Attitude Of Nurses Towards Relapse Prevention Among Psychiatric Patients In Federal Neuropsychiatric Hospital

Project and Seminar Material for Nursing (Science)

Attitude Of Nurses Towards Relapse Prevention Among Psychiatric Patients In Federal Neuropsychiatric Hospital


Abstract


The problem of every hospital when the targeted objective is not achieved is that there is something wring either with health care givers, the patients or the general public. In order to improve the standard of health of the patients and keep them progressively fit. The reason why such lapse are present here to be sought and the remedy met in order to achieve the set objective of the hospital.

This study is based on the Attitude of nurses towards Relapse prevention among psychiatric patients in Federal neuropsychiatric hospital Barnawa Kaduna. The aim and objective of this study are all directed towards bringing out lasting solutions to curtail this menace. It also intends to actively involve the management of the hospital especially on employing new and scientific approach to holistic patient care. The instruments used for data collection were from interview and Questionnaire which were represented in tabular form, bar chart, pie chart and percentages. Nurses were used for the study .the data collected were analyzed. The result showed that many factor contribute to the effect of relapse.

All these can be prevented through adequate Education, Family oriented therapies, good social support, compliance and keep the follow-up appointment.


Table Of Content


Preliminary Page(s)

  • Title page
  • Certification
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Content

Chapter One

Introduction

  • 1.1 Background of Study
  • 1.2 Statement of Problem
  • 1.3 Objective of the Study
  • 1.4 Significance of the Study
  • 1.5 Research Questions
  • 1.6 Scope of the Study
  • 1.7 Limitation of the Study
  • 1.8 Operational Definition of Terms

Chapter Two

Review Of Literature

  • 2.0 Introduction
  • 2.1 Conceptual Framework
  • 2.1.1 Background of the Study
  • 2.1.2 Concept of Attitude
  • 2.1.3 Causes of Relapse
  • 2.1.4 Phases of Psychiatric Illness
  • 2.1.5 Types of Relapse
  • 2.1.6 Prevention of Relapse among Psychiatric Patients
  • 2.2 Theoretical Framework
  • 2.2.1 Cognitive Behavioral Chain
  • 2.2.2 Problem of Immediate Gratification (P.I.G)
  • 2.2.3 Abstinence Violation effect (A.V.E)
  • 2.3 Conclusion

Chapter Three

Methodology

  • 3.0 Introduction
  • 3.1 Research Design
  • 3.2 Research Setting
  • 3.3 Target Population
  • 3.4 Sampling Techniques
  • 3.5 Instrument For Data Collection
  • 3.6 Validity and Reliability of Instrument
  • 3.7 Method of Data Collection
  • 3.8 Method of Data Analysis
  • 3.9 Ethical Consideration

Chapter Four

Data Analysis

  • 4.0 Introduction
  • 4.1 Data Presentation
  • 4.2 Answering Research Questions
  • 4.3 Data Analysis
  • 4.4 Conclusion

Chapter Five

Summary, Conclusion and Recommendations

  • 5.0 Introduction
  • 5.1 Discussion of Findings
  • 5.2 Relationship with other Studies/Literature Review
  • 5.3 Implication for Nursing
  • 5.4 Summary
  • 5.5 Conclusion
  • 5.6 Recommendations
  • References
  • Appendix

Chapter One


Introduction

1.1 Background of Study

Psychiatric illness has fascinated and confounded healers, scientist and philosopher for centuries, it symptoms have been attributed to possession by demons considered to be punishment by the gods for the evil done or accepted as evidence of the inhumanity of its sufferers victims. Thus explanation resulted in enduring stigma for those whose were diagnosed with such disorders. Even today, much of the sigma persist although it has less to do with demonic possession than with society’s unwillingness to shoulder the tremendous cost associated with mental illness.

Relapse is one of the most severe problem of mental health care givers. It is common in about 1.3% of the already treated cases of mental illness or more than two million people (U.S. Department of Health and Human Services [USDHHS] 1999). Its economic cost is envious. Direct cost of relapse treatment expenses of most psychiatric illness were estimated 2.5% of the total treatment of first hand mental illness care budget in 1998 (American Psychiatric Association [APA] 2000).

The last year for which these data were available (USDHHS, 1999). In 1997, this accountant for $23.6 billion of mental health care dollar spent. The indirect cost such as lost of wages, premature death and incarceration were estimated to be $46 billion in the first half of 1998 (APA, 2000).

Further unemployment among permanent disability is 10% (APA 1998). The cost relapse in terms of individuals and family suffering are probably inestimable.

Despite the current trend in modern treatment, there is still an alarming rate of relapse and the reoccurrence of psychiatric illness globally. Individual who ought to be productive and responsible in life are wasting away on daily basis.

Today patients are required to stay for a short period of time in the hospital admission and discharge to home environment to help reduce dependency on the hospital care and reducing relapse. Also this helps to reduce stigmatization and prevent complications (Feyinsayo, A. 2009). This study will attempt an overview of Nurse and also to show how proper utilization of psychiatric Nursing service will go a long way in reducing and eradicating the ever growing cases of relapse among psychiatric patients in Federal Neuropsychiatric Hospital Barnawa, Kaduna.


1.2 Statement of Problem

The frequency of patients having readmission into the hospital over the last few years has become a problem. This has made the achievement of good control of patients’ symptoms and cure impossible.

Nursing Staff and the Hospital has suffered frustration seeing the readmission of patients, whom were recently discharged home after being stabilized on admission. Some patient relapse as soon as they are discharged home.

Other on trials discharge relapse while other still relapse while on admission. Various factors ranging from financial problems, lack of adequate staff have contributed to the relapse of patients.

Some patients have about a day or two days journey distance to the hospital resulting in poor monitoring and accessibility to the mental health services. Other factors also include stigmatization and dependency on care giver. All these have contributed in the frequency of relapse experienced in the care of these groups of patient leading to the social disability.

Hence, resulting in the following:

  1. Low manpower
  2. Untold hardship
  3. Financial constraints
  4. Societal nuisance

If not properly handled and solutions found, the economy may suffer and the society will be at a loss apart from the untold hardship. This is what motivated the researcher to investigate the cause, give suggestions, remedy the situation and also reduce the high rate of relapse.


1.3 Objective of the Study

  1. To evaluate the relationship between the educational background of the Nurses and their attitude towards prevention of relapse.
  2. To ascertain he relationship between the status of the Nurse and her ability to prevent relapse among psychiatric patients.
  3. To determine the relationship between the experience of the Nurse and their ability to identify symptoms of relapse.
  4. To find out whether poverty can predispose psychiatric patient to relapse.
  5. To determine the relationship between drug compliance among psychiatric patient and relapse prevention.

1.4 Significance of the Study

The significance of this study is to help Nurses develop a positive attitude towards the care to the psychiatric patient thereby reducing the incidence of relapse.


1.5 Research Questions

  1. What is the relationship between the educational background of the Nurse and their attitude toward relapse prevention?
  2. What is the ability of the Nurse towards Relapse prevention among psychiatric patients?
  3. What is the experience of the Nurse toward identifying symptoms of relapse?
  4. Can poverty predispose psychiatric patients to relapse?
  5. Can drug compliance prevent relapse among psychiatric patient?

1.6 Scope of the Study

The scope of this study is restricted to Federal Neuropsychiatric Hospital Barnawa Kaduna which is one of the tertiary healthcare institutions owned by the federal Government of Nigeria.


1.7 Limitation of the Study

Financial Constraint as there is no adequate Funds.

The limitations of this study were due to lack of time due to the limited time within which the study had to be carried out.


1.8 Operational Definition of Terms

1. Attitude:

The way you think and feel about something.

2. Disability:

Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being.

3. Management:

The process of treatment or control of disease or disorders or the care of patient who suffer them.

4. Nurse:

A person whose job is to care for people who are ill.

5. Psychiatric Nursing:

This is a branch of medicine that deals with the prevention, treatments, diagnosis, cause of mental illness.

6. Prevention:

To keep away from happening or arising of stop from occurring.

7. Psychiatric Patient:

Person who suffers from mental illness which could be minor or major.

8. Rehabilitation:

Restore to effectiveness or normal life by training especially after illness.

9. Relapse:

The return of disease after an interval of convalescence.


Chapter Five


Summary of Findings, Conclusion and Recommendation

5.0 Introduction

This chapter summarizes the discussion of finding, show the relationship of the research to other studies and the implication to Nursing. It also summarize the whole chapter showing the conclusion and recommendations. The study is based on the study conducted in Federal Neuropsychiatry Hospital Barnawa, Kaduna.


5.1 Discussion of Findings

The research carried out showed that Attitude of Nures towards relapse prevention among psychiatric patients in Federal Neuropsychiatry Hospital Barnawa Kaduna can play a greater role in reducing the cases of relapse among psychiatric patient. The finding revealed that there is high rate of relapse among psychiatric patient which is common cause of concern to patients, their relations and the general public as a whole. This fact has proven by this research work.

The finding also revealed that relapse affect both the receiving treatment in the hospital and patients after discharge, it was also observed that the majority of the respondent consented that relapse rate should be reduced.
Section A which carries the personal data of the respondent shows that female respondents were the majority which shows the dominance of female respondents in Federal Neuropsychiatry hospital Kaduna. This is shown in Table 1,Table 2 shows that majority of the respondent. Age range from 41-50years of age which shows that this age group is fill of experience in life and were useful in the compilation of the data. Section B respondent in chart 1 agreed that the educational background of the nurse can affect their attitude towards relapse prevention. Chart 2 also indicate that 80% of the Nurses attitude have significant role to play in relapse prevention.

Chart 3,4,5 shows how psycho education ,status of the Nurse and her ability can prevent relapse among psychiatric patient. chart 6 and 7 shows that majority of the respondent agreed that relapse among psychiatric patient can be prevented. Chart 8,9,10 agreed that poverty predisposes and affect the care of patient since they don’t have money for to maintain the care. Chart 11 shows that majority of the respondent agreed that rehabilitation can reduce the rate of relapse.

Chart 12,13,14,15, also agreed that drugs used in psychiatric are effective and patient don’t breakdown while on routine medication. Table 16,17 agreed that patient are well educated on the importance of keeping appointment while Table 17-20 shows that majority of the respondent agreed that the hospital has not formulated policies on prevention of relapse among psychiatric patient, Relapse prevention can be effective in the hospital. Misconception contributes to the relapse of psychiatric patient and also the Government does not subsidize drugs given to psychiatric patients.


5.2 Relationship with other Studies/Literature Review

This study incorporates with 0ther studies such as related illness symptoms can be severe enough to disrupt daily activities or require unscheduled in patient or outpatient intervention (Murphy and Moller 2002).

Non-compliance with medication, lack of proper follow-up and keeping appointments also are the major factors that contributes to relapse among psychiatric patients.(Barbara Scheon Johnson 2000).Also this study has investigated and found out that if the general public bring relapsed psychiatric patients promptly to the hospital and the patients attended to promptly that relapse rate will be greatly reduced (Denzin 1996).

Feyinsayo A.(2009), today patients are required to stay for short period possible of time in the hospital admission and discharge to home environment to help reduce dependency on the hospital care thereby reducing relapse. Also this helps to reduce stigmatization and prevents complication. Nursing care at the tertiary level of prevention can be administered on individual or group basis and in a variety of setting such as inpatient hospitalization.


5.3 Implication for Nursing

The nurse should advise patient on the importance of compliance and follow-up for continuity of care. The relatives should be encouraged to show love to the patients and they should be told the importance of incorporating the patients back into the family and community.

The patients should be advised to keep self occupied and stay away from the company that may influence them negatively especially if the relapse was as a result of drug abuse. Family therapy should be advised in order to prevent relapse because when the family is involve in the care of the patient, it reduce the rate to zero level.

The nurse should encourage rehabilitation from admission to discharge. This enables the patient to be engaged and productive in life and also help in the prevention of relapse.


5.4 Summary

The research study was carried out in response to the increasing relapse cases of psychiatric disorders in our society and also the attitude of nurses towards preventing relapse among psychiatric patient. Chapter one deals with introduction of the topic, objective of the study significance of the study, statement of the problem research question, scope, limitation and operational terms were used in this research. Chapter two and three looks at the view of others in relation to the topic of the research while chapter three dealt with the methodology of the research .chapter three and four also dealt with research design and method used. The population which is 100 samples and its also involved the analysis the data acquired in respect to the research questions.


5.5 Conclusion

In the course of the study, it was discovered that there are five(5) types of relapse namely primary, secondary, tertiary, partial and total relapse all of which have devastating effect on patients. It was shown in the study that the families and the hospital should be fully involved in the care of the patient in order to prevent relapse. It was also discovered that with frequent relapse rate the might be thrown out of jobs, be divorced.

Attitude of nurses towards relapse prevention plays a vital role in preventing relapse to occur. “prevention they say is better than cure “in line with this statement relapse like any other condition is preventable. Alongside drug therapy, avoidance of stressful situations and good family support systems are good preventive measures. Drug compliance also tremendously assists in the stability of the patient mental state. To this extent, the patient is health educated on the need to comply with drugs.

With proper management and care, the possible complication that may result from frequent relapse, can be reduce as much as possible.


5.6 Recommendations

  1. Nurse and other healthcare giver should enlighten the public on the causes and preventive methods of mental illness. This will help them know what to do and when to act when they come into contact with relapsed patient/patients with mental illness.
  2. The nurse should at every level of contact with patients relative should health educate them on the importance of active participation in the care of psychiatric patients taught the need of visiting psychiatric hospitals.
  3. Long hospitalization of patients should also be avoided in order not to make patient lose contact with home environment, community, friends and colleagues as this also trigger relapse.
  4. The government should formulate a policy to subsidize for drugs given to psychiatric patient as the prices of the drugs are on the increase and some of the patient are unable to buy them.
  5. The national mental health act should receive reviewed and proper implementation by the government agencies involved.
  6. Nurses should be send for training so as to be up to date and empowerment of more man power should be made.
  7. The occupational therapy departments should be well equipped with modernized equipments necessary for the rehabilitation of patients where some of them can learn new trades to practice when discharged from the hospital.

Recommendation for Further Studies

The research urges the general public particularly the health sector to embark on more study in order to reduce the rate of relapse among psychiatric patients.


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