The reasons why some patients suffering from schizophrenia miss clinic appointments

English: Missed clinic appointments among the patients who are suffering from schizophrenia has been identified through the statistical records at Botshabelo psychiatric clinic. Missed clinic appointments remain a world-wide problem which results from the nature of the illness, the patient, the family, health services, culture, employment and other environmental factors. A conceptual model which is based on the principles of the system theory has been discussed and indicated that the patient as part of the system is easily influenced by the environmental factors and the illness itself to stop visiting the clinic for treatment. During missed clinic appointments there is a break or cut between the patient and the clinic due to subsystems which play the negative role within a system (Fawcett, 1989:63). The purpose of the study was to determine the possible reasons for missed clinic appointments for patients who are suffering from schizophrenia and to suggest nursing guidelines to enhance clinic attendances. Quantitative research methodology usinq descriptive and exploratory designs was chosen. The population consisted of the patients who are suffering from schizophrenia referred to the clinics between January 1995 and January 1996, and missed clinic appointments twice or more within a period of 12 months, both females and males, ages from 19 years and above were included. Sampling procedure was purposive consisting of two groups. Group A were patients who are suffering from schizophrenia and missed clinic appointments twice or more and Group B consisted of one immediate family member for each patient who was identified in the patient's record, and who live with the identified patient. A pilot study was done to test the reliability and validity of the data-collecting instrument. Two patients and two family members were selected for the pilot study and were not included in the main study. To verify reliability and validity of the instrument some of the experts were contacted as follows: • Nursing Research Committee at the University of the Orange Free State. • Ethics Committee at the Faculty of Health Sciences, University of Orange Free State. • Computer Science personnel at the same university. • Clinical psychiatric nursing personnel who are experienced In the psychiatric field. • The researcher herself who acquires necessary skills in psychiatric nursing and experience played an important role to ensure reliability and validity of the instrument. Data collection was done using a semi-structured interview aided by a questionnaire. Both closed and open-ended questions were designed to obtain the required information. Questionnaires used were completed by the researcher to counteract illiteracy among the respondents. Data was coded by the computer centre at the University of Orange Free State. Analysis and interpretation of data was done by the researcher using graphs and tables. Ethical consideration was maintained. Informed consent was obtained from the respondents. Privacy, confidentiality, person with diminished autonomy and right to protection from discomfort and harm was maintained throughout the study. The results indicated that the major reason for missed clinic appointments among patients who are suffering from schizophrenia, is a fear of medication side-effects. This occurs to the patients who have been on treatment before, and experienced side-effects of medication [28.1 %J. The other reasons which appear to be caused by a lack of knowledge about the importance of aftercare management are as follows: - Feeling well when not on treatment - The patient stayed at home with no apparent reason - Poor nurse-patient relationship - Substance abuse - Stigma attached to mental illness All these reasons remain problem, which require immediate and long-term solutions. Recommendations to address these problems were made by the researcher and the nursing quide-lines as explained.