooperative and aggressive

Non‐psychiatric nurses described their daily experiences and mentioned uncooperative and aggressive MHCUs. Participants noted that some of the MHCUs are uncooperative in the acute psychiatric wards; they refused medication, and some of the participants explained and said:

The challenge we have experienced is who they are because they become uncooperative; with some other patients, when we give them medications, they end up putting on their mouth and take water and act as if they are swallowing at the end when you check you will see that there is a floor on the floor. Sometimes you find that others did not take treatment because clever patients sometimes refuse to take medications. They turn their backs and spit the medication unnoticed. You can see now that something is missing. He did not get treatment. They hide treatment. Participant 11

Yeah, we experience some challenges. Some do not want to bathe, and some eat chicken today. Tomorrow will tell you I do not eat chicken. Participant 13

That lady, when she saw us as new faces to her, started insulting, cursing, and using vulgar words towards us. The aggressive behaviour makes me scared, thinking about whether in this ward I will be able to cope or not, whether I will be able to work with those patients who, when I come here happy and are starting to make us angry and making me feel sad at this moment. So this makes us realize that these mentally ill people are dangerous, even in the community. They can also be dangerous to us as workers. Even when caring for them, one must be alert and wise. Participant 6

3.1.2. Sub‐theme 1.2: Non‐psychiatric nurses assaulted by MHCUs

Non‐psychiatric nurses assaulted by MHCUs emerged as another daily experience. The following statements from participants are evidence that they are experiencing assault in acute psychiatric wards:

Sometimes they can come and beat you, or they can come and swear on you, so it was hectic. Nursing those mentally ill patients with a mental disorder is not easy; even if you are a male nurse, you will be beaten more, especially by young male patients. Participant 12

Yeah, there are challenges here. The patient is aggressive and can beat you. They seriously slap us on the face in such a way that one will feel like not coming and working here again; there is no guarantee that one cannot be beaten. New patients are very uncooperative in the ward. Participant 13

Some non‐psychiatric nurses in this study perceived aggression as offensive, humiliating, and unacceptable. However, they understood that it was due to MHCUs' mental state at that particular time. One nurse stated:

Those patients are troublesome. When I arrived here on Monday, I remembered they differed from those patients. One patient once pours porridge on my face. ‘It did not make me feel well at all. I wanted to pay revenge, but you cannot pay revenge to the patient’. Participant 7

3.1.3. Sub‐theme 1.3: Lack of human resources, especially male nurses

Some of the non‐psychiatric nurses were concerned about a shortage of staff. They viewed MHCUs as threatening their safety. Female nurses were more concerned for their safety and felt more insecure when caring for MHCUs without a male nurse.

A female RSN stated:

Mmmmm, I think more special most of the time, especially the female nurses. They must not be alone. They can hire more male nurses because our patients are very clever and can see more, especially if you are alone. If you are a female nurse, they will attack you, but if they are a male nurse around, they do not attack anyone; if you are a female, you must not be left alone or work alone, but let me say in our ward, mainly in the male ward, they must ensure that there are more male nurses than female nurses. Participant 9

Another male RSN concurred with the above quotes:

To mention a few, those patients mostly do not fear nurses because they have studied, but they fear the voice of the male somebody. If you are a male nurse, you stand a better chance of being respected by those patients. Participant 12

RANs were also concerned about the shortage of male nurses. A male RAN stated:

Here, our scope is to assist as enrolled auxiliary nursing nurses. We assist whatever registered nurses and professional nurses are doing then we assist. We assist in whatever they are doing. Here it's different because we have few professional nurses. That's why it's challenging because we are running short of male professional nurses. Participant 4

3.2. Theme 2: Managing difficulties due to lack of skills

All 15 participants were concerned about their lack of necessary mental health nursing skills to care for MHCUs as they are not psychiatrically trained. The theme is important to no‐psychiatric nurses as they should care for MHCUs using mental health nursing skills and knowledge skills. To meet the care needs of service users, mental health nurses must possess a wide range of clinical skills. A wide range of abilities has been identified by authors, including administration, communication, risk management and administration of psychotropic medication (Comiskey et al., 2019; Santangelo et al., 2018). Participants believed that the lack of basic psychiatric nursing knowledge and skills makes it difficult to provide the expected patient care. In this theme, two sub‐themes emerged and are discussed below.

3.2.1. Sub‐theme 2.1: Lack of knowledge of mental health nursing

Non‐psychiatric nurses expressed their knowledge gap in mental health nursing, mental disorders, and knowledge of medications. Non‐psychiatric nurses expressed feelings of discomfort as a result of unclear duties and responsibilities. This included being unsure of one's professional commitment, lacking the requisite knowledge and skills to deal with work‐related tasks and ward procedures and having to adjust the behaviour of people with mental disorders. Below is the remark on dealing with role uncertainty:

Honestly, it is difficult because managing them without being trained is not easy. However, working with patients with mental disorders is challenging once they are very aggressive. Professional nurses are the ones who give the medication when the patient is aggressive as they are trained in psychiatry because I am not qualified; I am ENA here, the ENA does not issue medication to patients. Participant 10

3.2.2. Sub‐theme 2.2: Lack of skills to manage MHCUs

All participants discussed the lack of skills when caring for MHCUs in an acute psychiatric ward. They indicated that they lack counselling skills, skills in the management of people with mental disorders and risk assessment skills of high‐risk MHCUs.

A female RAN stated:

I cannot counsel them because I lack counselling skills. It means I must call someone with advanced psychiatry and explain what the patient said, and they will sit down with the patient and listen to his story and show the patient the way forward. Participant 1

Another female RSN shared:

The first time I came here, I had a challenge the first day of being allocated here in the psychiatric ward because I did not know how to manage patients with mental disorders, and for me, it was the first time. First time like seeing mentally disturbed people being taken care of in an institution. So, it was challenging for me. Participant 2

A female RAN indicated the lack of skills to deal with the aggressive behaviour of MHCUs:

I do not know the management of mentally ill patients, how to manage an aggressive patient, and I do not know how to handle that. If the patient became aggressive, I did not know how to handle it. I did not know about risk assessment. Some patients, before they act, some sign physically that this patient is not okay, but by then, I did not notice, yeah, I did not know that risk assessment. Participant 8

A male RAN concurred with the above statement:

We are not trained on handling aggressive patients here. It is not easy as we do not have the skills to calm them down. We end up being in danger of being beaten, sometimes they fight each other, and you need to stop them without being trained is not easy. Participant 5

3.3. Theme 3: Strategies to overcome the experienced challenges

The last theme focuses on approaches to overcome the experienced challenges in acute psychiatric wards. It has three subthemes: provision of adequate resources, conduct of in‐service training and programme for psychiatric training. The subthemes are discussed below.

3.3.1. Sub‐theme 3.1: Sufficient trained staff

Some participants indicated that another approach that can be used to overcome the experienced challenges is that the hospital must hire nurses to address the staff shortage, especially male nurses. A female auxiliary nurse opined:

They must employ those who have some skills, yes elective psyche nurses, advanced psychiatric nurses they must hire more male, male nurses are needed. Psychiatric patients are very clever. They take advantage and say she is a woman, and this one is a man. Sometimes planning cannot work, and sometimes one can be injured. Participant 8

3.3.2. Sub‐theme 3.2: Acquired training courses

Participants indicated that in‐service training and workshops should also form part of the approach, which can be used to overcome experienced challenges in acute psychiatric wards by non‐psychiatric nurses. They shared the below regarding their views.

A male RAN said:

They can take us to a workshop so that they can teach us. Yes, we need to be workshopped to have more information about the care of mental healthcare users; they must organize a workshop. The sister in charge must talk to the nursing managers. Participant 3

Another female RSN stated:

I think the first thing before being allocated in this ward, they must workshop us so that we know what we are going to face and what to do, explain and do a workshop about mentally ill patients and their behaviours, how to manage them, and how to cope with the. Participant 2

3.3.3. Sub‐theme 3.3: Programme for psychiatric training

Non‐psychiatric nurses in acute psychiatric wards need training in psychiatry to understand mental disorders and manage MHCUs.

The following quotes are evidence that psychiatric training is necessary:

A female RSN stated:

For me to know mental conditions is when I am taught or sent for training at school so that I can learn those mental conditions. So, they must take us to school for psychiatry training. I think professional nurses must tell their managers to train nurses here at the acute psychiatric ward; they must be trained; managers in the ward must tell the CEO to motivate for training. Participant 4

4. DISCUSSION

The study explored and described the daily experiences of non‐psychiatric nurses in acute psychiatric wards in Limpopo Province, South Africa. Study findings identified three themes: unsafe working environment, managing difficulties due to lack of skills and strategies for overcoming experienced challenges. Those themes are important for non‐psychiatric nurses as they experience challenges when rendering care treatment and rehabilitation to MHCUs. The significance of each theme will be indicated separately. However, our study is among the first to report the daily experiences of non‐psychiatric nurses in acute psychiatric wards in South Africa.

4.1. Unsafe working environment

Non‐psychiatric nurses in an acute psychiatric ward experienced an unsafe working environment due to MHCUs displaying violent and aggressive behaviours. These experiences resulted in concerns for their safety and the safety of other people. The theme is important to non‐psychiatric nurses as a persistent sense of insecurity and trauma impacts individuals' physical and psychological well‐being. Nurses feared patient assault because they believed people with mental disorders might become irritable and aggressive. Similarly, studies alluded that fear about what lies ahead of workplace violence (WPV) is an emotional reaction to the possibility of becoming a victim of WPV, and it negatively affects both organizational growth and the individual's health. Fear of future WPV is an important source of workplace stress at the organizational level, which can lower worker productivity. Most nurses are concerned about job security due to the high frequency of workplace violence against them; this will probably distract nurses from their duties (Fu et al., 2021; Portoghese et al., 2017).

Again, Rahmani et al. (2021) identified that non‐psychiatric nurses face difficulties when caring for MHCUs, such as facing unapproachable people. In addition, non‐psychiatric nurses in this study indicated that they face people who refuse medication, which is in line with what Hao et al. (2020) found in their research on South African nurses experiencing challenges in psychiatric settings of people refusing medication. Similarly, Mulaudzi et al. (2020) expressed difficulties nurses face in psychiatric wards, such as inadequate safety measures.

4.2. Managing difficulties due to a lack of skills

In addition, the participants in this study indicated that they experience managing difficulties due to a lack of skills when caring for MHCUs in acute psychiatric wards. The theme is important to non‐psychiatric nurses as they must use mental health nursing skills and knowledge to render care to MHCUs, skills like interpersonal skills, communication skills, management of aggressive people and risk assessment skills. Similarly, Gutierrez (2019) reported that non‐psychiatric nurses express that nursing care for people with mental disorders is out of their scope of practice, and they feel that they lack the psychiatric knowledge and skills to meet the needs of people with mental illnesses. Furthermore, Rahmani et al. (2021) alluded that inadequate professional skills in psychiatric nursing were among the leading causes of nurses' lack of interest. Non‐psychiatric nurses indicated they were not ready for psychiatric care practice when starting their unacceptable work conditions and lacked the professional knowledge to work in psychiatric wards. Similarly, Joung et al. (2017) reported that non‐psychiatric nurses express that nursing care for people with mental disorders is out of their scope of practice, and they feel that they lack psychiatric knowledge and skills to meet the needs of people with mental disorders. A study in China revealed that the mental health literacy of non‐psychiatric nurses is inadequate, with recognition of mental health conditions like schizophrenia, depression and generalized anxiety disorders (Rahmani et al., 2021).

4.3. Strategies for overcoming experienced challenges

Non‐psychiatric nurses suggested strategies to overcome the challenges they experienced daily in acute psychiatric wards. The suggested theme is important to non‐psychiatric nurses as this will give the non‐psychiatric nurses the knowledge and skills to render care treatment and rehabilitation of MHCUs. Non‐psychiatric nurses saw it as a chance to fulfil their dreams of becoming psychiatric nurses. They said that the psychiatric nurse position was more appropriate for providing care to MCHUs since they had to deal with the role ambiguity and misunderstanding of being non‐psychiatric nurses.

They suggested conducting in‐serve training and workshops, a programme for psychiatric training and provision of human resources. The findings of this study are similar to those of Joung et al. (2017), who recommended developing psychiatric health education programmes for non‐psychiatric nurses and support by the institution to reduce negative attitudes towards psychiatric nurses and difficulties in caring for psychiatric people. Furthermore, Netshakhuma (2016) also recommends in‐service training and support of non‐psychiatric nurses before and during taking care of MHCUs. It has been established that continuing professional development through training programmes and workshops based on current information and trying to cut research is essential for ensuring high standards of service (Alshowkan & Gamal, 2019). Ongoing education and training for non‐psychiatric nurses in specialist psychiatric nursing techniques would boost the nurse's self‐efficacy in providing care for people with mental disorders (Ollila, 2021).

Mutshatshi et al. (2022) alluded that there are several perceived advantages of an in‐service training programme, such as enhancing nurses' skills and knowledge, enabling them to provide high‐quality patient care, boosting staff morale and motivation and encouraging information sharing among nursing staff. Compared to nurses who were not taught, nurses who receive in‐service training are more likely to provide high‐quality nursing care during practice.

Furthermore, workshops and in‐service training are used to train employees while providing services to an organization's clients. Since a position in healthcare is never static and is prone to rapid change, it entails updating, training, educating and informing the individual about the current job requirements. Continuous in‐service training is required for healthcare personnel. The in‐service training programme is designed to keep personnel updated on new rules, diagnosis and treatment approaches and the operation of new types of equipment. In‐service training is carefully organized and is part of ongoing education (Booyens & Bezuidenhout, 2015).

Similarly, in their studies Joubert and Bhangwan (2018) recommended developing a psychiatric training programme to address the identified challenges of non‐psychiatric nurses. However, Timor and Suryani Sutini (2019) and Bekelepi and Martin (2022) reported that some nurses expressed their need for psychiatric emergency training to master the technique of dealing with acute psychiatric people. It could reduce the risk of injury when faced with people who display violent behaviour.

As a result, Heim et al. (2020) noted that non‐psychiatric nurses lacked training in specialized clinical and communication skills, except for one study that showed a favourable impact of interview skills training on attitudes. However, Timor and Suryani Sutini (2019) support these findings to ensure patient safety and high‐quality treatment by stating that the primary goal of nursing education is to give nursing professionals the required level of competency. Several efforts should be made to the request for nursing educational change to develop nursing practitioners who can provide safe and effective patient care.

Similarly, Joung et al. (2017) recommended developing psychiatric health education programmes for non‐psychiatric nurses with support from the institution to reduce negative attitudes towards psychiatric nurses and difficulties in caring for people with mental disorders. Participants indicated the importance of adequate nursing staff in acute psychiatric wards as it minimizes their challenges. Similarly, it was found that adequate staffing is an essential component in the nursing practice environment that influences nurses' perceptions of the nursing practice environment's quality (Rivaz et al., 2017). The study found that in South Korean hospitals, a larger patient–nurse ratio, high workload, bad practice conditions and a lack of educated nurses all contributed to higher mortality, which is preventable.

4.4. Study limitations

Most participants were females, although the study's recruitment process achieved diversity in age, category and work experience. The goal of future recruiting to workforce studies with non‐psychiatric nurses should be to increase the proportion of male participants. Including non‐psychiatric nurses from three chosen districts, representing various age groups and work experiences, has enhanced transferability. However, these limitations did affect the study results as they cannot be generalized. Individuals were used to collect the data for this study, and people make mistakes. Nevertheless, the researchers tried very hard to reduce the constraints by employing methods that improve trustworthiness at various data collection and analysis phases.

5. CONCLUSIONS

This study describes the daily experiences of non‐psychiatric nurses in acute psychiatric wards in Limpopo Province, South Africa. Non‐psychiatric nurses lack the education preparation to deal with mentally ill people. Continuing professional development education should include content related to psychiatric nursing care. Furthermore, hospital management should establish a training programme for non‐psychiatric nurses to empower nurses working in an acute psychiatric ward. Other measures addressing issues, such as the availability of male nurses, should also be considered. The institutions should address concerns about safety and psychiatric nursing competence expressed by non‐psychiatric nurses.

6. RELEVANCE FOR CLINICAL PRACTICE

However, this study adds to the collective understanding of the daily experiences of non‐psychiatric nurses in which care for MHCUs was affected. It could benefit non‐psychiatric nurses by improving their knowledge and abilities in mental health nursing when providing care to MHCUs. Hospital management and psychiatric nurses are urged to remain mindful of the risks associated with providing direct patient care to MHCUs by nurses who are not trained in psychiatric care. They should be committed to preserving quality nursing care for their people.

FUNDING INFORMATION

The research did not receive funding from public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

The authors report no conflict of interest.

Supporting information

File S1.

Rangwaneni, M. E. , Raliphaswa, N. S. , Maluleke, M. , & Masutha, T. C. (2024). Daily experiences of non‐psychiatric nurses in acute psychiatric wards. Nursing Open, 11, e2174. 10.1002/nop2.2174

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.