Effectiveness of a needs-tailored nurse-led recovery program for community-dwelling people with schizophrenia: a cluster-randomized controlled trial.

BACKGROUND: Meeting people's needs is positively correlated with their recovery. However, recovery services rarely include nurse-led programs tailored to the needs of these people. This study aimed to evaluate the effectiveness of a new needs-tailored recovery program by using a cluster-randomized controlled trial design. METHODS: We conducted a parallel randomized controlled trial in two community psychiatric departments, employing nurse-level clustering for intervention delivery and selecting participants through convenience sampling. The participants were people diagnosed with schizophrenia that were receiving homecare services. The experimental group (n = 82) received needs-tailored recovery program for six months. The control group (n = 82) received traditional homecare. Data were collected at baseline, post-intervention, and the three-month follow-up (the study ran from February to December 2021). The outcomes were recovery, needs, hope, empowerment, psychotic symptoms, and medication adherence. We used repeated measures ANOVA tests to examine the effect of the group × time interaction. RESULTS: The participants in the experimental group demonstrated statistically significant improvements in recovery, hope, and medication adherence compared to the control group, both immediately post-intervention and at the three-month follow-up. Moreover, they exhibited statistically significant reductions in needs compared to the control group at the three-month follow-up (p < .05). While the interaction effect for psychotic symptoms was not significant, the time effect was significant (p < .05). No significant interaction or time effect was observed for empowerment. CONCLUSION: The findings increase our understanding of recovery-oriented care that prioritizes therapeutic alliance, integrated needs assessment, individual goals, hope, and empowerment. TRIAL REGISTRATION: The Clinicaltrials.gov identifier NCT05304780 retrospectively registered on 03/31/2022.

[Community Psychiatric Mental Health Nursing: Practice and Challenges].

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.

Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study.

BACKGROUND: Functional degradation among community-dwelling patients with schizophrenia can negatively influence their recovery. Given the importance of patient empowerment during recovery, this study examined the mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia. METHODS: This cross-sectional study recruited community-dwelling patients with schizophrenia from northern and central Taiwan. Questionnaires with verified reliability and validity were provided and collected on site by trained nurses. Global function, empowerment, and personal recovery were measured using the Global Assessment of Functioning (developed by the American Psychiatric Association), Empowerment Scale, and Questionnaire on the Process of Recovery, respectively. The causal steps approach proposed by Baron and Kenny and the Sobel test were utilized to verify the mediation effect. The causal steps approach tested the four following pathways (regression coefficients): global function on empowerment (Path a), global function and empowerment as predictors of personal recovery (Path b), global function on personal recovery (Path c), and global function and empowerment on personal recovery (Path c'). RESULTS: A total of 373 participants completed the survey. After controlling for factors associated with recovery, Paths a (ß = .24, p < .001), b (ß = .68, p < .001), and c (ß = .19, p < .001) were found to be significant; however, Path c' was not significant (ß = .03, p = .452). Empowerment was determined to exert "full mediation" over the effects of global function on personal recovery, and the Sobel test indicating significant mediation (Z = 3.61, p < .001). CONCLUSIONS: Empowerment fully mediates the association between global function and personal recovery. This study suggested that offering empowerment-oriented care services may be more effective than global function improvement in recovery among these patients.

Effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia: A systematic review and meta-analysis.

Medication adherence and recovery rates are <50% among persons with schizophrenia; therefore, this health concern needs attention. Empowerment is a vital element for behavioural change, but previous studies have presented different results and lack specific connotations about empowerment. Therefore, this study systematically reviewed and meta-analysed the effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia. The databases searched included the PROSPERO registration network, Cochrane Library, PubMed, Embase, CINAHL, PsycAricle, and Airiti Library. The research steps were based on PRISMA. RoB 2.0 was used for article quality evaluation, the effect size was calculated using RevMan software, and the random-effect model and standardized mean differences (SMD) were established. Eight randomized controlled trials (RCTs) involving 859 participants were used to investigate the effect of empowerment on medication adherence. The trials involved the use of effective strategies as inducing medication motivation, promoting self-medication management, and providing support resources. A moderate effect was observed (SMD = 0.58, 95% CI 0.18-0.99). Ten RCTs involving 1473 participants were used to investigate the effect of empowerment on recovery. These trials involved the use of such effective strategies as using self-strength, connecting external forces, understanding personal needs, and overcoming self-stigma. A moderate effect was observed (SMD = 0.55, 95% CI 0.10-0.99). Empowerment in illness management can effectively promote the medication adherence and recovery of persons with schizophrenia. In the future, nurses can use self-strength care to promote medication motivation and connect internal and external forces to assist a person's medication adherence and recovery.

A Systematic Review and Meta-Analysis of the Effectiveness of Adherence Therapy and Its Treatment Duration in Patients with Schizophrenia Spectrum Disorders.

Background: Adherence therapy (AT) is an intervention for improving medication adherence of people with schizophrenia spectrum disorders, but no systematic reviews have yet summarized the effectiveness and minimum treatment duration of AT. We here aimed to systematically examine the effectiveness of AT in improving outcomes versus treatment as usual (TAU) and its minimum effective duration for people diagnosed with schizophrenia spectrum disorders. Patients and Methods: Eligible randomized controlled trials were identified from four databases (Web of Science, PubMed, CINAHL and Cochrane Library) for the period 1 January 2006 to 1 January 2023. Of 1087 retrieved candidate studies, five studies with a total of 726 participants met the inclusion criteria. The search terms consisted of adherence therapy, compliance therapy, schizophrenia, schizoaffective disorder, schizophrenic disorder, medication adherence, and medication compliance (combined with OR and AND). Two investigators independently selected studies, extracted data, and conducted bias risk assessments. Random-effects models were used to analyze the pooled data. Results: Meta-analysis of the five selected studies showed that AT had a significantly greater positive effects than TAU on psychiatric symptoms, but no significant effects on adherence behaviors and attitudes. Conclusion: The AT had limited effects in terms of improving the attitudes and behaviors of people with schizophrenia spectrum disorders with respect to medication adherence, but did improve patients' psychiatric symptoms. The therapy should be performed by trained staff for maximum benefit, and the recommended duration of the intervention is 12 hours.

Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model.

Background: Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators. Purpose: To examine the insight-medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude. Patients and Methods: This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains. Results: In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect. Conclusion: In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients' medication attitude may be more effective in improving medication adherence than merely enhancing insight.

Factors associated with personal recovery among psychiatric nursing home residents.

WHAT IS KNOWN ABOUT THE SUBJECT?: Poor recovery will cause harm to the quality of life and well-being of residents and that the scope of influence includes the self, family and society. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The factors associated with personal recovery are empowerment, social support and global functioning. This pioneer study contributes new evidence that personal recovery is mainly predicted by empowerment, social support and global function, with empowerment exhibiting the highest predictive value. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support. Mental health professionals should shift to empowerment-oriented care to improve individuals' personal recovery, such as offering more opportunities to achieve autonomy, encouraging individuals' involvement in decision-making and promoting individuals' motivation for achieving their goals. ABSTRACT: Introduction Individuals diagnosed with mental illness have a need for recovery. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. Aim The study aimed to identify the factors associated with personal recovery among psychiatric nursing home residents. Methods This was a cross-sectional study with convenience sampling. Participants were recruited from a psychiatric nursing home in Northern Taiwan between April and June 2018. Data were collected through self-reported, structured questionnaires with verified reliability and validity. Descriptive and hierarchical regression analyses were performed. The present study followed the STROBE guidelines. Results The study included 158 participants. The factors associated with recovery according to bivariate associations were religious belief, psychotic symptoms, global function, social support and empowerment. In the hierarchical regression, empowerment, social support and global function were the main predictive factors of recovery, with the explained variation reaching 40.8%. Empowerment exhibited the highest predictive value for the recovery. Implications for clinical practice Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support.

Mediating Effect Of The Motivation For Medication Use On Disease Management And Medication Adherence Among Community-Dwelling Patients With Schizophrenia.

BACKGROUND: Nearly half of patients with schizophrenia do not adhere to the long-term medical treatment needed to manage their disease. Programs to promote medication adherence include promotion of motivation as a critical element to influence task performance. PURPOSE: This study investigated the mediating effect of motivation for medication use on disease management and medication adherence in schizophrenia. METHODS: This cross-sectional, descriptive correlational study enrolled a convenience sample of 373 community-dwelling patients with schizophrenia in the northern and central regions of Taiwan. Data were collected with questionnaires and a series of validated assessment tools. Hierarchical regression was used to analyze the mediating effect of motivation for medication use on disease management and medication adherence. RESULTS: The medication adherence rate of the patients was 47.2%. The mediating effect of motivation for medication use on therapeutic alliance and medication adherence was 50%, whereas that on insight and medication adherence was 41% and that on medical social support and medication adherence was 72%. CONCLUSION: Developing a medication motivation care model may be more effective than promoting therapeutic alliance, insight, or medical social support for promoting medication adherence. It also had greater impact on preventing relapses of community-dwelling patients with schizophrenia.