A Study to Evaluate the Effectiveness of Structured Teaching Programme on Expressed Emotions and Knowledge regarding Relapse Prevention among Caregivers of Patients with Schizophrenia in a Selected Hospital, Salem

Ms. A. Sahaya Vivitha

MGM New Bombay College of Nursing, MGM Educational Campus, Plot no 1 & 2, Sector 1, Kamothe,

Navi Mumbai -410209

*Corresponding Author Email: sahayavivitha.a@gmail.com

ABSTRACT:

This study was conducted to evaluate the effectiveness of structured teaching programme on expressed emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia in a selected hospital, Salem. The design adopted was pre experimental one group pre test post test design. The non probability purposive sampling technique was used to select the 30 caregivers from Sri Gokulam Hospital. Expressed Emotions was assessed by using Level of Expressed Emotions Scale (LEE) and knowledge regarding relapse prevention was assessed by using structured self reporting questionnaire. Data were analyzed by using both descriptive and inferential statistical methods. The study finding revealed that during pre test, 12(40%) had low Expressed Emotions and 18(60%) had high Expressed Emotions. Whereas during post test, 23(76.67%) had low Expressed Emotions and 7(23.33%) had high Expressed Emotions. During pre test, 23(76.67%) had inadequate knowledge and 7(23.33%) had moderately adequate knowledge regarding relapse prevention. During post test, 23(76.67%) had adequate knowledge and 7(23.33%) had moderately adequate knowledge regarding relapse prevention. The pre test mean score on Expressed Emotions was 23.43±11.20 and knowledge regarding relapse prevention was 11.23±2.13. The post test mean score on Expressed Emotion was 14.33±8.20 and knowledge was 18.97±1.94. The obtained paired ‘t’ test value was 31.13 which was significant at p ≤ 0.05 (table value 2.05) level. This indicates that the structured teaching programme was effective in improving the level of knowledge regarding relapse prevention among caregivers of patients with schizophrenia. Hence the hypothesis H₁ was retained. The correlation between the Expressed Emotions and knowledge in pre test score was 0.15 and the post test score was 0.12. This revealed that there was a positive correlation. Hence the hypothesis H₂ was retained at p≤0.05 level. There was a significant association found between the Expressed Emotions, knowledge regarding relapse prevention with relationship to the client (χ² =13.18 at p≤0.01 and χ² =8.4 at p≤ 0.05 level respectively) Hence H₃was retained. This study concluded that structured teaching programme was effective in increasing the knowledge regarding relapse prevention and decreasing the Expressed Emotions among caregivers of patients with schizophrenia.

KEYWORDS: Structured teaching programme, expressed emotions, relapse prevention, caregivers.

INTRODUCTION:

“Perhaps it is good to have a beautiful mind, But an even greater gift is to discover a beautiful heart.”-

John Nash

Schizophrenia is a severe mental disorder that has been recognized and described throughout the history. (Eugen Bleuler (1857-1939) suggested the term “schizophrenia” emphasizing the “splitting of the mind (Niraj Ahuja, 2011). Schizophrenia affects around 0.3 – 0.7% of people at some period in their life or 24 million people worldwide as of 2011 (about one of every 285). Each year, one in 10,000 people at the age group of 12 to 60 develops schizophrenia. It is diagnosed 1.4 times more frequently in males than females and typically appears earlier in men and the peak ages of onset are 20–28 years for males and 26–32 years for females. Onset in childhood is much rarer because most of the time the onset is middle or old age (WHO, 2011).

Healthy family social environment may reduce schizophrenia risk by 86% in high risk groups. Pharmacological therapies and psychosocial interventions play a role in the prognosis of schizophrenia as an essential component of a comprehensive schizophrenia treatment. The Schizophrenia can be controlled but not curable. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in their communities (William M,et.al, 2006).

In a broader sense, relapse is the return of signs and symptoms after a remission. Patients who did not take medication continuously showed relapse rates of 48% at the one year follow up, 61% at the second year’s follow up and 82% at the end of the five years time. Risk factors for developing relapse are stressful life, demanding life, lack of regular routines, lack of social, family and community support, substance use or abuse, poor diet pattern, poor sleeping habits, medication use problems like medication is stopped without consulting the psychiatrist, taken irregularly or the dose is too low, conflicts with others, thoughts or situations that have come before a previous episode of illness, other medical or physical problems and high levels of expressed emotions include criticism, hostility or too much emotional over involvement from family members, low expressed emotions include positive regard and warmth (Kissling 2005).

Expressed Emotions (EE) are adverse family environment, which includes the quality of interaction patterns and nature of family relationships among the family caregivers and patients of schizophrenia and other psychiatric illness. Expressed Emotion is divided into high and low. There are five components of Expressed Emotions, which are critical comments, hostility, emotional over involvement, positive regard, and warmth. Research has demonstrated that individuals from families with high "Expressed Emotion" are 3.7 times more likely to relapse than in families from low Expressed Emotion families (William M, et.al, 2004). Main goal of psychosocial interventions are primarily aimed at reducing from high to low expressed emotions. Psychosocial interventions are psycho education, communication skills, problem-solving skills, social skills and occupational training, crisis management, and healthy coping strategies with the continuous medicines proved to be effective in reducing the high Expressed Emotions [EE] and improving treatment outcome (Anekal C, et .al, 2012).

NEED FOR THE STUDY:

The Prevalence rate of schizophrenia is approximately 1.1% of the population over the age of 18 or one in life time 51 million people worldwide suffer from schizophrenia. It includes 6 to 12 million people in China , 4.3 to 8.7 million people in India, 2.2 million people in USA ,285,000 people in Australia, Over 280,000 people in Canada and over 250,000 diagnosed cases in Britain. Schizophrenia ranks among the top 10 causes of disability in developed countries worldwide. The prevalence for the 2014 year is about one in 4,000. So about 1.5 million people will be diagnosed with schizophrenia in worldwide. In the United States 100,000 will be diagnosed with schizophrenia (US NIMH 2012).

A study was conducted in Tamil Brahmin caste. The result revealed that (499/504) individuals having schizophrenia Most affected individuals exhibited negative symptoms (>90%) and a severe, chronic course. All participants lived in the same geographic and climatic region and most affected individuals resided with close family members, increasing uniformity of the socio cultural environment (Thara R, et. al, 2009).

STATEMENT OF THE PROBLEM:

OBJECTIVES:

1. To assess the expressed emotions among caregivers of patients with schizophrenia.

2. To assess the knowledge regarding relapse prevention among caregivers of patients with schizophrenia.

3. To find out the effectiveness of structured teaching programme on expressed emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia.

4. To correlate the expressed emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia.

Hypotheses:

H₁: There will be a significant difference in the pre and post test knowledge among care givers of patients with schizophrenia after structured teaching programme at p≤0.05 level.

H₂: There will be a significant correlation between the Expressed Emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia.

MATERIAL AND METHODS:

Research Approach:

The research approach adopted for this study was quantitative evaluative approach.

Research Design:

The research design chosen for this study was pre experimental design. [One group pre test - post test design].

Population:

The study population comprises of caregivers of patients with schizophrenia.

Sample:

The sample comprised of caregivers of patients with second episode of schizophrenia and those who fulfilled the inclusion criteria

Sample size:

The sample size was 30.

Sampling Technique:

In this study non probability purposive sampling technique was adopted to select the samples.

Criteria for sample selection:

Inclusion criteria:

· Care givers of Patients with second episode of schizophrenia attending both inpatient department and outpatient department.

· Those who are willing to participate in the study.

· Both male and female caregivers.

· Those who can read and write Tamil and English.

· Those who are present during the study period.

Exclusion criteria

· Caregivers with chronic physical illness.

· Caregivers with cognitive dysfunction.

Ethical consideration:

Written permission was obtained from the Managing Director of Sri Gokulam Hospital, Salem, oral consent was taken from the study samples to participate in the study and then the main study was conducted.

Plan for Data Analysis:

In this study both descriptive and inferential statistics were used to analyze the data.

· Demographic variables were calculated by using frequency percentage and mean.

· The effectiveness of structured teaching programme on Expressed Emotions and knowledge regarding relapse prevention was calculated by using inferential statistics [t-test].

· To find out the correlation between Expressed Emotions and knowledge regarding relapse prevention the correlation coefficient test was used.

RESULTS:

The collected data was tabulated, organized and analyzed by using descriptive & inferential statistics as follows,

Fig -1: Percentage Distribution of caregivers according to their pre test score on expressed emotions

EXPRESSED EMOTIONS:

Fig 2: Percentage Distribution of caregivers of patients with schizophrenia according to their pre test score on knowledge regarding relapse prevention .

Fig 3: Percentage Distribution of caregivers of patients with schizophrenia according to their post test score of expressed emotions

Fig.4: Percentage Distribution of caregivers of patients with schizophrenia according to their post test score on knowledge regarding relapse prevention.

Table-1:Frequency and percentage distribution of caregivers of patients with schizophrenia according to their Expressed Emotions before and after intervention. n = 30

Level of Expressed Emotions	Pre test		Post test
Level of Expressed Emotions	f	%	f	%
Low Expressed Emotions	12	40	23	76.67
High Expressed Emotions	18	60	7	23.33

Table -2: Frequency and percentage distribution of caregivers of patients with schizophrenia according to their knowledge before and after intervention. n=30

Level of knowledge	Pre test		Post test
Level of knowledge	f	%	f	%
Adequate knowledge	-	-	23	76.67
Moderately adequate knowledge	7	23.33	7	23.33
Inadequate knowledge	23	76.67	-	-

Table -3: Mean, SD, Mean percentage and Differences in mean percentage scores on knowledge regarding relapse prevention among caregivers of patients with schizophrenia before and after intervention

Knowledge

Maximum score

Mean

Mean %

Difference in mean %

Pre test

11.23

2.13

44.92

30.96

Post test

18.97

1.94

75.88

Table -4.: Mean, Standard deviation, Paired ‘t’ test value among caregivers of patients with schizophrenia according to their pre test and post test scores on Expressed Emotions and knowledge regarding relapse prevention n=30

Knowledge	Mean	SD	‘t’ test value	df
Pre test	11.23	2.13	31.13*	29
Post test	18.97	1.94	31.13*	29

*Significant at p≤0.05level: Table value=2.05

The above table reveals that the mean score during pre test on knowledge is 11.23±2.13 and the mean score during post test is 18.97 ±1.94. The obtained ‘t’ test value is 31.13 significantly higher than the table value that is 2.05 at p≤0.05level. Hence the stated hypothesis H₁ is retained. Thus it becomes evident that the structured teaching programme is effective in improving the knowledge.

Fig. 5 shows that the obtained ‘r’ value is 0.15 and it reveals that there is a positive correlation between the pre test score on Expressed Emotions and knowledge regarding relapse prevention. When knowledge is decreased the Expressed Emotions is increased. Hence the stated H₂is retained at p≤0.05 level.

Fig. 6 shows that the obtained ‘r’ value is 0.12 and it reveals that there is a positive correlation between the post test score on Expressed Emotions and knowledge regarding relapse prevention. When knowledge is increased the Expressed Emotions is decreased. Hence the stated H₂ is retained at p≤0.05 level.

Fig -5: correlation between the pre test Expressed Emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia.

Fig 6: correlation between the post test Expressed Emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia.

CONCLUSION:

The study was conducted to evaluate the effectiveness of structured teaching programme on expressed emotions and knowledge regarding relapse prevention among caregivers of patients with schizophrenia in a selected hospital, Salem. The results of this study revealed that structured teaching programme had significant effect in gaining adequate knowledge regarding relapse prevention and decreasing expressed emotions among caregivers of patients with schizophrenia.

IMPLICATIONS FOR NURSING PRACTICE:

There are several important implications for nursing practice.

Nursing education:

1. The nurse educator should encourage patients to actively participate in educational programmes regarding relapse prevention.

2. Nurse educators should emphasize the concept of Expressed Emotions and relapse prevention and also encourage the student nurses to appreciate the role of the nurse as a educator to the patient and family.

3. The nurse educator should play role in creating awareness among caregivers on relapse prevention and insisting them to follow healthy practices.

4. Nurse educator need to influence nurse researchers to take up various research studies on relapse prevention and Expressed Emotions.

5. In service educational programmes, workshops and continuing education programmes are to be conducted to update the knowledge of the nursing personnel regarding the relapse prevention and Expressed Emotions.

Nursing Administration:

1. The nurse administrator should insist and motivate staff nurses to conduct structured teaching programme on Expressed Emotions and knowledge regarding relapse prevention before discharging the patients and caregivers from the hospital.

2. Nurse administrator need to take necessary steps in formulating policies in providing patients education and also plan made regarding the essential manpower, material and the time to conduct successful and useful caregivers’ education programmes.

Nursing Research:

1. The nurse researchers can take this study as a base line to build up future studies.

2. This study brings about the fact that more studies need to be done at different settings such as community or in industries.

3. The study can also facilitate research on other aspects of care in caregivers with Expressed Emotions like burden and coping strategies.

4. The generalization of study the result can be made by further replication of the study.

REFERENCE:

1. Anekal C et.al. Expressed emotions in schizophrenia: an overview. Indian Journal of Psychological medicine. 34(1);2012: 12-20

2. Niraj Ahuja. A Short Text Book of Psychiatry. New Delhi: Jaypee Brothers Medical Publishers, 2011

3. Kissling et.al The Effect of Family Interventions on Relapse and Rehospitalization in Schizophrenia—A Meta-analysis. Oxford Journals 2005; 27(1): 73-92

4. Polit and Beck. .Nursing research principles and methods. Philadelphia: Lippincott Williams & Wilkins.2004.

5. Thara R, R. Padmavati,P. Karpagavalli. Family education in schizophrenia: A comparison of two approaches. Indian Journal of Psychiatry. 47(4); 2009 : 218-221

6. William D. Voss et al, (2006). Service Use among Patients with Schizophrenia in Psycho educational Multiple-Family Group Treatment. Psychiatric service article. doi: 10.1176/appi.ps.53.6.749