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Arch Psychiatr Nurs ; 35(1): 9-16, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33593521


Patient-perceived quality of inpatient/outpatient psychiatric care remains under-researched. A cross-sectional survey with purposive sampling comprising 567 inpatients and 549 outpatients was conducted among eight psychiatric care facilities in Taiwan to examine the factors influencing patient-perceived care quality. Inpatients and outpatients perceived moderate quality of care, where "Encounter" was reported as the highest dimension. Inpatients perceived "Secure environment" as the lowest; outpatients rated "Discharge/Referring" as the lowest. Hospital region and customer loyalty were significantly associated with patient-perceived care quality. Other significant factors were also identified: inpatient employment, perceived mental health and treatment effects, understanding diagnosis, previous treatment, and visited by appointment.

J Affect Disord ; 273: 517-523, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32560948


BACKGROUND: The association between illness perceptions and the effectiveness of patients' illness-management strategies has been supported across a range of medical and psychiatric disorders. Few studies have examined these variables or their association in bipolar disorder (BD). This study examined the main and interactive associations between illness perceptions and one important illness management strategy - social rhythms stability on mood symptom severity in adults with BD. METHODS: A cross-sectional study with 131 patients with BD in Taiwan was conducted using clinician- and patient-rated mood symptoms, self-reported illness perceptions, and a measure of daily and nightly social rhythms. RESULTS: Illness perceptions were associated with mood symptom severity, but social rhythms were not. Unfavorable illness perceptions (e.g., beliefs of experiencing more BD symptoms, having stronger emotional responses to the illness) were associated with more severe mood symptoms. Favorable illness perceptions (e.g., beliefs of being able to understand and control the illness) were associated with less severe mood symptoms, with personal control as the strongest correlate of mood symptom severity. Finally, social rhythm stability moderated the relationship between unfavorable illness perceptions and clinician-rated manic symptoms. LIMITATIONS: The cross-sectional design limits our ability to make causal conclusions. Also, the effects pertain to patients in remission and may not generalize to more severely ill or hospitalized bipolar patients. CONCLUSIONS: This study indicates that in patients with BD, illness perceptions are associated with symptom severity. Interventions to enhance favorable IPs and reduce unfavorable IPs may improve mood outcomes, particularly when patients have adopted regular social rhythms.

J Psychiatr Ment Health Nurs ; 27(5): 584-594, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32009270


WHAT IS KNOWN ON THE SUBJECT?: Internalized stigma in people diagnosed with mental illness has several negative outcomes; however, it remains unclear in an Indonesian context. The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of the existing stigma against mental illness and deficiencies in the country's mental healthcare services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best of our knowledge, this is the first study to examine the level of internalized stigma and related factors among Indonesians diagnosed with schizophrenia. Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Specifically, younger and unemployed people with more psychotic symptoms had higher levels of internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of adequate pharmacological and psychosocial treatments to help people manage their psychotic symptoms is extremely important to ameliorate stigma. Vocational rehabilitation and employment support for unemployed people may potentially reduce their internalized stigma and promote recovery. ABSTRACT: Introduction The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of societal stigma associated with mental illness and deficiencies in the country's mental healthcare services. Knowledge about internalized stigma among people diagnosed with schizophrenia in lower middle-income Muslim countries is also scarce. Aim To identify the level of internalized stigma and related factors among people diagnosed with schizophrenia in Indonesia. Method A cross-sectional survey was conducted with a purposive sample of 300 people diagnosed with schizophrenia from an urban Indonesian psychiatric hospital. Results Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Younger age, unemployment status and having psychotic symptoms significantly increased the risk of internalized stigma when analysed in a multivariable ordinal logistic regression. Discussion The present study firstly identified the high levels of internalized stigma among Indonesian individuals diagnosed with schizophrenia. Implications for practice Mental health nurses are suggested to provide early anti-stigma illness management and family psychoeducation interventions to people diagnosed with schizophrenia and their family caregivers, helping them to develop an optimistic understanding about the concept of schizophrenia and mitigating the negative consequences of public and internalized stigma.

Patient Prefer Adherence ; 13: 1877-1887, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31806936


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.

Hu Li Za Zhi ; 65(2): 64-74, 2018 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-29564858


BACKGROUND: The ideology of recovery addresses the autonomy of patients with mental illness and their ability to reconstruct a normal life. Empirical knowledge of this process of recovery and related factors remains unclear. PURPOSE: To assess the process of recovery and related factors in patients with mental illness. METHODS: This cross-sectional, correlational study was conducted on a convenience sample in a psychiatric hospital. Two-hundred and fifty patients with mental illness were recruited and were assessed using 3 instruments: Questionnaire about the Process of Recovery (QPR), Perceived Psychiatric Stigma Scale (PPSS), and Personal and Social Performance Scale (PSP). Data were analyzed using descriptive statistics, χ2, analysis of variance, and multiple linear regression analysis. RESULTS: Most of the participants were male, middle-aged, unmarried, educated to the senior high school level, employed, receiving home-care treatment, and diagnosed with schizophrenia. Those who were unemployed, living in a community rehabilitative house, and living in the community, respectively, earned relatively higher recovery scores (p < .05). The total scores of QPR and the 3 subscales were negatively correlated with PPSS (p < .01) and positively correlated with PSPS (p < .01; p < .05). Multiple regression analysis indicated that the factors of education, employment, having received community rehabilitative models, and stigma, respectively, significantly explained the recovery capacity of patients with mental illness. CONCLUSIONS: Community psychiatric nurses should provide care to help employed patients adapt to stresses in the workplace, strengthen their stigma-coping strategies, and promote public awareness of mental health issues by increasing public knowledge and acceptance of mental illness in order to minimize patient-perceived stigma and facilitate their recovery.

Transtornos Mentais/psicologia , Adaptação Psicológica , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estigma Social
J Nurs Res ; 26(2): 72-79, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29016467


BACKGROUND: Case management is a complex process involving multiple activities. It is vital that nurses are competent in all related tasks for case management. A competence scale is a valuable tool for assessing task-related competency. PURPOSE: The aims of this study were to examine the reliability and validity of an assessment scale for nurse case management competence and to use this scale to assess the current competency of nurses. METHODS: A nurse case management competence scale was developed in three stages: (a) selection of assessment items according to standards of practice for case management and literature review, (b) determination of content validity using the Delphi technique with a panel of experts, and (c) psychometric testing of the developed competence scale using a cross-sectional design. Convenience sampling was used to recruit psychiatric nurses at seven psychiatric centers in Taiwan to complete the scale anonymously. An exploratory factor analysis was performed to analyze construct validity. Discriminant validity, internal consistency, and 2-week test-retest reliability were also examined. RESULTS: Two hundred eighty-five psychiatric nurses completed an assessment scale comprising 18 items (originally 25 items). The content validity index reached 0.96 after the Delphi technique was applied twice in the expert panel. Seventy-eight percent of the total variance was explained by two dimension factors: coordination facilitation competence and direct care competence. Participants who had undertaken case management courses had superior case management ability compared with those who had not, indicating that the scale possesses excellent discriminant validity. Cronbach's α and the test-retest results showed excellent reliability. Of the two competence factors, direct care competence (3.03) was better than coordination facilitation competence (2.81). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: There is a dearth of studies investigating the development and psychometric testing of case management competence scales. The results of this study provide evidence to support the reliability and validity of the developed case management competence scale among Taiwanese psychiatric nurses. It is a reliable and valid assessment instrument that may help identify educational needs and improve the case management competencies of nurses.

Administração de Caso , Competência Clínica , Recursos Humanos de Enfermagem no Hospital/psicologia , Enfermagem Psiquiátrica , Inquéritos e Questionários , Adulto , Estudos Transversais , Técnica Delfos , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes , Taiwan , Adulto Jovem