A nurse-led, needs-based psycho-education intervention for Chinese patients with first-onset mental illness
Wai Tong Chien
School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, PR China
Sau Fong Leung
Lecturer, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR
Cecilia SK Chu
Advanced Practice Nurse, United Christian Hospital, Hospital Authority, Hong Kong SAR
PP: 194 - 209
Abstract
Background: To shorten the waiting time for psychiatric treatment, nurse-led services may help in the first-line mental health consultation and interventions for patients with recent first onset of mental illness.
Aims: The study evaluated the effectiveness of a 6-session nurse-led, needs-based psycho-education program for Chinese patients with mental health problems newly referred to an outpatient clinic in Hong Kong, when compared with routine outpatient care.
Method: A randomized controlled trial with a pretest and posttest, control group design was conducted. Seventy-nine patients were randomly assigned to either the nurse-led psycho-education program (n=39), or to usual psychiatric outpatient care (n=40). Multiple patient outcomes and services utilization were measured at recruitment and two weeks after the intervention.
Results: The results of a MANOVA test indicated that the psycho-education group had significantly greater improvements in mental and overall health status, insights into their treatment and illness, and hospitalization rates at the post-test.
Implications: The findings provide evidence that nurse-led, needs-based psycho-education can improve mental health, self-efficacy and insights into mental illness in Chinese first-onset mentally ill patients. A future multi-center controlled trial of this nurse-led intervention is recommended.
Keywords
controlled trial; advanced nursing practice; needs-based intervention; psycho-education; first-episode mental illness
Article Text
People with mental health problems often present to mental health care many months or years after the onset of symptoms. There appears to be a significant negative relationship between the duration of untreated mental illness and its outcome (Frank, Howard & McGuire 2009); the longer the duration of the untreated symptoms, the more negative the eventual health outcome. There is a need for care prior to the symptoms becoming severe and sustained. Otherwise, the rate and length of patients' hospitalizations increase (Aron et al 2009). Since the early 1990s, a variety of national and international efforts have been made in developed Western countries such as the United States (US) and United Kingdom (UK) to reform mental healthcare services and treatment approaches, setting the scene for much more attention and greater emphasis on early diagnosis and intervention for people with mental health problems. As a result, some of those with less severe mental health problems and/or considerable community and family support need not be admitted into psychiatric hospitals for in-patient treatment. Triage and subsequent mental healthcare services provided by psychiatric outpatient clinics, such as continuous mental status assessment, psychiatrist consultation and first-line psycho-education and illness management become important in treating people with first onset mental illness in the community.
However, due to limited resources and manpower, long waiting lists of newly referred cases for psychiatrists' first consultation and treatment can be found, particularly among those presenting with mild to moderate levels of psychiatric symptoms or those with a relatively stable mental state and adequate family support (Chien 2006). Recently, the development of advanced practice nurses (APNs), formerly nurse specialists, in psychiatric care in the U.S. and other Western countries has attempted to address this service need and purported to protect those with first-onset mental illness from hospitalization and/or relapse from illness (Tucker et al 1999). As expected by mental health care services and consumers, psychiatric APNs are employed to address the psychiatric symptoms of patients with first-onset mental illness and noticeable mental health problems, seeking high quality and timely care for those health problems and needs. Nevertheless, very few controlled trials and thus little clinical evidence have been found to prove the effectiveness of the nurse-led psychosocial interventions designed and provided by psychiatric APNs for these patients newly known and referred to psychiatric care.
Therefore, this controlled trial was the first one conducted in an Asian country to test the effectiveness of a nurse-led, needs-based psycho-education program for Chinese people with first-onset, moderately severe mental health problems.
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