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EPH
-
International Journal of
Medical and Health Science
ISSN (Online): 2456-6063
Volume 01 Issue 02 September 2015
DOI:
https://doi.org/10.53555/eijmhs.v1i3.95
THE NURSES’ KNOWLEDGE ON PSYCHIATRIC PATIENT ADMISSION
PROCEDURES AT THE NATIONAL TEACHING AND REFERRAL MENTAL
HEALTH HOSPITAL IN KENYA
Dr. Mutunga-Mwenda C S1*, Kangethe, A2, Maranga, A. K3
*1School of Nursing, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
2School of Nursing, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya Alicekangethe82@gmail.com
3Deparment of Nursing, Egerton University, P.O. Box 536-20115, Egerton, Kenya Alice.ondieki@ymail.com
*Corresponding Author:-
Email:-Mutungacs@gmail.com
Abstract:-Mental illness is a global health crisis which results in significant morbidity and is a major factor that
influences the social determinants of health of individuals, families and communities. To deal with this health crisis,
mentally sick patients have to be admitted in psychiatric hospitals for management. In Kenya, the Mental Health Act
cap 248 (Laws of Kenya) prescribes procedures that must be followed in the admission of patients to a mental
health hospital. Nurses, among other health care workers have a great role in the provision of the initial care of the
mentally ill patients presenting in various outpatient departments. This calls for the nurses to be skillful when handling
the mentally ill patients at the OPD, during admission.
Aim: The aim of this study was to determine the knowledge on admission procedures among nurses working at the
National Teaching and Referral hospital.
Methods and material: This was a descriptive cross-sectional, with national hospital being purposively selected since
it admits mentally sick patients who have been referred from different parts of the country. Systematic sampling was
used to select the sample size of 132 nurses for the purposes of documenting their knowledge and attitude on admission
procedures while purposive sampling was used to observe nurses for the purposes of documenting their admission
practices at the outpatient department. Semi-structured questionnaires were used to document the knowledge of the
nurses whereas predetermined checklist was used to document observations made at the outpatient department in
relation to patient admission process. The collected data was analyzed using SPSS version 20 and presented in form of
charts, tables and narratives.
Findings: Results of the study revealed that majority of the respondents 69% were knowledgeable regarding admission
of voluntary patients to psychiatric units, although most of the respondents, 79.7% displayed knowledge deficit in
relation to discharge of voluntary admission patients from psychiatric units. About 31% of the respondents lacked
knowledge on the admission procedures for voluntary patients. The results also demonstrated that some of the
respondents were utilizing the prescribed patient admission procedures while others were not. Various challenges to
the implementation of the prescribed admission procedures were also identified by the respondents.
Recommendations: The study recommended that the hospital management should ensure that most of the nurses who
work in the institution have specialization in psychiatric nursing. In house education on patient admission and
discharge procedures should be carried out to reach the nurses who lacked knowledge in this aspect.
Key words: psychiatric patient admission procedures, National Teaching and Referral mental health Hospital
Copyright 2015 EIJMHS
Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS
Volume-1 | Issue-3 | Sep, 2015 6
INTRODUCTION
Mental illness is a global health crisis which results in significant morbidity and is a major factor that influence the
social determinants of health of individuals, families and communities (Shaban, 2006). The Mental Health Act cap
248 (Laws of Kenya) prescribes procedures that must be followed in the admission of patients to a mental health
hospital. The Act prohibits admission or detention of persons in a mental health unit without applying the rules
stipulated therein. Patients may be admitted to a mental health hospital as voluntary, involuntary, or emergency
patients.
When a person seeks admission as a voluntary patient, he/she fill a form (med 613), while the admitting doctor will fill
a form (med 615), to authorize the admission. In 72 hours, the patient can write a letter seeking discharge.
When a patient is admitted through involuntary admission, it means that the patient is incapable of making informed
decision to his/her Mental Health status. Involuntary admission may also be used in mental health patients who refuse
health interventions (National Council for Law Reporting, 2012). To authorize the admission of involuntary patients,
the doctor will fill a form (med 615), while the accompanying person will fill another form (med 614). A court of law
may also order for an involuntary admission of a person based on its (National Council for Law Reporting, 2012).
Globally, reform of mental health care systems advocate for increased participation of a wide range of health care
workers in providing services to people with mental disorders. Health-care professionals across all disciplines require
increased skills to better equip them to recognize and manage mental illness, along with improved coordination of
consumer of mental health services, and increased community interest and involvement in mental health issues
(Shaban, 2006). Nurses among other health care workers have a great role in the provision of the initial care of mentally
ill patients, presenting in various outpatient departments (OPD). This calls for the nurses’ to be skillful when handling
the mentally ill patients at the OPD, during admission.
However, at the Mathari national teaching and referral mental hospital, there are no documented studies in relation to
health care worker’s abilities to follow the prescribed procedures when admitting mentally ill patients. This formed the
basis for the researcher’s motivation to carry out this study on knowledge, attitude and practice on admission
procedures among nurses at the Mathari national teaching and referral hospital.
MATERIALS AND METHODS
Study design
This was a descriptive cross-sectional study on the Nurses knowledge, attitude and practice on admission procedures
at Mathari National Teaching and Referral hospital. The study involved interviewing nurses in the hospital.
The Study Area
The study was carried out in Mathari National teaching and referral Hospital, which is situated off Thika super highway
opposite Muthaiga police station, about six Kilometers north of Nairobi City Centre. It neighbours the Mathari valley
(See appendix –VII). The hospital was established in 1910 by the colonial government. It has 200 nurses and a capacity
of 700 beds, although the average occupancy is about 1500. The hospital has several wards which include five male
wards, three female wards, an amenity ward and a drug rehabilitation center. MNTRH offers general outpatient
services, dental services and outpatient psychiatric services to the general public. The institution also has physiotherapy
and occupational therapy departments, which are part of treatment for admitted patients. Other clinics include Maternal
and child health, comprehensive care, child psychiatry and methadone clinics. The hospital has a civil wing for civil
patients and a maximum security unit for mentally ill offenders who have committed capital offenses. The institution
serves as a national referral hospital for patients with mental health conditions. Mathari Hospital offers clinical
experience to both undergraduate and postgraduate Medical students from various universities in Kenya. The hospital
is also a clinical experience center for both basic and post basic students from Mid-level Medical training Colleges.
Study Participants
The study population was nurses at the Mathari National Teaching and Referral Hospital during the period of the study.
The target population was 384 nurses in direct care of psychiatric patients who have worked at Mathari National
Teaching and Referral Hospital for more than six months. The selection was done using systematic random sampling
where every 2nd nurse was sampled from nurses’ duty schedule.
Data Collection Tools and Methods
During data collection, the research assistants distributed questionnaires to the respondents and collected them back
once they were filled.
Data Management
The research assistant cross checked the data collection tools to ensure that correct entries were performed. Data entry
in to the computer data base was carried out by the data entry clerk and secured with a password. Raw data tools were
put in a folder a stored in a lockable cabinet for reference purposes. Quantitative data from the respondents was entered
into a computer and descriptive analysis computed using SPSS version 20. In respect to the qualitative data, themes
arising from the analysis were recoded and analyzed accordingly with some of the reports being narrated. The outputs
were presented in form of narratives, charts and tables.
Ethical Considerations
Ethical clearance to collect data was obtained from Mount Kenya University Ethical Review Committee (ERC). The
researcher also obtained permission from the management of the MNTRH. The researcher also ensured that the
questionnaires were coded and no respondent’s name was entered during data collection. To collect data, all the
Volume-1 | Issue-3 | Sep, 2015 7
respondents were requested to sign an informed consent after getting full information in relation to the study being
conducted. All information obtained during the study was treated with confidentiality, with the data being stored in a
computer with a pass word. The latter was only accessible to the researcher and the data entry clerk. For security
purposes, the raw data questionnaires were stored in a lockable cabinet. Once the researcher completes the project, the
findings will be disseminated to the management of MNTRH for the appropriate utilization.
STUDY RESULTS
Demographic characteristics
Respondents’ age: Most of the respondents, 50(34.1%) were aged between 25 to29 years, while the least numb of
respondents, 10 (7.8%) were aged below 25 years. The respondents who belonged to age group 30 to 34 years were16
(12.5%), while the ones aged between 35 and 39 years were 15 (11.7%). The respondents who were aged 40 years and
above were 37(28.9%).
Age groups
Figure 1: Respondents age in years
Respondents’ professional qualifications:Figure 2 shows that most of the respondents, 67(52%) were diploma
holders, with the least numbers of respondents, five (4%) being certificate holders. The respondents who had higher
diplomas were 22(17%), while 34(27%) respondents had bachelors level of qualifications.
Respondents with post basic psychiatric nursing course
Most of the respondents, 102 (79.7%) had not undergone any post basic Psychiatry nursing course.
Post basic Psychiatry
nursing course attended
No of
respondents
Percentage
Yes 26 20.3
No 102 79.7
Total 128 100
Respondents working experience in years
7.8
39.1
12.5 11.7
28.9
0
5
10
15
20
25
30
35
40
Below 25 25-29 30-34 35-39 40And
Volume-1 | Issue-3 | Sep, 2015 8
Figure 3 shows that most of the respondents, 65(50.8%) had worked for at least six years. Fourty eight (37.5%)
respondents had worked for four to six years, with 15 (11.7%) having worked for four to six years.
Fig 3- Respondents' years of experience
Respondents’ Knowledge on Patients’ Admission Procedures To Psychiatric Unit
Majority of the respondents 89 (69%) said that it was not a must for voluntary patients to be accompanied to the
hospital while 39(31%) said that all voluntary admission patients must be accompanied to the hospital.
Yes
No
Figure 4 - Voluntary patients must be accompanied to hospital
Responses on whether it’s a must for voluntary patients to be authorized by a doctor before admission
Forty eight (38%) of the respondents said that it is not a must for admission voluntary patients to be authorized by a
doctor before admission, while 80(62%) disagreed with the statement.
31%
69%
Volume-1 | Issue-3 | Sep, 2015 9
Nurses responses on the period for which voluntary admission patients must be retained in a psychiatric unit
before requesting for discharge
In relation to how long a voluntary admission patients should remain in the hospital before requesting for discharge,
most of the respondents, 55(43%) said that the patients should remain in hospital until they fully recover. Twenty eight
(21.9%) of the respondents said that the patients should request for discharge after 48 hours, 26(20.3%) said that the
patients should be discharged after 72 hours while 19 (14.8%) said that the patients should be discharged after 12 hours.
Table 2: Period for which voluntary admission patients should be retained in a psychiatry unit before requesting
for discharge
Period (Hours) Number Percentage
12 19 14.8
48 28 21.9
72 26 20.3
Until recovery 55 43
Total 128 100
Nurses’ responses on whether voluntary patients may leave hospital without prior notice
When asked whether voluntary admission patients may leave the hospital without prior notice, 93 (73%) of the
respondents said no while 35(27%) of the respondents said that the patients can leave without prior notice.
Figure 6- Whether voluntary patients should leave hospital without
prior notice
Respondents’ opinion on the characteristics of patients admitted as emergency
Table 3 shows that most of the respondents, 90 (70.3%) described emergency admission patients as the ones who are
dangerous to themselves, while 28(21.9%) of the respondents said that emergency patients are the ones who are a
nuisance to the public because of their medical disorder. Ten (7.8%) of the respondents said that these are patients who
may be mistreated by their relatives because of the mental disorder.
Yes
No
7
%
2
%
Volume-1 | Issue-3 | Sep, 2015 10
Table 3: Responses on characteristics of patients admitted as emergency
Characteristics Number Percentage
Patients who is dangerous to himself and others 90 70.3
Patient who, because of the mental disorder is a nuisance to the
public
28 21.9
Patient who, because of the mental disorder may be mistreated by
relatives
10 7.8
TOTAL 128 100
Nurses’ responses on whether officers from the armed forces must have authority from their MOH’s before
admission to psychiatric unit
When asked whether armed forces officers must obtain authorization by their medical officers before admission to a
psychiatric unit, 34 (27%) of the respondents agreed while 94 (73%) disagreed.
Figure 7-Whether armed force must be authorized by their MOH's before
admission
DISCUSSION
The study showed that most of the respondents, 34.1% were aged between 25 to29 years. This was contrary to a study
by Kumar et al (2011) on the knowledge of staff nurses regarding legal and ethical responsibilities in psychiatric
nursing in a selected psychiatric centre associated with Swift Medical College, Jaipur which established that most of
the respondents were above 30 years of age. The study findings also showed that most of the respondents were females
(66%), which contradicted the study by Kumar et al (2011), whereby most of the respondents were males. In this
current study, most of the respondents were diploma holders but in the study by Kumar et al (2011) majority of the
respondents had a bachelor of science in nursing. Among the 128 respondents interviewed, only 20.3% of them had a
post basic diploma in psychiatric nursing, a situation which could adversely affect the provision of quality care to the
mentally sick patients, especially in relation to the utilization of standard admission procedures in the OPD. The fact
that most of the respondents, 50.8% had worked for at least six years explains why an equivalent number where either
Nursing officers one or senior nursing officers. However, Kumar et al (2011) established that most of the respondents
in there study had worked for less than five years.
The study revealed that majority of the respondents 69% were knowledgeable regarding admission of voluntary patients
to psychiatric units since they said that it was not a must for them to be accompanied to the hospital. This could also
be the reason why almost the same number, 62% of the respondents said that voluntary patients should not seek
authority before admission to a psychiatric unit. This was true because the only requirement for admission of voluntary
patients is to make a written request and fill the prescribed form (med 613). These findings were almost similar to those
of a study by Gakinya et al (2014) on the Knowledge and practice in the management of mental patients at Mathari
Hospital which established that 75.9% of the nurses interviewed knew the admission procedures in details. However,
with 31% saying that all voluntary admission patients must be accompanied to the hospital shows that still there is a
large number of nurses in the institution who lack knowledge on the admission procedures for voluntary patients. This
could be probably because of the fact that most nurses in the hospital had not undergone any post basic course in
psychiatric nursing, meaning that they utilize the knowledge they acquired in their basic training to manage patients in
the hospital.
Most of the respondents, 79.7% displayed knowledge deficit in relation to discharge of voluntary admission patients
from psychiatric units. This showed that a large group of the respondents were aware of some of the legal requirements
Volume-1 | Issue-3 | Sep, 2015 11
for patients in psychiatric units. This was similar to the findings of a study by Kumar (2011) on knowledge of staff
nurses regarding legal and ethical responsibilities in psychiatric nursing in a selected psychiatric centre associated with
Swift Medical College, Jaipur which established that most of the respondents (90%) had moderate level of knowledge
in the legal and ethical responsibilities in the field of psychiatric nursing.
Only 20.3% were able to state that voluntary admission patients may request for discharge after 72 hours of admission
according to the mental health Act cap 248 (National Council for Law Reporting, 2012). However, most of the
respondents, 73% displayed good knowledge in some aspects of voluntary patients admission processes since they
said that voluntary admission patients should give a prior notice before discharge, which is true according to the mental
health Act cap 248. Most of the respondents, 70.3% were knowledgeable in terms of defining emergency admission
patients since they said that these were the ones who are dangerous to themselves, hence require immediate admission
without any delays. These findings were similar to those of a study by on Psychiatrists’ attitudes toward the procedure
of involuntary admission to mental hospitals in China which showed that 98.1% of the respondents said that the patients
were admitted because they were dangerous to themselves (Shao et al, 2012). When asked whether armed forces
officers must obtain authorization by their medical officers before admission to a psychiatric unit, 73% disagreed. This
showed that they lacked knowledge in relation to the admission of armed forces officers, since according to the mental
health Act cap 248, armed forces medical officer must authorize their admission to a psychiatric unit (National Council
for Law Reporting, 2012).
CONCLUSIONS
In terms of the respondents’ knowledge on the admission procedures to psychiatric unit, it was evident that they lacked
knowledge in some of the processes, like admission of armed forces officers.However, majority of them still
demonstrated good knowledge in relation to admission of voluntary patients. Despite this, most of the respondents
could at least explain what entails emergency admission of patients to psychiatric units.
RECOMMENDATIONS
The hospital management should ensure that most of the nurses who work in the institution have specialization in
psychiatric nursing ii. In house education on patient admission and discharge procedures should be carried out to reach
the nurses who lacked knowledge in this aspect.
REFERENCES
[1]Gakinya,BN, Mburu JM, Othieno CJ, Ndetei DM, Obondo AA.(2014). Knowledge and Practice in the Management
of Mental Patients at Mathari Hospital, Kenya in relation to the
[2]Mental Health Act of 1989, International Journal of Novel Research in Healthcare and Nursing, 1(1): 15-20
[3]Kumar R, MehtaS and Kalra R. (2011). Knowledge of staff nurses regarding legal and ethical responsibilities in the
field of psychiatric nursing. Nursing and Midwifery Journal, 7 (1)
on.orgyalaw.kenwwwomrfievedRetr248.CapAct[4]National Council for Law reporting. (2012). Mental Health
27th August, 2015
.orgyalaww.kenwwmfroievedetrR[5]National Council for Law Reporting, (2012). Criminal Procedure Code Cap 75.
on 27th August, 2015
[6]Shaban,R . (2006). Paramedics’ clinical judgment and mental health assessments in emergency contexts: Research,
practice, and tools of the trade, Australasian Journal of Paramedicine, 4(2). Retrieved from
http://ro.ecu.edu.au/jephc/vol4/iss2/4
[7]Shao Y, Xie B and Wu Z. (2012). Psychiatrists’ attitudes toward the procedure of involuntary Admission to mental
hospitals in China, Int J Soc Psychiatry, 58 :( 4):440-447
APPENDIX II –LETTER OF ETHICAL
CLEARANCE
Volume-1 | Issue-3 | Sep, 2015 12
Volume-1 | Issue-3 | Sep, 2015 13
