ประสบการณ์และความท้าทายของพยาบาลในการดูแลผู้ป่วยโรคจิตเภท ที่มีการใช้สารเสพติดร่วม ในบริบทพหุวัฒนธรรม

Abstract

Abstract

This qualitative research aimed to explore the experiences and challenges of nurses caring for patients with schizophrenia and co-occurring substance use disorders within the context of a psychiatric inpatient ward in Yala Province. The purposive sample consisted of seven registered nurses with at least two months of experience in caring for dual-diagnosis patients at the Ratchaphruek Ward, Yala Tertiary Hospital. Data were collected through focus group discussions using a five-point semi-structured interview guide. Data analysis was conducted using the Content Analysis method.

Research Findings: The demographic data revealed that the majority of participants were female (71.43%), aged between 35–45 years (71.43%), and identified as Muslim (85.71%). Furthermore, 57.14% had 2–5 years of experience in psychiatric nursing, while 57.13% had not received specialized training. Key challenges were categorized into four distinct phases: Admission Phase: Incomplete substance use histories due to insufficient information provided by relatives. In-patient Care Phase: Management of aggressive behaviors, inappropriate sexual conduct, and complexities regarding medication dosage adjustment. Discharge Phase: Family anxiety regarding safety and subsequent refusal of patient reintegration. And Follow-up Phase: Environmental factors facilitating easy access to cannabis and kratom. In this multicultural context, nurses must integrate religious beliefs with nursing care to foster acceptance and treatment adherence.

Recommendations: The findings suggest a critical need for Clinical Nursing Practice Guidelines (CNPG) tailored to the local cultural context. Enhancing cross-cultural competence by integrating religious dimensions and local beliefs is essential to mitigate conflict and improve therapeutic cooperation. Additionally, a robust continuous care support system should be established through collaborative networks with religious and community leaders to enhance safety and ensure sustainable treatment efficacy.

Keywords: Experiences, Challenges, Nurses, Schizophrenia with Substance Use Disorder, Multicultural