The reasons why some patients suffering from schizophrenia miss clinic appointments

[摘要] English: Missed clinic appointments among the patients who are suffering fromschizophrenia has been identified through the statistical records at Botshabelopsychiatric clinic. Missed clinic appointments remain a world-wide problemwhich results from the nature of the illness, the patient, the family, healthservices, culture, employment and other environmental factors.A conceptual model which is based on the principles of the system theoryhas been discussed and indicated that the patient as part of the system iseasily influenced by the environmental factors and the illness itself to stopvisiting the clinic for treatment. During missed clinic appointments there is abreak or cut between the patient and the clinic due to subsystems which playthe negative role within a system (Fawcett, 1989:63).The purpose of the study was to determine the possible reasons formissed clinic appointments for patients who are suffering from schizophreniaand to suggest nursing guidelines to enhance clinic attendances.Quantitative research methodology usinq descriptive and exploratorydesigns was chosen. The population consisted of the patients who aresuffering from schizophrenia referred to the clinics between January 1995and January 1996, and missed clinic appointments twice or more within aperiod of 12 months, both females and males, ages from 19 years and abovewere included.Sampling procedure was purposive consisting of two groups. Group Awere patients who are suffering from schizophrenia and missed clinicappointments twice or more and Group B consisted of one immediate familymember for each patient who was identified in the patient's record, and wholive with the identified patient.A pilot study was done to test the reliability and validity of the data-collectinginstrument. Two patients and two family members were selected for the pilotstudy and were not included in the main study.To verify reliability and validity of the instrument some of the experts werecontacted as follows:�?Nursing Research Committee at the University of the Orange Free State.�?Ethics Committee at the Faculty of Health Sciences, University of OrangeFree State.�?Computer Science personnel at the same university.�?Clinical psychiatric nursing personnel who are experienced In thepsychiatric field.�?The researcher herself who acquires necessary skills in psychiatric nursingand experience played an important role to ensure reliability and validity ofthe instrument.Data collection was done using a semi-structured interview aided by aquestionnaire. Both closed and open-ended questions were designed to obtainthe required information. Questionnaires used were completed by theresearcher to counteract illiteracy among the respondents. Data was codedby the computer centre at the University of Orange Free State. Analysis andinterpretation of data was done by the researcher using graphs and tables.Ethical consideration was maintained. Informed consent was obtained fromthe respondents. Privacy, confidentiality, person with diminished autonomy andright to protection from discomfort and harm was maintained throughout thestudy.The results indicated that the major reason for missed clinic appointmentsamong patients who are suffering from schizophrenia, is a fear of medicationside-effects. This occurs to the patients who have been on treatment before,and experienced side-effects of medication [28.1 %J.The other reasons which appear to be caused by a lack of knowledge aboutthe importance of aftercare management are as follows:- Feeling well when not on treatment- The patient stayed at home with no apparent reason- Poor nurse-patient relationship- Substance abuse- Stigma attached to mental illnessAll these reasons remain problem, which require immediate and long-termsolutions.Recommendations to address these problems were made by the researcherand the nursing quide-lines as explained.

[发布机构] University of the Free State