Female mental health care users perspectives of their occupational engagement at a tertiary psychiatric facility
| dc.contributor.advisor | Cloete, Lizahn | en_ZA |
| dc.contributor.author | Sonday, Haseena | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy. | en_ZA |
| dc.date.accessioned | 2021-02-23T12:00:46Z | |
| dc.date.accessioned | 2021-04-21T14:26:34Z | |
| dc.date.available | 2021-02-23T12:00:46Z | |
| dc.date.available | 2021-04-21T14:26:34Z | |
| dc.date.issued | 2021-03 | |
| dc.description | Thesis (MOccTher)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY : Introduction: The prevalence of mental illness, burden of disease in South Africa is increasingly high, a global trend amongst other low-and middle-income countries, affecting more females than males. Poverty, crime, intimate partner violence and the existence and co-morbidities, such as HIV, make people in previously disadvantage areas, particularly females, more vulnerable to mental illness. South Africa’s legislation, and vision for mental health, outlined in Healthcare 2030 exemplified the improvement of tertiary psychiatric services and patient experience, in the face of decentralisation. Despite this, readmission rates remain high, a complex phenomenon, for which the reasons are multifaceted. One of the reasons cited is that the lack of meaningful occupational engagement for patients in mental health care leads to a deterioration of mental health and subsequent relapse and readmission. The aim of the study is to explore female mental health care users’ perspectives of their occupational engagement in the pre-discharge ward at a tertiary psychiatric facility. Methodology: The study is grounded in a constructivist paradigm. A qualitative method of inquiry investigates the subjective underpinnings of meaningful occupational engagement of mental health care users. The collective case study used data from interviews, the Activities Clock, participant observations and the programme in the pre-discharge ward. Five (n=5) participants were included in the collective case study. Inductive analysis was used to analyse data. A four phased analytical strategy, thematic, content, within-case and across-case analyses was performed. Credibility was ensured through member checking. Data triangulation was ensured by using multiple data sources. An audit trail and thick descriptions were used to ensure transferability. The findings of the study were verified amongst other researchers in the field, ensuring confirmability. Reflexive journaling was used to bracket the researcher’s thoughts and feelings. The study received ethical approval and adhered to sound ethical practices. Findings: Two themes emerged. The first theme, “this is not a prison, it’s a hospital”, demonstrated mental health care users’ experience of dehumanisation in the pre-discharge environment. Mental health care users experienced gross human rights violations in the number of restrictions they were subject to, the lack of privacy and freedom enforced by staff in the pre-discharge ward. The second theme, “we need to do more” highlights that mental health care users were unstimulated, bored, and frustrated in the pre-discharge ward. There were not enough opportunities for meaningful occupational engagement in the pre-discharge ward. Discussion: Tertiary psychiatric facilities situated in the medical model violated the occupational and human rights of mental health care users and creates an environment ill conductive for occupation-based practice. Navigating mental health care users’ rights to freedom and privacy, with the responsibility of healthcare providers to offer a safe and caring environment, that is supportive of the recovery of mental health care users in the pre-discharge ward, remains a challenge. Conclusion: Tertiary psychiatric services should embrace a shift in paradigm from a dominantly medical model towards an occupation-based practice and recovery approach, in an environment that is less restrictive, that creates opportunities for meaningful occupational engagement, within a human and occupational rights framework. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING : Inleiding: Soos in baie ander lae- en middelinkomstelande wêreldwyd, maak geestesiekte in Suid-Afrika ’n al hoe groter deel uit van die nasionale siektelas. Vroue word erger as mans geraak. Armoede, misdaad, geweld tussen verhoudingsmaats sowel as onderliggende toestande soos MIV maak mense in voorheen benadeelde gebiede, veral vroue, meer kwesbaar vir geestesiekte. Te midde van desentralisasie stel die Suid-Afrikaanse wetgewing en visie vir geestesgesondheid in Healthcare 2030 ’n verbetering in tersiêre psigiatriese dienste en pasiëntervarings in die vooruitsig. Nietemin bly heropnamesyfers hoog. Die redes vir hierdie komplekse toedrag van sake is uiteenlopend. Een daarvan is die gebrek aan sinvolle aktiwiteitsverbintenis (“occupational engagement”) onder gebruikers van geestesgesondheidsorg, wat ’n verswakking in geestesgesondheid en gevolglike insinking en heropname tot gevolg het. Die doel van die studie was om vroulike gebruikers van geestesgesondheidsorg se sienings van hulle aktiwiteitsverbintenis in die voorontslagsaal by ’n tersiêre psigiatriese fasiliteit te ondersoek. Metodologie: Die studie is binne ’n konstruktivistiese paradigma uitgevoer. ’n Kwalitatiewe navorsingsmetode is gebruik om die subjektiewe elemente van sinvolle aktiwiteitsverbintenis by gebruikers van geestesgesondheidsorg te bestudeer. Die kollektiewe gevallestudie het van data uit onderhoude, die aktiwiteitsklok, deelnemers se waarnemings en die program in die voorontslagsaal gebruik gemaak. Vyf (n = 5) deelnemers is by die gevallestudie ingesluit. Data is induktief ontleed. ’n Driefase- analitiese strategie is gevolg, met ontledings volgens tema, per deelnemer sowel as tussen deelnemers. Geloofwaardigheid is verseker deur deelnemerbekragtiging, en datatriangulasie deur die gebruik van veelvuldige databronne. ’n Ouditspoor en ryke beskrywings het oordraagbaarheid verseker. Die bevindinge van die studie is by ander navorsers op die gebied nagegaan, wat bevestigbaarheid verseker het. Die navorser het ook ’n oordenkingsdagboek bygehou om gedagtes en gevoelens op te teken. Die studie het etiekgoedkeuring ontvang en aan alle vereiste etiese praktyke voldoen. Bevindinge: Twee temas het aan die lig gekom. Die eerste tema, “Dit is nie ’n tronk nie, dis ’n hospitaal”, het geestesgesondheidsorggebruikers se ervaring van ontmensliking in die voorontslagsaal getoon. Deelnemers het erge menseregteskendings beleef ten opsigte van die getal inperkings en ingekorte privaatheid en vryheid waaraan personeellede in die voorontslagsaal hulle onderwerp het. Die tweede tema, “Ons moet meer doen”, het beklemtoon dat geestesgesondheidsorggebruikers in die voorontslagsaal ongestimuleer, verveeld en gefrustreerd gevoel het. Daar was nie genoeg geleenthede vir sinvolle aktiwiteitsverbintenis in dié saal nie. Bespreking: Tersiêre psigiatriese fasiliteite binne die mediese model blyk die beroepsvryheid en menseregte van geestesgesondheidsorggebruikers te skend, en skep nie ’n bevorderlike omgewing vir aktiwiteitsgebaseerde praktyk nie. Dit bly oënskynlik ’n uitdaging om ’n middeweg te vind tussen geestesgesondheidsorggebruikers se reg op vryheid en privaatheid, en gesondheidsorgverskaffers se verantwoordelikheid om ’n veilige en deernisvolle omgewing te bied wat herstel by persone in die voorontslagsaal ondersteun. Gevolgtrekking: Tersiêre psigiatriese dienste behoort ’n paradigmaskuif te ondergaan van ’n oorwegend mediese model na ’n benadering van aktiwiteitsgebaseerde praktyk en herstel. Dít behoort te geskied in ’n minder beperkende omgewing, wat geleenthede skep vir sinvolle aktiwiteitsverbintenis binne ’n raamwerk van menseregte en beroepsvryheid. | af_ZA |
| dc.description.version | Masters | |
| dc.format.extent | xv, 146 pages ; illustrations, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/109797 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject | Mental health -- Women patients -- Attitudes -- South Africa | en_ZA |
| dc.subject | Mental health services -- Evaluation -- South Africa | en_ZA |
| dc.subject | Teaching hospitals -- South Africa | en_ZA |
| dc.subject | UCTD | |
| dc.title | Female mental health care users perspectives of their occupational engagement at a tertiary psychiatric facility | en_ZA |
| dc.type | Thesis | en_ZA |