ORIGINAL RESEARCH

 

Facilitation of the mental health of adolescents abusing substances: A concept analysis

 

 

Tinyiko N. Rikhotso^{I, II}; Mary Maluleke^I; Ndidzulafhi S. Raliphaswa^I; Thingahangwi C. Masutha^I; Mphedziseni E. Rangwaneni^III

^IDepartment of Advanced Nursing Sciences, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
^IIDepartment of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
^IIIDepartment of Advanced Nursing Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

Correspondence

 

 

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ABSTRACT

BACKGROUND: The use and abuse of substances, especially among the youth, continues to be of serious concern within the international community. This behaviour affects them as individuals, their families, the community in which they live, and society at large. Findings from a study conducted by the researcher indicate that adolescents who abuse substances experience a range of emotional, physical, academic and social setbacks, and challenges. Ultimately, the mental health of these adolescents is affected
AIM: The study aims to identify and define the central concept 'facilitation of mental health' of adolescents abusing substances
SETTING: The researcher's minor dissertation, whereby the lived experiences of adolescents abusing substances were explored. The basic elements, structure and functions were examined and analysed
METHODS: The concept's basic elements, structure and functions were examined, followed by an analysis and reasoning strategies to define the central concept. The process was implemented over two phases
RESULTS: The central concept 'facilitation of mental health' of adolescents abusing substances was identified and defined using dictionary and subject definitions
CONCLUSION: The identification and definition of the central concept is an important part of developing a model as a frame of reference for psychiatric nurses to facilitate the mental health of adolescents abusing substances
CONTRIBUTION: The findings of the study would assist in the development of a model as a frame of reference for psychiatric nurses to facilitate the mental health of adolescents abusing substances

Keywords: concept analysis; facilitation; adolescents; substance abuse; mental health.

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Introduction

The use and abuse of substances, especially among adolescents continues to be a serious concern within the international community. This behaviour affects adolescents as individuals, their families, the community in which they live, and society at large. Substance abuse causes social and family disorganisation, economic instability, social insecurity, and curbs progress for individuals, families, and the State. Some effort towards intervening in this challenge, focussing on mental health promotion and substance abuse prevention was made, yet it appears it was not enough (Steel et al. 2020; World Health Organization [WHO] 2020). There are some shortfalls in these interventions as there is no satisfying improvement related to this phenomenon; instead, the prevalence of substance abuse is becoming worse each day (Cardenas et al. 2021; Setlalentoa, Ryke & Strydom 2016) Findings from the researcher's minor dissertation (Rikhotso 2008) indicate that adolescents who abuse substances experience a range of emotional, physical, academic, and social setbacks and challenges.

Certain interventions concerning adolescents' substance abuse were cited in another study (Salam et al. 2016) and included promoting sexual and reproductive health, nutrition interventions, immunisation, mental health promotion, substance abuse prevention and the prevention of unintended injuries. Another study conducted in the North-West Province of South Africa (Setlalentoa et al. 2016) proposed some interventions to address alcohol abuse. These called for holistic, multi-level and multi-sectoral interventions for all role-players, such as government departments, non-governmental organisations, the community, and faith-based organisations (Setlalentoa et al. 2016). Moreover, (Gallop et al. 2020) recommendations to reduce adolescent substance abuse included (Rikhotso 2008) health promotion activities, programmes, and services; (WHO 2020) constructive media-based public education campaigns; (Steel et al. 2020) development and implementation of school-based substance abuse programmes; and (Cardenas et al. 2021) provision of recreational facilities.

Among the interventions that were developed so far, according to the latter studies, it is evident that few had minimal impact while most of them had no effect at all. The South African Nursing Council has not acknowledged the facilitation of mental health of adolescents abusing substances for inclusion in the scope of practice of psychiatric nurses. The researcher, therefore, conceived the idea that developing a model whereby psychiatric nurses who provide care for adolescents abusing substances while admitted in psychiatric institutions to facilitate their mental health would bridge the gap. Moreso, because the model would not be something that is imposed on the adolescents but a step-by-step interactive process between the psychiatric nurses and those adolescents.It would be a participatory interaction for both on the way towards achieving adolescent's mental health. To develop such a model, the researcher had to identify the concepts from the previous study, (Rikhotso 2008) define and classify these concepts, and place them into relationship. As a result, this study of concept analysis to develop a model to facilitate the mental health of adolescents was conducted.

 

Objective

The objective of this article is to define the central concept 'facilitation of mental health' of adolescents abusing substances.

 

Research methods and design

This study utilised a qualitative, exploratory, descriptive, contextual approach and theory generating design, and was guided by a Post-modern Constructivist Philosophy of Science. This philosophy relies on two concepts: post-modernism and social constructivism. Post-modernism's emphasis is on setting knowledge claims within the conditions of the world today and in the multiple perspectives of class, race, gender and other group affiliations (Creswell 2018). Social constructivism occurs through social and environmental interactions and emphasises that knowledge exchange between researchers and healthcare professionals must happen in a mutually created social context (Thomas et al. 2014).

According to Walker and Avant (2011), concept analysis is the process of examining the basic elements, structure, and functions of a concept. Rodgers, Jacelon and Knafl (2018) view concept analysis as a branch of empirical linguistics, as it contains the assumption that a definition of a term may be found that pertains to its representation in a natural language. The concept analysis process was undertaken during model development, since it provides precise theoretical and operational definitions for use in model development and research. It also enables the researcher to classify similar concepts.

The basic elements, structure, and functions of a concept were examined, following the theory development approaches, namely, analysis, synthesis, and inductive reasoning strategy (Martinez et al. 2021) to define the central concept. The identified central concept in this study was analysed to identify essential criteria to define it (Gomba 2017; Walker & Avant 2011). This study warranted the application of synthesis so that the broken down and sorted concepts from the researcher's previous study (Rikhotso 2008) could be reconnected to form a meaningful and comprehensive whole (Leedy & Ormrod 2015; Walker & Avant 2011). The researcher followed the inductive reasoning approach whereby the conclusions that were developed through the phenomenological interviews and the observations, as reflected in the field notes, were drawn from the participants' shared experience (Ravitch & Carl 2016; Tema 2017).

The process of concept analysis was implemented over two phases. Phase One involved identifying the central concept 'facilitation of mental health' of adolescents abusing substances, derived from the researcher's minor dissertation (Rikhotso 2008), in which the lived experiences of adolescents were explored using semi-structured individual phenomenological interviews. Phase Two involved defining the concepts and placing them into relationship. Those took place through the use of theoretical and operational definitions obtained from dictionaries and subject sources.

Ethical considerations

Ethical approval was received from the Faculty of Health Sciences Research Committee of University of Johannesburg on 15 November 2016 with the ethical clearance number REC-01-169-2016.

 

Results

The results of Phase One helped the researcher identify the central concept, and in Phase Two, the central concept was defined and classified. The process unfolded as presented in the following sections:

Phase one: Identification of the central concept

To identify the central concept, the researcher obtained the findings from her minor dissertation from which the central concept was derived. The minor dissertation focussed on substance abuse among adolescents in Limpopo Province (Rikhotso 2008). Five themes were identified. These are summarised in Table 1, including the respective direct quotes from the participants (Rikhotso 2008).

 

 

Considering the findings from a study by conducted by Hlahla and Mothiba (2022), it is evident that adolescents need to be assisted for them to be mentally healthy. From the narratives, the researcher identified that adolescents engaged in substance abuse activities to self-medicate (Mianowski, Borodo & Schreiber 2019). Some adolescents were abusing substances to ease depressive feelings, others as a means of running away from the reality or fear of confronting their parents, avoiding rejection by peers, and having a feeling of belonging. There were also instances where research participants claimed they were abusing substances to find solutions to their problems; only to find that even if there were solutions, they were temporary, and their situation ultimately worsened.

The adolescents' experiences of abusing substances influenced their decision-making abilities and choices. The fact that the interviews with adolescents took place in a psychiatric ward shows that their mental status was affected. Therefore, they had moved from mental health to the mental illness continuum, as seen by the disharmony between their thoughts, feelings, and actions (Perko & Kreigh 1988). Perko and Kreigh (1988) further point out that mental illness encompasses psychological, emotional, and social disequilibrium, as noted from the quotes. To strike a balance between these dimensions implies that the mental functioning of individuals needs to be facilitated in order for them to adjust and adapt to daily living. The participating adolescents further acknowledged their awareness of being in an unfavourable situation and seeking assistance. However, they did not know how to go about obtaining this assistance. As the statements were placed into relationship, the experiences by adolescents in relation to substance abuse confirmed that:

• Adolescents who abuse substances have causative reasons for starting to abuse substances.

• Adolescents have internal and external factors that make it difficult for them to stop abusing substances, even if they wish to.

• Adolescents' lives are affected in different dimensions as they use different substances.

• There are some driving forces that initiate a zeal in adolescents to discontinue abusing substances.

• Adolescents themselves are not pleased with their substance abuse behaviour, thus making plans to discontinue.

From the verbatim, the essential and related concepts were derived (See Table 2). These were classified based on shared characteristics.

 

 

The central concept was therefore identified as the 'facilitation of mental health' of adolescents abusing substances by psychiatric nurses as they are brought under their care.

Phase two: The definition of the central concept

While defining the central concept, the researcher used sources that enabled the provision of a link between theoretical abstractions and empirical indicators (Chinn & Kramer 2017). For each of the related concepts, a dictionary definition, which provides synonyms and antonyms and conveys commonly accepted ways in which words are used (Chinn & Kramer 2017), was employed. A subject definition, which conveys meanings about the discipline's domain from which the concept comes, was also incorporated (Chinn & Kramer 2017).

These concepts are 'facilitation' and 'mental health', respectively. As stated, dictionary (both hard copies and online) and subject sources (including psychiatric nursing, psychiatry and psychology) were used to obtain definitions for these concepts. During concept analysis, the essential criteria were written in Italics. Table 2 provides a summary of dictionary and subject definition of the concept 'facilitation' and 'mental health', in which the central, essential, and related criteria are indicated.

Dictionary definitions of the concept 'facilitation'

Waite (2012) defines 'facilitation' as to make something easy or easier. The verb for 'facilitation' is 'facilitate', which is defined as to make an action or process possible or easier. Conversely, a 'facilitator' is defined as a person who helps somebody do something more easily by discussing problems, giving advice, and so forth, rather than telling them what to do. It is a thing that helps a process to take place (Hornby 2010). Free Dictionary (2021) presents 'facilitation' as the act of making easy or easier, or the state of being made easy or easier. According to Princeton WordNet Dictionary (2003-2012), 'facilitation' is the condition of being made easy; the act of making easier the progress, or improvement of something.

Subject definition of 'facilitation'

'Social facilitation' is defined as the improvement of a group, produced by the mere presence of others (McAllister, Withyman & Knight 2018). Ntshingila et al. (2021) argue that the purpose of facilitation is to enable a group of people to achieve their own purpose in their own agreed way. They also describe group facilitation as an intuitive art form of moment-by-moment awareness that requires discipline. Facilitators frequently must act 'in the moment'; that is, deciding if, when and how to intervene in group discussions (Ntshingila et al. 2021).

The facilitator is described as a gentle guide, making it easier for the group to reach its goals International Council on Archives (ICA) 2014. The facilitator must be fully present and transparent in the group (Ntshingila et al. 2021). The facilitator has the role of empowering the participants and ensuring that the facilitation of learning occurs through active and conscious involvement of the whole person (Downing 2012).

Facilitation, as defined by the Theory for Health Promotion in Nursing (University of Johannesburg 2017), is a dynamic interactive process for the promotion of health through the creation of a positive environment and the mobilisation of resources, as well as the identification and bridging of obstacles. Facilitation is concerned with helping people (individually or in groups) to work effectively and efficiently to achieve a particular goal or learning outcome. It is a combination of skills, techniques and art involving interaction with adolescents abusing substances to draw out their ideas and lead them to new meanings and understandings (Nkuna 2017).

Facilitation is increasingly being used as a participatory approach that enhances team effectiveness in dialogue, analysis, decision-making, planning, divergence, and convergence (Thorpe 2016). Thorpe (2016) further alluded that, for facilitation to yield the expected outcomes, the facilitator must have the following competencies:

• Set and maintain a shared group culture - the facilitator ensures that care and respect are present in interventions, uses behaviours and attitudes that enable greater participation by the group, shares valid information that enables participants to learn together, holds and supports the group in their culture, and works with others to set expectations for participation and manage acknowledgements.

• Plan and prepare - the facilitator develops appropriate lead times, prepares access to group technologies and their effective use, ensures that the right decision-making people are involved, and are timely and responsive to others.

The facilitation process can be described as a road on which the facilitator walks with the client, accompanying that client on the journey of self-discovery (Grobler, Schenck & Mbedzi 2013). A facilitated session is a highly structured meeting in which the meeting leader, who is the facilitator, guides the participants through a series of pre-defined steps to arrive at a result that is created, understood, and accepted by all the participants (Wilkinson 2012). The process makes it possible for participants to explore issues such as: 'Who am I?', 'What are the thoughts, perceptions, feelings, needs, behaviours and values that make me who I am?' and 'What prevents me from being who I want to be or living to my full potential?' The facilitator cannot walk this road for the participant. Only the participant knows what it feels like under his feet and how it feels to walk in his shoes, where he wants to go or where he is going, where he does not want to go, or which road is too steep for his legs.

Exforsys (2021) states that the facilitator guides participants to a learning journey to discover their own experiences and explore those of others, identify their strengths and weaknesses, and share what they already know with the rest of the group. In certain instances, the facilitator also shares knowledge apart from just guiding the group in the process. Effective facilitation skills must be demonstrated. This includes the ability to communicate, the ability to manage and lead a group, active listening skills, effective questioning skills, and the ability to easily resolve any conflicts and misunderstandings.

Dictionary definition of the concept 'mental health'

Mental health includes emotional, psychological, and social wellbeing. It affects how an individual thinks, feels and acts in response to specific life situations. It also determines how an individual handles stress, relates to others, and makes choices. Mental health is important at every stage of life, from childhood, adolescence, through to adulthood (Medline Plus 2021). Mental health is a level of psychological wellbeing, or an absence of mental illness. It is the psychological state of someone functioning at a satisfactory level of emotional and behavioural adjustment (Smith 2021).

Mental health is the condition of being mentally and emotionally sound as characterised by the absence of mental illness and presence of adequate adjustment, especially as reflected in feeling comfortable about oneself, having positive feelings about others, and the ability to meet the demands of daily life (Merriam-Webster 2021). Free Dictionary (2021) defines 'mental health' as a state of emotional and psychological wellbeing in which an individual can use their cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.

Emotional intelligence is the measure of an individual's ability to recognise and manage their emotions, and the emotions of other people, both individually and in groups. People with higher emotional intelligence find it easier to form and maintain interpersonal relationships and 'fit in' to group situations. They are also better at understanding their own psychological state, which can include managing stress effectively. A range of skills are elements of emotional intelligence, such as self-awareness, self-management, self-motivation, empathy, and social skills (Skills You Need 2021).

Beyond Blue (2021) is of the opinion that 'mental health' is often used as a substitute for mental health conditions, such as depression, anxiety disorders, schizophrenia, and others. It is about achieving and helping everyone reach their full potential. This will contribute to the prevention of mental health conditions and support people who have experienced these conditions to get as well as they can and lead a full and contributing life. Having social connections, good personal relationships, and being part of the community is vital to maintaining good mental health and contributing to people's recovery, should they become unwell.

Subject definition of the concept 'mental health'

World Health Organization (2014) defines 'mental health' as a state of wellbeing in which every individual realises one's own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to own community. It is further indicated that mental health, physical health, and social functioning are interdependent, and the relationship between these is complex. Mental health is defined as a state of subjective wellbeing whereby an individual's socio-emotional intelligence and positive or spiritual emotions are above normal, as characterised by resilience, in which individuals overcome stressful situations by developing defence mechanisms to cope (Sadock, Sadock & Ruiz 2020).

Sadock et al. (2020) again added that there are six contrasting approaches to mental health. These include: (1) Mentally healthy people function above normal, meaning they are in a reasonable state of functioning. (2) The association of mental health and maturity is likely mediated by progressive brain myelination and the evolution of emotional and social intelligence through experience. In this model, adolescents must achieve an identity that allows them to become separate from their parents. The task of identity requires mastering the last task of childhood. (3) Mental and spiritual health is defined as the amalgam of the positive emotions that bind us to other human beings and involves human connections. These positive emotions appear to be common denominators of major faiths, some of which include excitement, interest, contentment, humour, and a sense of mastery. (4) Socio-emotional intelligence reflects above-average mental health. Anyone can become angry; that is easy. But socio-emotional intelligence is when one becomes angry with the right person, for the right reason, to the right degree, at the right time, and in the right way. (5) Mental health is subjective wellbeing. The maintenance of self-efficacy, agency, and autonomy makes additional environmental contributions to subjective wellbeing. This implies that not only does an individual impose joy on others, but also involves subjective happiness. Assuming responsibility for favourable and unfavourable outcomes is another main factor leading to subjective wellbeing. (6) Mental health as resilience involves three classes of defence mechanisms, namely consciously seeking support from others, conscious cognitive strategies that individuals use to master stress, and healthy adaptive involuntary coping mechanisms (humour, altruism, sublimation, suppression, anticipation) that distort perceptions of internal and external reality in order to reduce objective distress, anxiety and depression.

Mental wellbeing refers not only to physical health but also, and more importantly, to the mental and social state of an individual. Mental order and disorders are observed as cultural categories adopted through or embodied in social interaction. Wellbeing and disorder are themes of the utmost importance, since everyone is touched by various disorders or illnesses and healing, wellbeing, or lack thereof (Katajala-Peltomaa & Niiranen 2014).

Uys and Middleton (2014) define 'mental health' as an evolving process in which the individual's internal demands and needs are brought into contact with the reality of the environment in which they live. Its achievement is obtained through successful adaptation, which requires an individual to establish a point of equilibrium between wants, needs, abilities, ambitions, values, and feelings. The real or perceived expectations of society and the surrounding environment influence the way in which the individual operates. Uys and Middleton (2014) talked about mentally healthy people being resilient, while Uys & Middleton (2014) said mentally healthy individuals use more adaptive coping skills.

Mental health status means the level of mental wellbeing of an individual as affected by physical, social and psychological factors, which may result in a psychiatric diagnosis (Mental Health Care Act [MHCA] 17 of 2002). Mental health recovery is a journey of healing and transformation, enabling persons with mental health problems to live a meaningful life in a community of their choice, while striving to achieve their full potential (Parker 2014).

Psychiatric mental health nursing is a specialised area of nursing practice committed to promoting mental health through the assessment of human responses to mental health problems and psychiatric disorders (Jones, Fitzpatrick & Rogers 2016). Mental health problems can be seen as a continuum varying from normal reactions to everyday events, to serious disability requiring long-term support. Connecting with people, being active, learning new things, acts of altruism and being aware of oneself is evidenced as ways of promoting our wellbeing, but mental order remains rather more loosely defined than mental disorder (Kinsella & Kinsella 2015).

Mentally healthy persons possess the ability to make adjustments that enable them to remain unhampered by emotional conflict and free from pathological symptomatology. This individual confirms and follows a philosophy of living; finds satisfaction and fulfilment in exercising and expanding his potential; and establishes and maintains meaningful relationships with others (Perko & Kreigh 1988).

Table 2 provides a list of central concepts, and essential and related criteria. The central concepts, essential criteria and related criteria are in italics.

The findings of this study were obtained from connecting isolated pieces of information by organising more than one interrelated concept to describe the structure and process of the model to assist psychiatric nurses in facilitating the mental health of adolescents abusing substances (Walker & Avant 2011). In the process, the unrecognised concepts were named and described (Gray, Grove & Sutherland 2017). The definition of the concepts 'facilitation' and 'mental health' were separately formulated, then finally, the central concept 'facilitation of mental health' was presented.

Definition of 'facilitation'

In this article, 'facilitation' is defined as the dynamic interactive process between the psychiatric nurse and adolescents abusing substances, through which the psychiatric nurse guides adolescents abusing substances, in a way making it easier for them to cope with the challenges they encounter.

Definition of 'mental health'

In this article, 'mental health' is defined as evidence that the adolescent has achieved a sense of maturity, exhibits positive emotions, has attained emotional intelligence, experiences subjective wellbeing and shows resilience.

Definition of 'facilitation of mental health'

In this article, 'facilitation of mental health' is a dynamic interactive process through which the psychiatric nurse guides adolescents abusing substances, in a way making it easier for them to cope with challenging situations as evidenced by the adolescents' achievement of maturity, the exhibition of positive emotions, attainment of emotional intelligence, the experience of subjective wellbeing, and showing resilience.

 

Discussion

To obtain the desired outcomes of defining the central concept 'facilitation of mental health' of adolescents abusing substances, dictionaries and subject sources were used (Walker & Avant 2011). It was critical to define 'facilitation of mental health' since the concept is new in its context. The role-players, especially psychiatric nurses, should understand this concept comprehensively because they are at the front line in the facilitation of mental health of adolescents abusing substances assigned to their care when they get admitted to psychiatric institutions. The definition of 'facilitation' shares its components with the Theory for Health Promotion in Nursing (University of Johannesburg 2017) and other South African literature sources. Therefore, the conclusion can be drawn that the definition was derived and analysed in the South African context. Another crucial element in the description of the central concept 'facilitation of mental health' is that it was used to develop a model to assist psychiatric nurses in facilitating the mental health of adolescents abusing substances. The model case highlights the need for psychiatric nurses to assist adolescents abusing substances to make behavioural and emotional adjustments to achieve mental health.

 

Constructing a model case

A model case is a concept that constitutes all the defining criteria of the concept (Walker & Avant 2011). The essential criteria of the concept 'facilitation of mental health' forms the basis of the model case (Rikhotso 2019).

Mr X is an 18-year-old boy who lives in a village in the Greater Giyani Municipality, situated around 20 km from the psychiatric institution where the study was conducted. He is the firstborn of two children and is living with his single mother and younger sister. His mother sells fruit to earn a living. He is still in Grade 10 because, in recent years, he has repeated every grade and sometimes does not even sit for examination because of hospitalisations on account of substance use induced psychosis. As a result of the scarcity of public transport in this area and the inaccessibility of police services to intervene, he is typically brought to the hospital in a hired vehicle, which is very expensive. He shared his story as follows:

The story, as explained to me by an old lady from the neighbourhood, is that Mr Smith (not the real name) impregnated my mother while she was still a teenager and lied to her that he was single. When she went to live with him in a nearby village, she discovered he was married and had children. For my mother, life became miserable, and she decided to return home. A few months later, when she was 4 months pregnant with me, she was proposed to by Mr Jones (not the real name), a man with whom she attended school and lived in the same village. Since he spent most of his time in Johannesburg, where he was working, he was not aware she was pregnant. My mother accepted the proposal and went back to Johannesburg with him. A month later, she returned home to Giyani, and she called him to say she was pregnant. Three months later, I was born. Mr Jones got the news that a baby boy was born, and he realised I was not his son. He rejected my mother, and she returned to her parents' home with me. I had mixed feelings when I heard the story, but I was happy I finally got the truth.

At this stage, I was drinking beer, and every time I was drunk, I would confront my mother about her reasons for lying to me about my father. I got used to drinking, so I would drink more frequently, even alone, and bitterness started to build up in me. My academic performance declined; hence, I am still in Grade 10. My relationship with my mother became bad. My younger sister became fearful when I was around because I would hit her for no reason. At times, I would be irritable and aggressive. In my own corner, I was overwhelmed with feelings of hatred, anger and loneliness. My drinking habit resulted in me being admitted to this psychiatric institution. I am told I would become violent, beat my younger sister, swear at my mother, spend sleepless nights, and turn the radio to maximum volume. I've had numerous admissions to this institution. Upon discharge after every admission, I would vow I would not be admitted again, but when I get home, the same peers and circumstances push me to the edge, and I start drinking again. I could see that my future was bleak and wished to change my lifestyle, but it was not easy. I wished I could get some help, but did not know from who, where, and how.

By God's grace, during my previous and last admission almost a year ago, I met Sister Margaret (not the real name), a psychiatric nurse in the ward in which I was admitted. To date, I am still in awe because for the first time in my admission history to this institution, I have spent many years at home without being readmitted. She introduced herself to me and offered to assist me. Although I was uncertain whether I would really get assisted, considering my recurrent admissions, I accepted her offer. At last, my question on where to go and from whom to get assistance was answered, though I still did not know how this would occur.

Together, we embarked on a journey of a dynamic interactive process that enabled me to open to her and share all my challenges regarding the use and abuse of substances, especially alcohol. This was possible after my conviction of her trustworthiness, and I became free to interact with and confide in her. I shared my addiction to drinking beer, my motives for continuing with the habit, the setbacks this has caused in my life, and the emotional, physical, and social challenges this has created with her. Although I did not have all the information, I was aware that my mind had been affected, and I therefore needed someone to guide and make it easier for me to become fully functional and for subjective wellbeing to unfold in my life.

She pointed out that from the information I gave her, I failed to fulfil my responsibilities as a young person and lacked a sense of maturity. Once I become willing to resume my responsibilities and become resilient, this dynamic interactive process would succeed. She further clarified that I am the one holding the key to my own future. Unless I take actions to enable me to improve my wellbeing and emotional intelligence, the process of our interaction would be of no use.

From that encounter to date, I cannot stop thinking about where I would be now if I did not have the opportunity to engage in the process of interacting with that sister. I am forever grateful for this because my life has not been the same since. I can relate socially to my mother and other people with whom I live. I manage to control my emotions and respond positively to challenges without being easily angered. Even my psychological state has improved; I am able to reason well and adjust to different situations I encounter. For a change, I have passed my examinations, and next year will attend Grade 11. I am very happy about this and never thought it would be possible. The changes that I already see in my life give me hope that I will end up living a life free from mental illness.

 

Limitations of the study

The literature sources for the definition of the concept 'facilitation' were commonly obtained from the field of psychology.

 

Recommendations

Recommendations are made for psychiatric nursing practice, education and research.

Recommendations for psychiatric nursing practice

It is important to define 'facilitation of mental health' of adolescents abusing substances in the context of nursing, especially in the psychiatric wards where these adolescents are admitted and entrusted to the constant care of psychiatric nurses. Psychiatric nurses should have profound knowledge about the 'facilitation of mental health' of affected adolescents to assist them in making reasonable adjustments to their behaviour to achieve their goal of mental stability. The psychiatric nurses should attend workshops or receive in-service training on facilitating adolescents' mental health to ensure they receive an effective and efficient service during their admission in the psychiatric ward and sustain their improvements after their discharge as this is not included in their formal training. The successful implementation of this concept could evoke a constructive debate in the field of nursing that would add to the body of knowledge in nursing practice within South Africa, as well as the global nursing community. This would improve the mental health of adolescents abusing substances based on the empowerment they would receive in handling the challenges they encounter. This will consequently improve mental health practice.

Recommendations for nursing education

The definition of the central concept 'facilitation of mental health' of adolescents abusing substances could assist in teaching psychiatric student nurses - both at undergraduate and postgraduate levels as this is currently not in the curricula - about adolescent mental health and the benefits these adolescents could achieve from their mental health being facilitated. Having acquired this knowledge, student nurses would be empowered, thereby being able to render effective psychiatric nursing care to adolescents abusing substances.

Recommendations for nursing research

In the process of analysing the central concept, the foundation was laid for the development of a model to facilitate the mental health of adolescents abusing substances. Psychiatric nurses' evaluation of the model's effectiveness progressively informed the need for further research on adolescents' substance abuse and their mental health.

 

Conclusion

The analysed concept acted as the foundation for developing a model for psychiatric nurses to facilitate the mental health of adolescents abusing substances. The nursing profession is enriched by defining the central concept since the 'facilitation of mental health' of adolescents abusing substances has never been defined before. It also illuminates psychiatric nurses' added role in facilitating the mental health of adolescents abusing substances, which the South African Nursing Council has not acknowledged for inclusion in the scope of practice of psychiatric nurses.

 

Acknowledgements

All the authors acknowledge the following for their contribution to the success of the study: University of Johannesburg for approval of the study, Limpopo Department of Health for granting permission to conduct the study, and the participants who set aside time to participate in the study.

Competing interests

The authors have declared that no competing interest exists.

Authors' contributions

T.N.R. conducted the research and wrote manuscript. M.M. finalised and assisted with submission of the manuscript. N.S.R., T.C.M., and M.E.R. edited the manuscript for final submission.

Funding information

This research received funding from the University of Johannesburg's Supervisor Grant.

Data availability

Data sharing is not applicable to this article as no new data were or analysed in this study.

Disclaimer

The views and opinions expressed in this article are those of the author(s) and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The author(s) are responsible for this article's results, findings, and content.

 

References

Beyond Blue, 2021, Get immediate help for depression and anxiety, viewed 13 June 2021, from https://www.beyondblue.org.au>get-immediatehelpfordepressionandanxiety.         [ Links ]

Cardenas, A., Martinez, M., Saenz, M.A. & Lotfipour, J., 2021, 'Early adolescent sub-chronic low-dose nicotine exposure increases subsequent cocaine and fentanyl self-administration in Sprague-Dawley rats', Behavioural Pharmacology 32(1), 86-91. https://doi.org/10.1097/FBP.0000000000000593        [ Links ]

Chinn, P.L. & Kramer, M.K., 2017, Knowledge development in nursing, 10th edn., Elsevier, Amsterdam.         [ Links ]

Creswell, J.W., 2018, Research design qualitative, quantitative, and mixed methods approaches, SAGE, New York, NY.         [ Links ]

Downing, C., 2012, 'A model for the facilitation of mental health through belly dancing as movement', thesis, University of Johannesburg.         [ Links ]

Exforsys, 2021, Facilitator's roles and responsibilities, viewed 13 June 2021, from http://www.exforsys.com>career-center>facilitato'srolesandresponsiblities.         [ Links ]

Free Dictionary, 2021, Facilitation, viewed 15 June 2021, from https://www.thefreedictionary.com/facilitation.         [ Links ]

Gallop, A., Chen, B., Gulati, V. & Barnes, A., 2020, 'Cultural appropriation and substance use disorder: A case report', Journal of Child & Adolescent Substance Abuse 29(1), 22-26. https://doi.org/10.1080/1067828X.2020.1805838        [ Links ]

Gomba, T., 2017, Factors leading mental health care users to use modern and traditional medicine in rural areas of Makhado Municipality in the Vhembe District of Limpopo Province in South Africa, University of Venda, Tswane.         [ Links ]

Gray, J., Grove, S.K. & Sutherland, S., 2017, Burns and grove's the practice of nursing research: Appraisal, synthesis and generation of evidence, 8th edn., Elsevier, St Louis, MO.         [ Links ]

Grobler, H., Schenck, R. & Mbedzi, P., 2013, Person centered facilitation: Process, theory and practice, 4th edn., Oxford University Press, Tshwane.         [ Links ]

Hlahla, L. & Mothiba, T.M., 2022, 'Support needs of parents of adolescents abusing substances in selected hospitals in Limpopo Province', The Open Public Health Journal 15(1) 1-7. https://doi.org/10.2174/18749445-v15-e2208040        [ Links ]

Hornby, A.S., 2010, Oxford advanced learner's dictionary, International student's edn., New 8th edn., Oxford University Press, New York, NY.         [ Links ]

International Council of Archives (ICA), 2014, Group facilitation methods, viewed 17 May 2021, from https://www.ica-uk>event>info.         [ Links ]

Jones, J.S., Fitzpatrick, J.J. & Rogers, V.L., 2016, Psychiatric-mental health nursing: An interpersonal approach, 2nd edn., Springer Publishing Company, Hoboken, NJ.         [ Links ]

Katajala-Peltomaa, S. & Niiranen, S., 2014, Mental disorders in later medieval Europe, Brill, Boston, MA.         [ Links ]

Kinsella, C. & Kinsella, C., 2015, Introducing mental health: A practical guide, 2nd edn., Jessica Kingsley, London.         [ Links ]

Leedy, P.D. & Ormrod, J.E., 2015, Practical research: Planning and design, 11th edn., Pearson, New York, NY.         [ Links ]

Martinez, N., Connelly, C.D., Perez, A. & Calero, P., 2021, 'Self-care: A concept analysis', International Journal of Nursing Sciences 8(4), 418-425. https://doi.org/10.1016/j.ijnss.2021.08.007        [ Links ]

McAllister, M., Withyman, C. & Knight, B.A., 2018, 'Facilitation as a vital skill in mental health promotion: Findings from a mixed methods evaluation', The Journal of Mental Health Training, Education and Practice 13(4), 238-247. https://doi.org/10.1108/JMHTEP-05-2017-0036        [ Links ]

Medline Plus, 2021, Mental health, viewed 24 June 2021, from https://medlineplus.gov>mentalhealth.         [ Links ]

Mental Health Care Act (MHCA) 17, 2002, 'Government Gazette, Republic of South Africa, Vol. 449, Act 17', English text signed by the President, viewed 06 November 2002, Government Printers, Pretoria.         [ Links ]

Merriam-Webster, 2021, Mental health, viewed 13 June 2021, from https://www.merriam-webster.com>mentalhealth.         [ Links ]

Mianowski, J., Borodo, M. & Schreiber, P., 2019, Memory, identity and cognition: Explorations in culture and communication, Springer, New York, NY.         [ Links ]

Nkuna, N.S.M., 2017, 'A psycho-educational model for the facilitation of mental health of young women living with HIV', thesis, University of Johannesburg.         [ Links ]

Ntshingila, M., Temane, A., Poggenpoel, M. & Myburgh, C., 2021, 'A model for psychiatric nurses to facilitate the mental health of women living with borderline personality disorder', Curationis 44(1), 1-10. https://doi.org/10.4102/curationis.v44i1.2157        [ Links ]

Parker, J., 2014, 'Recovery in mental health', South African Medical Journal 104(1), 77. https://doi.org/10.7196/SAMJ.7732        [ Links ]

Perko, J.E. & Kreigh, H.Z., 1988, Psychiatric and mental health nursing: A commitment to care and concern, 3rd edn., Appleton & Lange, New York, NY.         [ Links ]

Princeton WordNet Dictionary, 2003-2012, WordNet 3.0, Farlex clipart collection, viewed 12 June 2021, from https://www.thefreedictionary.com/Princeton+WordNet.         [ Links ]

Ravitch, S.M. & Carl, N.M., 2016, Qualitative research. Bridging the conceptual, theoretical, and methodological, SAGE, Washington, DC.         [ Links ]

Rikhotso, T.N., 2008, 'Substance abuse among adolescents', MCur Psychiatric Nursing minor-dissertation, University of Johannesburg.         [ Links ]

Rikhotso, T.N., 2019, 'A model for psychiatric nurses to facilitate the mental health of adolescents abusing substances', DCur thesis, University of Johannesburg.         [ Links ]

Rikhotso, TN., 2020, 'A model for psychiatric nurses to facilitate the mental health of adolescents abusing substances', Doctoral thesis, University of Johannesburg, viewed 15 November 2023, from https://ujcontent.uj.ac.za.         [ Links ]

Rodgers, B.L., Jacelon, C.S. & Knafl, K.A., 2018, 'Concept analysis and the advance of nursing knowledge: State of the science', Journal of Nursing Scholarship 50(4), 451-459. https://doi.org/10.1111/jnu.12386        [ Links ]

Sadock, B.J., Sadock, V.A. & Ruiz, P., 2020, Kaplan and Sadock's comprehensive textbook of psychiatry, 11th edn., Wolters Kluver Health, Alphensaan den Rijn.         [ Links ]

Salam, R.A., Das, J.K., Lassi, Z.S. & Bhutta, Z.A., 2016, 'Systematic review and meta-analysis of interventions to improve access and coverage of adolescent immunization', Journal of Adolescent Health 59(4), 40-48. https://doi.org/10.1016/j.jadohealth.2016.07.005        [ Links ]

Setlalentoa, B., Ryke, E. & Strydom, H., 2016, 'Intervention strategies used to address alcohol abuse in the North-West Province, South Africa', Social Works Journals 50(5), 1-429. https://doi.org/10.15270/51-1-429        [ Links ]

Skills You Need, 2021, Facilitation, viewed 13 June 2021, from https://www.skillsyouneed.com>lead>facilitation.         [ Links ]

Smith, M., 2021, The emotional learner: Understanding emotions, learners and achievement, Routledge, Abingdon.         [ Links ]

Steel, D.W., Becker, S.J., Danko, K.J., Balk, E.M., Saldanha, I.J., Adam, G.P. et al., 2020, Interventions for substance use disorders in adolescents: A systematic review, Agency for Healthcare Research and Quality, PubMed, Rockville, MD.         [ Links ]

Tema, T.R., 2017, 'A model to facilitate the mental health of psychiatric nurses in a forensic unit to manage hostile behaviour constructively', D Cur Psychiatric Nursing thesis, University of Johannesburg.         [ Links ]

Thomas, A., Menon, A., Boruff, J., Rodriguez, A.M. & Ahmed, S., 2014, 'Applications of social constructivist learning theories in knowledge translation for health care professionals: A scoping review', Implementation Science 9, 54. https://doi.org/10.1186/1748-5908-9-54        [ Links ]

Thorpe, S.J., 2016, 'Online facilitation competencies for group facilitators', A Research and Application Journal 13, 79-90.         [ Links ]

University of Johannesburg, 2017, Theory for health promotion in nursing, University of Johannesburg, Johannesburg.         [ Links ]

Uys, L.R. & Middleton, L., 2014, Mental health nursing: A South African perspective, 6th edn., Juta, Cape Town.         [ Links ]

Waite, M., 2012, Paperback Oxford English Dictionary, 7th edn., Oxford University Press, Oxford.         [ Links ]

Walker, O.L. & Avant, K.C., 2011, Strategies for theory construction in nursing, 5th edn., Pearson, Boston.         [ Links ]

Wilkinson, M., 2012, The secrets of facilitation: The SMART guide to getting results with groups, Jossey-Bass, Hoboken, NJ.         [ Links ]

World Health Organization (WHO), 2014, Mental health: A state of well-being, World Health Organization, Geneva.         [ Links ]

World Health Organization (WHO), 2020, Mental health and substance use: WHO-UNICEF helping adolescents thrive initiative, World Health Organization, Geneva.         [ Links ]

 

 

Correspondence:
Tinyiko Rikhotso
tinyiko.rikhotso@univen.ac.za

Received: 31 Jan. 2023
Accepted: 09 Oct. 2023
Published: 27 Feb. 2024