Efficacy of Nursing Interventions in Family Burden among Individuals suffering from Neurotic Disorders

 

Nagarajaiah¹, Jothimani. G², Giri A.T.S³, Dr. Kusuma⁴

¹Nagarajaiah, Additional Professor, Dept of Nursing,

National Institute of Mental Health and Neuro Sciences, Bangalore. India.

²Clinical Instructor, College of Nursing,

National Institute of Mental Health and Neuro Sciences, Bangalore. India.

³Principal, Goutam College of Nursing, Bangalore.

⁴Ward in charge, NIMHANS, Bangalore-29

 

ABSTRACT:

Background: Individuals suffering from neurosis do suffer from family burden similar to that of psychoses. Though understanding of burden in neurosis is essential in appropriate management of the clients, the relevant interventional studies are very limited.

Aim: The present study is an attempt to evaluate the effect of nursing interventions in reducing family burden among  neurotic patients. Methodology: 60 neurotic patients diagnosed as per ICD 10 criteria were randomly assigned to experimental and control groups followed by pre assessment by interview schedule for the assessment of the burden on the family of psychiatric patients developed by Pai and Kapur (1981). 10 sessions of nursing intervention; among which, 3 were individual sessions with clients, 5 sessions with clients and family members and 2 sessions with small group of clients with similar problems were administered to the nursing intervention group and non nursing intervention group received the routine drug treatment at rural community mental health centre, NIMHANS, Bangalore. The post assessment was carried out first, second, and the third month followed by the nursing intervention.

Results: The findings revealed statistically significant reduction in family burden. A community based psychosocial intervention lead by community health nurses catering to the needs of neurotic patients is indicated by the results.

Conclusion: In the present study it is observed that nursing intervention group had more improvement than their counterparts. The financial burden was more significant when the patient was male and unable to work. Better community services, mobile crisis intervention teams, and sensitivity counseling will significantly reduce family burden and contribute to improve the quality of care of mentally ill.

 

 

 

INTRODUCTION:

Neuroses form one of the significant problems in the community setting. Neuroses and therapeutic management of problems related to neuroses has been the subject of concern to the mental health scientists, particularly psychiatric nurses for several years. (Stengler-Wenzke, 2004). It is being evident that 15-20 % of all patients who seek professional help in general health services do so for emotional and psychosocial problems.  (Channabasavanna, S.M., Sriraman, T.G. and Udayakumar, K. 1993) Social burden experienced by relatives of neurotic patients was studied extensively and its relationships with locus of control, social support and coping strategies were investigated by Gupta et al. (1991). The study found that 95% of the relatives felt burden. Burden was more if the patient was an unemployed male. Severity of illness had significant influence on burden. Majority of the relatives used minimization, seeking social support and blaming self as primary coping strategies.

 

The families of neurotic patients report considerable burden due to illness and reduce their social activities, leading to an increase in their feeling of isolation and distress. They also report poor Quality of Life in the domains of physical wellbeing, psychological wellbeing and social relationships. A study done in India comparing the family burden across various anxiety disorders reported that the degree of burden was essentially comparable across all the groups. (Gururaj  2008).

 

BACKGROUND:

Most of the individuals with neuroses are aware of their problems but believe that they are suffering from some serious physical illness. The psychopharmacological approaches to reduce these symptoms though useful in relieving initially, the benefits and hazards of long term use are well known.  Some of these neurotic disorders often a source of disability and of a significant loss of working capacity. In a view of modern concept in psychosocial management of neuroses, it is well evident that nurse lead community based interventions also could do the best in reducing the family burden secondary to neuroses.

 

AIM:

The present study was aimed to study the efficacy of nursing intervention in Family burden among Individuals suffering from Neurotic Disorders.

 

METHODS:

Setting

The study was conducted in the rural community mental health centre of department of psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. The patients were selected using simple random technique from those who are attending the outpatient service provided by the rural community mental health centre . The subjects who have been included in the study were patients who were diagnosed as neuroses on the basis of ICD-10 criteria. Patient group included both the males and females, age ranging from 18- 65 years. A random sampling procedure was adopted to allot patients into experimental and control group using a random  number table. This procedure was continued until each group got 30 patients with neuroses. The experimental group patients received a package of nursing intervention services provided by the researcher in addition to routine drug treatment. Both the group of patients received routine drug treatment.

 

 

Design

Study was undertaken using the true experimental research design, with experimental group and control group and “before” “during” and “after” measurements to evaluate the efficacy of nursing intervention in reducing the Family burden among Individuals suffering from Neurotic disorders.

 

Measurements

The instruments used for data collection were Socio-demographic schedule and interview schedule for the assessment of the burden on the family of psychiatric patients developed by Pai and Kapur (1981). The inter rater reliability of the tool was determined by two way analysis of variance and the reliability coefficient was 0.9.

 

The assessments were made in the following stages:

1.      Before nursing intervention was started, i.e. baseline data

2.      At the completion of first month of nursing intervention

3.      At the end of second month of nursing intervention and

4.      After the completion of third month of nursing intervention, i.e., final phase of assessment.

 

Brief description of the Nursing intervention package 

The nursing interventions were conducted in 10 sessions, among which, 3 were individual sessions with clients, 5 sessions with clients and family members and 2 sessions with small group of clients with similar problems. In the first session, efforts were made to establish rapport with the client and to understand the problems as perceived by the client. Active listening, expressing of empathy, genuine concern, warmth, respect were the techniques used and clarification was provided appropriately. In the second session, importance was given to determining the nature or dynamics of the client’s problems through confrontation and self exploration and also by translating insight and understanding into corrective action that is facilitating client’s initiative in creating change. Explanation about nature of the problem and the relationship between the personal and psychosocial environment in causation of the problem and ways in dealing with them was provided. In the third session, review of each clients’ experience in using the skills practiced in previous sessions were made. Utilization of social skills and self reinforcement principles etc. were examined. Further efforts were taken for understanding family conditions and dynamics. The fourth session mainly focused on discussion with the client regarding family related issues and the client was enabled to develop required skills to cope with problems. Clients were helped to cope with painful feelings, ambivalence about forming new relationships, concerns about their fears and anxieties of being alone and lack of self confidence in managing their life independently. The fifth session was exclusively dealt with the family members like husband, wife, in laws, grown up children and other close relatives. The subsequent two sessions that is the sixth and seventh sessions dealt with clients in group setting by forming homogenous group of 4-5 clients with similar background characteristics like sex of the client, nature of problems, age and place of residence. The group participants were encouraged to share their suggestion about improving their skills and dealing with problems. The common mode of problem solving was identified and they were informed to the group members. In the last sessions, that are 8^th, 9^th and 10^th sessions were scheduled and planned depending upon the progress made by the client. The nursing intervention package meant for helping the patients was interpersonal oriented, family centered, culturally relevant to coping strategies. Problem solving mechanisms and social support measures were planned, and organized by nurse therapist.

Statistical analysis

The data was collected by strictly following the instructions given by the author of the tools used in the study. The systematically collected data was processed and analyzed using descriptive and inferential statistics. The non-parametric test - Chi-sqaure test was used to find out the significance differences between two groups at P<0.05. To find out the effect of nursing intervention on experimental group in comparison with control group independent ‘t’test was used. Differences were considered statistically significant for p<0.001. All statistical analyses were conducted using SPSS 16.

 

RESULTS:

Table. 1. SOCIO-DEMOGRAPHIC VARIABLES OF THE PATIENTS            N=60

 

 

The table 1 denotes the socio demographic variables  sex, religion, marital status, family type of the  experimental and non experimental group, chi-Square was computed and both groups were similar in nature with respect to background variables at p<05.

 

 

Table 2. OVERALL FAMILY BURDEN OF THE PATIENTS

Sl.No	Dimension	Experimental Group		Control Group
		Mean	SD	Mean	SD	‘t’
1.	Financial Burden	2.150	1.855	3.275	1.283	5.46
2.	Disruption of routine family activities	2.225	1.872	3.667	1.446	6.68
3.	Disruption of family leisure	2.233	1.482	2.275	0.935	6.51
4.	Disruption of family Intervention	1.358	1.222	2.766	1.828	7.02
5.	Effect on physical health of others	0.108	0.312	0.125	0.322	0.04
6.	Effect on mental health of others	0.365	0.517	0.775	0.557	5.88

P< 0.001

 

 

TABLE 3. SUBJECTIVE BURDEN ON THE FAMILY

Sl. No	dimension	Statistical measures	Experimental group (N=120)	Non experimental group (N=120)	‘t’ values
1		Mean	0.675	1.292	8.08
2		Standard deviation	0.676	0.492

  p<0.001

 

 

TABLE 4. TOTAL FAMILY BURDEN

Sl. No	Statistical measures	Experimental group (N=120)	Non experimental group (N=120)	‘t’ values
1	Mean	8.442	13.883	7.60
2	Standard deviation	6.319	4.653

  p<0.001

 

 

Table 2 depicts the mean, standard deviation and statistical significance related to family burden at 6 dimensions i.e. financial burden, disruption of family activities, distruption of family leisure, disruption of family intervention, effect on physical health of others, effect on mental health of others. It is observed that nursing intervention group had more improvement than their counterparts. These differences were found to be statistically significant. Only in dimension that is physical health problems of other family members the difference is not found to be statistically significant. However the nursing intervention group had less physical health problems among other family members. 

 

The table 3. Denotes the subjective burden on the families of both the study groups. It found that the non nursing intervention group had subjective family burden than the nursing intervention group. The difference is found to be statistically significant.

 

The table 4. Provides the total family burden in both study groups. The total burden is assessed in 6 dimensions and it was found that the nursing intervention group of patients had less mean total burden than the non nursing intervention group. The difference is found to be statistically significant.

 

DISCUSSION:

Of mental health problems in primary mental health care, the great bulk are neuroses, forming 88 percent of those identified in four third of world countries- Columbia, Philippines, Sudan and India (Harding et al., 1980). The study subjects represent the rural populations of catchment of rural community health centre, NIMHANS. Women had higher rate in all age group up to 65 years than did men. The female preponderance of neurotic disorders in primary care settings has been observed in other Indian studies (Shama Sundar et al. 1986: Sen, 1987) as well as in general population studies. The mean age of the patients was 37 years, majority of them belongs to Hindu religions and most of them are married, illiterates are predominant. The mean annual income of the family ranges from Rs. 12,000 to Rs. 15,000. Similar findings were reported in earlier studies by Karthikeya, (1979); Sridhara, (1981) and Channabasavanna et al. (1993).

 

On statistical analysis it was found that the two groups do not differ significantly in respect to age, sex, religion, marital status, years of education, occupational status, annual income, nature of tenancy, type of house, type of families, family history of psychosis, epilepsy, alcoholism, mental retardation, and chronic physical illness, psychosocial precipitating factors for patients illness and duration of illness. The study by Gururaj GP, Math S Bada, Reddy JYC, Chandrashekar CR(2008)  on Family burden, quality of life and disability in obsessive compulsive disorder: An Indian perspective also revealed that, primary care givers of OCD patients reported similar family burden as primary care givers of schizophrenia with regard to disruption of family leisure, family interaction and effect on physical and mental health of others. Cooper M. (1996) reported that the greatest burden was felt for disruption in family routine and leisure activities, with lesser burden also being felt on family interaction and financial matters.

 

In the present study it is observed that nursing intervention group had more improvement than their counterparts. Studies carried out mostly measured the family burden in psychotic patients.(Pai 1980). There were few studies which specifically focused on family burden on neurotic patients.(Gupta et al 1991).they found that 95% of the families of neurotic patients have felt mild to moderate burden. The financial burden was more significant when the patient was male and unable to work.

 

Though studies (Francell et al, 1988) have shown that interventions reduced the burden in case of psychotics such studies are not conducted with patients suffering from neurosis. Family burden is one of the important indicators of severity of illness. When the burden is reduced by intervention strategy the family members get convinced about effectiveness of the treatment. Francell et al 1988) based on their work with families of mentally ill are of the opinion that family education, inclusion of families in treatment, better community services, mobile crisis intervention teams, and sensitivity counseling will significantly reduce family burden and contribute to improve the quality of care of mentally ill.

 

LIMITATION:

The numbers of samples were only 30 each in the experimental group and the control group, it is too small for any generalization.

 

The subjects for the study were selected from the patients who sought the services of  rural community Mental health centre. Patients with neurosis who do not seek the services of the centre were not focused.

It is confined in rural setting only.

 

CONCLUSION:

The findings of the study on efficacy of nursing interventions in reducing family burden among patients with neurosis emphasized that the role of nurse therapist and also the importance of nursing intervention in the management of patients suffering from neuroses in rural settings.

 

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Received on 11.07.2014           Modified on 28.08.2014

Accepted on 12.09.2014           © A&V Publication all right reserved