NURSES’ PERCEIVED BARRIERS TO THERAPEUTIC CARE OF PATIENTS WITH SCHIZOPHRENIA IN A TERTIARY CARE HOSPITAL IN KARACHI: A QUALITATIVE STUDY

Abstract

Schizophrenia is a complex illness that requires ongoing therapeutic engagement, skilled communication, symptom management, and a safe and supportive environment of care. nurses are pivoted, but clinical complexity, resource constraints, organizational factors and emotional and attitudinal issues can be barriers to nursing practice. Limited context-specific evidence exists on perceived barriers to schizophrenia care by nurses in Karachi. Understanding these barriers is critical in improving nursing preparedness and quality of mental health care.The aim of the study is to explore the perceptions of registered nurses on barriers to effective therapeutic care for patients with schizophrenia in a tertiary care hospital in Karachi, Pakistan. A descriptive qualitative design was used. Eight registered nurses with experience in caring for patients with schizophrenia were recruited by purposive sampling. Data were collected using a semi-structured interview guide based on the Capability, Opportunity, Motivation–Behaviors (COM-B) model. Interviews were thematically analyzed using Braun and Clarke’s six-phase approach. The study adhered to ethical principles of informed consent, voluntary participation, confidentiality and protection of the participants’ identities. Four interconnected themes emerged: (1) Navigating Clinical Complexity with Limited Preparedness, (2) Delivering Care Within a Resource-Constrained Clinical Environment, (3) Balancing Fear, Stigma and Professional Commitment, and (4) Building a Supportive System for Competent and Compassionate Schizophrenia Care. Nurses reported challenges related to therapeutic communication, psychotic symptoms, aggression, treatment refusal, staffing shortages, workload, limited resources, fear, safety concerns, and stigma. Participants said the priorities for improvement were practical training, adequate staffing, organizational support, supervision, teamwork and person-centered care.The barriers to the care of schizophrenia are more than the competence of individual nurses and reflect the interaction of clinical, organizational and motivational influences. Strengthening pragmatic psychiatric training, staffing, supportive supervision, resources, safety measures, and interdisciplinary collaboration may improve nurses’ confidence and promote safer, compassionate, person-centered mental health care.