The reasons why some patients suffering from schizophrenia miss clinic appointments

Abstract

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.

Afrikaans: Versuim om kliniekafsprake na te kom is deur middel van statistiese rekords by die Botshabelo psigiatriese kliniek geïdentifiseer. Hierdie versuim is 'n wêreldwye probleem en is die gevolg van die aard van die siekte, die pasiënt, die familie, gesondheidesdienste , kultuur, werk en ander omgewingsfaktore. 'n Konseptueie model wat op die sisteemteorie gebaseer is, is bespreek. Dit het aangedui dat die pasiënt, as deel van die sisteem, maklik deur omgewingsfaktore en die siekte self beïnvloed word om op te hou om die kliniek vir behandeling te besoek. Kliniekafsprake wat nie nagekom word nie, veroorsaas; 'n breuk tussen die pasiënt en die kliniek weens subsisteme wat 'n negatiewe rol binne die sisteem speel (Fawcett, 1989:63]. Die doelstelling van die studie was om die moontlike redes vir afsprake wat nie deur pasiënte met skisofrenie nagekom word nie, vas te stel. Die doelwit van die studie was om die moontlike rede vir afsprake wat nie nagekom word nie, te bepaal en om strategieë vir beter kliniek bywoning voor te stel. 'n Kwantitatiewe navolrsingsmetodologne met die gebruik van beskrywende en verkennende ontwerpe is geselekteer. Die populasie was die pasiënte met skisofrenie wat tussen Januarie 1995 en Januarie 1996 na die kliniek verwys is en wat twee of meer keer binne 'n periode van 12 maande versuim het om hul afsprake na te kom. Mans en vroue van 19 jaar en ouer is ingesluit. Doelgerigte bemonstering met twee groepe is gebruik. Groep A het bestaan uit pasiënte met skisofrenie wat twee of meer keer nie hul afsprake nagekom het nie en Groep B uit een gesinslid van elke pasiënt wat in die pasiëntrekord geïdentifiseer is en wat saam met die pasiënt gewoon het. 'n Loodsstudie is uitgevoer om die betroubaarheid en geldigheid van die data versamelingsinstrument te toets. Twee pasiënte en twee gesinslede wat nie aan die hoofstudie deelgeneem het nie, is vir die loodsstudie geselekteer. Die volgende kundiges is genooi om die geldigheid en betroubaarheid van die instrument te verifieer: • Die verpleegkundige navorsingskomitee aan die Universiteit van die Oranje- Vrystaat • Die etiekkomitee van die Fakulteit van Gesondheidswetenskappe aan die Universiteit van die Oranje-Vrystaat • Die personeel van die rekenaarsentrum van bogenoemde universiteit • Ervare kliniese psigiatriese verpleegpersoneel • Die navorser, wat die nodige vaardighede in psigiatriese verpleegkunde verwerf het, het self 'n belangrike rol gespeelom die betroubaarheid en geldigheid van die instrument te verseker. Data is deur middel van onsemi-gestruktureerde onderhoud met behulp van on vraelys versamel. Beide geslote en oop-einde vrae is ontwerp om die verlangde inligting te bekom. Die vraelys is deur die navorser ingevul weens die ongeletterdheid van die respondente. Die data is deur die rekenaarsentrum aan die Universiteit van die Oranje-Vrystaat gekodeer. Die navorser het die data met behulp van grafieke en tabelle geanaliseer en geïnterpreteer. Etiese oorwegings is voor oë gehou en ingeligte toestemming is van die respondente verkry. Privaatheid en vertroulikheid en die reg tot beskerming teen ongemak en skade is deurlopend verseker ° ook van diegene met verminderde outonomie. Die resultate dui daarop dat die hoofrede vir die mis van kliniek afsprake wat vrees vir die newe-effekte van medikasie. Dit gebeur met pasiënte wat op behandeling was en newe-effekte ondervind het in 28.1 % van gevalle. Die ander redes wat dui op Ongebrek aan kennis oor die belangrikheid van nasorg is as volg: - Die pasiënt voel goed wanneer nie op behandeling - Die pasiënt bly tuis sonder rede - Swak verpleegkundige- pasiënt verhoudings - Substans misbruik - Stigma gekoippel aan psigiatriese siekte Alle redes bly probleme wat onmiddellike en langtermyn oplossings vereis. Voorstelle om die probleme aan te spreek, is gemaak deur die navorser en deur die verpleegriglyne soos verduidelik.