Burnout and job satisfaction of nursing staff in a South African acute mental health setting.

BACKGROUND: Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in Belville and provides all levels of psychiatric care to a large part of the Cape metro region. To our knowledge, no previous studies have examined burnout and job satisfaction among nurses in this setting. AIM: We assessed the relationship between burnout and job satisfaction among the nursing staff. SETTING: The study was conducted at Stikland Psychiatric Hospital, Cape Town, South Africa. METHODS: This cross-sectional study used the Copenhagen Burnout Inventory and an established job satisfaction questionnaire to assess burnout and job satisfaction among 127 staff members associated with psychiatric nursing. RESULTS: In this population comprising mostly female (83.5%) nurses, scores for personal, work-related and client-related burnout were relatively high, but job satisfaction was also high. Higher levels of burnout were significantly associated (Pearson's linear correlation, r = -0.077, p < 0.01) with lower levels of job satisfaction. There were no significant associations between burnout or job satisfaction and gender, rank or years of experience. CONCLUSIONS: If mental health service delivery is to be optimised, supportive or preventative processes should be implemented to reduce the prevalence of burnout in psychiatric nurses. This study adds to the scarce local knowledge and provides information that can be used to inform the development of supportive strategies for psychiatric nursing staff in South Africa.

Demographic and clinical profile of patients utilising a transitional care intervention in the Western Cape, South Africa.

BACKGROUND: The World Health Organization's action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South Africa. AIM: To describe the demographic and clinical profile of all patients admitted to New Beginnings between 01 January 2011 and 31 December 2015. SETTING: New Beginnings is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down setting. METHODS: In this retrospective audit, we reviewed the medical records of all patients (N = 730) admitted to New Beginnings between 01 January 2011 and 31 December 2015. RESULTS: Most admissions were male (n = 600; 82.2%), unmarried (92.1%) and unemployed (92.7%) patients with a mean age of 28 years. Only 20.7% had completed their schooling and 37.9% were receiving a disability grant. Most patients lived in the Cape Town Metro area (89%) with their families (94.7%), and 75.6% had no children. Schizophrenia (53.7%) was the most common primary psychiatric diagnosis, and most patients were on a combination of oral and depot treatment (46.8%). Illicit substances were used by 75.9% of patients with 30% using both cannabis and methamphetamine. Most patients (74.9%) had only one admission to New Beginnings. CONCLUSIONS: These baseline data could inform improved service delivery. Further research is needed to evaluate the success of New Beginnings and highlight the need for more of these facilities in the Western Cape and across South Africa.

The rise of assertive community interventions in South Africa: a randomized control trial assessing the impact of a modified assertive intervention on readmission rates; a three year follow-up.

BACKGROUND: Many countries have over the last few years incorporated mental health assertive interventions in an attempt to address the repercussions of deinstitutionalization. Recent publications have failed to duplicate the positive outcomes reported initially which has cast doubt on the future of these interventions. We previously reported on 29 patients from a developing country who completed 12 months in an assertive intervention which was a modified version of the international assertive community treatment model. We demonstrated reduction in readmission rates as well as improvements in social functioning compared to patients from the control group. The obvious question was, however, if these outcomes could be sustained for longer periods of time. This study aims to determine if modified assertive interventions in an under-resourced setting can successfully maintain reductions in hospitalizations. METHODS: Patients suffering from schizophrenia who met a modified version of Weidens' high frequency criteria were randomized into two groups. One group received a modified assertive intervention based on the international assertive community treatment model. The other group received standard care according to the model of service delivery in this region. Data was collected after 36 months, comparing readmissions and days spent in hospital. RESULTS: The results demonstrated significant differences between the groups. Patients in the intervention group had significantly less readmissions (p = 0.007) and spent less days in hospital compared to the patients in the control group (p = 0.013). CONCLUSION: Modified assertive interventions may be successful in reducing readmissions and days spent in hospital in developing countries where standard care services are less comprehensive. These interventions can be tailored in such a way to meet service needs and still remain affordable and feasible within the context of an under-resourced setting.