A model is a symbolic representation of an empiric experience in the form of words, pictorial or graphic diagrams, mathematic notations or physical material (Chinn & Kramer 2011:157). In this study, a model is a graphic diagram representing a process whereby an APN facilitates the mental health of PNs to manage hostility by MHCUs constructively.

Facilitation is defined as a dynamic interactive process through the creation of a positive environment and mobilisation of resources, as well as the identification and bridging of obstacles in the promotion of health (University of Johannesburg 2012:7). Facilitation in this study is the process whereby the PNs who are experiencing hostile behaviour by MHCUs in a forensic unit are actively engaged in various activities by an APN. These activities enable them to acquire knowledge, skills and attitudes that are essential in facilitating their mental health, in order for them to manage hostility by MHCUs in a forensic unit in a constructive manner.

Mental health is a dynamic interactive process that reflects harmonious interaction of the internal and external environments of the PN, as well as mobilisation of resources, to promote mental health as part of holistic health and well-being (University of Johannesburg 2012:5). In this study, mental health is the congruent integration of the physical, spiritual and psychosocial aspects of a PN, and access to available resources essential for enhancing mental health as a component of holistic health.

To manage is to carry out the task of ensuring that a number of activities are performed in such a way that a defined objective is achieved. To manage is to succeed in doing something difficult (Longman South African School Dictionary 2007:420). In this study, managing refers to the concerted efforts of the PNs in a forensic unit in the application of their knowledge, a wide range of skills and attitudes, to manage hostility by MHCUs constructively.

Constructively means being useful or helpful, serving to build or improve (Oxford South African Concise Dictionary 2013:156). In this study, constructively refers to the ability of PNs in a forensic unit to manage hostility by MHCUs in a helpful manner, thus enhancing the mental health of PNs.

Hostile behaviour is behaviour characterised by verbal abuse, threatening and aggressive behaviour, uncooperativeness and behaviours that have been defined as undesirable or in violation of established limits (Schultz & Videbeck 2005:74). In this study, hostility is behaviour characterised by lack of a constructive nurse–patient relationship, threats from MHCUs, ineffective communication and MHCUs challenging PNs’ authority.

The description of the structure of the model is based on the following: theoretical definitions, relationship statements, purpose of the model, assumptions of the model and the process description. The theoretical definitions and the relationship statements have been discussed in the paragraphs above.

The purpose of the model is to provide a frame of reference that can be used by the APN to facilitate the empowerment of PNs in a forensic unit to manage hostility by MHCUs in a constructive manner.

In this study, the assumptions of the model were adapted from the Theory of Health Promotion in Nursing of the Department of Nursing (University of Johannesburg 2012:4). The assumptions are as follows:

The structure of the model is depicted in Figure 1. It has a base, three oval structures representing the phases of the model, and they are in a pink border, representing the forensic unit. The following is the progression of the model to facilitate the empowerment of PNs.

Phase 1 is the relationship-building phase and it has two aspects, that is, dynamic interactive process and making it possible. The dynamic interactive process serves as a foundation on which the APN lays the three phases of empowerment and also as a vehicle for the facilitation of the empowerment process. The APN conveys an attitude of acceptance that is essential in creating a warm and safe environment to allay PNs’ fears. The APN explains his or her role and the roles of the PNs, to work collaboratively. Making possible is the second aspect of the relationship-building phase, and in this session the focus is on assessment and identification of challenges. The APN engages the PNs in brainstorming to explore their purpose, objectives and expectations. The PNs make a commitment to participate actively in the empowerment process. James (2008:71) asserts that a commitment plan provides opportunity for follow-up checkpoints and motivational reminders.

The working phase entails three aspects: PNs having authority, providing support and helping them to be competent. The APN makes it possible for the PNs to have control over their situations, by encouraging them to exercise their rights to independence in making decisions and being responsible and accountable for the outcomes of the decisions in managing hostility in a constructive manner. The APN as a resource person applies his or her specialised knowledge, wide range of skills and attitude to provide emotional and informational support to the PNs and bring about change to their lives. Through the provision of support by the APN, the PNs in a forensic unit become confident and encouraged to implement what they have acquired in a real practical situation (see earlier in article results of step 1 defining and classifying central concepts as well as Table 2 thinking map of concepts).

The APN helps the PNs to be competent by encouraging them to master and internalise significant skills and qualities that will make it possible for them to use themselves as the therapeutic tool in the interactive-intervention process with the MHCUs in a forensic unit. Competencies that the PNs are facilitated to master are constructive self-concept, emotional control, effective communication skills, interpersonal skills, assertiveness skills and problem-solving skills.

Constructive self-concepts and identities are the central orientational devices with which PNs navigate and negotiate their everyday lives (Lofland et al. 2006:135). The PNs are assisted to gain self-confidence. Northouse (2013:24) states that self-confidence is the ability to be certain about one’s competencies and skills. It includes a sense of self-esteem and self-assurance and belief that one can make a difference in other people’s lives (Verderber, Verderber & Sellnow 2015:32).

Myburgh, Poggepoel and Du Plessis (2011:600) assert that emotional stability and ability to build and maintain healthy interpersonal relationships are essential in handling personal aggression. Ngambi (2013:45) adds that the hallmarks of self-control are openness to change, trustworthiness and integrity. A healthy and open dialogue depends on the leader staying attuned to others’ emotional states and controlling his or her own impulses to respond in ways that might not impair or restrict open communication (Manion 2011:117).

Effective communication plays a vital role in the management of aggression (Bimenyimana et al. 2016:6), and it leads to better interpersonal skills and also creates a better spirit of cooperation within the organisation (Konar 2011:160). Improvement in the emotional intelligence of nurses enhances their clinical competencies, including communication skills (Zhu et al. 2016:163). Remaining silent until the other person finishes speaking improves communication and strengthens relationships (Fine 2009:59).

Healthy interpersonal relationships can be attained by mastering interpersonal skills, which entails constructive communication, listening and responding and addressing interpersonal conflict (Naicker, Myburgh & Poggenpoel 2014:6) and Harrison and Hart (2008:23) add that genuineness enhances therapeutic interactions by allowing the helper to present himself or herself as a human being rather than as a role player. Empathetic attitudes allow people to see the world through the lens of other people, and active listening, respect and courtesy are essential pillars for high-quality relationship (Lapena-Monux et al. 2015:260).

Assertiveness is defined as the ability to have self-confidence about what you want and being able to communicate effectively about it (Perry 2007:206). Elder, Evans and Nizette (2010:433) add that some of the assertiveness skills that one can use in handling difficult situations include giving negative feedback or being confrontational. Myburgh and Poggenpoel (2009:447) believe that the attitude that one chooses when faced with a challenging situation is important, and one can choose to take a positive stand in an unaltered situation. Assertiveness results in self-confidence (Elder et al. 2010:433).

Problem-solving is focused on trying to solve immediate problems, which is viewed as a gap between ‘what is’ and ‘what should be’. Problem-solving and decision-making require critical thinking, which is a high-level cognitive process (Yoder-Wise 2009:93). Critical thinking includes being objective (Cottrell 2011:5) and taking a different perspective when looking at the same information. An open mind and the use of professional judgement are essential (Gopee & Galloway 2014:91).

In the termination phase, the measure for successful termination will be the extent to which the PNs have achieved the set objectives. Both the APN and PNs assess whether the PNs have been empowered through obtaining authority and competency in managing hostility by MHCUs in a forensic unit constructively. Psychiatric nurses are engaged in self-assessment and are encouraged to continue with self-assessment even after the termination phase, to maintain their level of competency.

The evaluation of the model, by a panel of model development experts, was based on the criteria for model evaluation, as described in Chinn and Kramer (2011:195) as follows: clarity, simplicity, generality, accessibility and importance. The panel of model experts consisted of two professors, one associate professor and six lecturers with PhDs.

Clarity: Aspects that are looked into when determining how clear the model is are semantic clarity, semantic consistency, structural clarity and structural consistency, that is, understanding the intended theoretical meaning of the concepts and the relationships between the concepts within the theory. Initially, the concepts in the model lacked semantic clarity. Chinn and Kramer (2011:199) state that the clarity of the model is reduced by use of unrelated concepts in the model. Corrections and modifications were performed, for the model to meet the criteria.

Simplicity: The model appeared to be too busy, as the spiral was punctuated in all phases with arrows. Arrows pointing down, representing PNs withdrawing from the empowerment process, were removed. Modifications were performed and the model was found to be simple.

Generality: There was evidence that the model met this criterion. The model is a psychiatric nursing model proposed to be used in a forensic unit to facilitate the empowerment of PNs to manage hostility by MHCUs in a constructive manner. The scope of the concepts and the purpose within the model showed that the model has a broad scope of application.

Accessibility: Accessibility refers to the extent to which empiric indicators can be identified and the extent to which the purpose of the model can be achieved (Chinn & Kramer 2011:2003). The concepts of the model were found to be accessible, as they are linked to the empiric indicators in the forensic unit.

Importance of the model: There is evidence that the model meets the criterion. The model was found to have clinical significance, as it will bring in a significant change in psychiatric nursing practice, specifically in a forensic unit. The model is also of value in enhancing the personal and professional growth and development of PNs in the forensic unit.