PROFORMA FOR REGISTRATION OF SUBJECTS EOR DISSERTATION
1) Name of the candidate & address : Ms. NATASHA THOMAS
I Year M.Sc. (N)
JSS COLLEGE OF NURSING
IST MAIN,SARASWATHIPURAM
MYSORE
2) Name of the institution : JSS College of Nursing, Mysore
3) Course of the study and subject : M.Sc. Nursing, Psychiatric Nursing
4) Date of admission to course : 1/5/2008
5) Title of the topic : Effectiveness of structured teaching program regarding home management of selected behavioral problems of psychiatric patients on knowledge, attitude and perceived competencies of their family caregivers at selected psychiatric care settings of Kerala.
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION :
A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders have changed over time and across cultures. In many cases there is no single accepted or consistent cause of mental disorders, model. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria for Mental illness at some point in their life. Services for mental disorders may be based in hospitals or in the community. Mental health professionals diagnose individuals using different methodologies, often relying on case history and interview. Psychotherapy and psychiatric medication are two major treatment options, as well as supportive interventions and self-help.
Psychiatric illness is viewed as one of the disabling disease which can affect various aspects of individual functioning, undesired behaviors on the part of the clients such as violence, aggressive behavior, lack of sense of responsibility dependency, isolation are significant .(1)with limited available psychiatric resources in the community, families have to bear the burden of patient at home which often results in social isolation from mainstream of the society and disruption of their social network (2)
6.1 NEED FOR THE STUDY:
Mental illness has reached an alarming proportion over the globe and has become a vitally important issue for the nations in terms of morbidity, mortality and huge economic burden. Apart from the established biological and genetic reasons, the current disruption of social fabric as a result of changing political scenario, violence and terrorism has affected the psyche of millions of individuals in this era. 450 million people in the world suffer from a mental or behavioral disorder (W.H.O, 2003). W.H.O. “2001”, states that 33% of the years lived with disability (YLD) are due to neuropsychiatric disorders, Unipolar Depressive disorders alone lead to 12-13% of years lived with disability and rank as the third leading contributor to the global burden of diseases. Four of the six leading causes of years lived with disability are due to neuropsychiatric disorders like: depression, alcohol use disorder, schizophrenia and bipolar disorder. More than 150 million suffer from depression at any point in time, nearly one million commit suicides every year, 25 million suffer from schizophrenia, 38 million suffer from epilepsy and more than 90 million suffer from an alcohol or drug use disorder (World Health Report, 2001). (3)
Psychiatric illness is viewed as one of the disabling affliction which can affect various aspects of individual functioning. Undesired behaviors on the part of the clients such as violence, aggressive behavior, lack of sense of responsibility, dependency, isolation are significant .(2)With limited available psychiatric resources in the community, families have to bear the burden of patient at home which often results in social isolation from mainstream of the society and disruption of their social network.(3) Presence of psychiatric client at home imposes several limitations on the family such as social burden, financial strain and psychological stress.(4-5) In this process dynamics of those families get affected, making the family environment less tolerant to psychiatric client.(6) To this end several studies have focused on the family’s response to the inevitable trauma of living with mentally ill member resulting in several promising research and clinical approaches.(7-8)
The benefit of involving family in the care of the loved ones with mental illness are well documented. Research confirms that family input in treatment decisions improves consumer outcomes, with maximum benefit occurring when the families are educated for these roles.
A series of supportive psycho educational models aiming at de-intensifying the family environment have been developed.(9)The family dynamics, attitude held toward mentally ill, and skills in management of client’s behavior appear to have a domineering role in client’s adjustment. Hence it is necessary to make families responsible caretakers by removing their biases and misconception about mental illness. Training program for families of a mentally ill when supplemented with psychiatric medication can ensure better outcome for psychiatric illness.(10)
There are research studies in which study result reveals that family interventions are beneficial in promotion of social and family functioning of patients, improved coping ability of family care givers, and reduction of relapse.(10,11,12).
Despite the importance of information and support to help family givers, studies on interventions to increase support for family care givers have lagged far behind those provided for patients. A focus on the family as a part of the patient’s therapeutic plan of care is largely absent from interventional research and from general clinical practice as well. Few randomized clinical trials of educational interventions directed towards family care givers have bee conducted or published, and there is limited research to inform us about skill training for care givers in the care giver situation. (13) And also the research literature had shown lack of such studies by Nurses in Indian setting. Hence it is significant to conduct this study in Indian setting. Nurses have a major contribution to make in tertiary prevention by educating patient and family members at the time of discharge. It helps family care givers to manage behavioral problems of patients and can reduce distress through education.
Findings of the current study will help Nurses to identify the knowledge, attitude and competency of the family care givers in managing the behavioral problems, based on which nurse can educate family care givers to manage behavioral problems and reduce stress and burden and equip the family members in effective care. Hence Researcher found it as a significant problem.
6.2 REVIEW OF LITERATURE
An experimental study was conducted to find out the effectiveness of psycho educational program in promotion of social and family functioning among Iranian psychiatric clients in the year 2005. 170 schizophrenics and 174 clients with mood disorders participated in the study. Research approach was Solomon’s Experimental Design. Experimental group underwent weekly educational program for a duration of 6 months. Different tools were used to assess family’s skill management of client’s verbal and nonverbal behavior. They compared experimental and control groups. Experimental group showed more attitudinal, cognitive and behavioral changes among families followed by more desirable role performance ability by clients. Results indicated that family education can bring about desirable changes in the family dynamics and better outcome of psychiatric disorders.(11)
A study was conducted on integrated psychological treatment for schizophrenic patients, in Spain, in the year 1999. The results of the study are based on a sample of 35 schizophrenic patients, 20 patients in a therapy group and 15 in a control group. Patients assigned to the therapy group received a one year integrated psychological program and psycho educational and behavioral training sessions. Psycho education and behavior therapy were also given to their family members. Analysis of the mean scores of clinical and family measures indicated that the therapy group had improved to a greater extent than the control group. (14)
A study investigated Burnout among relatives of psychiatric patients attending psycho educational support group in Netherlands in the year 2000. This study determined the relationship between subjective burden and objective burden. The study used pretest data from an intervention study in which a total of 164 participants from 19 psycho educational groups were evaluated, using Mas Lach Burnout inventory. Result showed strong evidence for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute to subjective burden than others. The findings suggest that psycho education should concentrate on helping relatives to cope with the strain on relationship with the patient and on improving their ability to cope the patient’s behavior. (12)
A study was carried out to assess the effectiveness of psycho education on Expressed Emotion (EE) among family care givers of patients with Mood disorders. In a waiting-list controlled study on a multi-family psycho-educational intervention in bipolar disorder, key relatives in the treatment group showed a significant change from high to low levels of expressed emotion (EE) compared with the control group. In addition, patients with low-EE key relatives had a significantly lower number of hospital admissions compared with those living with high-EE key relatives. (15)
A study was conducted on effectiveness of psycho education and compliance on schizophrenia. Study examined whether psycho educational groups for patients with schizophrenic disorders and for their families can reduce re hospitalization rates and improve compliance. 236 inpatients who met DSM-III-R criteria for schizophrenia or schizoaffective disorder and who had regular contact with at least 1 relative or other key person were randomly assigned to 1 of 2 treatment conditions. In the intervention condition, patients and their relatives were encouraged to attend psycho educational groups over a period of 4 to 5 months. Outcomes were compared over 12-month and 24-month follow-up periods. It was possible to significantly reduce the re-hospitalization rate after 12 and 24 months in patients who attended psycho educational groups compared with those receiving routine care (p < .05). Patients who attended psycho educational groups showed better compliance than patients under routine care without psycho-education.(16)
A study was conducted on the effect of behavioral family management on family communication and patient outcome in schizophrenia in the year 2000. Result showed that family interventions for schizophrenia have proved to be highly effective in preventing relapse.(10)
A study investigated the factors of Psychological significance related to stigma of the relatives. 162 relatives of patients in acute psychiatric wards were interviewed to explore psychological factors related to stigma. According to study results a majority of the relative’s experienced psychological factors of stigma .18% of the relatives thought that that the patient would be better to die and 10%had experienced suicidal thoughts. Stigma by association was greater in relatives experiencing mental health problems of their own, and was not affected by patient back ground characteristics. (17)
A study investigated the effect of Family Functioning and Family Sense of Competence on people with Mental Illness. The study found out the relative influences of family functioning and family members sense of competency on the community adaptation of 180 seriously mentally ill patients. Stratified sampling was used for mixing up of socio economic status and ethnic groups. Both variables were significantly associated with the ill family members level of adaptation, sense of competence was the more powerful influence. Results also showed that this is particularly important for the lower middle class.(18)
An editorial on Stigma in Mental Health care shows that patients with Mental illness are stigmatized and suffer adverse consequences such as increased social isolation, limited life chances and decreased access to treatment. In addition to poorer social functioning, those with the stigma of mental illness also encounter significant barrier to obtaining general medical care and to recovery from mental illness. The added burden that stigma imposes on the struggle to recovery can alter behavior, generate anxiety and ultimately cause isolation from the mainstream culture. (19)
In a Swedish study, 185 of relatives of patients with severe mental illness reported that the patient would be better off dead. This figure increased to 40% in relatives who felt that the patient’s illness caused mental health problems in themselves. (19)
A study investigated Depressive Symptoms and Family Functioning in the Caregivers of Recently Hospitalized Patients with Chronic/ Recurrent Mood Disorders. 16 caregivers of patients with chronic / recurrent mood disorders were recruited during their relative’s in-patient psychiatric stay and data collected using self-reports instruments.. Despite reporting significant amounts of strain and burden, caregivers felt that care giving was rewarding. 72% of the caregivers scored positively for depressive symptoms. Caregivers who reported poor family functioning had dysfunction in all areas of family functioning. (20)
A study examined the relationship between patient’s negative symptoms, family care givers knowledge of Schizophrenia, care givers attributions about the cause of patient’s symptoms and care givers response to symptoms.84 care givers of patients with schizophrenia were interviewed using interview. Results indicated that above mentioned variables significantly predicted care giver’s criticism of patients. (21).
STATEMENT OF THE PROBLEM
A study to assess the effectiveness of structured teaching program regarding home management of selected behavioral problems of psychiatric patients on knowledge, attitude and perceived competencies of their family caregivers at a selected psychiatric care settings of Kerala.
6.3 OBJECTIVES
The objectives of the study are
1. To assess the knowledge of family care givers regarding home management of selected behavioral problems of psychiatric patients before and after administration of structured teaching program.
2. To assess the attitude of family care givers regarding home management of selected behavioral problems of psychiatric patients before and after administration of structured teaching program.
3. To assess the perceived competencies of family care givers regarding home management of selected behavioral problems of psychiatric patients before and after administration of structured teaching program.
4. To determine the effectiveness of structured teaching program regarding home management of selected behavioral problems of psychiatric patients in terms of gain in knowledge, attitude and perceived competency scores of their family care givers.
5. To find the relationship between Family care givers
1) Knowledge &attitude
2) Knowledge &perceived competency
3) Attitude & perceived competency