Year

2011

Degree Name

Doctor of Philosophy

Department

School of Nursing, Midwifery, and Indigenous Health, Faculty of Health and Behavioural Sciences

Abstract

There is a challenge for Thai mental health nurses to provide recovery-oriented mental health care for people living with schizophrenia. This study aimed to seek a comprehensive view of Thai mental health nurses’ understanding and nursing practices in relation to recovery from schizophrenia. It also sought to determine whether nurses’ perceptions and practices regarding recovery from schizophrenia were consistent with a recovery model. The study was designed as a sequential exploratory mixed-methods study which began with a descriptive qualitative study and was followed by a cross-sectional survey. Although the two research approaches were implemented and analysed separately, a segregated design of mixed-methods analysis was utilised in order to draw conclusions from both. In the first phase, the descriptive qualitative study set out to investigate the understanding that Thai mental health nurses had about recovery from schizophrenia and their nursing practices to promote recovery from mental illness. Data were collected using semi-structured interviews with 24 mental health nurses who delivered care for people living with schizophrenia. A thematic analysis of the interview data revealed five themes related to recovery from schizophrenia; 1) the meaning of recovery, 2) the characteristics of recovery, 3) the facilitators of recovery, 4) the barriers to recovery, and 5) nursing practices to promote recovery. The findings suggest that the perceptions and nursing practices of Thai mental health nurses were most consistent with a traditional medical model. In the second phase, a cross-sectional survey was undertaken to investigate the level of Thai mental health nurses’ knowledge, attitudes, and nursing practices regarding a recovery model. It involved a survey using self-reported questionnaires including the Recovery Knowledge Inventory (RKI), the Recovery Attitude Questionnaire (RAQ), and the Recovery-Oriented Nursing Practice (RONP). Data were analysed from questionnaires completed by 476 mental health nurses who worked in public sectors across the country and provided care for people living with schizophrenia. The main finding was that Thai mental health nurses had poor knowledge, attitudes, and nursing practices in relation to a recovery orientation. In addition, educational x qualifications and work settings were related to the delivery of recovery-oriented nursing practices. Again, findings suggested that the knowledge, attitudes, and nursing practices were consistent with a traditional medical model rather than a recovery model. The emphasis of a traditional medical model rather than a recovery model may be explained by insufficient knowledge of psychological recovery among Thai mental health nurses and the dominance of a traditional medical model in Thai mental health system. Training and formal education related to recovery-oriented nursing care should be introduced for mental health nurses at all levels. To promote psychological recovery from schizophrenia, nurses should find a balance between illness-oriented interventions and recovery-oriented practices. They should emphasise nursing practices to help clients develop hope, self-determination, and responsibility for recovery from mental illness.

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