As the MEGA app is continuing development, the training materials for nurses on mental health and health care are ready for testing and implementation. The test was carried out by UFS team in actual settings. The training was conducted in a boardroom of the Heidedal Community Health Centre (CHC) at the Pelonomi Hospital in the Free State province. Nevertheless, that the clinics are busy with their daily work, the training was prioritised, and one nurse and one social worker of the clinic were released for the pilot training for one full day.
In preparation, the trainer of the UFS team put together a book with the relevant training materials and supplements supplied by the MEGA project as well as an additionally sourced video on depression, a contextually appropriate article on depression conducted among Sesotho speaking respondents in the Mangaung Metro area, where the Free State teams MEGA project focus. The Free State team further included a cultural competency test in the materials. The preparations for the testing of the training took good three.
Despite meticulous planning and preparation, the UFS team faced some challenges. On the day the training was scheduled for an unannounced taxi strike occurred. Several nurses working in the facility were absent as a result, and the nurse who was earmarked to be trained could not be spared because the clinic was severely short-staffed. Only the social worker was released for the training.
The training commenced at 09:00. After an hour of training, the trainee informed the team that she is unable to stay much longer as she must attend to patients at a special clinic on a Wednesday (which was the training day). The team were not informed about this situation beforehand. The team requested that the trainee to at least complete the Personal Reflection checkbox sheet and stay to go through the app questions and get her impressions on that and the training that did take place before she left. She agreed to stay for a while longer. Completing the checkbox sheet took up 10 minutes and going through the evaluation took up 30 minutes.
Before she left, the trainee expressed her gratitude for the training and the book with training materials and supplementary information on mental health and mental health care, and expressed that she would like to be part of the rest of the training, provided it is spread over two-hour sessions and several days – on days and times that suit all the trainees identified for the training.
It is clear from the pilot experience that it may prove challenging to recruit nurses for the eventual formal training, and to get their buy-in. Furthermore, the Free State MEGA team will have to play it by ear per individual clinic as situations and preference will differ between clinics regarding the training periods and venues. The team will have to work very hard to get buy-in from the Free State Department of Health, facility managers and the earmarked trainees themselves for the training to take place successfully.
It should also be noted that mental health care is a lower priority part of the public health care system in the Free State, and presumably elsewhere in South Africa. In general, the mental healthcare receives the limited time, attention and resources in comparison to other health care programmes. For this reason, it may be difficult to recruit nurses for training.
A short evaluation of the training that did take place on the day was conducted. The trainee was asked to name mental health/illness topics she would like to see included in the eight-hour training course on mental health and mental health care. She indicated that she would like to see information on depression, and the difference between stress and depression. These two concepts are contextually not often separated by the patients and some nurses in this area, i.e. the difference is not always clear for patients and some health care workers. The same is true about PTSD and anxiety, what is the difference between stress and PTSD and anxiety? It is important to include clear guidelines for nurses to distinguish between stress, depression, PTSD and anxiety.”
She also suggested material on when a nurse or social worker should refer a patient to a psychiatric unit or a psychologist or psychiatrist. This is not clear to either nurses or social workers and seeing the shortage of resources for mental health care referral, nurses and social workers should have clear guidelines when a patient can be treated in a clinic and when a patient should be treated at a higher level of care.
The trainee was also asked her opinion about whether it would be better to do the training in a full day or two-hour sessions broken up over several days? She indicated that her opinion was that a whole day is too long to take personnel out of their duty, as clinics are short-staffed and absenteeism is rife. Therefore it will be better to break the training down into two hours over several days.