INTRODUCTION:

Psychotic disorders are now referred to as schizophrenia spectrum and other psychotic disorders. The percentage of people who suffer from any psychotic symptom at any one time prevalence varies greatly from country to country. Men are thought to develop psychotic disorders more often and at younger ages than women.¹ Conative behaviour among patients with psychosis declines or increases according to the psychotic features. Most of the literatures demonstrated poor skill among mentally ill patients in performing their daily activities.² The goal of self management support is to assist the mentally ill client to reach their self management goals and move along the continuum towards optimal health and wellbeing. Self management support is challenging, given the difficulties clients face in developing or changing entrenched behaviours under demanding circumstances. The key is ensuring the care goals negotiated and approaches adopted are appropriately matched to the needs, circumstances and preferences of each client and nurses have the necessary skills to facilitate and support clients to enhance their capacity to self manage. ³

MATERIALS AND METHODS:

This study on Outcome of Self Management Support on Conative Behaviour of Patients with Psychosis was approved by Institutional Ethical Committee. After obtaining written informed assent from the care givers of psychosis patients, 40 participants 10 in each experimental group I, II, III and IV who fulfilled the inclusion criteria like the age group between 18 and 65 years with learned insight and patients diagnosed with Schizophrenia, Unipolar Mood disorder and Bipolar Affective Disorder were recruited and enrolled in the study between August 2013 and September 2013 in Government Head Quarters Hospital, Erode, Tamil Nadu. Psychosis patients with marked catatonic features were excluded from the study. True Experimental Randomized block design was undertaken as the blue print for this study. The blocking variables in this study were based on gender Male and Female patients with psychosis.⁴ Participants were randomly allocated by using random number table method based on 2 aspects such as Bathing and behavior chart in which male and female subjects are initiated to take bath and maintain a chart containing self evaluation on bathing for 5 days followed by self bathing with the duration of 10 to 15 minutes and chart maintenance for the next 5 days within 5 to 10 minutes. In bathing male and female subjects are instructed to take bath for 5 days followed by self bathing for the next 5 days with the duration of 10 to 15 minutes. The tools used were demographic variables and Conative Behaviour Assessment Rating Scale. The scale was interpreted based on the 4 point rating which consists of 10 items.

Pretest was conducted for the male and female patients in experimental group I, II, III and IV by using the tools. Followed by self management support was given for the Experimental group I and III in which the principal investigator supported and gave the command, how to take bath by self and helped the male and female patients with psychosis, how to maintain the behaviour chart, followed by the participants has to take bath regularly and maintain the behaviour chart by self, without the help and support of the researcher. Likewise in Experimental group II and IV the principal investigator supported and gave the command how to take bath by self for male and female patients with psychosis, without maintaining the behaviour chart, followed by the participants has to take bath regularly by self, without the help and support of the researcher. The self management support was given once in the forenoon for the first 5 days under the guidance of the researcher followed by self performance by the participants for the next 5 days. After the implementation of self management support posttest was conducted for the male and female patients in experimental group I, II, III and IV by using Conative Behaviour Assessment Rating Scale.

RESULTS:

The onset of illness in Experimental group I depicts that the majority (90%) of them were with chronic onset, however the least (10%) were with acute onset of illness. Experimental group II showed that (100%) of them were with chronic onset of illness and none of them had acute onset of illness. Experimental group III depicts that the majority (70%) of them had chronic onset of illness and the least (30%) had acute onset of illness. Experimental group IV showed that (90%) of them were with chronic onset; however the least (10%) were with acute onset of illness.

According to their diagnosis in Experimental group I depicts that the majority (80%) had schizophrenia and only (20%) had unipolar mood disorder whereas none of them had bipolar affective disorder. Experimental group II showed that the highest (60%) had schizophrenia and (30%) of them had unipolar mood disorder and the least (10%) of them had bipolar affective disorder. Experimental group III depicts that the highest (40%) had schizophrenia, (30%) of them had unipolar mood disorder and (30%) of them had bipolar affective disorder. Experimental group IV showed that the highest (80%) of them had schizophrenia, however least (20%) of them had unipolar mood disorder whereas none of them had bipolar affective disorder.

In pretest majority (60%) of patients with psychosis in experimental group I had average conative behaviour and (40%) of them were with poor conative behaviour, whereas in experimental group II majority (70%) of them were with poor conative behaviour and (30%) of them were with average conative behaviour, Likewise in experimental group III majority (70%) of them had poor conative behaviour and least (30%) had average conative behaviour and in experimental group IV highest (60%) of them had poor conative behaviour and only (40%) had average conative behaviour. None of the patients with psychosis had good conative behaviour in all the experimental groups. In posttest majority (60%) of patients with psychosis in experimental group I had poor conative behaviour and (40%) of them were with average conative behaviour, In experimental group II majority (60%) of them were with average conative behaviour and (40%) of them were with poor conative behaviour, in experimental group III majority (60%) of them had poor conative behaviour and least (40%) had average conative behaviour and in experimental group IV majority (70%) of them had average conative behaviour and only (30%) had poor conative behaviour. None of the patients with psychosis had good conative behaviour in all the experimental groups.

As displayed in Table 1 the comparison of mean and standard deviation of pretest and posttest scores on conative behaviour among experimental group I show that the pretest mean and standard deviation score was (12.98±1.37) respectively, whereas posttest mean and standard deviation score was (15.54±1.89) respectively. Likewise in experimental group II the pretest mean and standard deviation score was (13.2±1.43) respectively, whereas posttest mean and standard deviation score was (15.24±1.75) respectively. Experimental group III shows that the pretest mean and standard deviation score was (13.08±1.47) respectively, whereas posttest mean and standard deviation score was (16.38±2.2) respectively. Experimental group IV shows that the pretest mean and standard deviation score was (11.8±1.25) respectively, whereas posttest mean and standard deviation score was (16.25±2.1) respectively.

Table-1 Comparison of Mean and Standard Deviation of pretest and post test connative behaviour scores among experimental group I, II, III and IV N=40 (n₁=10, n₂=10, n₃=10, n₄=10)

Experimental groups	Pretest		Posttest
Experimental groups	Mean	SD	Mean	SD
Group-I	12.98	1.37	15.54	1.89
Group-II	13.2	1.43	15. 24	1.75
Group-III	13.08	1.47	16.38	2.2
Group-IV	11.8	1.25	16.25	2.1

When compared with group I and II (Male), group III and IV (Female) shows higher rates with mean and standard deviation respectively. It seems that the self management support was more effective among female patients when compared with male patients with psychosis. From the mean pretest and posttest values in all experimental groups it can be concluded that when compared with experimental I – Bathing and behaviour chart (Male), experimental group II - Bathing (Male) shows more effectiveness, likewise experimental III – Bathing and behaviour chart (Female) shows more effectiveness when compared with experimental IV – Bathing (Female).

Table 2 Shows the F1 ratio (Male) value was (3.14) for the experimental group I and II and F2 ratio (Female) value was (4.72) for the experimental group III and IV. When compared with table value (2.84) the calculated value was high among experimental group I, II, III and IV which indicates the significance. This significance shows the comparison in the outcome of self management support between male and female patients with psychosis. When compared with male patients, female patient’s conative behaviour had improved after the implementation of self management support.

Table-2 Comparison of Randomized block design ANOVA posttest scores on conative behaviour among experimental group I, II, III and IV.

N=40 (n₁=10, n₂=10, n₃=10, n₄=10)

Experimental Groups	F ratio	Table Value	Level of significance
Group I and II(F₁)	3.14	2.84	P<0.05 Significant
Group III and IV(F₂)	4.72	2.84	P<0.05 Significant

No significant association was found between posttest scores on conative behaviour and their selected demographic variables such as age, education, occupation, marital status, onset of illness and diagnosis (P >0.05) in experimental group II, III and IV. Association was found only with diagnosis in the experimental group I.

DISCUSSION:

Nurses play a vital role in improving conative behaviour among psychosis patients by implementing self management support. The systematic review and evidence based practice on self management support finds a big research gap which can be effectively used in hospital and community settings. One systematic review on E–mental health self-management interventions included psychoeducation, medication management, communication, shared decision making, and management of daily functioning, lifestyle management, peer support and real-time self-monitoring by daily measurements. Summary effect sizes were large for medication management (.92) and small for psychoeducation (.37) and communication and shared decision making (.21). The only economic analysis conducted reported more short-term costs for the e–mental health intervention. People with psychotic disorders were able and willing to use e–mental health services. Results suggest that e–mental health services are at least as effective as usual care or non technological approaches. Larger effects were found for medication management e–mental health services. Results must be interpreted cautiously, because they are based on a small number of studies.²⁰Ongoing Randomized Controlled Trial on effectiveness of a peer-led self-management programme for people with schizophrenia includes reducing psychotic symptom severity, hospital readmission, psychiatric consultation, enhancing cognition, empowerment, functioning level, medication adherence, perceived recovery, quality of life and social support.²⁴Self management support on bathing with and without behaviour chart can be used as a protocol in the daily activity of the patients with psychosis. Psychiatric nurses should educate the nursing professionals about the self management support on conative behaviour and its application in clinical practice. Self management support on conative behaviour for psychosis patients should be added and revised in the nursing curriculum. The findings of this study strongly recommend for the longer duration of Self management support as treatment protocol in order to observe the improvement in conative behaviour with psychosis patients. This study can also be conducted further with neurosis patients. A similar study can be undertaken to find out the effectiveness of self management support by adding other components of activities of daily living. This study can be replicated on large sample size and there by findings can be generalized with target population.

Conflict-of-Interest Statement:

Conflict of interest does not exist with the author, author's institution or with financial relationships.

Statement of Informed Consent:

In the systematic review of all the studies prior written informed consent was obtained from the subjects. Funding source was not obtained for the manuscript writing.

Statement of Human Rights:

The data collection methods followed was in accordance with the ethical standards of the responsible committee on human experimentation.

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Received on 16.03.2017 Modified on 28.03.2017

Int. J. Adv. Nur. Management. 2017; 5(3): 233-236.

DOI: 10.5958/2454-2652.2017.00050.6