Exploring the Challenges of Psychiatric Nurses in Providing Care to Persons With Mental Health Problems in Selected Health Facilities in Ghana

Exploring the Challenges of Psychiatric Nurses in Providing Care to Persons With Mental Health Problems in Selected Health Facilities in Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the Challenges of Psychiatric Nurses in Providing Care to Persons With Mental Health Problems in Selected Health Facilities in Ghana Anita Fafa Dartey, Wisdom Kwesi Mensah Avor, Christopher Ayisah, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7999245/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Mental health nurses play a pivotal role in caring for individuals with mental health challenges, particularly in hospital settings where patients may exhibit challenging behaviors. Understanding the experiences of mental health nurses regarding the behavior of persons living with mental health problems is crucial for improving patient care and staff well-being. Aim This study explored the experiences of mental health nurses regarding the behavior of persons living with mental health problem in selected health facilities in the Ho municipality. Method A qualitative exploratory design was employed, using purposive sampling to recruit 14 mental health nurses from the psychiatric unit of Ho Teaching Hospital and Ho Municipal Hospital. Data collection was conducted using a semi-structured interview guide. The collected data were audio-recorded, transcribed verbatim, and analyzed through content analysis using a deductive approach. Results The content analysis yielded three themes and nine subthemes. The analysis revealed that mental health nurses experienced significant stress and potentially hazardous working conditions due to patient aggression, non-compliance with medication, and systemic issues such as understaffing and inadequate infrastructure. Additionally, community stigma exacerbated their challenges. Despite these obstacles, nurses demonstrated resilience through effective coping strategies, including teamwork, vigilance, and support from their families. Conclusion The study revealed major occupational challenges among mental health nurses at Ho Municipal Hospital, including patient aggression, illness denial, understaffing, and stigma. It calls for structured mental health training, adequate staffing, supportive supervision, and stigma-reduction strategies to enhance workplace safety, improve service delivery, and strengthen nurses’ resilience in line with Sustainable Development Goal 3. Experiences Mental health nurses Mental disorder Psychiatric Figures Figure 1 Introduction Mental health is increasingly acknowledged as a global priority because of the substantial negative impact mental health disorders have on populations [1]. According WHO, A mental disorder is defined as a clinically meaningful disruption in a person’s thinking, emotional control, or behavior [2]. Mental disorders account for approximately 14 % of he worldwide disease burden, affecting an estimated 264 million people with depression, 46 million with dementia, and 45 million with bipolar disorder [3, 4]. In the African region, the WHO estimated that over 116 million people were living with mental health conditions before the pre-pandemic [5]. In Sub-Saharan Africa specifically, pooled prevalence rates are 31% for anxiety, 30% for depression, and 24% for insomnia [6]. In Ghana, approximately 2.1 million people suffer from moderate to severe mental illness, of whom roughly 650,000 are projected to have severe disorders [7]. National surveys further indicate that around 10% of the population experiences common mental health disorders and 1 to 3% endure severe psychiatric conditions such as schizophrenia [8]. Yet, in many developing countries, the voices of mental health nurses, who play a critical role in caring for these patients, remain underrepresented in the literature [9]. However, research has shown that nearly 20% of patients in acute psychiatric wards may display sudden and unpredictable violent behavior [10], which can be directed toward both staff and fellow patients, posing a serious safety risk within care settings [11]. Persons living with mental health problem frequently exhibit a wide range of challenging behaviors such as agitation, aggression, self-harm, treatment noncompliance, and communication difficulties [12, 13]. These behaviors not only exacerbate patients’ own distress but also place mental health nurses in complex, high-risk situations [13]. In such high-risk environments, the ability of nurses to promptly de-escalate situations is essential, although delivering care under these conditions is both dangerous and challenging [14]. A mental health nurse is responsible for coordinating and delivering care to individuals with mental health conditions. They provide support and treatment to patients experiencing a wide range of mental health issues, including anxiety, depression, personality disorders, and eating disorders, with the aim of promoting recovery and achieving optimal health outcomes [15]. In Ghana, becoming a mental health nurse requires the completion of an accredited nursing training programme that includes mental health and psychiatric nursing components. After completing the training, individuals must register with the Nursing and Midwifery Council of Ghana, the official regulatory body for nursing practice[16]. Mental health nurses are three to four times more likely to experience violence and aggression than any other health care worker while performing their duties in mental health care institutions [17, 18]. For instance, a study revealed that 43% of nurses reported assaults by mental health care users, whereas only 13.8% of doctors experienced such incidents [19]. Moreover, how nurses perceive and respond to aggressive behavior is shaped by their personal judgments, attitudes, and tolerance levels further influencing their professional experiences and the outcomes for patients [20]. Beyond violence, psychiatric hospitals expose nurses to verbal abuse, stigma, sexual harassment, and the cumulative emotional burden of supporting self-harming or suicidal patients [21]. Such ongoing stressors contribute heavily to burnout, poor life satisfaction, sleep disturbances, anxiety, depression, and even professional exit, undermining both workforce retention and quality of care [22]. Despite the evident challenges, there are limited knowledge about how psychiatric nurses perceive, interpret, and cope with such behaviors in their daily work. This lack of understanding hinders the development of tailored interventions, including training, de-escalation protocols, and psychological support systems, that could improve nurses’ safety, resilience, and job satisfaction. Therefore, this study investigated the lived experiences of mental health nurses at Ho Teaching Hospital and Ho Municipal Hospital concerning the behaviors of persons living with mental health problem. Methods Study design This study utilized a qualitative exploratory design. This design was chosen to allow for an in-depth investigation of the issues in their natural context, providing flexibility to explore participants’ views and uncover underlying factors influencing the phenomenon under study [23, 24]. Study population The study population included all registered mental health nurses with at least one year of working experience at the selected health facilities. This was because one year of experience was sufficient for mental health nurses to have adequate experiences with individuals living with mental health problems. Eligibility criteria This study included mental health nurses employed at the psychiatric unit of Ho Teaching Hospital and Ho Municipal Hospital. Participants were required to have a minimum of one year of work experience and to provide consent to participate in the study. Sample and sampling technique Participants were chosen through purposive sampling. A total of 14 participants were considered adequate, based on the concept of data saturation, which is the point at which no new themes or insights arise from additional interviews. Research instrument and data collection procedures Data were collected using semi-structured interviews designed to explore the experiences of mental health nurses regarding the behaviors of individuals living with mental health conditions. Prior to data collection, an introductory letter was sent to the selected health facilities to obtain permission and formally introduce the study. Informed consent was secured from all participants before participation. Interviews were conducted in private, quiet settings within the facilities to ensure comfort and confidentiality. Each interview session lasted approximately 30–45 minutes. To maintain anonymity, participants were assigned pseudonyms, and no third parties were present during the sessions. Participants were informed of their right to withdraw from the study at any point without any consequences. Ethical considerations Ethical approval for the study was obtained from the University of Health and Allied Sciences Research Ethics Committee [UHAS-REC A.11[28] 23–24] and the Municipal Health Directorate. Before data collection, participants were fully informed about the study’s purpose and verbal consent was obtained. They were assured of their right to withdraw at any time without affecting their care. Confidentiality and anonymity were maintained by assigning pseudonyms and special codes, with data securely stored and accessible only to the researchers. Although there were no direct benefits, participants were informed that their contributions would help inform relevant policies and recommendations. Data analysis Data analysis followed the methodological framework outlined by [25]. All audio recordings were transcribed verbatim into Microsoft Word and subjected to rigorous content analysis to identify underlying insights, patterns, and meanings. The research team engaged in repeated readings of the transcripts to ensure immersion and comprehensive understanding of the data. Coding was conducted by systematically labeling text segments that encapsulated salient ideas. These codes were then organized into preliminary themes, which were iteratively reviewed, refined, and named to align with the study objectives. The final stage involved synthesizing the findings into a coherent narrative, supported by illustrative participant quotations to substantiate the thematic interpretations. Rigour Research rigor was established through [24] four trustworthiness criteria. For dependability, transcripts were reviewed repeatedly and independently coded by two researchers, with coding decisions validated through team discussions. To achieve confirmability, researchers-maintained memos, field observations, and analytic decisions, integrating these into transcripts and preserving a meticulously labelled audit trail of audio files, transcripts, field notes, and meeting records at every stage. Transferability was supported by a thorough description of study methods and instruments, the use of purposive sampling to capture diverse staff perspectives, and the replication of data collection procedures across different demographic groups and locations. Finally, credibility was reinforced by returning transcripts to participants for feedback and clarification, and by employing data triangulation, thus comparing field notes with interview transcripts to minimize bias and enhance accuracy [26, 27]. Results Table 1 shows that most (31.25%) of the nurses were aged between 24 and 29 years. Majority (62.5%) were Females, and Christians (75%). More than half (62.5%) were married, and a little more than half (68.75%) were Ewe. Majority (56.25%) held a bachelor's degree (BSc), and most of the participants (31.25%) had between 6 and 10 years of professional experience. Table 1. Sociodemographic Characteristics of Participants Variables Frequency (N) Percentage (%) Age 24-29 30-34 35-39 40-44 45-49 5 4 3 1 1 31.25 25 18.75 12.5 12.5 Gender Female Male 10 4 52.5 37.5 Religion Christian Muslim Traditionalist 10 3 1 75 18.75 6.25 Marital Status Single Married 6 8 37.5 52.5 Ethnicity Ewe Akan 10 4 68.75 31.25 Level Of Education Degree Diploma 8 6 56.25 43.75 Years Of Practice 1-2 3-5 6-10 11-20 3 4 4 3 18.75 25 31.25 25 Emerged themes The transcribed data underwent a thorough content analysis, revealing the lived experiences of mental health nurses at Ho Teaching Hospital and Ho Municipal Hospital concerning the behaviors of persons with mental health problems. The content analysis was categorized into three themes and nine subthemes. The identified themes included: 1) Hindrances to Nursing Care, 2) Health System Challenges, and 3) Coping Strategies Adopted by Mental Health Nurses as shown in (fig.1). Fig 1. Key Themes and Sub-themes 1: Hindrances to Nursing Care Mental health nurses face a range of challenges, including noncompliance, behavioral obstacles, gender-biased behavior, and stigmatization, which affect the care they provide to their clients. a) Noncompliance and behavioral barriers Participants revealed that individuals with mental health problems often display aggressive and violent behaviors during admission. In addition to aggression, nurses reported challenges with patients who refuse to take prescribed medications. Some patients deny having any mental illness, even in severe cases, which further hinders their willingness to accept care. Even though we don’t have severe cases here like that, we often encounter challenges like dealing with aggressive behavior of the client… They can be all nice and funny with you, but the next second they are so moody and violent…. ( Participant 1, 11years of practice) There have been challenges especially when administering medications. They haven’t accepted that something is wrong with them, hence they don’t see the need to take medications. So, if you try to explain or insist them to take the medication, they can become aggressive and even hurt you. Some ever tried to hurt me before but I was vigilant to swerve his hand and quickly call for backup. ( Participant 9, 15years of practice) Dealing with patients who refuse treatment is a major challenge here. Imagine entering client cubicle to administer medications and he/she looks up to you and tells you that nothing is wrong with him/her and he/she doesn’t need drugs… Some will eventually take it while others won’t no matter what you do or say. It is very frustrating. ( Participant 6, 13years of practice) The main challenge I encounter, is with the administration of medications. Most oral medications, they refuse them. And you have to be with them and be talking to them before they take it. It is time exhausting …. ( Participant 8, 11years of practice) b) Gender bias conducts Many patients exhibit good and respectful conduct when male staff members are on duty, yet they tend to become more disruptive or deviant when only female nurses are present in the ward or assigned to their cubicles. Some nurses recounted their experiences, highlighting the inconsistencies in patient behavior based on the gender of the nursing staff, which complicates the caregiving process. The problem we encounter is that, especially we females, when we are providing care to the male patients, they don't allow us. So, we females encounter challenges with the male patients because they feel like the females are so soft. So, they don't take our instructions …. But when the guys are there, they cooperate.…. ( Participant 14, 7years of practice) Some of the male patients will try to harassed you sexually. They will be making advances at you especially when you are running night shift and you are not careful; you will be raped…... ( Participant 8, 3 years of practice) c: Stigmatization Mental health nurses who provide essential care to vulnerable individuals often face stigma and exclusion from their own communities, encountering judgment and isolation instead of compassion and support they facilitate for patients. Stigmatization on the side of the public. People devalue you because of what you are doing or what other people say about your work. ( Participant 12, 8 years of practice) The problem is that, when you go public and something happens and you want to give your point of view, people tend to see you as one of your patients and pass comments that are degrading. I was told once that I was behaving like my patients ... (Participant 6, 13years of practice) 2. Health System Challenges Participants reported that factors such as understaffing, inadequate resources, and a lack of ongoing training from management make working conditions difficult, creating multilayered challenges that mental health nurses must navigate in their daily responsibilities. Two subthemes emerged from this section and included a) Understaffing and inadequate infrastructure, and b) Lack of continuing training. a) Understaffing and inadequate infrastructure Participants reported that persistently high nurse-to-patient ratios and staffing shortages increase individual workloads, leading to overwhelming job demands, elevated stress levels, and reduced job satisfaction. Many facilities still lack the necessary resources, such as sufficient beds, equipment, and support staff, which further hinders nurses’ ability to deliver safe, high-quality care. Even though we don’t have much psychiatric hospital in the country, the mental health units in the various hospital are not having enough staff. Yes, there are shortages of staff... ( Participant 1, 11years of practice) … we face challenges like inadequate infrastructures. We don’t have the needed facilities to care holistically for mental health clients. Even though this is not a psychiatric hospital, at least basic psychiatric facilities should be available for use. ( Participant 13, 3 years of practice) b) Lack of continuous training Participants emphasized the importance of continuously updating their knowledge on current health trends and practices. However, they regrettably noted that this was lacking among mental health nurses. Back in school, the curriculum was used to teach us. But what we have on the field is bigger than what we were taught in the classroom. So, there is a need for continuous training while we are practicing but there isn’t. So, the lack of continuous training and support for dealing with challenging behaviors is a significant issue. ( Participant 1, 4years of practice) There are new innovations each day and better way of doing certain things as compared to years ago. So, for us to be up to date, we constantly need to keep learning. Mostly this learning is supposed to be facilitated by our leaders but such one is not available ... ( Participant 4, 10years of practice) 3: Coping Strategies Adopted by Mental Health Nurses Participant reported instances of aggression and violence from clients, emphasizing the need for effective strategies to ensure physical safety on the ward. This theme examines the coping mechanisms participants employ to mitigate harm and maintain a secure work environment. Under this theme, four subthemes emerged and included a) Safety Tips, b) Work Ethics, c) Resilience and experiences, and d) Family support. a) Safety Tips Participants emphasized the importance of maintaining constant awareness and alertness on the ward. By being vigilant, closely observing patients' behaviors, anticipating potential risks, and staying prepared to respond to any signs of aggression, they were able to overcome the stressful behaviors and situations. Yes, we have to be alert. I'm always alert and don't turn my back towards them. Probably always my back is on the wall, facing them. You don't know when and where anything might come in. … ( Participant 10, 11years of practice) My health first. If I am not healthy, I can’t provide care, so I am always on the guard. So, I make sure I protect myself always in every way to keep healthy. ( Participant 5, 19years of practice) Our work is like a war zone or peacekeeping missions. You may come to work alright and may not go back or go back injured. So, we have to be extra careful and alert at all times, because a patient can come at you at any time... ( Participant 3, 10years of practice) Others cope emotionally by ignoring baseless or slanderous remarks to maintain their focus and calm, and by using diversional therapy to engage patients in activities like art, music, or games in order to reduce agitation and promote recovery. Some can lie on you, that you’ve taken their belonging, like money. They'll tell you; my money is with you, give me my money to buy this. I saw you picking my money when I was sleeping. They can even shout and be calling you names. But all we do is to ignore them... ( Participant 11, 5years of practice) Diversional therapy really helps. When it is properly put in place, an aggressive client can just relax and communicate with the staff well. A patient who is moody or isolated from everyone was able to regain normal life in the shortest possible time … ( Participant 2, 4years of practice) b) Work ethics Participants indicate that teamwork and effective prioritization of tasks are fundamental to their approach. By collaborating with colleagues and focusing on the most pressing needs, participants strive to maintain high standards of care while ensuring that they support one another in a demanding work environment. ...we mostly don’t get any support from anywhere. So, we depend on each other here as a team. When the workload is too much, we call for help from other staff to come in and support. If any of us have a problem, we mobilize ourselves and support that fellow… ( Participant 10, 11 years of practice) The support is always from fellow colleagues; we do support each other. We are always there for each other. From colleagues, financially, they also come in.… From the hospital the only support we receive is logistics wise. But psychological support, like when you are traumatized, there hasn’t been anything ( Participant 7, 6 years of practice) While nurses make efforts to depend on their own abilities, they expressed disappointment over the frequent absence of managerial support when challenges arise. We don't receive anything. There is nothing we receive from the hospital. We don't receive anything. We do it by ourselves. No, from outside, no. Because in here, if a patient hurts you or a patient hits you with something, you are going to take your care by yourself... ( Participant 14, 9 years of practice) It is also worth to note that participants acknowledged that while some nursing activities are important, they may not significantly impact a patient's immediate condition. As a result, they choose to set aside these less urgent tasks during time of excess work overload to concentrate their efforts on interventions that are more likely to yield positive outcomes for their clients at that moment. Work overload has been one of the key challenges. So, in such instances, we prioritize our care. Though all are needed we do attend to those that need the urgent care. In that way, we won't be overwhelmed ... We are always understaffed so we keep adjusting. (Participant 12, 8 years of practice) Ooh yeah, it is all about prioritizations. Imagine you have a client who is refusing everything, doesn’t want to take medication, and doesn’t want to bath either. In your quest to solve this problem, what will you spend most of your energy on? Though personal hygiene is important, you will try to convince a client to take his/her medications ( Participant 4, 10years of practice) c) Resilience and experiences Participants have drawn on their personal strength and accumulated experience to build resilience. Familiarity with challenging situations helped nurses to develop effective coping strategies, boosting their confidence and adaptability. Yes. The coping mechanism is individual. To me, I just make sure I just do what I do with the ones that are within my capacity, and I leave the rest to others. That's how I cope.... ( Participant 10, 11years of practice) ... Yeah, that's what we are using to challenge ourselves …. So, we take our coping mechanism in order to help us deal with the patient. …. If it comes to the patient, we school the patient... You don't need to go close to the patient for some time. We do it so that the patients calm down. ( Participant 14, 9years of practice) b: Family support Nurses indicated that they do not face their challenges in isolation, as their families offer support that helps them stay grounded and resilient. This support comes in various forms, including emotional reassurance, practical assistance, and a strong sense of belonging, which collectively help them cope with work-related stress and safeguard their mental well-being. I rely on a strong support network of my family, and friends. Regular conversation with my family help in sharing the load and getting different perspectives…. (Participant 1, 3years of practice) … wherever you see yourself, never cut yourself from your family. No matter how successful you’ve become. If not for my family who is always supporting me, I wouldn’t be here practicing as a mental health nurse…. (Participant 9, 15years of practice) Discussion The study explored the experiences of mental health nurses in selected health facilities within the Ho Municipality. It aimed to understand how the behavior of individuals with mental health conditions affects nursing care. The study specifically focused on the challenges nurses face in hospital settings, including patient aggression and non-compliance with treatment. Findings revealed that nurses experience high levels of stress and work under potentially hazardous conditions. Prolonged stress and unsafe conditions may lead to burnout, low job satisfaction, and ultimately, high turnover among mental health nurses. Also nurse distress and aggression from patients can affect empathy, decision-making, and patient-nurse interactions, possibly reducing care quality. Participants described incidents of verbal abuse, physical violence and attempts at sexual harassment. For instance, Participants recounted instances where patients would abruptly change from calmness to extreme aggression, necessitating swift action to prevent potential harm. This is consistent with previous studies, which found that approximately 20% of patients in acute psychiatric hospitals exhibit sudden, unpredictable violent outbursts, posing significant safety concerns [10]. These similarities may be attributed to shared responsibilities among mental health nurses and the structural challenges within the healthcare systems across similar settings. Participants reported patients’ refusal to medication and denial of illness due to a lack of insight into their condition. Illness denial can initially aid coping but often hinders timely care, treatment adherence, and self-management, thereby increasing the risk of poorer health outcomes [28]. Patient noncompliance often stems from poor mental health literacy and a lack of family support [29]. This implies that when individuals do not acknowledge their condition, they are far less likely to adhere to prescribed treatment regimens, leading to symptom exacerbation such as worsening hallucinations, delusions, mood instability, or cognitive decline and an increased risk of acute psychiatric episodes. Most participants described how public misconceptions about mental illness extended to the nurses themselves, leading to social isolation. Mental health professionals are often stigmatized due to their association with mentally challenged individuals [30]. Widespread social stigma discourages many from entering psychiatric nursing, and structural stigma stemming from government neglect and insufficient resources hinders nurses and other mental health providers in performing their duties, ultimately undermining the quality of care for those with mental health conditions [30]. Community education is crucial in reducing stigma, which can improve the social acceptance of mental health nurses [31]. Studies revealed that, mental health professionals in Ghana frequently face stigma, which impacts their social lives and professional morale [8]. Participants in the current study reported limited community engagement in mental health awareness campaigns. Community education initiatives can mitigate stigma [32]. Stigma from the community could isolate mental health nurses by limiting their social and professional interactions, undermining their confidence and professional identity. This devaluation could lead to lower job satisfaction and an increased risk of burnout, ultimately threatening staff retention and the quality of patient care. Participants identified health system challenges, including understaffing, inadequate infrastructure, and a lack of continuous professional development. Understaffing was frequently reported, as nurses reported that the lack of adequate staff compromised their ability to manage patients effectively. The study aligns with previous research indicating that understaffing in psychiatric units leads to increased workload, diminished job satisfaction, and compromised patient care [33] Participants mentioned that the nurse-to-patient ratio was often too low, particularly during crises, which contributed to burnout. Previous studies linked understaffing to increased job dissatisfaction and turnover among healthcare workers [34]. Most participants lamented the absence of essential facilities, such as seclusion rooms, which are crucial for managing patients with aggression. Studies revealed that many African countries face significant challenges, including resource constraints, workforce shortages, inadequate infrastructure, and weak supply chains [35]. In contrast, a study found that, despite recent infrastructural upgrades in several urban psychiatric units, staff perceived only minimal improvements in their work environment [36]. Nurses reported they relied on outdated practices due to the absence of ongoing education programs. This finding is consistent with [9], who emphasized the importance of regular training sessions in equipping nurses with contemporary, evidence-based practices. Understaffing, poor infrastructure, and limited professional development collectively strain nursing staff, resulting in burnout, compromised care quality, and an inability to adopt best practices[37]. Participants reported employing various safety strategies, including vigilance, ignoring slander and emotional coping mechanisms. Vigilance was a key coping mechanism, as they described adopting a defensive stance, such as avoiding turning their backs on patients. Similarly, a study reported that hyper-vigilance is common among psychiatric nurses working with aggressive patients, ignoring slanderous remarks was another strategy employed to maintain professionalism[38]. Similar findings highlighted that nurses often dismiss patient insults to prevent emotional distress[39]. This implies that vigilance enables nurses to anticipate and mitigate risks, reducing the likelihood of harm to themselves and others. Also, nurses employing emotional coping techniques help sustain mental well-being, decreasing stress and safeguarding against burnout Teamwork and task prioritization emerged as essential strategies in managing workload and patient care. Participants reported relying heavily on colleagues for support, particularly during patient crises. This finding aligns with a study stating that teamwork enhances resilience and job satisfaction in psychiatric settings [40]. Participants noted that collaboration with fellow nurses helped distribute the workload, thereby reducing stress and enhancing patient care. However, while teamwork is beneficial, it needs to be supplemented with institutional support to be truly effective. Task prioritization was also crucial for managing workload, as participants focused on critical tasks to optimize care delivery. This aligns with findings that prioritization strategies can mitigate the impact of understaffing [41].This implies that nurses can reduce stress, prevent errors, and maintain high quality care even under pressure. Prioritization also supports better time management, thereby enhancing overall productivity and patient outcomes. Participants reported relying on personal resilience and family support to cope with job-related stress. Resilience was often attributed to accumulated experience, which helped nurses manage complex patient behaviors more effectively. This finding aligns with research by [10], who found that resilience among mental health nurses is strongly associated with years of practice. This implies a need for supportive structures that not only foster resilience in early-career nurses through mentorship and training but also recognize and leverage the expertise of experienced staff. Strengthening these coping resources can contribute to improved staff retention, reduced burnout, and better quality of patient care. Participant reported that family support was a vital coping mechanism, offering both emotional reassurance and practical assistance during difficult times. Previous studies have shown that social support networks play a significant role in strengthening resilience among healthcare professionals [42, 43]. This implies that resilience and family support enhance nurses’ capacity to cope, thereby reducing the risk of burnout and improving job satisfaction. Limitation A strength of this paper was the systematic approach used in sampling, data collection and analysis to enhance the reliability and validity of the analysis, checking of transcripts against audio-recordings and field notes taken, triangulation among coders by consensus, and feedback of themes to participants, to ensure rigor. In addition, purposeful sampling was used to select a wide range of providers with different experiences. The study focused solely on a sample from the Ho Municipality, which may have overlooked insights from other districts or municipalities in the region and the country, potentially limiting the diversity of perspectives. Additionally, the reliance on the purposive sampling method raises the possibility of response bias, as individuals with particularly strong opinions or experiences may have been more likely to participate. Conclusion The study revealed systemic occupational and psychosocial challenges confronting mental health nurses at Ho Municipal Hospital, including patient aggression, illness denial, gender bias, and chronic understaffing, compounded by persistent community stigma. To address these, the study advocates for institutionalized mental health capacity-building programs, strategic workforce expansion, and the integration of structured psychosocial support and supervision frameworks. Additionally, implementing culturally responsive, evidence-based stigma-reduction interventions within both clinical and community settings is essential to strengthen occupational safety, optimize care outcomes, and sustain nurses’ psychological resilience. These targeted actions will enhance the operational efficiency of mental health services and advance Sustainable Development Goal 3 (Good Health and Well-being). Declarations Ethical consideration and consent to participate Ethical approval for the study was obtained from the University of Health and Allied Sciences Research Ethics Committee [UHAS-REC A.11[28] 23–24] and the Municipal Health Directorate. All participants were over 18 years old and provided voluntary verbal informed consent to take part in the study. Consent for publication Not applicable Conflict of interest No funding was provided for the study Clinical trial number Not applicable Funding This study received no financial support from external sources, with all research-related costs being exclusively covered by the Authors themselves. Author Contribution A. F. D, conceptualized the project. A. F. D, C. A, F. M. S, I. E. A and E. O wrote the main manuscript and C. A, F. M. S performed the analysis, W. K. M. A checked the information provided within the manuscript and revised the main manuscript and all author reviewed the manuscript Acknowledgement The authors express their profound gratitude to the management of the selected facilities, as well as to Oduro Samuel, Enyonam Regina Sani, Sitsofe Irene Atika, Ama Mercy Essien, Hilarius Tamakloe. Data Availability The datasets generated or analyzed in this study are not publicly accessible due to confidentiality restrictions; however, they can be obtained from the corresponding author upon reasonable request and with ethical approval from UHAS-REC. References Kigozi-Male NG, Heunis JC, Engelbrecht MC. Primary health care nurses’ mental health knowledge and attitudes towards patients and mental health care in a South African metropolitan municipality. BMC Nurs 2023; 22: 1–8. WHO. Mental disorders, https://www.who.int/news-room/fact-sheets/detail/mental-disorders (2022, accessed 5 August 2025). James SL, Abate D, Abate KH, et al. 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Patience Sehularo M, van der Wath A, Veronica Sepeng N. Coping strategies of nurses caring for mental health care users displaying violent and aggressive behaviour in mental health care institutions in North West province. Int J Afr Nurs Sci 2024; 21: 100799. Hopkins M, Fetherston CM, Morrison P. Aggression and violence in healthcare and its impact on nursing students: A narrative review of the literature. Nurse Educ Today 2018; 62: 158–163. Välimäki M, Lam J, Bressington D, et al. Nurses’, patients’, and informal caregivers’ attitudes toward aggression in psychiatric hospitals: A comparative survey study. PLoS One 2022; 17: e0274536. Zwane PG, Shongwe MC, Shabalala FS. Challenges faced by mental health nurses working with people living with mental illness in Eswatini: A qualitative study. Int J Afr Nurs Sci 2022; 17: 100475. Mulaudzi NP, Mashau NS, Akinsola HA, et al. Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa. Curationis ; 43. Epub ahead of print 2020. DOI: 10.4102/CURATIONIS.V43I1.2081. Courtney McKim. Meaningful Member-Checking: A Structured Approach to Member- Checking. American Journal of Qualitative Research 2023; 2: 41–52. Elo S, Kääriäinen M, Kanste O, et al. Qualitative Content Analysis. Sage Open ; 4. Epub ahead of print 1 January 2014. DOI: 10.1177/2158244014522633. Busetto L, Wick W, Gumbinger C. How to use and assess qualitative research methods. Neurol Res Pract 2020; 2: 1–10. Maher C, Hadfield M, Hutchings M, et al. Ensuring Rigor in Qualitative Data Analysis: A Design Research Approach to Coding Combining NVivo With Traditional Material Methods. Int J Qual Methods ; 17. Epub ahead of print 1 January 2018. DOI: 10.1177/1609406918786362/ASSET/7E4B1848-5057-4483-828A-6E1814A0EC57/ASSETS/IMAGES/LARGE/10.1177_1609406918786362-FIG5.JPG. Forero R, Nahidi S, De Costa J, et al. Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine. BMC Health Serv Res 2018; 18: 1–11. Patierno C, Fava GA, Carrozzino D. Illness Denial in Medical Disorders: A Systematic Review. Psychother Psychosom 2023; 92: 211–226. Weobong B, Ae-Ngibise KA, Sakyi L, et al. Towards implementation of context-specific integrated district mental healthcare plans: A situation analysis of mental health services in five districts in Ghana. PLoS One 2023; 18: e0285324. Mensah DK, Fino E, Booth WA, et al. Perspectives of psychiatric nurses on the stigmatization of mental healthcare in Ghana: a qualitative study. Front Public Health 2024; 12: 1423445. Corrigan PW, Talluri SS, Qin S. Difference and Disdain as Indicators of the Public Stigma of Mental Illness. Journal of Nervous and Mental Disease 2021; 209: 645–649. Nersessova KS, Jurcik T, Hulsey TL. Differences in beliefs and attitudes toward Depression and Schizophrenia in Russia and the United States. International Journal of Social Psychiatry 2019; 65: 388–398. Dickens GL. Mental health nurses’ attribute compromised inpatient care quality chiefly to understaffing. Evidence Based Nursing 2025; 28: 13–13. Xiaolu Zhu Weiling C. FACULTY OF HEALTH AND OCCUPATIONAL STUDIES Nurses’ occupational stressors and their coping strategies A descriptive review 2019. Nesengani TV, Downing C, ten Ham-Baloyi W. Barriers to effective patient care as experienced by nurses in primary healthcare clinics in African countries: a systematic review of qualitative studies. BMC Nurs 2025; 24: 232. Isbell LM, Chimowitz H, Huff NR, et al. A Qualitative Study of Emergency Physicians’ and Nurses’ Experiences Caring for Patients With Psychiatric Conditions and/or Substance Use Disorders. Ann Emerg Med 2023; 81: 715–727. Tamata AT, Mohammadnezhad M. A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nurs Open 2022; 10: 1247. Ayhan CH, Aktaş MC, Karan E. Psychiatric nurses’ experiences of patient violence on acute psychiatric units in Turkey: a qualitative study. BMC Nurs 2025; 24: 1–14. Huff NR, Chimowitz H, DelPico MA, et al. The consequences of emotionally evocative patient behaviors on emergency nurses’ patient assessments and handoffs: An experimental study using simulated patient cases. Int J Nurs Stud 2023; 143: 104507. Nyman M, Hofvander B, Nilsson T, et al. Mental Health Nurses’ Experiences of Risk Assessments for Care Planning in Forensic Psychiatry. Int J Forensic Ment Health 2020; 19: 103–113. Middleton S, Charnock A, Forster S, et al. Factors affecting individual task prioritisation in a workplace setting. Future Healthc J 2018; 5: 138. Drageset J. Social Support. Health Promotion in Health Care - Vital Theories and Research 2021; 137–144. Stensletten K, Bruvik F, Espehaug B, et al. Burden of care, social support, and sense of coherence in elderly caregivers living with individuals with symptoms of dementia. Dementia 2016; 15: 1422–1435. Additional Declarations No competing interests reported. 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09:53:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2275479,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7999245/v1/4a079322-f9bb-4683-abbe-919f1ee85cdb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring the Challenges of Psychiatric Nurses in Providing Care to Persons With Mental Health Problems in Selected Health Facilities in Ghana\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health is increasingly acknowledged as a global priority because of the substantial negative impact mental health disorders have on populations [1]. According WHO, A mental disorder is defined as a clinically meaningful disruption in a person\u0026rsquo;s thinking, emotional control, or behavior [2]. Mental disorders account for approximately 14 % of he worldwide disease burden, affecting an estimated 264\u0026nbsp;million people with depression, 46\u0026nbsp;million with dementia, and 45\u0026nbsp;million with bipolar disorder [3, 4]. In the African region, the WHO estimated that over 116\u0026nbsp;million people were living with mental health conditions before the pre-pandemic [5]. In Sub-Saharan Africa specifically, pooled prevalence rates are 31% for anxiety, 30% for depression, and 24% for insomnia [6].\u003c/p\u003e\u003cp\u003eIn Ghana, approximately 2.1\u0026nbsp;million people suffer from moderate to severe mental illness, of whom roughly 650,000 are projected to have severe disorders [7]. National surveys further indicate that around 10% of the population experiences common mental health disorders and 1 to 3% endure severe psychiatric conditions such as schizophrenia [8]. Yet, in many developing countries, the voices of mental health nurses, who play a critical role in caring for these patients, remain underrepresented in the literature [9]. However, research has shown that nearly 20% of patients in acute psychiatric wards may display sudden and unpredictable violent behavior [10], which can be directed toward both staff and fellow patients, posing a serious safety risk within care settings [11]. Persons living with mental health problem frequently exhibit a wide range of challenging behaviors such as agitation, aggression, self-harm, treatment noncompliance, and communication difficulties [12, 13]. These behaviors not only exacerbate patients\u0026rsquo; own distress but also place mental health nurses in complex, high-risk situations [13]. In such high-risk environments, the ability of nurses to promptly de-escalate situations is essential, although delivering care under these conditions is both dangerous and challenging [14]. A mental health nurse is responsible for coordinating and delivering care to individuals with mental health conditions. They provide support and treatment to patients experiencing a wide range of mental health issues, including anxiety, depression, personality disorders, and eating disorders, with the aim of promoting recovery and achieving optimal health outcomes [15]. In Ghana, becoming a mental health nurse requires the completion of an accredited nursing training programme that includes mental health and psychiatric nursing components. After completing the training, individuals must register with the Nursing and Midwifery Council of Ghana, the official regulatory body for nursing practice[16]. Mental health nurses are three to four times more likely to experience violence and aggression than any other health care worker while performing their duties in mental health care institutions [17, 18]. For instance, a study revealed that 43% of nurses reported assaults by mental health care users, whereas only 13.8% of doctors experienced such incidents [19].\u003c/p\u003e\u003cp\u003eMoreover, how nurses perceive and respond to aggressive behavior is shaped by their personal judgments, attitudes, and tolerance levels further influencing their professional experiences and the outcomes for patients [20]. Beyond violence, psychiatric hospitals expose nurses to verbal abuse, stigma, sexual harassment, and the cumulative emotional burden of supporting self-harming or suicidal patients [21]. Such ongoing stressors contribute heavily to burnout, poor life satisfaction, sleep disturbances, anxiety, depression, and even professional exit, undermining both workforce retention and quality of care [22]. Despite the evident challenges, there are limited knowledge about how psychiatric nurses perceive, interpret, and cope with such behaviors in their daily work. This lack of understanding hinders the development of tailored interventions, including training, de-escalation protocols, and psychological support systems, that could improve nurses\u0026rsquo; safety, resilience, and job satisfaction. Therefore, this study investigated the lived experiences of mental health nurses at Ho Teaching Hospital and Ho Municipal Hospital concerning the behaviors of persons living with mental health problem.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThis study utilized a qualitative exploratory design. This design was chosen to allow for an in-depth investigation of the issues in their natural context, providing flexibility to explore participants\u0026rsquo; views and uncover underlying factors influencing the phenomenon under study [23, 24].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population included all registered mental health nurses with at least one year of working experience at the selected health facilities. This was because one year of experience was sufficient for mental health nurses to have adequate experiences with individuals living with mental health problems.\u003c/p\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eThis study included mental health nurses employed at the psychiatric unit of Ho Teaching Hospital and Ho Municipal Hospital. Participants were required to have a minimum of one year of work experience and to provide consent to participate in the study.\u003c/p\u003e\n\u003ch3\u003eSample and sampling technique\u003c/h3\u003e\n\u003cp\u003eParticipants were chosen through purposive sampling. A total of 14 participants were considered adequate, based on the concept of data saturation, which is the point at which no new themes or insights arise from additional interviews.\u003c/p\u003e\n\u003ch3\u003eResearch instrument and data collection procedures\u003c/h3\u003e\n\u003cp\u003eData were collected using semi-structured interviews designed to explore the experiences of mental health nurses regarding the behaviors of individuals living with mental health conditions. Prior to data collection, an introductory letter was sent to the selected health facilities to obtain permission and formally introduce the study. Informed consent was secured from all participants before participation.\u003c/p\u003e\u003cp\u003eInterviews were conducted in private, quiet settings within the facilities to ensure comfort and confidentiality. Each interview session lasted approximately 30\u0026ndash;45 minutes. To maintain anonymity, participants were assigned pseudonyms, and no third parties were present during the sessions. Participants were informed of their right to withdraw from the study at any point without any consequences.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e for the study was obtained from the University of Health and Allied Sciences Research Ethics Committee [UHAS-REC A.11[28] 23\u0026ndash;24] and the Municipal Health Directorate. Before data collection, participants were fully informed about the study\u0026rsquo;s purpose and verbal consent was obtained. They were assured of their right to withdraw at any time without affecting their care. Confidentiality and anonymity were maintained by assigning pseudonyms and special codes, with data securely stored and accessible only to the researchers. Although there were no direct benefits, participants were informed that their contributions would help inform relevant policies and recommendations.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003e Data analysis followed the methodological framework outlined by [25]. All audio recordings were transcribed verbatim into Microsoft Word and subjected to rigorous content analysis to identify underlying insights, patterns, and meanings. The research team engaged in repeated readings of the transcripts to ensure immersion and comprehensive understanding of the data. Coding was conducted by systematically labeling text segments that encapsulated salient ideas. These codes were then organized into preliminary themes, which were iteratively reviewed, refined, and named to align with the study objectives. The final stage involved synthesizing the findings into a coherent narrative, supported by illustrative participant quotations to substantiate the thematic interpretations.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRigour\u003c/h3\u003e\n\u003cp\u003eResearch rigor was established through [24] four trustworthiness criteria. For dependability, transcripts were reviewed repeatedly and independently coded by two researchers, with coding decisions validated through team discussions. To achieve confirmability, researchers-maintained memos, field observations, and analytic decisions, integrating these into transcripts and preserving a meticulously labelled audit trail of audio files, transcripts, field notes, and meeting records at every stage. Transferability was supported by a thorough description of study methods and instruments, the use of purposive sampling to capture diverse staff perspectives, and the replication of data collection procedures across different demographic groups and locations. Finally, credibility was reinforced by returning transcripts to participants for feedback and clarification, and by employing data triangulation, thus comparing field notes with interview transcripts to minimize bias and enhance accuracy [26, 27].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1 shows that most (31.25%) of the nurses were aged between 24 and 29 years. Majority (62.5%) were Females, and Christians (75%). More than half (62.5%) were married, and a little more than half (68.75%) were Ewe. Majority (56.25%) held a bachelor\u0026apos;s degree (BSc), and most of the participants (31.25%) had between 6 and 10 years of professional experience.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185239381\"\u003eTable\u0026nbsp;1. Sociodemographic Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eFrequency (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e24-29\u003c/p\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003cp\u003e40-44\u003c/p\u003e\n \u003cp\u003e45-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eChristian\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003cp\u003eTraditionalist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003cp\u003e6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEwe\u003c/p\u003e\n \u003cp\u003eAkan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68.75\u003c/p\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel Of Education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDegree\u003c/p\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.25\u003c/p\u003e\n \u003cp\u003e43.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears Of Practice\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003cp\u003e3-5\u003c/p\u003e\n \u003cp\u003e6-10\u003c/p\u003e\n \u003cp\u003e11-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e31.25\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2 id=\"_Toc190804001\"\u003eEmerged themes\u003c/h2\u003e\n\u003cp\u003eThe transcribed data underwent a thorough content analysis, revealing the lived experiences of mental health nurses at Ho Teaching Hospital and Ho Municipal Hospital concerning the behaviors of persons with mental health problems. The content analysis was categorized into three themes and nine subthemes. The identified themes included: 1) Hindrances to Nursing Care, 2) Health System Challenges, and 3) Coping Strategies Adopted by Mental Health Nurses as shown in (fig.1).\u003c/p\u003e\n\u003cp id=\"_Toc185239382\"\u003eFig 1. Key Themes and Sub-themes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;1: Hindrances to Nursing Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMental health nurses face a range of challenges, including noncompliance, behavioral obstacles, gender-biased behavior, and stigmatization, which affect the care they provide to their clients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Noncompliance and behavioral barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants revealed that individuals with mental health problems often display aggressive and violent behaviors during admission. In addition to aggression, nurses reported challenges with patients who refuse to take prescribed medications. Some patients deny having any mental illness, even in severe cases, which further hinders their willingness to accept care.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEven though we don\u0026rsquo;t have severe cases here like that, we often encounter challenges like dealing with aggressive behavior of the\u0026nbsp;client\u0026hellip; They can be all nice and funny with you, but the next second they are so moody and violent\u0026hellip;.\u003c/em\u003e (\u003cstrong\u003eParticipant 1, 11years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere have been challenges especially when administering medications. They haven\u0026rsquo;t accepted that something is wrong with them, hence they don\u0026rsquo;t see the need to take medications. So, if you try to explain or insist them to take the medication, they can become aggressive and even hurt you. Some ever tried to hurt me before but I was vigilant to swerve his hand and quickly call for backup.\u003c/em\u003e (\u003cstrong\u003eParticipant 9, 15years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDealing with patients who refuse treatment is a major challenge here. Imagine entering client cubicle to administer medications and he/she looks up to you and tells you that nothing is wrong with him/her and he/she doesn\u0026rsquo;t need drugs\u0026hellip; Some will eventually take it while others won\u0026rsquo;t no matter what you do or say. It is very frustrating.\u003c/em\u003e\u0026nbsp; (\u003cstrong\u003eParticipant 6, 13years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe main challenge I encounter, is with the administration of medications. Most oral medications, they refuse them. And you have to be with them and be talking to them before they take it. It is time exhausting \u0026hellip;.\u003c/em\u003e (\u003cstrong\u003eParticipant 8, 11years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb) Gender bias conducts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany patients exhibit good and respectful conduct when male staff members are on duty, yet they tend to become more disruptive or deviant when only female nurses are present in the ward or assigned to their cubicles. Some nurses recounted their experiences, highlighting the inconsistencies in patient behavior based on the gender of the nursing staff, which complicates the caregiving process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe problem we encounter is that, especially we females, when we are providing care to the male patients, they don\u0026apos;t allow us. So, we females encounter challenges with the male patients because they feel like the females are so soft. So, they don\u0026apos;t take our instructions \u0026hellip;. But when the guys are there, they cooperate.\u0026hellip;. (\u003c/em\u003e\u003cstrong\u003eParticipant 14, 7years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSome of the male patients will try to harassed you sexually. They will be making advances at you especially when you are running night shift and you are not careful; you will be raped\u0026hellip;...\u003c/em\u003e (\u003cstrong\u003eParticipant 8, 3 years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec: Stigmatization\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMental health nurses who provide essential care to vulnerable individuals often face stigma and exclusion from their own communities, encountering judgment and isolation instead of compassion and support they facilitate for patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStigmatization on the side of the public. People devalue you because of what you are doing or what other people say about your work.\u003c/em\u003e (\u003cstrong\u003eParticipant 12, 8 years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe problem is that, when you go public and something happens and you want to give your point of view, people tend to see you as one of your patients and pass comments that are degrading. I was told once that I was behaving like my patients ...\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(Participant 6, 13years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Health System Challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported that factors such as understaffing, inadequate resources, and a lack of ongoing training from management make working conditions difficult, creating multilayered challenges that mental health nurses must navigate in their daily responsibilities. Two subthemes emerged from this section and included a) Understaffing and inadequate infrastructure, and b) Lack of continuing training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Understaffing and inadequate infrastructure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported that persistently high nurse-to-patient ratios and staffing shortages increase individual workloads, leading to overwhelming job demands, elevated stress levels, and reduced job satisfaction. Many facilities still lack the necessary resources, such as sufficient beds, equipment, and support staff, which further hinders nurses\u0026rsquo; ability to deliver safe, high-quality care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEven though we don\u0026rsquo;t have much psychiatric hospital in the country, the mental health units in the various hospital are not having enough staff. Yes, there are shortages of staff...\u003c/em\u003e (\u003cstrong\u003eParticipant 1, 11years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip; we face challenges like inadequate infrastructures. We don\u0026rsquo;t have the needed facilities to care holistically for mental health clients. Even though this is not a psychiatric hospital, at least basic psychiatric facilities should be available for use.\u003c/em\u003e (\u003cstrong\u003eParticipant 13, 3 years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;b) Lack of continuous training\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants emphasized the importance of continuously updating their knowledge on current health trends and practices. However, they regrettably noted that this was lacking among mental health nurses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBack in school, the curriculum was used to teach us. But what we have on the field is bigger than what we were taught in the classroom. So, there is a need for continuous training while we are practicing but there isn\u0026rsquo;t. So, the lack of continuous training and support for dealing with challenging behaviors is a significant issue.\u003c/em\u003e (\u003cstrong\u003eParticipant 1, 4years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere are new innovations each day and better way of doing certain things as compared to years ago. So, for us to be up to date, we constantly need to keep learning. Mostly this learning is supposed to be facilitated by our leaders but such one is not available ...\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 4, 10years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3: Coping Strategies Adopted by Mental Health Nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipant reported instances of aggression and violence from clients, emphasizing the need for effective strategies to ensure physical safety on the ward. This theme examines the coping mechanisms participants employ to mitigate harm and maintain a secure work environment. Under this theme, four subthemes emerged and included a) Safety Tips, b)\u0026nbsp;Work Ethics, c)\u0026nbsp;Resilience and experiences, and d)\u0026nbsp;Family support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Safety Tips\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants emphasized the importance of maintaining constant awareness and alertness on the ward. By being vigilant, closely observing patients\u0026apos; behaviors, anticipating potential risks, and staying prepared to respond to any signs of aggression, they were able to overcome the stressful behaviors and situations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYes, we have to be alert. I\u0026apos;m always alert\u0026nbsp;and\u0026nbsp;don\u0026apos;t turn my back towards them. Probably always my back is on the wall, facing them. You don\u0026apos;t know when and where anything might come in. \u0026hellip; (\u003c/em\u003e\u003cstrong\u003eParticipant 10, 11years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMy health first. If I am not healthy, I can\u0026rsquo;t provide care, so I am always on the guard. So, I make sure I protect myself always in every way to keep healthy.\u003c/em\u003e\u0026nbsp; (\u003cstrong\u003eParticipant 5, 19years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOur work is like a war zone or peacekeeping missions. You may come to work alright and may not go back or go back injured. So, we have to be extra careful and alert at all times, because a patient can come at you at any time...\u003c/em\u003e (\u003cstrong\u003eParticipant 3, 10years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOthers cope emotionally by ignoring baseless or slanderous remarks to maintain their focus and calm, and by using diversional therapy to engage patients in activities like art, music, or games in order to reduce agitation and promote recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSome can lie on you, that you\u0026rsquo;ve taken their belonging, like money. They\u0026apos;ll tell you; my money is with you, give me my money to buy this. I saw you picking my money when I was sleeping. They can even shout and be calling you names. But all we do is to ignore them... (\u003c/em\u003e\u003cstrong\u003eParticipant 11, 5years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDiversional therapy really helps. When it is properly put in place, an aggressive client can just relax and communicate with the staff well. A patient who is moody or isolated from everyone was able to regain normal life in the shortest possible time \u0026hellip; (\u003c/em\u003e\u003cstrong\u003eParticipant 2, 4years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb) Work ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants indicate that teamwork and effective prioritization of tasks are fundamental to their approach. By collaborating with colleagues and focusing on the most pressing needs, participants strive to maintain high standards of care while ensuring that they support one another in a demanding work environment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e...we mostly don\u0026rsquo;t get any support from anywhere. So, we depend on each other here as a team. When the workload is too much, we call for help from other staff to come in and support. If any of us have a problem, we mobilize ourselves and support that fellow\u0026hellip;\u003c/em\u003e (\u003cstrong\u003eParticipant 10, 11 years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe support is always from fellow colleagues; we do support each other. We are always there for each other. From colleagues, financially, they also come in.\u0026hellip; From the hospital the only support we receive is logistics wise. But psychological support, like when you are traumatized, there hasn\u0026rsquo;t been anything\u003c/em\u003e (\u003cstrong\u003eParticipant 7, 6 years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile nurses make efforts to depend on their own abilities, they expressed disappointment over the frequent absence of managerial support when challenges arise.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe don\u0026apos;t receive anything. There is nothing we receive from the hospital. We don\u0026apos;t receive anything. We do it by ourselves. No, from outside, no. Because in here, if a patient hurts you or a patient hits you with something, you are going to take your care by yourself...\u003c/em\u003e\u0026nbsp; (\u003cstrong\u003eParticipant 14, 9 years of practice)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is also worth to note that participants acknowledged that while some nursing activities are important, they may not significantly impact a patient\u0026apos;s immediate condition. As a result, they choose to set aside these less urgent tasks during time of excess work overload to concentrate their efforts on interventions that are more likely to yield positive outcomes for their clients at that moment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWork overload has been one of the key challenges. So, in such instances, we prioritize our care. Though all are needed we do attend to those that need the urgent care. In that way, we won\u0026apos;t be overwhelmed ... We are always understaffed so we keep adjusting.\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(Participant 12, 8 years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOoh yeah, it is all about prioritizations. Imagine you have a client who is refusing everything, doesn\u0026rsquo;t want to take medication, and doesn\u0026rsquo;t want to bath either. In your quest to solve this problem, what will you spend most of your energy on? Though personal hygiene is important, you will try to convince a\u0026nbsp;client to take his/her medications\u003c/em\u003e (\u003cstrong\u003eParticipant 4, 10years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec) Resilience and experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have drawn on their personal strength and accumulated experience to build resilience. Familiarity with challenging situations helped nurses to develop effective coping strategies, boosting their confidence and adaptability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYes. The coping mechanism is individual. To me, I just make sure I just do what I do with the ones that are within my capacity, and I leave the rest to others. That\u0026apos;s how I cope....\u003c/em\u003e (\u003cstrong\u003eParticipant 10, 11years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e... Yeah, that\u0026apos;s what we are using to challenge ourselves \u0026hellip;. So, we take our coping mechanism in order to help us deal with the patient. \u0026hellip;. If it comes to the patient, we school the patient... You don\u0026apos;t need to go close to the patient for some time. We do it so that the patients calm down.\u003c/em\u003e (\u003cstrong\u003eParticipant 14, 9years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb: Family support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNurses indicated that they do not face their challenges in isolation, as their families offer support that helps them stay grounded and resilient. This support comes in various forms, including emotional reassurance, practical assistance, and a strong sense of belonging, which collectively help them cope with work-related stress and safeguard their mental well-being.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI rely on a strong support network of my family, and friends. Regular conversation with my family help in sharing the load and getting different perspectives\u0026hellip;.\u003c/em\u003e \u003cstrong\u003e(Participant 1, 3years of practice)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip; wherever you see yourself, never cut yourself from your family. No matter how successful you\u0026rsquo;ve become. If not for my family who is always supporting me, I wouldn\u0026rsquo;t be here practicing as a mental health nurse\u0026hellip;.\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(Participant 9, 15years of practice)\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study explored the experiences of mental health nurses in selected health facilities within the Ho Municipality. It aimed to understand how the behavior of individuals with mental health conditions affects nursing care. The study specifically focused on the challenges nurses face in hospital settings, including patient aggression and non-compliance with treatment. Findings revealed that nurses experience high levels of stress and work under potentially hazardous conditions. Prolonged stress and unsafe conditions may lead to burnout, low job satisfaction, and ultimately, high turnover among mental health nurses. Also nurse distress and aggression from patients can affect empathy, decision-making, and patient-nurse interactions, possibly reducing care quality. Participants described incidents of verbal abuse, physical violence and attempts at sexual harassment. For instance, Participants recounted instances where patients would abruptly change from calmness to extreme aggression, necessitating swift action to prevent potential harm. This is consistent with previous studies, which found that approximately 20% of patients in acute psychiatric hospitals exhibit sudden, unpredictable violent outbursts, posing significant safety concerns [10]. These similarities may be attributed to shared responsibilities among mental health nurses and the structural challenges within the healthcare systems across similar settings. Participants reported patients\u0026rsquo; refusal to medication and denial of illness due to a lack of insight into their condition. Illness denial can initially aid coping but often hinders timely care, treatment adherence, and self-management, thereby increasing the risk of poorer health outcomes [28]. Patient noncompliance often stems from poor mental health literacy and a lack of family support [29]. This implies that when individuals do not acknowledge their condition, they are far less likely to adhere to prescribed treatment regimens, leading to symptom exacerbation such as worsening hallucinations, delusions, mood instability, or cognitive decline and an increased risk of acute psychiatric episodes.\u003c/p\u003e\u003cp\u003eMost participants described how public misconceptions about mental illness extended to the nurses themselves, leading to social isolation. Mental health professionals are often stigmatized due to their association with mentally challenged individuals [30]. Widespread social stigma discourages many from entering psychiatric nursing, and structural stigma stemming from government neglect and insufficient resources hinders nurses and other mental health providers in performing their duties, ultimately undermining the quality of care for those with mental health conditions [30]. Community education is crucial in reducing stigma, which can improve the social acceptance of mental health nurses [31]. Studies revealed that, mental health professionals in Ghana frequently face stigma, which impacts their social lives and professional morale [8]. Participants in the current study reported limited community engagement in mental health awareness campaigns. Community education initiatives can mitigate stigma [32]. Stigma from the community could isolate mental health nurses by limiting their social and professional interactions, undermining their confidence and professional identity. This devaluation could lead to lower job satisfaction and an increased risk of burnout, ultimately threatening staff retention and the quality of patient care.\u003c/p\u003e\u003cp\u003eParticipants identified health system challenges, including understaffing, inadequate infrastructure, and a lack of continuous professional development. Understaffing was frequently reported, as nurses reported that the lack of adequate staff compromised their ability to manage patients effectively. The study aligns with previous research indicating that understaffing in psychiatric units leads to increased workload, diminished job satisfaction, and compromised patient care [33] Participants mentioned that the nurse-to-patient ratio was often too low, particularly during crises, which contributed to burnout. Previous studies linked understaffing to increased job dissatisfaction and turnover among healthcare workers [34].\u003c/p\u003e\u003cp\u003eMost participants lamented the absence of essential facilities, such as seclusion rooms, which are crucial for managing patients with aggression. Studies revealed that many African countries face significant challenges, including resource constraints, workforce shortages, inadequate infrastructure, and weak supply chains [35]. In contrast, a study found that, despite recent infrastructural upgrades in several urban psychiatric units, staff perceived only minimal improvements in their work environment [36]. Nurses reported they relied on outdated practices due to the absence of ongoing education programs. This finding is consistent with [9], who emphasized the importance of regular training sessions in equipping nurses with contemporary, evidence-based practices. Understaffing, poor infrastructure, and limited professional development collectively strain nursing staff, resulting in burnout, compromised care quality, and an inability to adopt best practices[37].\u003c/p\u003e\u003cp\u003eParticipants reported employing various safety strategies, including vigilance, ignoring slander and emotional coping mechanisms. Vigilance was a key coping mechanism, as they described adopting a defensive stance, such as avoiding turning their backs on patients. Similarly, a study reported that hyper-vigilance is common among psychiatric nurses working with aggressive patients, ignoring slanderous remarks was another strategy employed to maintain professionalism[38]. Similar findings highlighted that nurses often dismiss patient insults to prevent emotional distress[39]. This implies that vigilance enables nurses to anticipate and mitigate risks, reducing the likelihood of harm to themselves and others. Also, nurses employing emotional coping techniques help sustain mental well-being, decreasing stress and safeguarding against burnout\u003c/p\u003e\u003cp\u003eTeamwork and task prioritization emerged as essential strategies in managing workload and patient care. Participants reported relying heavily on colleagues for support, particularly during patient crises. This finding aligns with a study stating that teamwork enhances resilience and job satisfaction in psychiatric settings [40]. Participants noted that collaboration with fellow nurses helped distribute the workload, thereby reducing stress and enhancing patient care. However, while teamwork is beneficial, it needs to be supplemented with institutional support to be truly effective. Task prioritization was also crucial for managing workload, as participants focused on critical tasks to optimize care delivery. This aligns with findings that prioritization strategies can mitigate the impact of understaffing [41].This implies that nurses can reduce stress, prevent errors, and maintain high quality care even under pressure. Prioritization also supports better time management, thereby enhancing overall productivity and patient outcomes.\u003c/p\u003e\u003cp\u003eParticipants reported relying on personal resilience and family support to cope with job-related stress. Resilience was often attributed to accumulated experience, which helped nurses manage complex patient behaviors more effectively. This finding aligns with research by [10], who found that resilience among mental health nurses is strongly associated with years of practice. This implies a need for supportive structures that not only foster resilience in early-career nurses through mentorship and training but also recognize and leverage the expertise of experienced staff. Strengthening these coping resources can contribute to improved staff retention, reduced burnout, and better quality of patient care. Participant reported that family support was a vital coping mechanism, offering both emotional reassurance and practical assistance during difficult times. Previous studies have shown that social support networks play a significant role in strengthening resilience among healthcare professionals [42, 43]. This implies that resilience and family support enhance nurses\u0026rsquo; capacity to cope, thereby reducing the risk of burnout and improving job satisfaction.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003eLimitation\u003c/h2\u003e\u003cp\u003eA strength of this paper was the systematic approach used in sampling, data collection and analysis to enhance the reliability and validity of the analysis, checking of transcripts against audio-recordings and field notes taken, triangulation among coders by consensus, and feedback of themes to participants, to ensure rigor. In addition, purposeful sampling was used to select a wide range of providers with different experiences. The study focused solely on a sample from the Ho Municipality, which may have overlooked insights from other districts or municipalities in the region and the country, potentially limiting the diversity of perspectives. Additionally, the reliance on the purposive sampling method raises the possibility of response bias, as individuals with particularly strong opinions or experiences may have been more likely to participate.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study revealed systemic occupational and psychosocial challenges confronting mental health nurses at Ho Municipal Hospital, including patient aggression, illness denial, gender bias, and chronic understaffing, compounded by persistent community stigma. To address these, the study advocates for institutionalized mental health capacity-building programs, strategic workforce expansion, and the integration of structured psychosocial support and supervision frameworks. Additionally, implementing culturally responsive, evidence-based stigma-reduction interventions within both clinical and community settings is essential to strengthen occupational safety, optimize care outcomes, and sustain nurses\u0026rsquo; psychological resilience. These targeted actions will enhance the operational efficiency of mental health services and advance Sustainable Development Goal 3 (Good Health and Well-being).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eEthical consideration and consent to participate\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEthical approval for the study was obtained from the University of Health and Allied Sciences Research Ethics Committee [UHAS-REC A.11[28] 23\u0026ndash;24] and the Municipal Health Directorate. All participants were over 18 years old and provided voluntary verbal informed consent to take part in the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003cp\u003eNo funding was provided for the study\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study received no financial support from external sources, with all research-related costs being exclusively covered by the Authors themselves.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA. F. D, conceptualized the project. A. F. D, C. A, F. M. S, I. E. A and E. O wrote the main manuscript and C. A, F. M. S performed the analysis, W. K. M. A checked the information provided within the manuscript and revised the main manuscript and all author reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors express their profound gratitude to the management of the selected facilities, as well as to Oduro Samuel, Enyonam Regina Sani, Sitsofe Irene Atika, Ama Mercy Essien, Hilarius Tamakloe.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated or analyzed in this study are not publicly accessible due to confidentiality restrictions; however, they can be obtained from the corresponding author upon reasonable request and with ethical approval from UHAS-REC.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKigozi-Male NG, Heunis JC, Engelbrecht MC. 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FACULTY OF HEALTH AND OCCUPATIONAL STUDIES Nurses’ occupational stressors and their coping strategies A descriptive review 2019.\u003c/li\u003e\n\u003cli\u003eNesengani TV, Downing C, ten Ham-Baloyi W. Barriers to effective patient care as experienced by nurses in primary healthcare clinics in African countries: a systematic review of qualitative studies. \u003cem\u003eBMC Nurs\u003c/em\u003e 2025; 24: 232.\u003c/li\u003e\n\u003cli\u003eIsbell LM, Chimowitz H, Huff NR, et al. A Qualitative Study of Emergency Physicians’ and Nurses’ Experiences Caring for Patients With Psychiatric Conditions and/or Substance Use Disorders. \u003cem\u003eAnn Emerg Med\u003c/em\u003e 2023; 81: 715–727.\u003c/li\u003e\n\u003cli\u003eTamata AT, Mohammadnezhad M. A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. \u003cem\u003eNurs Open\u003c/em\u003e 2022; 10: 1247.\u003c/li\u003e\n\u003cli\u003eAyhan CH, Aktaş MC, Karan E. 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Social Support. \u003cem\u003eHealth Promotion in Health Care - Vital Theories and Research\u003c/em\u003e 2021; 137–144.\u003c/li\u003e\n\u003cli\u003eStensletten K, Bruvik F, Espehaug B, et al. Burden of care, social support, and sense of coherence in elderly caregivers living with individuals with symptoms of dementia. \u003cem\u003eDementia\u003c/em\u003e 2016; 15: 1422–1435.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Experiences, Mental health nurses, Mental disorder, Psychiatric","lastPublishedDoi":"10.21203/rs.3.rs-7999245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7999245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMental health nurses play a pivotal role in caring for individuals with mental health challenges, particularly in hospital settings where patients may exhibit challenging behaviors. Understanding the experiences of mental health nurses regarding the behavior of persons living with mental health problems is crucial for improving patient care and staff well-being.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThis study explored the experiences of mental health nurses regarding the behavior of persons living with mental health problem in selected health facilities in the Ho municipality.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA qualitative exploratory design was employed, using purposive sampling to recruit 14 mental health nurses from the psychiatric unit of Ho Teaching Hospital and Ho Municipal Hospital. Data collection was conducted using a semi-structured interview guide. The collected data were audio-recorded, transcribed verbatim, and analyzed through content analysis using a deductive approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe content analysis yielded three themes and nine subthemes. The analysis revealed that mental health nurses experienced significant stress and potentially hazardous working conditions due to patient aggression, non-compliance with medication, and systemic issues such as understaffing and inadequate infrastructure. Additionally, community stigma exacerbated their challenges. Despite these obstacles, nurses demonstrated resilience through effective coping strategies, including teamwork, vigilance, and support from their families.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study revealed major occupational challenges among mental health nurses at Ho Municipal Hospital, including patient aggression, illness denial, understaffing, and stigma. It calls for structured mental health training, adequate staffing, supportive supervision, and stigma-reduction strategies to enhance workplace safety, improve service delivery, and strengthen nurses\u0026rsquo; resilience in line with Sustainable Development Goal 3.\u003c/p\u003e","manuscriptTitle":"Exploring the Challenges of Psychiatric Nurses in Providing Care to Persons With Mental Health Problems in Selected Health Facilities in Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 10:48:31","doi":"10.21203/rs.3.rs-7999245/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T06:54:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T20:55:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T13:34:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191096930592819986986881249225954558938","date":"2025-12-08T18:50:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-04T11:57:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309219951393552484761507603117151302512","date":"2025-11-30T14:47:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284297352508158254222952926728978357160","date":"2025-11-29T17:19:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-29T12:25:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-17T06:09:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-15T13:41:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-14T16:17:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Health Systems","date":"2025-11-14T16:14:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80940352-f794-4fd4-9c3c-ffd2ffae0b24","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T04:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 10:48:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7999245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7999245","identity":"rs-7999245","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}