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In Japan, mental health care is currently undergoing a transformation, in accordance with new government policies under the slogan: “from inpatient to community health care”. Nevertheless, the mean period of hospitalization is longer and the number of beds for psychiatric patients in Japan is greater than in other countries, and symptoms recur and lead to readmission in many patients. Recurrence of mental diseases is likely to be prevented by improvement of medication adherence on the part of psychiatric patients (Kissling, 1991). Xia, Merinder, and Belgamwar (2011) reported in a literature review related to randomized controlled trials focusing on psychoeducation for patients with schizophrenia that psychoeducation reduced relapse, readmission, and encouraged medication adherence.
In Japan, mental health care institutions have paid attention to psychoeducation as psychosocial treatment. However, in Japan, only approximately 30% of psychiatric care facilities have adopted psychoeducation so far. Consequently, we considered that it was extremely important to evaluate a training program of psychoeducational practice developed by Matsuda and Kono (2013).
Objective
The objective of this study was to evaluate the usefulness of a psychoeducation practitioner training program (PPTP) with regard to nursing competency (Defloor et al., 2006) with the exclusion of skill.
Methods
Research design was applied to a one-group, pre-test/post-test study. The participants were recruited from among nurses working in all psychiatric hospitals in A Prefecture, Japan. The PPTP was developed based on the survey results, literature associated with psychoeducation, and the principles of NPE developed by Matsuda (2008). The program was conducted over two consecutive days. A questionnaire survey consisted of their Characteristics, the Knowledge of Illness and Drugs Inventory (KIDI; Maeda, Mukasa, & Ogoh, 1992), the General Self-Efficacy Scale (GSES; Sakano, 1986), the Japanese Version of the Evidence-Based Practice Attitude Scale (EBPAS-J; Okumura, Fujita, Noda, & Ito, 2010), the Work Motivation Measurement Scale for Nurses (WMMSN; Sano & Yamaguchi, 2005) and Nurses’ perception of psychoeducation practice. Statistical differences were detected by non-parametric Wilcoxon rank sum test. Prior to its commencement, this study was approved by the Institutional Review Board.
Results
Forty nurses participated in the PPTP, of whom 38 (17 men and 21 women) completed a two consecutive days curriculum (dropout rate: 5 %). The mean KIDI total score after intervention was significantly higher than that before intervention (Z (38) =2.094, p<.05). Furthermore, between pre and post intervention, the ‘knowledge of drugs’ subscale score had a significant difference (Z=3.902, p<.05), but the ‘knowledge of illness’ subscale score had no significant difference. The total GSES scores showed no significant differences between pre and post the intervention, whereas there was significant difference in the ‘social positioning of one's ability’ subscale score. The EBPAS total scores and the ‘openness’ (Z=3.295, p<.001), ‘appeal’ (Z=.3.080, p<.05) and ‘requirements’ (Z=1.981, p<.05) of its subscale scores after intervention were significantly higher than those before intervention, but the ‘divergence’ subscale showed no significant change.
On the other hand, the WMMSN fell short of statistical significance (p=n.s). Nurses’ perception of psychoeducation questionnaire scores showed significant differences in the ‘I have an understanding of psychoeducation’ (Z=5.245, p<.001) and ‘Psychoeducation should be provided by other professions’ items score (Z=2.707, p<.05). However, the other items’ score showed no significant change.
Discussion
The PPTP was considered to help participants develop an extensive knowledge of psychoeducation in a short period of time. The ‘social positioning of one's ability’ subscale score of the GSES indicated a statistically-significant difference. If the nurses who participated in the PPTP have a successful experience of conducting psychoeducation, this may improve their self-efficacy.
Especially, improving subscales of the EBPAS showed that the PPTP provided not only satisfaction with the contents of the program but also interest in psychoeducation for the participants.
The PPTP was not able to directly support the acquisition of particular skills of psychoeducation for psychiatric nurses; however, the result of this study indicated that the program generally improved those nursing competencies required to provide psychoeducation. Thus, in a future study, it will be necessary to consider the methodology of the program to reinforce these skills.
References
Defloor T, Van Hecke A, Verhaeghe S, Gobert M, Darras E, Grypdonck M. (2006). The clinical nursing competences and their complexity in Belgian general hospitals. J Adv Nurs. Dec; 56(6):669-78.
Kissling, W. (1991). The current unsatisfactory state of relapse prevention in schizophrenicpsychoses--suggestions for improvement. Clinical neuropharmacology Clinical neuropharmacology. 14 Suppl 2, S33-44.
Maeda, M., Mukasa, H., & Ogoh, J. (1992). Psychoeducational meeting for the schizophrenia patients. Japanese Journal of Clinical Psychiatry, 21, 1195-1202 (in Japanese).
Matsuda, M. (2008). A nurse-led version of psychoeducation program for patients with schizophrenia, referred to as Nursing Psychoeducation. Japan: Kinpodo (in Japanese).
Okumura, Y., Fujita J., Noda, T., & Ito, H. (2010). Psychometric Properties of the Japanese Version of the Evidence-Based Practice Attitude Scale. Seishin Igaku (Clinical Psychiatry), 52(1), 79-85 (in Japanese).
Sakano, Y. (1989). Verification of Validity of General Self-Efficacy Scale (GSES). Waseda journal of human sciences, 2, 91-98 (in Japanese).
Xia,J., Merinder, L.B., & Belgamwar, M.R.(2011). Psychoeducation for schizophrenia. Schizophrenia Bulletin. January; 37(1), 21–22. doi: 10.1093/schbul/sbq138. Epub 2010 Dec 8.