Effect of Empowerment Intervention on

Helplessness, Recovery and Quality of Life among Schizophrenic

Patients
A Thesis

Submitted for Partial Fulfillment of Master Degree in Nursing Science (Psychiatric

and Mental Health Nursing)

By

Hadeer Saber Mohammed Amin

B.SC

Demonstrator in Psychiatric and Mental Health Nursing Department

Faculty of Nursing – Mansoura University
Supervisors
Prof. Dr. Mona Ahmed Elbilsha
Professor of Psychiatric and Mental Health Nursing
Faculty of Nursing
Mansoura University
Dr. Azza Ibrahim Abd-Elraof
Lecture of Psychiatric and Mental Health Nursing Department
Faculty of Nursing
Mansoura University

2023
1
 Supervisor Sheet

A thesis title: Effect of Empowerment Intervention on Helplessness, Recovery and

Quality of Life among Schizophrenic Patients.

Researcher Name: Hadeer Saber Mohammed Amin

Under Supervision of:

Name Job Signature

1 Prof. Dr. Mona Ahmed El-bilsha
2 Dr. Azza Ibrahim Abd-Elraof
Professor of Psychiatric and Mental
Health Nursing, Faculty of Nursing
Mansoura University
Lecture of Psychiatric and Mental
Health Nursing, Faculty of Nursing
Mansoura University

Head of the Vice dear for Dean of

Department Postgraduate studies and researches the faculty
 Approval Sheet

A thesis title: Effect of Empowerment Intervention on Helplessness, Recovery and

Quality of Life among Schizophrenic Patients

Researcher Name: Hadeer Saber Mohammed Amin

Under Supervision:
Name Job Signature
1 Prof. Dr. Mona Ahmed Professor of Psychiatric and
Elbilsha Mental Health Nursing
Faculty of Nursing
Mansoura University
2 Dr. Azza Ibrahim Abd- Lecture of Psychiatric and
Elraof Mental Health Nursing
Faculty of Nursing
Mansoura University

Approval Committee:
Name Job Signature
1 Prof. Dr. Mona Ahmed Professor of Psychiatric and Mental
Elbilsha Health Nursing-Faculty of Nursing
Mansoura University
2 Prof. Dr. Mervat Mostafa Professor of Psychiatric and
El Gueneidy Mental Health Nursing, Faculty of
Nursing-Alexandria University
Prof. Dr. Ahmed Gamal Professor of Neurological and
Azab Psychiatric Medicine Faculty of
Medicine, Mansoura University
Head of the Vice dear for Dean of
Department Postgraduate studies and researches the faculty
 Acknowledge
In the name of Allah, the most gracious and the most merciful, First and
foremost profound gratitude goes to almighty "ALLAH" for giving me strength,
knowledge, ability and opportunity to undertake this study.
I sure it is Allah's blessing and grace that I completed my work and ended up with
this dissertation.
I would like to express my deepest gratitude and sincerest appreciation to
Prof. Dr. Mona Ahmed El-Bilsha, Professor of Psychiatric and Mental
Health Nursing – Faculty of Nursing – Mansoura University for her constructive
supervision, valuable advices, Kind help, and continuous encouragements, and
support offered throughout the entire course of this work.
My deepest thanks go to Dr. Azza Ibrahim Abd El-Raoof, Lecture of
Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University,
who gave me all encouragement and support, her valuable guidance and sincere
advice.
I am grateful and indebted to psychiatric patients and their caregivers for
helping me during the collection of the data and implement of the intervention.

I wish to offer my whole- hearted thanks to my colleagues in Psychiatric and

Mental Health Nursing department, Faculty of Nursing, Mansoura University, for
their continuous support during the fulfillment of this work.
My heartiest thanks and appreciation to my family specially my father, my
husband, my sons, , my brother, my sister for their support, encouragement, and
tolerance to reach that point and achieve this work.

Hadeer Saber Mohammed

Table of Contents
 CHAPTER PAGE
I Introduction 1

Aim of the Study 5

II Review of Literature
 Overview of Schizophrenia 6
 Helplessness 18
 Quality of Life 25
 Recovery about Schizophrenia 32
 Management of Schizophrenia
 Empowerment Intervention 47
 Nursing Role in Recovery and Empowerment 57
III Subject and Method 60
IV Results 75
V Discussion
VI Conclusion and Recommendation
VII Summary
VIII References
IX Appendices
I. Tools
II. Program
III. Protocol
X Arabic Summary

List of Tables
 Table Page
Table (1) Frequency Distribution of studied sample according to
Socio-demographic characteristics
Table (2) Frequency Distribution of studied sample according to
Social condition
Table (3) Frequency Distribution of studied sample according to
Physical condition
Table (4) Frequency Distribution of the studied sample according to
Clinical data
Table (5) Total score of Schizophrenia quality of life (SQOL-18)
between pre assessment, immediately and after one month
Table (6) Total score of scoring system of Learned Helplessness
scale between preassessment, immediately and after one
month
Table (7) Total score of Learned Helplessness scale between
preassessment, immediately and after one month
Table (8) Total score of scoring system about Recovery Assessment
Scale- Domains and Stage (RAS-DS) Pre-assessment, post-
assessment (immediately and after one month)
Table (9) Total score of Recovery Assessment Scale- Domains and
Stage (RAS-DS) Pre-assessment, post- assessment
(immediately and after one month)
Table (10) Total score of Empowerment Scale between pre-
assessment, immediately and after one month
Table (11) Total score of Positive and Negative Symptoms Scale
(PANSS) between pre-assessment, immediately and after
one month
Table (12) Total score of scoring system of Positive and Negative
Symptoms Scale (PANSS) between pre-assessment,
immediately and after one month
Table (13) Correlation between studied patients scores on different
study variables Pre assessment
Table (14) Correlation between studied patient’s scores on different
study variables Post Immediately
Table (15) Correlation between studied patient’s scores on different
study variables After one month

List of figures
 Figures Page
Figures (1) Diagram of Learned Helplessness Theory.

Figures (2) Factors potentially impairing QoL in patients with schizophrenia.

Figures (3) Empowerment Paradigm of Development, Healing and Recovery.
Figures (4) Potential impacts of Empowerment Intervention

List of Abbreviations
Abbreviation Full words
WHO World Health Organization

APA American Psychiatric Association

DSM-5 Diagnostic and Statistical Manual of Mental Disorders (5th ed)

NIMH National Institute of Mental Health

LH, LHS Learned helplessness, Learned Helplessness Scale

QOL Quality of life

WHOQOL World health organization quality of life

HRQoL Health-related quality of life

FGA First-generation antipsychotics

SGA Second-generation antipsychotics

ECT Electroconvulsive treatment

RAS-DS Recovery assessment scale-Domain and Stage

RAT Recovery Alliance Theory

RSWG Remission in Schizophrenia Working Group

PANSS Positive and Negative symptoms Scale

BPRS Brief Psychiatric Rating Scale

ES or RES Empowerment Scale or Rogers Empowerment Scale

SQoL-18 Schizophrenia Quality of Life Scale (18 item)

Abstract
Schizophrenia imposes a significant disability on people with suffering from and very often
unable to achieve life various goals. Schizophrenia is associated with a heterogeneous group of
symptoms that cause significant distress to their sufferers; affecting their interpersonal relations,
personal care, with its negative impact on patient’s quality of life and recovery. Empowerment
intervention is a core component of the recovery framework, together with connectedness, hope
and optimism about the future identity and meaning of life. Empowerment intervention is
strengthen the individual's competence, natural helping systems and proactive behaviors found to
be effective in promoting recovery and overcoming their illness-related disability. Therefore, this
study aimed at assesses the effect of empowerment intervention on helplessness, recovery and
quality of life among schizophrenic patients. A quasi-experimental research design [pretest -
posttest] was carried out between January 2021 and January 2022 involving 60 participants who
had been diagnosed with schizophrenia were chosen according to inclusion criteria, was
conducted at the inpatient and outpatient psychiatric department of the Mansoura University
Hospital. Method the instruments used for data collection was socio-demographic data sheet,
Learned Helplessness Scale, Schizophrenia Quality of Life-18, Recovery Assessment Scale-
Domains and Stages, Rogers Empowerment Scale and Positive and Negative Symptoms Scale.
These 60 participants were divided into ten groups, six participants in each group; each group
attended twelve sessions (3 sessions /week). Results revealed that there was statistical significant
difference in mean scores of helplessness, recovery, empowerment, quality of life and positive
and negative symptoms before and after Empowerment Intervention. To conclude, it is
concluded that, helplessness, recovery, empowerment, quality of life and positive and negative
symptoms of patients with schizophrenia improved significantly after Empowerment
Intervention. Recommendation: Further research on developing programs that are needed for a
better understanding of relation between Schizophrenia, Empowerment and to improve and self-
Empowerment levels of patients with Schizophrenia.

Keywords: Schizophrenia, Empowerment, Recovery, Quality of Life, Helplessness.

Introduction
 Schizophrenia is a terrible and permanent mental illness. Individuals with
schizophrenia frequently experience a variety of deprivations, including poor
physical health, powerlessness, early death, severe functional disability, and low
quality of life (Law, 2017). 1% of the population is affected by schizophrenia
(World Health Organization [WHO], 2018).

About 24 million people worldwide experience schizophrenia. It was listed

as one of the top 10 diseases burdening the world's population. About 20% of those
with schizophrenia tend to have a good and favorable course, and a small number
of people reportedly make a full recovery (Desalegn, Girma & Abdeta, 2020).

Schizophrenia spectrum disorders and other psychotic disorders are "defined

by abnormalities in one or more of the following domains: delusions,
hallucinations, disorganized thinking (speech), grossly disorganized or abnormal
motor behavior (including catatonia), and negative symptoms," according to the
Diagnostic and Statistical Manual of Mental Disorders 5th ed., DSM-5 (American
Psychiatric Association [APA], 2013; National Institute of Mental Health [NIMH],
2016). These symptoms may be detrimental to a person's quality of life and social,
occupational, or interpersonal functioning (Alshowkan, Curtis & White, 2015).

Many people with schizophrenia are symptom-free, while others can have
quite productive lives. However, most of them will continue to have some function
impairment, and many will have frequent relapses or persistent levels of their
positive symptoms. Although the definition of symptom remission is clear, the
term "recovery" is more ambiguous and diffuse concept like productivity,
independence, and fulfilling relationships (Park & Sung, 2013).
Recovery is not connected to partial symptom improvements; rather, it is the
total or almost complete remission of psychiatric symptoms and impairments
(Hasan & Musleh, 2017). The development of daily well-being, which
encompasses environmental mastery, personal growth, life purpose, improved
autonomy, self-acceptance, and healthy interpersonal relationships, is one part of
rehabilitation (Eisenstadt, Monteiro, Diniz & Chaves, 2012; Slade et al., 2014).
Hope, accepting one's condition, taking responsibility for one's own health,
receiving the best care possible, and being in supportive surroundings have all been
found to be elements that support in these recovery (Soundy et al., 2015).

Schizophrenic patients face a variety of challenges, struggle and obstacles in

their daily lives. Throughout the rehabilitation and recovery process, people must
acquire the knowledge, abilities, endurance, and strategies necessary to combat the
negative effects brought on by their mental health issues, such as schizophrenia
(Law, 2017).

In addition, the majority of schizophrenia sufferers lack confidence in their

ability to recover and do not believe they have, despite receiving therapy
(Corrigan, Rafacz, & Rusch, 2011). They are therefore helpless and without hope.
Professionals rarely discuss this subject, and this problem is made worse by the
fact that patients are unable to confront these feelings without sufficient
understanding of their own condition. Another crucial element in developing a
shared understanding of recovery between professionals and patients is the
patient's sense of helplessness with regard to their own recovery (Lam et al., 2011).

Additionally, even if they are on the most recent antipsychotic treatment,

those who have been diagnosed with a mental disease like schizophrenia will have
a sense of powerlessness if they have to spend a lot of time in the hospital (Park &
Sung, 2013). It has been discovered that acquired helplessness is a significant
obstacle to patients' integration into their communities. An effective method of
treating schizophrenia patients that aids in their recovery is to instruct those who
have severe mental diseases like schizophrenia to manage their psychiatric
symptoms and prevent a relapse at the early stages (Jo, 2009; Shearer, 2009).

The term of ‘recovery’ which originated in the patient movement and

conveying a meaning similar to the concept of ‘quality of life”, recognized by
several expertise. Both ideas emphasize the development of human potential to
meet the demands of fulfilling societal and personal roles, as well as patients'
holistic viewpoints on various facets of life (Ho, Chiu, Lo & Yiu, 2010). The
consideration of quality of life has recently been made in the study of psychiatric
illnesses like schizophrenia as a result of a greater emphasis on patients'
experiences and their needs. In the study and treatment of severe mental diseases,
the quality of life dimension adds great evidence that is advantageous to a
multidimensional approach (Vrbova et al., 2017).

Schizophrenia drastically lowers quality of life (Holubova et al., 2016).

Numerous factors, including age, the degree of psychopathology, the frequency of
psychiatric hospitalizations, the presence of depression, social anxiety, avoidance,
a poor or absent partner, low education, unemployment, and low self-esteem, can
have a negative impact on the quality of life in psychiatric patients (Wartelsteiner
et al., 2016 ;Wang, Petrini, & Morisky, 2017).

"Both subjective and objective methods have been used to assess the quality
of life (QoL) of people with schizophrenia. Subjective measurements of quality of
life (QoL) encompass general life satisfaction indicators and a variety of life
domains, including contentment with one's career, family, social relationships,
finances, and housing status. The socio-demographic data, role functioning in
society, and indicators of the external conditions of living are typically included in
the objective assessments of quality of life (Desalegn, Girma, & Abdeta, 2020).

Lower levels of subjective quality of life caused due to reduce of

empowerment (Rogers, Anthony, Cohen & Davies, 1997). Since schizophrenia is a
chronic illness that affects almost every aspect of a person's life, treatment
planning focuses on three main objectives: 1) symptom reduction or elimination, 2)
maximizing quality of life and adaptive functioning, and 3) promoting and
maintaining recovery from the illness' crippling effects as much as possible
(Lehman et al., 2004).

Antipsychotic medications, drug therapy for anxiety, depression, and

aggression / hostility, electroconvulsive therapy, psychological interventions,
family interventions, vocational rehabilitation, assertive community treatment, case
management, and empowerment interventions are some of the interventions that
are important to improve the quality of life, recovery, and cost effectiveness of care
for patients with schizophrenia (Priya Rajan, 2012).

The relationship between a sense of personal competence, a desire for and a

willingness to take action in the broader society is known as psychological
empowerment. A process of "gaining control over one's life and affecting the
organizational and societal framework in which one lives" is another definition for
it (Rappaport, 1997). The ability to make decisions, assertiveness, a sense of being
able to change things, learning to deal with and express anger, feeling a part of a
group, understanding one's rights, growth and change that is never-ending and self-
initiated, increasing one's positive self-image, and overcoming stigma are among
the core characteristics of empowerment (Slade, 2010).

Mental health professionals work to empower schizophrenia sufferers

because empowerment is an essential component of the rehabilitation and recovery
process for these individuals (Park & Sung, 2013). The operational measurement
of empowerment, however, is not well understood (Warner, 2009). Schizophrenic
patients are likely to feel very powerless, yet there are little researches that have
looked into empowerment in the schizophrenic patients (Chou et al., 2012).

In terms of recovery in psychiatric health services, empowerment

intervention in schizophrenia patients is a particularly significant challenge. Only a
small number of researches, meanwhile, have looked into mental ward
interventions to support and empower patients with schizophrenia, enhance their
prognoses, and lower the chance of relapse. A better awareness of one's condition
and a more positive attitude toward medication can improve outcomes. Services
geared toward recovery or psychological rehabilitation may be significantly
impacted by educational treatments that change patients' views. We focused on
schizophrenic patients who were psychiatric inpatients with the primary objective
of boosting patients' endurance and hopes for recovery (Park & Sung, 2013).
 Aim of the study

To assess effect of Empowerment Intervention on helplessness, recovery and

quality of life among schizophrenic patients

Research Hypotheses

Empowerment Intervention will improve Helplessness, Recovery and

Quality of Life among Schizophrenic Patients.

15
 Overview about Schizophrenia
Definition of schizophrenia
Schizophrenia is one of the most common and serious forms of mental
illness and is often chronic, recurrent, disabling and debilitating an extreme
psychotic disorder that manifests as a variety of symptoms, including cognition,
perceptual, avolition, and affective disturbances as well as psychomotor
abnormalities (Carpenter & Tandon, 2013). It changes how people see reality and
has an impact on their overall wellness, productivity, autonomy, and subjective
well-being (Desalegn, Girma, Tessema, Yeshigeta & Kebeta, 2020).

Schizophrenia is a psychological illness marked by recurrent psychotic

episodes (Owen, Sawa & Mortensen, 2016). The psychotic symptoms may be
increased by not taking prescribed medication, alcohol and drug abuse or being
involved in stressful situations. Schizophrenia is among the most severe and
debilitating of the major mental disorders, and imposes an enormous
socioeconomic burden on patients, caregivers and society (Chong et al., 2016;
Callaghan & Lymn, 2015).

Schizophrenia is a serious and persistent mental disorder and the 3rd leading
cause of worldwide disability among mental disorders across age groups. Although
the outcome of schizophrenia is not uniformly negative, only a minority of
individuals with first episode psychosis return to work or report being in a
relationship (Dondé et al., 2023). Schizophrenia is associated with deficiencies in a
number of cognitive functions that result in problems of abstract thinking and
make it difficult to deal with psychological and social challenges in daily life.
(Deshpande, Bhatia, Mohandas & Nimgaonkar, 2016).
 Schizophrenia, one of the most devastating mental illnesses in the world, is
associated with recurrence, a high hospitalization rate, decreased capacity to work,
early death, and huge economic expenses on a global world. Schizophrenic patients
experience stigmatization, which leads to discrimination, and negatively affects
their access to housing, healthcare services, education, job, and social interactions.
Life expectancy and quality of life are impacted by schizophrenia. This may have a
big influence on society and people with schizophrenia (Mahmoud, Ali & Bassma,
2021).

Epidemiology of schizophrenia
According to Zwicker, Denovan-Wright, and Uher (2018), 1% of the world's
population has been diagnosed with schizophrenia, which means that over 21
million individuals experience schizophrenia illnesses at any given moment
(WHO, 2018). According to Orrico-Sánchez, López-Lacort, Muoz-Quiles,
Sanfélix-Gimeno & Dez-Domingo (2020) seven people out of every 1000 will
experience schizophrenia at some point in their lives. 12 million men and 9 million
women worldwide suffer from schizophrenia.

The most prevalent type of psychiatric illness in Egypt is schizophrenia,

which accounts for the majority of admissions at our mental hospital (Fouad, &
Fawzi, 2013). One percent of the population in Egypt has schizophrenia (Sabry,
Rabie, Shaker, Noby & Ali, 2017).

Schizophrenia is first manifests between the late teen years and the mid-30s.
The first psychotic episode often begins in men when they are in their early to
middle 20s, while it does in women when they are in their late 20s. Because
schizophrenia begins in women later than in men, the clinical symptoms are also
less severe in women. This might be as a result of estrogen's anti-dopaminergic
effects. Although the illness's initial five to ten years might be turbulent and
stormy, this time is typically followed by decades of somewhat stable symptoms
(though a return to baseline is unlikely) (APA, 2013).

According to epidemiological data, people from lower socioeconomic

classes experience schizophrenia symptoms more frequently than people from
higher socioeconomic classes. Conditions associated with poverty, like congested
housing accommodations, poor nutrition, a loss of prenatal care, a shortage of
funds to deal with stressful situations, and emotions of powerlessness and
helplessness to break the cycle of poverty, can be used to illustrate this (Puri &
Treasaden, 2011).

The core characteristics of schizophrenia

1. Positive symptoms, also known as psychotic symptoms where there is a lack
of reality contact such as delusions and hallucinations. The positive
symptoms have a tendency to relapse and remit, extended psychotic
symptoms, although some patients feel residual prolonged psychotic
symptoms.
2. Negative symptoms, which includes in specific impaired motivation, drop in
spontaneous speech, social withdrawal.
3. Cognition deterioration: Cognitive signs are the up-to date classification in
schizophrenia. These symptoms are not specific and therefore, they should
be severe enough for the others to notice them. Cognitive symptoms
comprise disorganized speech, attention, and thought, eventually impairing
the person’s capability to communicate (Paul, Strauss, Gates-Woodyatt,
Barchard & Allen, 2023). The negative and cognitive symptoms have a
 tendency to be chronic and are related to long-term effects on societal
function (Fatani et al., 2017).

The initial psychotic episode typically follows social withdrawal, among

other atypical (schizoid) behavior patterns; however, some people may display no
abnormalities at all. Characteristics of a psychotic episode include patient
symptoms and behavior (sometimes referred to as psychotic characteristics) that
reflect the "false reality" that has developed in the patient's awareness. Sometimes
occurring in late adolescence or early adulthood, the first attack of psychosis is
frequently preceded by a prodromal stage known as at risk mental state. In
addition, premorbid cognitive and social competence deficiencies go back a very
long time as well. However, in other instances, previously healthy people develop
the condition suddenly and abrupt (Fatani et al., 2017).

Symptoms frequently develop gradually over time, start in young adulthood,

and seldom go away (National Institute of Mental Health [NIMH], 2016). A small
percentage of people with schizophrenia may fully recover, and around half of
individuals with the diagnosis will have considerable improvements over time with
no subsequent relapses. Serious forms of schizophrenia may necessitate frequent
hospital admissions (Vita & Barlati, 2018). A permanent disability will affect the
other half (Lawrence, First & Lieberman, 2015).

Predisposing factors
There is no recognized exact etiology of schizophrenia. According to
studies, a person may be more susceptible to develp schizophrenia due to a mixture
of genetic, psychological, and environmental factor (Janoutová et al., 2016).
 Biological Factors (hereditary)

It has been clear that certain families are seeing a rise in the occurrence of
schizophrenia almost since it was initially discovered. Others accepted the harmful
effects of the environment alone, while some maintained that only hereditary
elements are involved. The development of schizophrenia is now understood to be
predisposed by both hereditary and environmental factors. The heredity of
schizophrenia has been estimated to be up to 80% (Hosak, 2013).

In identical twins, the potential of one twin developing schizophrenia is as

high as 48% if the other twin also has the schizophrenia, while in non - identical
twins, the risk is between 12% and 14%. When both parents have schizophrenia,
the potential that their offspring would get the disorder is around 40%. If one
parent is affected, the risk of developing schizophrenia in their offspring is about
13% (Hersen & Beidel, 2011).

 Neuroanatomical factors
There are several generalized micro and macro neuroanatomical
abnormalities that are linked to schizophrenia disease. With significant cortical and
cerebellar atrophy, micro-abnormalities have also been seen. And macro
abnormality as, the cerebral lateral ventricles are often expanded, the third
ventricle is typically increased, and the amount of grey matter is generally
diminished, Amygdala and hippocampus volume loss in the temporal lobe is more
pronounced on the left side. Monozygotic twins with one twin suffering from
schizophrenia had a smaller total brain capacity (Castle & Buckley, 2011).
 Neurotransmitters factors (Biochemical)
Multiple biochemical pathways likely contribute to schizophrenia, which is
why detecting one particular abnormality is difficult. Based mostly on how patients
react to psychoactive substances, a variety of neurotransmitters have been
connected to this condition. Common neurotransmitters implicated in the reason of
schizophrenia include dopamine, serotonin, norepinephrine, GABA, and glutamate
(Ayano, 2016).

Dopamine hypothesis proven by two observations as:

First, The Phenothiazine medication class, which blocks dopamine activity,
may be able to lessen psychotic symptoms, which led to the first finding that
dopamine plays a role in schizophrenia. Second, disulfiram drug inhibits dopamine
hydroxylase and exacerbates schizophrenia, whereas amphetamines stimulate
dopamine release and can cause a paranoid psychosis (Maia & Frank, 2017).

Glutamate plays a significant role in schizophrenia, according to the

Glutamate Hypothesis, which links impaired glutamate receptor activity to
schizophrenia's pathogenesis. Consumption of phencyclidine and ketamine, a
glutamate antagonist, creates an acute syndrome equivalent to schizophrenia and
mimics cognitive issues associated with it. These facts have been largely supported
by incredibly low levels of glutamate receptors discovered in postmortem brains of
people who had previously been diagnosed with schizophrenia (Ma et al., 2023).

Serotonin excess is implicated as the source of both the positive and

negative symptoms of schizophrenia, according to another evidence for the
schizophrenia. The viability of this hypothesis has been aided by the serotonin
antagonist properties of clozapine and other second-generation antipsychotics
(SGA), as well as clozapine's ability to reduce positive feelings in long-term
clients. Selective neuronal degeneration within the norepinephrine reward neural
system may be responsible for loss of interest in schizophrenic patients, according
to research on norepinephrine neurotransmitters and the pathophysiology of
schizophrenia illness (Sadock, B. J., Sadock, V. A & Ruiz, 2015).

 Psychological factors

 Sigmund Freud

A conflict between the id, ego, and superego results from the patient's
extremely traumatic childhood experiences, according to the psychodynamic
interpretation. Regression to the initial phases of psychosexual stages or obsession
comes from this conflict if it is not resolved. In particular, basic narcissism, a
period of the oral development where the ego was still attached to the id, is linked
to schizophrenia. The person thus ceases to function according to the reality
principle (Kline, 2013).

 Theories of psychoanalysis
According to Sullivan, schizophrenia is a disorder of interpersonal
relationships and described that schizophrenia is an appropriate strategy used to
avoid panic, horror, and the dissolution of the sense of self. The patient's extreme
anxiety causes a sense of relatedness that is transformed into parataxis
abnormalities, which are typically persecutory but not always. Throughout
development, accumulating experiencing traumas have been the cause of
pathological anxiety. That adaptation problems and ongoing stress were the two
main causes of schizophrenia (Sullivan, 2013).

 The Family Theory

 There are several hypotheses on how family influences the onset of
schizophrenia (Kotrotsiou, Papathanasiou & Kotrotsiou, 2019).

Double-Bind Communication hypothesis

Previously, was formerly thought to be the root of schizophrenia
maladaptation. The basic nature of the double-bind phenomenon is that the child
receives two opposing massages from the parents, both of which must be obeyed.
For example, the parents hold out his arms and says, “Come here and give me a
hug”; when the child responds, the parents pushes the child away and says, “Why
would I want to touch a bad boy like you?” The child is punished if he expresses
love for the parent and if he does not; he can find no way out of the situation
(Bateson, Jackson, Haley & Weakland, 1956).

Skewed Families and Marital Schism

Theodore Lidz gave two examples of atypical family behavior patterns. The
Skewed family is a power struggle between the parents and the subsequent
domination of one parent, which results in a distorted connection between a kid
and one parent. The other form of family, Schism family is one parent becomes too
attached to a child who is the opposite gender in a certain family type when there is
a clear divide between the parents. These dynamics show how little schizophrenic
individuals can adjust to their environment (Lidz, 1973).

Expressed Emotion Theory

The notion of expressed emotion draws attention to the environment in the
house as a representation of the family's emotional attitude toward the person,
which may be either good or negative and is expressed via the conduct of the
patient. Regardless of whether these feelings are pleasant or negative, studies claim
that they place an unreasonable strain on the patient (Skotnik & Samochowiec,
2018).

Expressed Emotion (EE) is a sign of emotions and reactions to a family

member who has a mental illness that a relative has shown. Feeling is transmitted
through the three traits of over-involvement, anger, and criticism. Families with
strong expressed emotion overtly exhibit negative remarks, hostility, or emotional
over-engagement with the patient (Hooley & Hoffman, 1999).

 Environmental precipitating factor

Birth and pregnancy difficulties
Results supporting developmental and non-genetic theories of the disease
have been obtained from the quest for a link between birth difficulties and
schizophrenia (Dorrington et al., 2014). Fetal hypoxia is the most commonly
documented complication that could be a risk factor. Preeclampsia, abnormalities,
and suction extraction during delivery are birth problems that may raise the chance
of developing schizophrenia. Children of moms with schizophrenia are most likely
to experience some type of prenatal harm (Vigod et al., 2014).

Birthdate, location of birth, and seasonal influences

Schizophrenia often affects persons born at the end of winter and beginning
of spring. Winter is the high season for influenza and other acute respiratory tract
infections (a flu epidemic) (Martínez-Ortega et al., 2011; Schwartz, 2011).
Influenza virus infection during pregnancy is a known risk factor for
neurodevelopmental abnormalities in the offspring, including the risk of
schizophrenia (Landreau et al., 2012).
 The fact that sunlight supplies the body with about 90% of the necessary
vitamin D is very significant. Lack of the vitamin (D) can cause insufficient fetal
growth factor in pregnant women, which can harm the fetus's brain growth.
Neonatal vitamin D concentrations are linked to increased risk of schizophrenia in
both high and low levels and concentrations (McGrath, Saha, Chant & Welham,
2008).

The risk of schizophrenia is around twofold for those born in cities or urban;
the higher the population density, the greater the risk. According to Szöke et al.
(2014), excessive noise, crime, pollution, stress, the availability of illegal drugs,
family dissolution, and other unfavorable aspects of the urban lifestyle may all
have a role in the development of schizophrenia.

Infection
The evidence suggesting an infectious cause of the illness is generally
circumstantial and indirect. It cannot, however, be disregarded. Bacterial,
protozoal, and viral infections are the causes of acute and subacute alterations
(Flegr et al., 2014; Konat, 2016).

Misuse of Alcohol, other Drugs and Smoking:

Cannabis, alcohol, and cigarettes are the drugs that are most often misused
(Pushpa-Rajah et al., 2015). Smoking dependence is common among people with
schizophrenia (Le Foll, Ng, Di Ciano & Trigo, 2015). 50% of people with
schizophrenia have been found to misuse alcohol, another addictive drug (Thoma
& Daum, 2013).
Schizophrenia Diagnostic Criteria in the DSM-V:
Diagnostic Statistical Manual of Mental Disorders (5th ed) DSM-5 states that
six criteria must be met in order to diagnose schizophrenia (APA, 2013).

A) Minimum of two (or more) of the items listed below must each be
present throughout the majority of a given month (or less if successfully treated).
(1), (2), or (3) must apply to at least one of the following:
 Delusions.
 Hallucinations.
 Disorganized speech (e.g., frequent derailment or incoherence).
 Grossly disorganized or catatonic behavior.
 Negative symptoms (i.e., diminished emotional expression or avolition).

B) For a significant portion of the time since the onset of the disturbance,
level of functioning in one or more major areas, such as work, interpersonal
relations, or self-care, is markedly below the level achieved prior to the onset (or
when the onset is in childhood or adolescence, there is failure to achieve expected
level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6-

month period must include at least 1 month of symptoms (or less if successfully
treated) that meet Criterion A (i.e., active-phase symptoms) and may include
periods of prodromal or residual symptoms. During these prodromal or residual
periods, the signs of the disturbance may be manifested by only negative
symptoms or by two or more symptoms listed in Criterion A present in an
attenuated form (e.g., odd beliefs, unusual perceptual experiences).
 D. Schizoaffective disorder and depressive or bipolar disorder with
psychotic features have been ruled out because either 1) no major depressive or
manic episodes have occurred concurrently with the active-phase symptoms, or 2)
If mood episodes have occurred during active-phase symptoms, they have been
present for a minority of the total duration of the active and residual periods of the
illness.

E. The disturbance is not attributable to the physiological effects of a

substance (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication

disorder of child hood onset, the additional diagnosis of schizophrenia is made
only if prominent delusions or hallucinations, in addition to the other required
symptoms of schizophrenia, are also present for at least 1 month (or less if
successfully treated).

The schizophrenia Course

1. Prodromal phase, most schizophrenic patients gradually have symptoms.
They generally begin with problems in general responsibilities,
relationships, learning and working. Moreover, their loss interest in
personal hygiene cares and withdraws from other people. Some may have
unusual behavior, which is not yet bizarre; however, relatives or close
friends usually notice these changes. The onset and duration of this phase
is uncertain, but it takes about one year before the symptoms become
active (Wójciak, Remlinger-Molenda, & Rybakowski, 2016).
2. The active stage in this stage, schizophrenic symptoms become apparent.
The majority of the symptoms, such delusions, hallucinations, illogical
speech, or strange behavior is favorable. In this stage, family and friends
 typically become aware of the symptoms and accompany the sufferers to
get medical help (Agius, Goh, Ulhaq & McGorry, 2010).

3. The residual phase. The symptoms resemble those of the prodromal

phase quite closely. Although they are not severely impacted, the patients
may still experience have hallucinations or delusions. According to
research by Wojciak, Remlinger-Molenda, and Rybakowski (2016),
depression affects 25% of people with schizophrenia.

According to Andreasen, 2010, Schizophrenia impacts a person's ability to

communicate, see the world, and have a sense of self.   As a result, it is typical to
see that persons with schizophrenia constantly struggle to feel and express their
emotions, build connections with others, interpret their previous experiences, and
make plans for the future. Additionally, some of the symptoms, such hallucinations
and delusions, cause intense emotional pain on a personal level. These
characteristics of schizophrenia severely impair and harm a patient's ability to
enjoy social interactions with family and friends and cause them to feel helpless
and powerless throughout their whole life and also effect on quality of life
(Friedman, Kanellopoulou, Novakovic, Albert & Wood, 2012).

Learned Helplessness
Overview
It is generally known that people with schizophrenia might struggle with
intense emotions of helplessness and powerlessness as well as a fragile sense of
wellbeing. Studies of the connections between helplessness, powerlessness, and
characteristics of the illness in schizophrenia have concentrated on the positive
symptoms. More extreme levels of positive symptoms are associated with higher
levels of subjective discomfort, indicating that severe symptomatology is
inherently disabling and causes emotions of powerlessness and helplessness
(Lysaker, Clements, Wright, Evans & Marks, 2001; Sharp, J. G., Sharp, J. C. &
Young 2020).

The emergence and persistence of positive symptoms in psychosis and

depressed symptoms in mood and psychotic illnesses are related to helplessness
(Ottman et al., 2019). Helplessness and hopelessness predicts a worse global
functioning and is a risk factor for suicidal behavior, its assessment must be an
essential issue to protect and promote the recovery of people with schizophrenia
(Monfort-Escrig & Pena-Garijo, 2021).

According to Kilday, 2013, apparent loss of hope has also been observed in
mental patients. When a hospital caught fire, some patients had to be forcibly
removed from the building because they would have stayed and died rather than
escape the fire. This failure to escape from something that should be considered
harmful when given the opportunity is learned helplessness.

This idea supported before by (Seligman & Maier, 1967), when describe the
idea of "learned helplessness" is widely accepted in both experimental and clinical.
The failure of certain experimental animals to avoid or escape shock when given
the chance to do so after prior exposure to inescapable shock is where the notion
initially appeared.

Since then, the phrase has come to refer to people's inability to find, use, or
acquire adaptive procedural actions, which is particularly pronounced in mental ill
people who appear to have given up on the idea of being able to effectively
manage significant environmental events and situation by voluntary action
(Seligman, 1975).

An understanding of the negative effects of being unable to control and

powerlessness significant environmental occurrences was a crucial initial step in
thinking that made this development possible. This limitation results in the
phenomena of learned helplessness (Maier, Peterson & Schwartz, 2000). And other
description of phenomenon of learned helplessness is a person's viewpoint may
change over time to become gloomy, giving them a false sense of control over their
circumstances. Develop a sense of helplessness when human efforts to change
unpleasant situations in their surroundings seem to be ineffective (Seligman,
1975).

The condition of learned helplessness, in which a person fails to benefit from

control even while the situation is objectively manageable, can be brought on
through exposure to uncontrollable events (Maier and Watkins 2000). Ziegler,
Gläser-Zikuda, Kopp, Bedenlier & Händel (2020) defined helplessness as
"hopelessness and despair learnt when a human senses no control over repeated
unfavorable situations and events."

Helplessness is thought to cause deficiencies in behavior, motivation,

emotions, and cognition (Wu and Tu 2019). Indeed, studies have consistently
demonstrated that the perception of one's own helplessness is linked to a wide
range of behavioral, personal, and social issues as well as negative emotions like
boredom and maladaptive behavior types such as internalizing (e.g. withdrawal,
depression) and externalizing problems (e.g. delinquent and aggressive behavior)
(Sorrenti et al., 2019).

The causes of helplessness and its (unfavorable) effects are still not fully
understood scientifically. This is partly because the phrase is not consistently used
(Ziegler et al., 2020). When a person feels helpless, nothing they choose to do have
any impact on what is occurring. Following the idea that whatever a person
accomplishes doesn't matter, it is the quitting or giving up response that is in
consideration (Nuvvula, 2016).

People suffering from LH accept that bad things will take place and they will
have little control over them. Those who are exposed to complex problems for an
extended period learn that responses and events are unconnected. Learning attained
in this situation weakens imminent learning and leads to inactivity. Consequently,
they will be unsuccessful to resolve any concern even if there is a possible solution
for the concern (Mohanty, Pradhan & Jena, 2015).

Theory of Learned Helplessness

The central idea behind learned helplessness theory is that the aversive
stimulus is uncontrollable. This means that the presence or absence of the aversive
stimulus is not under the control of any behavior. Uncontrollability is most
prominent when the probability of an outcome is equal in the presence and absence
of behavior (Maier & Seligman, 1976).

Two of the pretreated animals' behaviors, which Seligman has termed

"learned helplessness," are as follows:
1. The inability or delay in the beginning of reactions to avoid shock.
2. The failure to understand the connection between response and ending
unpleasant stimulus is the second issue (Fibel, 1976).

The three components of uncontrollability's consequences are motivational

deficits, cognitive deficits, and emotional deficits.

A) Lack of Motivation:
In the first stage of the learned helplessness hypothesis, a loss in motivation
is defined as a reduced response to an escapable unpleasant stimuli following
exposure to an inescapable aversive stimulus (Maier & Seligman, 1976). When
offered the chance to avoid (prevent) shocks after being exposed to uncontrolled
shocks, participants not only fail to do so but also refuse to do so. Accordingly,
uncontrollability seems to impair the desire to engage in prophylactic action in
addition to preventing the development of escape behavior, as shown by Overmier
and Seligman (1967) In comparison to dogs that weren't first exposed to
unavoidable stimuli, dogs who were first exposed to unavoidable stimuli had a
harder time evading following avoidable shocks.
B) Lack of Cognition:
Even if a reaction is successful in ending an unpleasant stimulus, the
uncontrollability of the undesired behavior may prevent the responder from
understanding this. Cognitive deficit is the term used to describe this failure in one-
trial learning. The lack of one-trial learning is used by the authors as proof that
learning cannot occur for people who have previously seen an unavoidable
unpleasant stimuli with just one right answer. This is especially startling when you
realize that experimentally untrained individuals can learn from just one accurate
response (Maier & Seligman, 1976).

Seligman, Maier, and Geer (1979) were conducted empirical research to

prove impact that Uncontrollability predicts that even after an escape reaction has
been made, the subject will find it difficult to realize that the escape response
removed the unpleasant stimulus, making it unlikely that they would make any
further escape responses.

When later tested with escapable shocks within a shuttle box after having
previously been subjected to inescapable shocks, the dogs failed to exhibit escape
tendencies. The dogs were crated and trained to initiate a flight reaction by being
pulled from one end of the shuttle box to the other in order to lessen the impact of
the uncontrolled unpleasant stimuli. Although it took some time, this strategy was
successful in lessening the learned helplessness impact (Kilday, 2013).

C) Lack of Emotion:
A fear or terror reaction to the unpleasant stimuli is the end result of
uncontrolled unpleasant stimuli, known as emotional deficits. According to Maier
and Seligman (1976), a fear or terror response would persist in the face of
uncontrollable unpleasant stimuli until the subject discovers whether the
unpleasant stimulus is controlled or uncontrolled. Terror and fear-related physical
manifestations include loss of weight, stomach ulcer development, more
defecation, and excessive drinking. When the subject realizes they have control
over the aversive stimuli, their level of anxiety and fear decreases, which in turn
results in less general movement after an escape reaction. However, if the person
realizes they have no control over the unpleasant stimuli, anxiety may give way to
despair, which causes diminished response.

Seligman (1972) recognized and outlined learned helplessness caused by the

motivational, cognitive, and emotional deficits, including (a) a delay in eliciting a
voluntary response (motivation), (b) a delay in understanding how behaviors can
prevent future trauma, and (c) an increase in emotional stress when faced with
uncontrollable trauma compared to equivalent controllable trauma (emotion).

The Learned Helplessness Theory is illustrated in Figure 1 below. Our idea

will serve as the basis for this investigation into helplessness and negative
symptoms especially depressed mood in schizophrenic patients. An individual is
driven to take action to change the situation when they encounter situational
elements including stress, difficulty, and unpleasant circumstances. The notion of
situation-based response-outcome independence is brought about by the inability
of such an action to alter the undesirable stimuli. Through repeated unsuccessful
attempts to modify the unwanted stimuli, the person suffers detrimental impacts to
motivation, cognition, and emotion, which results in a condition of learned
helplessness (Seligman, 1975).
 Figure (1): Diagram of Learned Helplessness Theory (Hiver & Larsen-Freeman, 2019).

According to this idea, when someone views a situation as an unpleasant

stress or challenge, learned helplessness first develops. The person then thinks
about possible ways to influence the circumstance so that it is less difficult,
stressful, and/or beneficial. An expectation of response-outcome independence is
developed through several unsuccessful attempts to change the circumstance to
produce a result desired by the human. The Learned Helplessness Theory bases its
core message on the independence of reaction and result. When people or animals
observe results coming about without any identity activity, they develop the
assumption that there will never again be a connection between their conduct and
the result (Maier & Seligman 1976).

According to Alloy & Seligman (1979), the individual experiences

frustration due to the perceived unpredictability and uncontrollability of the
observed event. As a consequence, the person discovers that how he or she reacts
to a circumstance and the result that follows are independent of one another. This
response-outcome independence decreases the person's chance of attempting to
begin a response in subsequent similar or related events; as a result, additional
learning of ways to bring about change is impeded. The environment in which
learned helplessness develops is one of impeded learning and the impression of
response-outcome independence.

Nuvvula (2016) describe helplessness if when a person feels helpless,

nothing they choose to do have any impact on what is occurring. When a person
comes to the conclusion that their actions are meaningless, they tend to give up or
stop. This definition's distinction between the objective and subjective aspects of
helplessness is a noteworthy feature. The first phrase presumes an objective
situation and the second one a subjective response to it. The earliest stage of
helplessness research, which examined helpless behavior in animals, was
dominated by the emphasis on the objective side. Research emphasis significantly
switched to the subjective side of understanding objective situations as its flaws
grew more and more evident.

Factors in the Explanation of Helplessness

People's perception of consequences independent of their conduct was the
initial theory for why people feel powerless and helpless. But being helpless refers
to more than just being unable to effect specific results. A lot of scholars pointed
out issues with such a limited answer. For instance, some individuals upped their
efforts and enhanced their performance rather than becoming helpless. The
individual perception of the negative, uncontrolled occurrence thus became the
main problem. According to the "attribution reformulation" of acquired
helplessness, helplessness was not caused just by inescapability and the feeling of
non-contingency. Instead, the participants' justifications for the reasons why the
non-contingency occurred predicted how powerless and helpless they would feel
(Hiver & Larsen-Freeman, 2019).

Abramson, Seligman & Teasdale (1978), utilizing attribution theory.

According to their hypothesis, people categorized bad experiences differently
depending on whether they were internal or external, stable or unstable, or global
or specialized. They hypothesized that persons were more likely to experience
depression than those who ascribed bad occurrences to causes at the other extremes
of the scales if they were more inclined to attribute negative events to internal,
stable, and global causes:
 A person makes a global attribution when they think that a negative
event's root cause is constant across contexts.
 A specific attribution happens when the person thinks that a specific
circumstance is the only one that could have caused a negative
incident.
 When someone thinks the cause is constant across time, they have a
stable attribution.
 When a person believes that the cause is particular to a certain
moment in time, this is known as an unstable attribution.
 While an internal attribution attributes causation to elements within
the person
 An external attribution assigns causality to situational or external
circumstances (Peterson, Maier & Seligman, 1993; Weiner, 2012).

Helplessness, negative self examination, pessimism and other negative

thoughts cause the depressive feelings, so patients with schizophrenia always see
the negative side and assume that they fail in whatever they do. As a positive
psychological capital, hope is often thought to be a protective factor that can be
used by these patients to face risks and prevent feelings of helplessness and
pessimism that arise from illness. Having a sense of hope can also contribute to
one’s belief that the recovery is feasible and can enhance one’s motivation to
engage in the recovery process (Abdo, Lachine & Mousa, 2022).

According to Winterflood & Climie (2020), Accomplishment in physical

and mental health and social well-being are just a few areas where learned
helplessness can have an effect on one's daily functioning. Additionally linked to a
number of mental illnesses is learned helplessness. It is a key component of
sadness and may make many diseases, such as anxiety, depression, and negative
symptoms in schizophrenia, worse by bringing out their unpleasant symptoms.
Effective strategies for overcoming acquired helplessness include pharmaceutical
therapies and non-pharmacological therapy as empowerment intervention.

Even after a partial or complete remission of symptoms, helplessness may

still have a significant impact on the patient's behavior and cognition, notably as
secondary unpleasant symptoms and poor psychosocial functioning. Helplessness
might thus, if established, represent a major barrier to the success of therapy and
rehabilitation. With regard to schizophrenia patients' quality of life (QoL), being of
assistance, hopeful, and optimistic is crucial (Martin, 2015). Six major areas were
discovered by QOL in mental health difficulties, including serious mental diseases
like schizophrenia: symptoms, belongingness, independence, self-perception,
activity, hope, powerlessness, and helplessness (Durgoji, Muliyala, Jayarajan &
Chaturvedi, 2019).
 Quality of Life (QoL)

Quality of life (QoL), which evolved during the post-World War II time to
improve the post-war economic affluence and standards of living, is a
comprehensive view of health from a bio-psycho-social perspective. This point of
view developed out of a perceived need to build on the achievements of modern
medicine to better quality of life in the case of long-term severe illnesses.
Sociologists, whose population-based QoL research has a substantial impact on
social indices, discovered several broad concepts. Work, family, wealth, religion,
and the environment are some of the common areas of quality of life (QoL) that
have always been covered (Alshowkan, Curtis & White, 2015).

About 20% of those with schizophrenia tend to have a good path, and a tiny
percentage of those people reportedly make a full recovery. The idea of treatment
has changed, placing greater focus on patient viewpoints like quality of life.
Numerous aspects of functioning are impacted by schizophrenia; those who suffer
from the condition frequently live alone and marginally, have low incomes, limited
education, and poor social and occupational skills. Most people work at lower
levels, and the bulk of them only interact with people outside of their families
occasionally. Patients with schizophrenia are also more likely to experience
stigma, which reduces their quality of life and chances (Ayano, 2016).

Kennedy, Altar, Taylor, Degtiar & Hornberger (2014), found link between
lower QOL and schizophrenia. Schizophrenia is a progressive illness distinguished
by its devastating progression. High levels of functional impairment result in
missed pay, work deterioration, and other individual, social, and financial
consequences.
 People with schizophrenia experience worse living circumstances and a
lower quality of life as a result of their current depressive and positive symptoms,
which are linked to struggles with finances, careers, relationships, and daily
functioning in clients who endure lengthy hospital stays, delayed recovery, and
subpar treatment outcomes, all of which significantly lower their quality of life
(de Pinho, Pereira, Chaves & Batista, 2018; de Almeida, Braga, Neto & de Mattos
Pimenta, 2013).

According to Pitkänen (2010), schizophrenic patients are seen as people

whose quality of life (QoL) may be compromised for a variety of reasons as a
result of their illness, so improving their QoL should be the primary goal of
treatment. As a result, services for mental illness should transition from a strong
focus on therapies centered on decreasing manifestations, in light of a limited
conception of health and disease, to a more comprehensive approach that takes into
account quality of life, well-being, and over function. QoL is a more important
result of mental health care (Hsiao, Lu, & Tsai, 2018).

Quality of life has gained importance as an outcome measure in psychiatry

over the past several years as it shows the success of psychosocial therapies and/or
pharmaceutical treatments. In addition, it offers a more comprehensive perspective
of an individual than symptom reduction alone (Picco et al., 2016).

The measurement of QOL, a multidimensional construct proposed as a

population health indicator, is used to enhance health promotion initiatives. A
person's quality of life (QOL), which includes physical, psychological,
independence level, social relationships, environmental, and spiritual pattern
domains, is defined as "individual perception of one's own stance in the context of
the culture and value system in which person is living and about person's goals,
expectations, standards, and concerns." Such characteristics as functional ability,
pain, general and mental health, energy, social factors, and emotional components
could be assessed using instruments measuring the quality of life (Almeida-Brasil
et al., 2017).

The improvement of quality of life and overall wellbeing is the "primary aim
of every government healthcare approach." The quality of life has been regarded as
a crucial element of functional success in any rehabilitation program. Healthy
living is only one aspect of high quality of life. The total of a person's physical,
social, emotional, spiritual, and occupational well-being may be represented by it
on an essential and important level (ElGhonemy, Meguid & Soltan, 2012).

The quality of life (QoL) of schizophrenic patients and their families is

crucial. However, the use of QoL indicators may help with enhanced patient
intervention adherence, stronger contentment with care, enhanced health outcomes
and lower healthcare expenditures. A new viewpoint on health known as QoL
evolved from a perceived need to balance and complement the achievements of
modern medicine to enhance QoL in situations of serious, chronic, and terminal
illnesses (Boyer et al., 2013).

Definition of quality of life

According to Pitkänen (2010), having a high quality of life includes "having
favorable psychological perspective and emotional well-being, good physical and
mental health, and the physical capabilities to do the things they desire to do,
having good relationships with family and friends, engaging in social activities and
recreation, living in a safe neighborhood with excellent resources and facilities,
having sufficient income, and being independent."

Quality of life (QOL) as a person's surroundings, social interactions, amount

of independence, belief of persons and psychological condition, all of which are
influenced by values and cultural systems (WHO, 2014).

In nursing literature the definition of QoL has followed definitions in other

fields, with an emphasis on the concept's multidimensionality (Padilla, Grant &
Ferrell, 1992). According to Forchuk, (1991), the mother of psychiatric nursing
and nursing theorist defined QoL as an all-encompassing concept that encompasses
almost all facets of living. According to her, quality of life is essentially a
perspective or notion that people develop after perceiving, watching, or
instinctively understanding the significance of anything they have encountered.
The core of a circumstance, a string of occurrences, or a current perspective on
one's life during a specific time period, in part or in full, is not an experience per se
but rather an opinion or judgment. Life quality is therefore influenced by both time
and circumstance. Peplau (1994), Based on a review of the literature, Penckofer,
Byrn, Mumby & Ferrans (2011) argued that the essential components of QoL are:

1. "a sense of satisfaction with one's life in general,"

2. "the mental capacity to evaluate one's own life as satisfactory or not,"
3. "An acceptable state of physical, mental, social, and emotional health
as determined by the individual referred to,"
4. "An objective assessment by another that the person's living
conditions are adequate and not life-threatening”. "
 The idea of quality of life is relevant for diseases with a chronic course and
when long-term therapy is necessary. In terms of the QoL, schizophrenia and other
medical conditions that have a protracted course have a lot in common. However,
there are several distinctions that may be specific to schizophrenia, such as how
psychopathology and symptoms affect QoL as well as the adverse effects of
treatments. The concept of QoL is currently recognized as a multidimensional
construct that includes subjective and objective measurements (Durgoji et al.,
2019).

Measurement of quality of life:

Both subjective and objective methods have been used to evaluate the
quality of life (QoL) of people with schizophrenia:
A) Subjective measures of quality of life (QoL) encompass a variety of life
domains, such as overall indices of life satisfaction and contentment with one's
employment, family, social relationships, money, and housing status.
B) The socio-demographic data, a person's position in society, and external
life situations are often included in the objective assessments of quality of life
(Desalegn, Girma & Abdeta, 2020).

Extreme psychiatric disorders as schizophrenia was classified into six

categories of QOL, including autonomy, symptoms, self-perception,
belongingness, hope, activity, powerlessness and helplessness. Significant factors
influencing QOL in people with schizophrenia, such as religion, spirituality, and
the family's function in a culture that leans more toward collectivism than toward
individualism may be (Durgoji et al., 2019).
Schizophrenia's Effects on a Patient's Quality of Life
Schizophrenia sufferers may become less functional, which has an adverse
impact on their capacity to carry out everyday tasks. Impairments in
neurocognitive function linked to issues with comprehension abilities, working
memory, information processing, concentration, and problem-solving abilities.
Additionally, people with schizophrenia frequently experience stigma and
prejudice, struggle to establish social connections, and have impaired social
functioning. They struggle to manage their sickness on their own in this situation,
which lowers their QoL (Gomes et al, 2016).

In schizophrenia patients, some factors lower QoL. When designing

interventions to improve patients' QoL, these aspects must be taken into
consideration. The WHOQOL Group's conceptualization of QoL domains—
psychological domain, physiological domain, degree of independence, social
connections, and surroundings be used to illustrate the aspects connected to
decreased QoL (World Health Organization quality of life assessment [WHOQoL],
1998). (Figure.2)

The multifaceted notion of quality of life (QoL) was first seen as an addition
to the conventional ideas of functionality and healthy. An individual's functional,
social, physiological and psychological health would all be evaluated as part of a
perfect and comprehensive health assessment. As new technologies have either
increased QoL without extending life or have prolonged life, sometimes at the
price of QoL, this idea has gained greater traction in the field of health care and
intervention. Therefore, it is now necessary to evaluate health-related quality of life
(HRQoL), as measures of outcomes like mortality rates and life expectancy alone
are no longer sufficient (Karimi & Brazier, 2016).
PSYCHOLOGICAL DOMAIN
 Psychiatric symptoms (e.g.
anxiety, depression, psychosis)
 Side effects of medication
 Low self-efficacy
 Low self-esteem
 Perceived stigma
 Negative coping
 strategies Negative attitude
toward antipsychotic
medication
 Weak problem-solving
ability
SOCIAL RELATIONSHIPS
 Poor social support
 Loneliness
 Unsatisfied amount of
contact with family members
LEVEL OF INDEPENDENCE
 Psychosocial dysfunction
PHYSICAL  High level of unmet needs
DOMAIN
 Low number of daily activities
 Physical
 Being admitted in a
symptoms
psychiatric hospital
 Many previous psychiatric
admissions
 Alcohol abuse
ENVIRONMENT
POOR
 Unemployment
SUBJECTIE
QUALITY  Dissatisfaction with work situation
OF LIFE  Insufficient financial means
 Meaningless leisure activities
 Few leisure activities
 Poor personal safety
 Being a victim of crime

Figure (2): Factors potentially impairing QoL in patients with schizophrenia grouped according
to the WHOQOL Group’s (1998) conception of QoL domains.

As a component of the multidimensional concept of health status, health-

related quality of life (HRQoL) is a measure of perceived physical and mental
health, encompassing functional ability, support networks, and socio - economic
status (Patrick & Erickson, 1993). Since the deindustrialization and public
rehabilitation of psychiatric patients, the practice of assessing HRQoL in chronic
disease has become well established and has also acquired popularity in severe
mental illness, such as schizophrenia (Kao & Huang, 2014). Such a review is
crucial for these patients because it examines other relevant aspects of their life in
addition to the immediate advantages of antipsychotics (such as decreased
psychotic symptoms) (de Almeida et al., 2020).

Schizophrenic patients have the opportunity to quality care, respectful

treatment, information, and the ability to make decisions on their own. The need to
reorient services toward objectives that are important to patients and improve
quality of life is highlighted by these new problems as well as by the quality
recommendations and guidelines for the treatment of schizophrenic patients. It is
no longer possible to describe outcomes just in terms of disease, but also in terms
of psychological health, everyday functioning, obtaining social opportunities, and
environmental assistance. Interventions to control symptoms are therefore
insufficient; rather, a more comprehensive approach is required, with the quality of
life of patients as the main priority (Bradstreet, 2006).

In order to assess the effectiveness of the care and therapies given to people
with schizophrenia, QoL evaluations have become crucial. A crucial component of
recovering from mental illness is taking a comprehensive perspective. Recovery is
the ability to have a fulfilling life, as determined by each individual, whether or not
they are experiencing symptoms. This comprehensive approach to treatment takes
into account all aspects of a person's quality of life, with a focus on a person's
strengths and a more upbeat attitude of psychiatric illness as schizophrenia
(Bradstreet & Mcbrierty, 2012).

Idea of therapy in mental health care needs to be replaced with the idea of
enhancing quality of life. Finding out how well they can improve the quality of life
for their users should be the major focus of evaluating mental health therapies,
especially rehabilitative interventions (Lehman, Ward & Linn, 1982; Gigantesco &
Giuliani, 2011).
 From the nurses’ descriptions of nursing interventions which they use to
support patients’ QoL five main categories (empowering interventions, social
interventions, activating interventions, security interventions and interventions
related to care planning) were identified. Nurses who improve patients' quality of
life through empowering interventions were defined as taking acts that demonstrate
interest, engage in conversation, encourage, provide knowledge, uphold optimism,
and motivate. Social interventions were defined by nurses as supporting patients'
families, providing patients with chances for social interaction or to complete their
education, and setting up social support. Activating interventions, which are acts
where nurses do activities with patients, plan activities, provide chances for
patients to participate in activities, and direct patients to activities, were defined as
ways that nurses promote patients' quality of life (Pitkänen, 2010).

The interaction between patients and nurses is the basis of psychiatric

nursing. The nurse-patient interaction can enhance QOL since human relationships
have a substantial impact on QOL. Quality of life offers a better and more
comprehensive perspective for such a connection, allowing patients to share their
own views and needs and to be active participants in their own treatment. Because
nursing stresses patients' reactions to the condition, their functional adaptability, as
well as comprehensive demands, nursing interventions in psychiatry is vital to
psychiatric treatment and patients' recovery (Kornhaber, Walsh, Duff & Walker,
2016; Mahmoud, Ali & Bassma, 2021).
 Recovery
Any mental disorder, including schizophrenia, may be recovered from by
regaining quality of life, taking on individual and societal responsibility, and
fortifying one's future resiliency. Recovery may also increase one's optimism and
sense of hope (De Sousa, Shah & Lodha, 2020).

The concept of recovery from a condition like schizophrenia is challenging

to define. Determining the criteria that would signify remission from a complicated
neuropsychiatric condition like schizophrenia has been a topic of discussion for
years. Wide approach of recovery includes "a very personal, unique process of
transforming one's attitudes, beliefs, feelings objectives, abilities, and/or roles." It
is a strategy for leading a fulfilling, optimistic, and useful life despite the
restrictions brought on by disorders (Anthony, 1993).

Recovery used to be viewed as being "cured from" or having all of the

symptoms of a mental illness "remitted" from the standpoint of medicine. This
viewpoint was constrictive in that those who had been diagnosed with a mental
disorder, as schizophrenia, could only be said to have recovered if they showed no
signs of the condition. However, many who have lived with schizophrenia in the
past connect healing with or without symptoms, that description in the past (Ng,
Chun & Tsun, 2012).

The idea of recovery in schizophrenia has been a crucial idea in the past 20
years when it comes to understanding and treating schizophrenia and other diseases
on the schizophrenia spectrum. Historically, "recovery" has been largely seen as a
result marked by symptom reduction or mitigation and enhancements in
functioning abilities. This perspective is based on the scientific model, which
emphasizes the symptomatic nature of mental diseases and the importance of
focused therapies to lower symptoms and limitations (Ahmed, Mabe & Buckley,
2011).

Since the second half of the 20th century, patient advocacy groups have
contested the notion that those who suffer schizophrenia are unable to lead
fulfilling lives. Even when psychotic symptoms are prolonged, recovery is
possible, according to patients (Bellack, 2006).

More lately and recently, a person's ability to take charge of their life and
making it individually significant and enjoyable has been identified as a sign of
recovery from psychiatric disorder (Roe, Mashiach-Eizenberg & Lysaker, 2011).
For those who are suffering with psychiatric illness, this idea of healing has the
capacity to inspire, empower, and strengthen realistic hope. However, given that
these definitions of recovery are framed within the framework of the industrialized
world, it is critical to comprehend how people in underdeveloped nations
experience schizophrenia recovery. Recovery is what individuals feel when they
are able to take control of their lives, live lives that are important and rewarding,
and feel a feeling of belonging in their specific society and/or culture (Nxumalo-
Ngubane, 2016).

Definition of Recovery:
Schizophrenia patients face considerable challenges and are frequently
unable to accomplish their goals in life. In mental health services across the world,
recovery has grown in importance as a component of treatment (Corrigan, Mueser,
Bond, Drake & Solomon, 2012). For schizophrenia, which has historically been
viewed as a disorder with a poor prognosis, recovery-oriented approaches have
become more popular. A personal and a clinical definition of recovery in
schizophrenia have been developed as a result of scientific and patient-based
influences (Slade, Amering & Oades, 2008).

In literature, the term "personal recovery" is frequently used to refer to the

patient-based description of recovery. The patient-based meaning of recovery was
created from the accounts of people who have dealt with mental disorders. Stories
from the patient movement have demonstrated that, despite persistent symptoms,
people with psychosis are capable of leading fulfilling lives. The phrase "the
creation of new meaning and purpose in one's life, as one develops beyond the
devastating impacts of mental illness" is the most often used patient-based
definition. The method of recovering from schizophrenia is not consistent and
differs from individual to individual (Van Eck, Burger, Vellinga, Schirmbeck & de
Haan, 2018).

Moreover, people with schizophrenia who have recovered have recognized

four crucial stages of personal rehabilitation: finding hope, reclaiming one's
identity, discovering one's purpose in life, and accepting responsibility for one's
own recovery. Have recognized comparable categories of personal recovery
processes, including CHIME (connectedness, hope, identity, meaning, and
empowerment) (Leamy, Bird, Le Boutillier, Williams & Slade, 2011).

Moreover, recovery is defined as remission of symptoms and improved

functional status is included in the clinical recovery definition. Remission is
defined by the Remission in Schizophrenia Working Group (RSWG) as a decrease
in the severity of core symptoms to the point that they no longer significantly
affect behavior. Operational requirements include receiving a moderate or lower
score on a few items of a symptom scale over a six-month period, such as the
Positive and Negative Syndrome Scale (PANSS) or the Brief Psychiatric Rating
Scale (BPRS) (Van Eck et al., 2018).

Having a meaningful and enjoyable life is what recovery is all about, as

determined by each individuals. Recovery doesn't always entail "clinical recovery,"
which is typically described in terms of symptoms and treatment; rather, it can also
entail "social recovery," which involves creating a life free of sickness without
necessarily eradicating its symptoms. People frequently characterize themselves as
being in recovery instead of having restored since recovery is often compared to a
journey with its unavoidable ups and downs. Recovery resembles a "healing
process" (Warner, 2013).

Recovery is merely a lovely dream, according to the idea's fundamental

notion, which seems more plausible. It claims that recovery is the optimum
condition, one in which (a) no medicine is required, (b) psychosocial functioning is
greater, and (c) interpersonal connections are fulfilling. Both individuals and
medical experts have diverse ideas of what constitutes a full recovery. In the event
that psychosocial functioning has improved, the latter can accept continued
medication and still declare recovery. It is recommended that, as physicians, we
focus less on symptom management and more on recovering from complicated
disorders like schizophrenia. Recovery is an individualized idea from a process
point of view, even though it may be scientifically defined as categorized concepts
of clinical and personal recovery or an understanding of the therapist and patient.
The course and degree of each patient's recovery are influenced by a number of
different variables (De Sousa, Shah & Lodha, 2020).
 According to Deegan (1996), recovery is a "way of life" and doesn't relate to
a finished product or outcome. ‘Recovery frequently entails self-transformation,
which requires accepting one's limitations as well as opening up to new
possibilities. The duality of recovery is that by acknowledging what we are unable
to accomplish or be, we may start to learn who we really are and what we're
capable of.

In addition to considering the fundamental elements of recovery

rehabilitation, mental health practitioners must consider the efficacy of rapport
building, which may serve as the initial step toward recovery. It is essential to
include personal objectives of a patient in medication and therapeutic goals in
order to strengthen the patient's will to heal. Although complete recovery from
psychological disorders, especially schizophrenia, can be challenging, the patient's
perception in recovery is essential for a successful treatment/therapeutic plan. This
perception aids in keeping the therapy and management process moving forward
(De Sousa, Shah & Lodha, 2020).

According to Schmolke, Amering & Svettini (2016), the meaning of

recovery includes performing inside those bounds of those aspects of life that are
inappropriate for people with disabilities. A person must consistently meet each of
the following requirements for two years in order to be deemed recovered from a
significant mental condition:
1. A persistent reduction of symptoms that make up the diagnosis at a
subclinical recurrence and intensity level;
2. Full- or part-time participation in a constructive, fruitful, and age-
appropriate instrumental role activity, such as employment or school;
3. leading a life free from parental or other caregiver oversight, including
 daily responsibilities for managing finances, medications, appointments,
shopping, food preparation, and personal property;
4. Pleasants family relationships;
5. Leisure hobbies in typical environments;
6. Positive peer connections characterized by involvement in an active
friendship, with friends, or through a social network.

Three key ideas that describe the recovery process include:

1. Hope: Without hope, healing is probably not possible. Hope is a crucial
component of recovery. It is necessary to maintain motivation and
encourage hopes for a personally fulfilling existence (Koh, 2005).

2. Agency: Agency refers to individuals feeling more in control of their life

and service users taking charge of their own issues, the services they
utilize, and their daily activities. It is focused on self-control, self-
determination, accountability, and option (Andresen, Oades & Caputi,
2003).

3. Opportunity: This connects rehabilitation to social inclusion and,

consequently, to people's involvement in a larger society. People with
mental health issues want to be a part of their communities, feel appreciated
there, be able to contribute, and take advantage of the possibilities that are
available there (Davidson, 2003).

Helen Glover reaffirmed her own journey toward recovery from mental
illness in an autobiographical essay. Glover was a teacher before she was given a
mental disorder diagnosis, but even after she fell ill, the Queensland Department of
Education felt unable to keep her on the job since she had been given a mental
illness diagnosis. She switched careers and became a social worker after
graduating, where she not only enjoyed helping those who were suffering from
mental illness but also saw it as a chance for her to heal as she engaged with
inspiring experts. Glover defined five developmental stages as a consequence of
her experience, and she thinks anyone going through the recovery process might
recognize them. Glover claims that the following are crucial in assisting survivors
to find direction in their life based on her experience (Glover, 2012):

1. From passive to an active sense of identity: The patient survivor has the
energy to use her power, talents, and effort in the healing process rather
than relying on the contribution and effort of others.
2. Moving from helplessness and despair to optimism: realizing there is
hope for the future rather than giving up.
3. Moving from being under the influence of others to taking individual
accountability and influence of one's actions instead of blaming people or
circumstances.
4. Using the previous to constructively impact the present or learning from
the past: from alienation to discovery.
5. Rather than isolating or being isolated as a result of living with a mental
illness, social participation and involvement with the rest of the
community as a citizen is preferred.
Principle of Recovery from Mental Illness as schizophrenia:
The following are the fundamental ideas in conquering any mental
condition, such schizophrenia (Shepherd, Boardman & Slade, 2008):
 Whether or not there are persistent or recurrent symptoms or issues,
recovery is about creating a meaningful and fulfilling life, as determined
by the individual.
 Recovering signifies a shift from pathologies, disease, and manifestations
to health, capabilities, and wellbeing.
 The ability to perceive how one may have greater agency over one's life
and how others have overcome obstacles can both help people find hope,
which is essential to rehabilitation and recovery.
 Self-management is promoted and made easier. Self-management
techniques are similar, yet what works for each person may be extremely
different. No situation is "one size fits all."
 The expert-patient relationship between clinicians and service users
changes to one of coach and partner on a discovery journey. The role of
the clinician is to be "on tap, not on top."
 Recovery does not occur in isolation. Involvement in meaningful and
gratifying social duties within one's local community, as opposed to
receiving treatment in a segregated setting, is strongly correlated with
recovery. In order to recover, a person must find or rediscover their sense
of self, which is distinct from their sickness or handicap.
 Finding or regaining a sense of one's own identity that is distinct from
one's disease or handicap is a key component of recovery.
 Family members and other allies are frequently essential to rehabilitation
and recovery, therefore it is best to work with them as partners whenever
 feasible. Peer support is crucial to many people's rehabilitation and
recovery.

Psychological Recovery stages:

Personal healing is a process of personal development and transformation,
according to the stages of recovery (Andresen, Caputi & Oades, 2006).

First Stage: Distress and Difficulty (Moratorium)

The beginning of a journey is frequently chaotic and dependent. Sometimes
a crisis sets them off, and we start to experience feelings of retreat, denial,
uncertainty, and pessimism. We can think we've lost our sense of ourselves and
self-preservation (Clarke, Oades & Crowe, 2012).

Second Stage: Being aware or awareness:

We transition from anguish to introspection. We must evaluate our
individual requirements, interests, difficulties, and strengths and shortcomings. We
need to reconstruct our self-image at this moment. Taking on three views can help
you get over this stage:
 Recognize the necessity for change. This encourages us to look for
healing.
 Have faith that change is both possible and likely. This isn't just fantasy.
It is realist pragmatism. We must accept that many people have already
made a full recovery and that there are several resources available to
assist us in doing the same.
 Be devoted to the effort required for change. Self-reliance is needed in
this. Despite the fact that we do require strong self-leadership, we are not
"doing it alone." We must have the confidence in ourselves to venture
 into unexplored area. We also require the fortitude and humility to accept
assistance.

We transition from hopelessness and helplessness to enthusiasm and

helpfulness when we acknowledge that we must change and that transformation
takes effort. We may find our own way to rehabilitation with the assistance of
skilled people; we are no longer dependent. The challenging job ahead may now
begin (Law & Morrison, 2014).

Third stage: Getting ready and preparation:

In order to achieve our goals, we must be willing to try out various
rehabilitation and recovery methods, educate ourselves on available therapies and
recovery possibilities, and create targets. Contacting others who can assist us is
also necessary (Copic, Deane, Crowe & Oades, 2011).

Fourth Stage: Reconstruction and Rebuilding:

We get ready, and then the action starts. Rebuilding includes doing working
toward objectives and actively overseeing the recovery process. Even though we'll
be testing out strategies with a track record of success, we could encounter
obstacles as we look for the best solutions for our particular circumstance. We
must put a lot of effort into preserving our connections with family, friends, and
caretakers along the journey. This stage necessitates fortitude and autonomy
(Bourdeau, Lecomte & Lysaker, 2015).

Fifth Stage: Maintenance

This is the last phase of recovery, when we are in a healthy state. We have
built autonomy, companionship, and a fresh sense of purpose after accepting who
we are. We pledge to keep this state in place. Even if certain psychological health
symptoms persist, we are aware that we are still capable of leading comprehensive
and fulfilling lives, of actively responding to failures, and of maintaining a hopeful
outlook on the future (Andresen, Oades & Caputi, 2011).

Recovery is described both objectively and subjectively during

schizophrenia therapy, according to Patel, Cherian, Gohil, and Atkinson (2014):
 The disappearance of symptoms and the patient's return to full-time
employment or enrolment in school are examples of objective measures
of recovery.
 The patient's personal growth, such as empowerment, a sense of hope,
helpfulness, future confidence, redefining self, overcoming stigma,
forming supportive relationships, taking responsibility, making sense of
life, and leading a satisfying life, are used to measure the subjective
dimensions of recovery. This concept presupposes that despite the
illness's potential to manifest at different levels, the individual continues
on the path to recovery (Ipçi et al., 2020).

Modals of recovery:

 Conceptual Model: This model, developed by Jacobson and Greenley

(2001), strives to link with the ideas that determine the methods utilized both
individually and collectively to facilitate recovery. Patients practice taking
on responsibility, creating objectives, collaborating with their healthcare
professionals, making decisions, and caring for their own needs as the
foundation of the approach. There were established internal and
environmental conditions that aided in the healing process. Hope,
 personality reconnection, taking charge, autonomy, bravery, accountability,
and connections were some of the internal states mentioned. The reduction
of stigma and prejudice, the development of a cooperative connection
between medical personnel and patients, and the focus on assistance for
recovery were highlighted as external states (decreasing symptoms, crisis
intervention, rehabilitation, basic safety etc.) (Andresen, Oades & Caputi,
2003).

 Recovery Alliance Theory (RAT): this model, developed by Shanley &

Jubb-Shanley (2007), is a paradigm that is founded on humanistic
philosophy and the interaction between the patient and the nurse. The
authors of it are. When developing the RAT model, researchers were
influenced by the recovery-focused approach. The humanist philosophy,
rehabilitation, partner relationships, an emphasis on power, empowerment,
and shared humanity are the six structural foundations of this paradigm.
Those six components gave rise to the concepts of coping, accepting
individual accountability, and cooperative effort, which form the foundation
of mental nursing practices. This idea contends that people are capable of
making their own decisions and have the capacity to enhance their self-
awareness, interpersonal interactions, and self-awareness. This concept
enables communication between mental nurses and patients. Patients who
think they can recover have a higher likelihood of doing so. Power-sharing
and interviews between the patient and psychiatric nurse are key
components of the patient-nurse interaction (Shanley & Jubb-Shanley,
2007).
 Tidal Paradigm: The foundation of mental nursing, this model is
entrenched and ubiquitous. The proper care environment for the population's
mental health is another area of concern. The focus of the concept is on the
adjustments and/or solutions that people must make in order to deal with
their issues. It highlights the need of developing close bonds with patients in
order to get their cooperation and delegate authority. Professionals
concentrate on assisting people in being aware of modifications in them and
using this knowledge to positively orient their lives. This model's proponents
believe that recovery is possible. People can start their path toward recovery
from a wide range of sources, and they are aware of which of these sources
is the most potent (Barker, 2003; cam & Yalçner, 2018).

 Watson Human Caring Model: this model describe that interactions

between the patient and the nurse can help the patient recover on their own
and achieve a high degree of consciousness. The interpersonal care
connection, the state of care, and assisting in the patient's healing process are
the three primary themes. A person's mind, body, and soul are all considered
to be a part of their integrity, as well as their harmony and individuality, in
the interpersonal care connection, which is a specific form of
communication and commitment between two individuals. Integrity of life
events and an individual's existential dimension provide the condition of
caring. By making the person aware of this integrity, it also aids in recovery.
The patient's happiness and safety are increased by the care given during the
healing process. By ensuring that the patient is treated as a whole, care given
as part of the healing process promotes patient satisfaction and protection
(Tektaş, 2015).
  Medical model: While the medical model has a tendency to emphasize the
clinical manifestation of schizophrenia as a significant predictor of recovery,
people with schizophrenia, such as Leete (1989) and Deegan (1996),
describe recovery as not just the absence of symptoms but also the capacity
to learn from and grow from the experience of mental illness. The latter is
particularly important when learning coping mechanisms to overcome day-
to-day difficulties while having to adjust to limits brought on by the illness.
The medical concept of recovery emphasizes symptom reduction,
alleviation, remission, and a return to premorbid levels of functioning as an
end state.

Reduced hospital stays, a favorable prognosis, and improved quality of life

are the results of early diagnosis of schizophrenia and recovery-focused therapies.
Hospitals may make it more difficult for some people to recover from their mental
illnesses since individuals who use the services are rumored to acquire sentiments
of powerlessness and hopelessness. In other words, prolonging a patient's stay in
the hospital encourages reliance and teaches patients to be dependent. Patients who
stay in hospitals for a longer duration will thus not heal as rapidly as those who
stay there for a shorter amount of time. Because of this, initial diagnosis, therapy,
and discharging are all seen as crucial components in fostering mental disease
recovery (Nxumalo-Ngubane, 2016).

Over the past few decades, it has been clear that therapies that just target the
symptoms of schizophrenia do not provide comprehensive treatment success, are
insufficient for successful employment, and do not foster positive interpersonal
interactions. Additional outcome measures, such as QoL, occupation, family,
leisure time, and other aspects of daily living, finances, and physical and mental
health, have been acknowledged as being pertinent for appropriate strategies in
schizophrenia (Juckel & Morosini, 2008).

An important outcome metric from this viewpoint was psychosocial

functionality, which is the capacity of patients to carry out their social obligations
as members of a family or in their line of work. Development in these outcome
indicators was identified as a key aim of therapy for schizophrenia, in addition to
symptom suppression and relapse prevention, in order to achieve functioning
recovery and patients' autonomy (Vita & Barlati, 2018). Antipsychotic medication
must be used continuously, along with psychosocial therapy and empowerment
interventions to lower the chance of relapse and encourage recovery from
schizophrenia, (Emsley, Chiliza & Asmal, 2013).

Training to self-manage a psychological illness includes making options

about starting, diluting, and shifting drugs. These decisions are discussed
frequently during clinical consultations. Decisions about medications are
influenced by things including the client's capacity for self-care and lifestyle
choices. Clients were expected to "comply" with physician recommendations and
had little say in treatment choices under the conventional medical model. In its
report, "Achieving the Promise: Transforming Mental Health Care in America,"
the President's New Freedom Commission on Mental Health urged for a paradigm
shift from this approach to the recovery model, and the idea of shared decision-
making gained traction (Mahone, Maphis & Snow, 2016).

The Substance Abuse and Mental Health Services Administration and the
American Psychiatric Nurses Association worked together on an endeavor to
change and transition recovery principles and attitudes to concrete recovery-
oriented practices as the model of mental nursing care provision (American
Psychiatric Nurses Association, 2011).

Recovery is often achieved by a mix of personal empowerment, a sense of

responsibility, choice, and active self-help. Recovery is a process of transformation
throughout which individuals improve their health and wellbeing, enjoy an identity
life, and work to achieve great things. An integrated self-care strategy model based
on a wider definition of "medicine" emphasizes the significance of using strong
communication techniques and attempting to release the "powerful synergies" of
pill medicine, personal medicine, and psychosocial treatment in order to manage
illness in order to aid in the promotion of recovery. Acts of self-care initiated by
the patient, which can help to avoid relapses and enhance client-reported outcomes
like quality of life (MacDonald-Wilson, Deegan, Hutchison, Parrotta, & Schuster,
2013).

The recovery paradigm, which emphasizes rehabilitation, is becoming more

widely used in mental health treatments (Tse et al., 2015). Recovery has several
facets; it includes empowerment, hope, and the pursuit of one's life's ambitions and
desired societal responsibilities. Additionally, recovery is linked to resiliency,
tolerance, improved symptom management, a lower chance of hospitalization, and
enhances public functioning, all of which are connected to quality of life (Choo,
Chew, Ho, C. S & Ho, R. C, 2017).

According to Lee, K. T., Lee, S. K., Lu, Hsieh & Liu (2021), significantly,
worldwide mental healthcare attempts to enhance recovery, and industrialized
nations have already created recovery programs and assessed their efficacy.
Additionally, mental health services need to be recovery-, human-, and
community-focused given that the degree of individual recovery might affect the
individuals with mental illnesses who live in the community. The recovery rates
for people with mental illnesses only ranged from 13.5 to 37.9%, according to
meta-analyses and follow-up research. In addition, a patient's recovery from
schizophrenia will lower medical expenses. Therefore, it is crucial to encourage
healing in those who are suffering from mental illnesses like schizophrenia.

Schizophrenia Management
Goals and objective for schizophrenia management:
Recent research have demonstrated that therapeutic interaction can speed
recovery from schizophrenia, which is a persistent and severe form of mental
disease marked by skewed perceptions, thoughts, and emotions. The use of therapy
can help someone's mindset, actions, attitudes, self-efficacy, emotional suffering,
and perceptions change. It is also seen to be essential to the healing process, giving
people with mental illnesses the knowledge and abilities to control their condition
(Hewitt & Coffey, 2005; Kopelowicz et al., 2008).

Interventions designed to promote self-determination in respect to a patient's

unique needs, objectives, and abilities have also been created. However, they also
include aspects and practices that enable participants to share personal experience
and accept help, learn and practice success-oriented skills, and identify and move
toward personal goals. Such initiatives could include aspects of self-management
skill development, psycho-education, and peer-based interventions. Peer-based
therapies have received little research, while recovery-focused programs have
received even less. However, the material that is now available points to the
possibility that these therapies can boost empowerment, hope, and recovery in
people with severe mental disorders (Keepers et al., 2020).
 There have also been established recovery-focused therapies that emphasize
encouraging self-determination in regard to a patient's own objectives,
requirements, and strengths. As well as components and activities that enable
participants to share experiences and receive support, learn and practice success-
oriented skills, and describe and move toward individual ambitions, such initiatives
may also include components of psycho-education, peer-based interventions, and
self-management skill development. Studies of peer-based therapies are few in
number, and studies of interventions with a recovery-focused approach are
likewise few. However, the material that is now available points to the possibility
that these therapies can help people with major mental disorders feel more
empowered, hopeful, and recovered (Keepers et al., 2020).

Early management must be holistic and specialized, with quick and simple
access to resources, planning for education and employment, and treatment of
coexisting conditions. Drug therapy, personal and community therapy, and family
psychosocial treatments as an empowerment intervention should all be included in
bio-psychosocial care plans (Nolin, Malla, Tibbo, Norman, & Abdel-Baki, 2016).

• Psychopharmacology
Antipsychotic medications, which stifle the positive symptoms, are the
foundation of therapy for schizophrenia. In both the acute and maintenance periods
of schizophrenia, antipsychotic medication is used to treat symptoms and prevent
recurrence (Huhn et al., 2019).

The most effective treatment for the main symptoms of psychosis is

antipsychotic medication, which is the first line of treatment for schizophrenia.
First-generation antipsychotics (FGA), also known as classic antipsychotics like
haloperidol, and second-generation antipsychotics (SGA), also known as atypical
antipsychotics like risperidone, olanzapine, and quetiapine, are two categories of
antipsychotic medications (National Institute for Health and Care Excellence,
[NICE], 2014).

Newly released psychiatric medications with improved effectiveness and

tolerability have replaced older ones as the standard of care in recent years. For
instance, modern medicine prefers atypical anti-psychotic medications like
risperidone, olanzapine, and aripiprazole over traditional ones like haloperidol
(Tayem, Jahrami, Ali, & Hattab, 2020).

 Electroconvulsive treatment (ECT)

In 1938, electroconvulsive therapy (ECT) was first used to treat
schizophrenia. Patients with schizophrenia who display of catatonia, significant
positive symptoms or affective symptoms are thought to be the most likely to
benefit by using ECT. The effectiveness of ECT in such individuals is comparable
to that of antipsychotics, but recovery may come more quickly. ECT augmentation
is still the therapy of choice in some circumstances, such as treatment-resistant
schizophrenia (Ayano, 2016).

In the treatment of schizophrenia, ECT is frequently used in combination to

antipsychotic medications. Studies have revealed that the speed or quality of the
response is significantly improved when ECT and antipsychotic medications are
used together. Furthermore, according to Fu, Czajkowski, Rund, and Torgalsben
(2017), functional status and subjective experience variables—factors linked to
quality of life, individual rehabilitation, and well-being—are less effective for both
SGAs and FGAs.
  Psychosocial therapy (Non Pharmacological Management)
Pharmacological treatment should be combined with non-pharmacological
management in order to increase the effectiveness of the treatment. The goals in
treating schizophrenia include targeting symptoms, preventing relapse, and
increasing adaptive functioning so that the patient can be reintegrated into the
community. Since patients hardly ever regain their pre-illness level of adaptive
functioning, it is necessary to combine pharmacologic and no pharmacologic to get
the best long-term results. The cornerstone of managing schizophrenia is
pharmacotherapy, yet residual symptoms may still exist. Non-pharmacological
therapies, including empowerment intervention, are crucial for this reason (Dipiro
et al., 2014).

Cognitive Behavior Therapy can improve coping for patients with symptoms
that are drug-resistant and, in particular, reduce positive manifestation (Valencia,
Fresan, Juárez, Escamilla, & Saracco, 2013). While cognitive remediation and
integrated psychological therapy support neurocognitive, social, and global
functioning, psychological education can encourage treatment adherence and
independent living. One kind of non-pharmacological and psychosocial treatment
is empowerment (Matheson, Shepherd & Carr, 2014).
 Empowerment

Schizophrenia is a persistent, severely disabling illness that affects many

aspects of daily living. The empowerment idea has arisen as a fresh strategy for
recovery-oriented therapies for community-dwelling schizophrenia patients, given
that significant gains may become challenging as the condition advances. One of
the key elements promoting recovery and achieving treatment objectives for
schizophrenia patients is empowerment (Jaiswal et al., 2020).

One psychosocial technique for managing schizophrenia is empowerment,

which, like recovery, is a complicated concept in mental health. Recovery
procedures must include empowerment, self-determination, and self-efficacy, and
empowerment is the process of acquiring a sense of mastery and control over one's
own surroundings and self (Schmolke, Amering & Svettini, 2016).

Patients with mental illnesses are more likely to heal when they feel
empowered. Finding a method to lead a fulfilling life despite symptoms has been
described as an individual journey in the recovery from mental illness. For those
with mental illnesses like schizophrenia, empowerment is seen to be crucial to this
process and entails gaining more influence over somebody's lives through
decision-making and being capable of going through on those decisions. This may
require developing knowledge and abilities (Sutton, Bejerholm & Eklund, 2019).

People with mental illnesses like schizophrenia who are empowered are
more at ease realistically teaching everyone else about their experiences,
viewpoints, and demands. The rest of the group seems to believe that individuals
with mental illnesses like schizophrenia would find it simpler to handle societal
concerns by self-advocacy if they are empowered. Some even suggested that
empowering one's identity would encourage one to be more forthcoming with one's
diagnosis (Fleming, 2015).

Enhancing patient’s autonomy, independence, decision-making and

responsibility, as well as self-management, is the major goal of empowerment.
Furthermore, empowerment can moderate the relationship between quality of life
and function in schizophrenia patients (Tabares, 2017).

Empowerment is viewed as a crucial component in promoting health. The

notion of empowerment is often discussed in the literature on mental health and
social work, which reflects its vast use across many sociopolitical situations. In
recent decades, the idea of empowerment has come to be increasingly regarded as
a guiding principle for both the practice of social work and the development and
delivery of mental health services (Cui, 2019; Cyril, Smith, & Renzaho, 2016).

Empowerment Concept:
Today's culture of health and social services has evolved to include the idea
of empowerment as a common and highly appreciated component. The Latin term
"potere," which means "to be able," is where the idea of empowerment originates
(Grealish, 2014).

The idea of recovery and the empowerment concept have been intertwined
in mental health studies. It is related to a situation in which people actively
participate in daily tasks and communal life while also experiencing fewer
symptoms of their psychiatric illness and the related stigma. Patients with
psychiatric illnesses who are empowered will experience higher self-growth,
reclaim their independence, and live meaningful lives in the community while
having mental disorders (Aziz, Fadzil, Othman & Kueh, 2021).

Empowerment as a concept it is, according to Perkins and Zimmerman

(1995), the process by which people, groups, and communities try to take charge of
problems that affect them. The term "community empowerment" especially refers
to people coming together in a planned manner to better their lives and strengthen
their ties to local groups and agencies that likewise want to enhance their quality of
life.

Role of Empowerment in Recovery:

Empowerment has been found as minimizing the detrimental impact that
psychological distress has on quality of life and has been acknowledged as being
important in the rehabilitation and recovery process. According to studies looking
at social rehabilitation, supporting individual activity increases empowerment,
confidence in one’s decisions and self-efficacy over medical issues and social
circumstances. According to certain theories, lowering decision-making obstacles
might help to lessen a person's sensation of helplessness and powerlessness. From
the standpoint of health promotion, increasing empowerment has been linked to a
decrease in symptom-related distress, an improvement in quality of life, greater
social support, and an increase in self-esteem. Service users have emphasized the
significance of improved coping skills, better life management, and personalized
treatment (Petersen, Friis, Haxholm, ielsen & Wind, 2015).

Empowerment has been linked to rehabilitation and learning "how to

recover." The intensity of symptomatology, quality of life, social support, sense of
empowerment, and self-esteem are all correlated with service users' assessments of
their own outcomes (chou et al., 2012). On the other hand, lack of empowerment
has been linked to relapse by causing helplessness, irrationality, powerlessness,
and low self-efficacy. Public health research has shown that depression and
disempowerment may coexist. Lower quality of life, feeling like a target for
medical attention, less self-efficacy, greater stigma, weaker social networks,
internalized stigma, and discrimination are all linked to disempowerment (Sibitz
et al., 2011).

Empowerment Paradigm

The National Empowerment Center's Dr. Dan Fisher created the

Empowerment Paradigm of Development, Healing, and Recovery as an alternative
to the conventional medical paradigm of sickness, which places more emphasis on
the person's control over their health than on medicine or a doctor. According to
the empowerment model of recovery, a person with a mental illness may recover
and carry on with their own personal growth if they are empowered and surround
themselves with others who believe in them (Fisher, 2017). 

Through three cycles—the cycle of recovery, the cycle of healing, and the
spiral of development—which represents the increasing growth of a person's voice
and self, this paradigm offers a compelling vision of how to move from a position
of being excluded from society due to being labeled as mentally ill. The 12
Principles of Empowerment feed the cycle. This enables the individual to create
fulfilling connections, including those in love and at employment (figure 3)
(Fisher, 2017). 
 Figure (3): Empowerment Paradigm of Development, Healing and Recovery (Fisher,
2017). 

Twelve Principles of Empowerment:

The following are the 12 Principles of Empowerment, all of which begin

with the letter P Fisher, D., & Spiro, L. (2010).

1. Personal connections: Meeting other advocates may be the most crucial

initial step in developing your advocacy skills.
2. Passion: Converting rage and bitterness into passion is crucial.
3. Principles of Recovery: Describe a recovery-based system that is
consumer-driven, self-determining on both the individual and system
levels, focuses on peer support, and allows people to attain full
community involvement, or social inclusion, through valued roles (e.g.,
worker, student, parent, tenant, etc.).
4. Positive view of the future: in order to encourage others and oneself to
feel hopeful once more, one needs hope to live strongly and persistently
within of them.
5. Purpose: Rather than passively or actively looking for an escape, many of
us have had to discover a purpose to anchor and invest in our lives.
Finding a purpose is crucial to empowerment because it gives our lives
meaning.
6. Patience, perseverance, and persistence: Never quit, never give up...
Anything may become a reality if we are persistent enough; our beliefs
can come to pass.
7. Presence: The ability to rapidly and favorably influence others by self-
assurance, composure, and civility.
8. Persuasion: The ability to persuade others to accept your viewpoint via
dialogue.
9. Practical prioritized advocacy plan which needs to come from a well-
prepared participant: A clear, prioritized strategy that you can put
forward is required if you want to modify policies.
10.Public speaking: Another crucial component of individual and group
empowerment is learning how to convey yourself and your ideas to
others.
11.Partnering and cooperative via negotiation and mediation.
12.Politics is the method through which social groupings come to choices.
Empowerment Definition:
"Empowerment" is defined as "a process through which people,
organizations, and communities achieve control over their affairs" or as "a
combination of personal determination over one's own life and democratic
engagement in the life of one's society, typically through mediating arrangements"
(Li & Chiu, 2017).

The description of empowerment offered by Chamberlin & Schene (2009)

includes the following set of qualities:
 Being capable of making decisions.
 Having resources available and information.
 Having a variety of alternatives (not simply yes/no, either/or) from which
to choose.
 Being assertive.
 A conviction that one is capable of making a difference (being hopeful). -
acquiring critical thinking skills, changing one's mindset, and developing
new perspectives, such as:
1. Being more aware of our identity (speaking in our own voice).
2. Expanding our definition of what is possible.
3. Redefining how we interact with established authority.
 Understanding and expressing rage.
 Feeling like a part of a group and not isolated.
 Recognizing the rights of others.
 Bringing about change in one's life and community.
 Acquiring abilities that the individual deems crucial, such as
communication.
  Changing how others view one's competence and ability to take action.
 Emerging from the closet.
 Self-initiated, never-ending growth and change.
 Improving one's perception of oneself and fighting stigma.

The term "health empowerment" describes a pattern of wellbeing and a

process improvement plan that result from the identification of one's own and one's
community's resources. The study by Rappaport (1995) also led to the
development of a different definition of empowerment, which he described as "the
relationship between a sense of personal competence, a desire for, and a readiness
to take action in the public arena." The process of "gaining control over one's life
and affecting the organizational and societal framework in which one lives" is
another definition of it.

Empowerment is the process of giving people a greater sense of power over

the choices they make in life so they may take action to meet their own, unique
therapeutic and life objectives. The importance of empowerment in psychotherapy
has grown, and it is favorably correlated with crucial recovery outcomes including
level of functioning and quality of life (Morris, Huang, Zhao, Sergent &
Neuhengen, 2014).

Participation of service users in important management and treatment

decisions is what is meant by empowering. In patients with schizophrenia,
understanding into the condition may not always be there, making this challenging.
Schizophrenic patients who have strong insight must participate in therapeutic
decision-making with their caretakers (Brohan, Elgie, Sartorius, Thornicroft &
Gamian-Europe Study Group, 2010).
Individual and group empowerment can be distinguished from one another.
At the individual level, empowerment refers to actions taken by a person to "take
his life in his own hands" and reclaim his identity and self-worth. At a group level,
it's about the contribution that those with lived experience make to the
administration and delivery of mental health services as well as to society. In the
field of mental health treatment, the idea of empowerment and the actions it
promotes have been gaining popularity. The establishment of so-called best
practices is the primary emphasis, especially those that are co-established and/or
co-controlled by persons with relevant knowledge (Boevink, Kroon, Delespaul &
Van, 2016).

Individual empowerment, often known as psychological empowerment,

refers to a range of qualities required for people to realize their own potential. This
may involve strengthening people's personal abilities or developing their coping
mechanisms so they may create a sense of confidence or self-worth and make
decisions about their health. Individual empowerment generally refers to people
feeling that they are in charge of their lives. According to research, this "feeling of
control" is particularly crucial since it directly affects a person's mental and
physical health (Woodall, Raine, South & Warwick-Booth, 2010).

Empowerment enhances one's feeling of self-worth, reduces stigma,

enhances one's quality of life, and averts undesirable results. To promote
rehabilitation, shared decision-making models with patients are crucial. Even if it
might not always be practical, this must be done. Advance directives for mental
health treatment have made it necessary to have crisis plans in place to fund
hospital admissions as necessary, which will decrease forced hospitalizations.
Psycho-education is required to raise patients' self-esteem and put more of an
emphasis on education than therapy (Vauth, Kleim, Wirtz & Corrigan, 2007).

In an effort to assist persons with schizophrenia feel that they are a part of
the healing process, empowerment intervention has been created (Shearer, 2009,
Warner, 2009). According to Rappaport (1997) a concept known as empowerment
connects personal skills and aptitudes, inborn support networks, and proactive
behaviors to social policy and societal change. In terms of health, empowerment
stresses enhancing one's perception of capacity to consciously engage in decisions
regarding one's health and healthcare.

According to Slade (2010) the ability to make decisions, assertiveness, a

sense of being able to make a difference, learning about and expressing anger,
feeling a part of a group, understanding that one has rights, growth and change that
is never-ending and self-initiated, improving one's positive self-image, and
overcoming stigma are among the core characteristics of empowerment. This
procedure makes it easier for people to actively participate in promoting their own
well-being and achieving their health goals.

Moreover, according to Collier (2010) idea of empowerment and the

development of sickness management skills have gained popularity. Prior to now,
recovery was conceptualized from a medical standpoint as being "cured" of mental
disease or returning to "normal". And also, enhancement of self-reliance and
beneficial effects on health and wellness that raise quality of life There has been
substantial discussion about the necessity of testing interventions aimed at
empowering adult schizophrenics to make informed health decisions in order to
enhance health among them (Callaghan & Lymn, 2015).
 By improving a patient's perception of their capacity to make knowledgeable
decisions about their health and treatment, psychiatric nurses make a vital
contribution to the empowerment of patients with schizophrenia. The upcoming
details are crucial: The primary elements of empowerment at this level are
individual medicines and actions toward the person, since these can influence how
needs, wishes, and desires are communicated. In order to preserve self-esteem and
trust, as well as to provide the person the freedom to share their thoughts, options,
and wishes, it is crucial to build a strong therapeutic connection. Be courteous,
nonjudgmental, and avoid making the person feel inadequate in order to do this
(Aggarwal, 2016).

Patients with schizophrenia who feel more empowered are better able to
manage their symptoms and have more control over their lives. Patients benefit
from empowerment in ways like enhanced quality of life and increased self-
confidence (Sibitz et al., 2011). On the other hand, disempowerment is the removal
of power from people, leaving them with a powerless, poor self-esteem, inability to
manage their lives, and a lower likelihood of success. Patients who are well
empowered by their own abilities tend to be more optimistic about their conditions,
feel more involved in their care, experience less helplessness, have less negative
mental symptoms, have higher quality of life, recover more quickly, and
experience fewer relapses (Elsherif, Badawy & Gado, 2022). Figure 4.
 Figure 4: Potential impacts of empowerment intervention (Hasan & Musleh, 2017).

A significant obstacle to rehabilitation in psychiatric health care is

empowerment intervention in Schizophrenic patients. Only a small number of
researches, meanwhile, have looked at patient empowerment, prognosis
improvement, and relapse prevention strategies on mental wards. Results can be
improved by having a better grasp of one's condition and a more positive attitude
toward medicine. Psychosocial rehabilitation and/or recovery-oriented therapies
are likely to be significantly impacted by empowerment (educational) programs
that change patients' perspectives (Callaghan & Lymn, 2015; Slade, 2010).

In addition, an essential element of wellness and self-empowerment is the

development of individual control and choice over the course of therapy and the
experience of symptoms. Children and their parents usually have negative opinions
of mental health treatments if the application of rule structures by therapists is
perceived as being condescending and rigid. They claim that these encounters
prevent them from using their own coping strategies and hamper their
rehabilitation. The methods through which doctors inflict helplessness as opposed
to empowerment reflect the causes and manifestations of sickness. Since the
psychotic adolescents are already likely to feel inferior, this could further
undermine their sense of empowerment than is typically anticipated for people of
their age (Grealish, Tai, Hunter& Morrison, 2013).

In order for a patient with a mental condition to recover, empowerment is

essential. Schizophrenia patients choose interventions that give them agency and
allow them to carry out all aspects of everyday living in the community on their
own. In addition to improving the lives of mentally ill people, empowerment
interventions are a beneficial way to support nurses who carry them out and inspire
them to keep doing so. Schizophrenia patients experience a lot of prejudice,
helplessness, and rejection. Therefore, empowerment is a crucial part of the
healing process. The empowerment program was created to alleviate the
helplessness and enhance quality (Strkalj Ivezic, Alfonso Sesar, & Muzinic, 2017).

According to certain theories, persons with schizophrenia who are

empowered are more likely to recover from their illness. As a result, mental health
professionals work to empower patients with schizophrenia. However, nothing is
understood about how empowerment may be quantified practically. Schizophrenic
individuals could feel quite powerless in this situation (Chou et al., 2012). It has
been discovered that having a thorough grasp of one's condition increases the
likelihood that one will respond favorably to medicine, which increases the
likelihood of recovery (Demoz et al., 2014).

Empowering interventions were defined as activities when nurses express

interest in patients, engage in conversation with patients, support patients, provide
knowledge to patients, and provide patients with opportunity to exercise self-
determination. Social interventions were defined as activities where nurses visited
patients' families, provided patients with social interaction chances, and provided
opportunity for patients to visit their homes while receiving inpatient treatment.
Actions involving occupational, creative, or physical treatments, as well as actions
where nurses provide patients with opportunities for leisure activities or to keep up
a hobby were all regarded as activating interventions. Security interventions were
defined as nursing care for patients' privacy and safety. Additionally, nurses' care
for patients' medications, observation of their somatic health, and provision of rest
chances were regarded as treatments enhancing physical health (Pitkänen, 2010).

The Role of Mental Health and Diseases Nursing During Empowerment and
Recovery

Nursing interventions in psychiatric care can play a crucial role in this new
holistic vision of psychiatric treatment and patients' rehabilitation because nursing
places a strong emphasis on patients' reactions to their illnesses, their functional
adaptations, and their holistic requirements. In order to improve patients' quality of
life, psychiatric nurses adopt broad-based treatments. The core element of
psychiatric nursing is an interactive process in the nurse-patient relationship.
Because human relationships are important determinants of QoL, patient-nurse
relationships are also expected to enhance patients’ QoL. QoL provides a good and
broad view for this interpersonal relationship to discuss the patient’s individual
perceptions and needs and to let the patient to become a central player in his or her
care (Peplau 1994).

The nurses stated that in order to improve patients' quality of life, they built
a connection with them based on respect, dignity, and empowerment, listening to
their aspirations and desires, speaking up for and educating them, and assisting
them in creating their own QoL objectives. Patients' QoL was improved by
providing for their fundamental requirements, facilitating access to resources, and
treating symptoms. On the other hand, in a nurse-patient relationship, nurses may
improve patients' quality of life by nearly any nursing intervention, depending on
the patient's specific requirements (Pitkänen, 2010).

The recovery and empowerment phase in psychiatry entails extensive and

coordinated bio-behavioral therapy. These programs give those who are mentally
ill the chance to acquire the required cognitive, emotional, social, mental, and
physical abilities so they may learn, work, live as independently as possible in
society, and be functioning (Durmaz & Okanlı, 2014).

In the field of psychiatry, recovery is possible if it is thorough, ongoing,

coordinated with other services, cooperative, in line with the patient's goals,
adaptable for each stage of the illness, consistent with the patient's culture and
individual needs, and linked to evidence-based practices, including society's
treatment. The psychiatric nurse's role at this time is to assist the patient in
adjusting to changes in their lives (Roberts & Bailey, 2013).

Before they begin their efforts, psychiatric nurses need to have a thorough
understanding of the types of challenges that people encounter and their goals.
Patients who feel understood develop therapeutic relationships with their nurses. A
crucial component of empowerment recovery is collaboration, which is a
component of the therapeutic method (Shanley & Jubb-Shanley, 2007).
 Expecting to recover might be difficult for patients. As a result, the nurse-
patient relationship must be one of support and opportunity for growth. Restoring
hope requires adjusting to all losses in those with severe mental illness. Patients
who have previously lost their identities and responsibilities might get in touch
with others who have gone through a similar situation since they could feel alone.
Nurses must be aware of patients' perspectives as they relate to cultural
conventions during the healing process. The time the health professionals spend
with patients, and the quality of the relationship they build with them, is more
significant than any level of knowledge (Aston & Coffey, 2012).

Continuity of medical care is crucial during the recovery process. Because to

adverse effects, stigmatization, and the belief that they do not need the
prescription, patients stop taking it. By assisting patients in being compliant with
taking medicine and continuing on the medication, nurses may play a significant
role in helping patients begin their recovery. Psychiatric nurses need to be aware of
how medical therapy impairs a person's quality of life. Nurse efforts for ongoing
medication usage include encouraging patients to raise questions about their
treatment, including patients in treatment planning, setting up psycho-social
training, involving the patient's family, and setting up society-focused assistance
(Roe & Swarbrick, 2007).

Given the support they receive, patient relatives, who are an integral part of
the recovery process, may go unnoticed. It's possible for patient relatives to feel
helpless, alone, and isolated. In order to improve the quality of life for patient
relatives, nurses must include them in their care. The conduct of patients, their
desire for assistance, their interactions with nurses, and their ability to adjust to
therapy are all significantly influenced by the manners and attitudes of community.
A person loses trust in their own value if others do not believe in them and what
they are capable of. For hope to be restructured, support and assistance are crucial.
In order to foster a recovering atmosphere, nurses must work together to boost
hope. Patients should be motivated to make plans for the future, rearrange their
priorities, enhance and strength of their self, and form optimistic perspectives.
Nurses should work together as an interdisciplinary team to educate patients,
families, and society (Ryrie & Norman, 2013).

The strong relationship between health and empowerment also between

hope, optimism with the perception of a good quality of life. When improved life
quality increased the recovery potential of schizophrenia patients. Those
psychiatric nurses were the people who were the most trusted in terms of
encouraging hope and helping the patients resume normal, social activities (Gale &
Marshall‐Lucette, 2012).
 Subjects and Method
Subjects

Research Design:
A quasi experimental research design [pretest - posttest] was used in the
current study.

Setting:
This study was conducted in the inpatient psychiatric department and the
outpatient clinics at the psychiatric department of Mansoura University Hospital.

The inpatient department and the outpatient clinics provide psychiatric care
for all patients with psychotic, neurotic disorders in addition to patients with
substance abuse. Most of the clinical services are provided for free of charge for
the majority of patients.

The inpatient department consists of five floors: the ground-floor includes a

lecture hall and the electroconvulsive therapy room. The second floor involves
male inpatient unit, nurses’ room and the administrative services. The third floor
consists of a unit for children, inpatient female, nurses’ station and consultation
room. The addiction department is located in the fourth floor. The fifth floor
contains the psychophysiology unit. The department not only provides therapeutic
services but also provides educational services in the field of psychiatry.

Population Target:
Patients diagnosed with Schizophrenia.
Sample Study:
A convenience sample of individuals with a diagnosis of schizophrenia was
used in this intervention. The study's sample size was 60 patients who complied
with the requirements listed below:

Inclusion criteria:
1. According to patient’s records, all clients diagnosed with schizophrenia met
the guidelines of the Diagnostic and Statistical Manual of Mental Disorders,
5th Edition.
2. Patients who are at least in the 2nd episodes.
3. Age from 18 to less than 60 years old.
4. Both sexes.
5. Able to communicate.

Exclusion criteria:
1. Schizoaffective disorders.
2. Psychotic disorder due to another medical condition.
3. Intellectual developmental disorder.

Tools for data collection:

Six tools were used in the current study to collect relevant required collect data.

Tool I: Patient Assessment Sheet (Socio-Demographic Characteristics and

Clinical Data) (Appendix-I):
This tool will be developed by the researcher based on reviewing recent
related literature. It will include information about:
A. Socio-demographic, as patient's name, age, sex, education level, marital
status, place of residence, etc.
 B. Clinical data, such as the diagnosis, the beginning and length of the
illness, the past number of mental hospital admissions, family history,
hallucination, delusion and smoking history.

Tool II: Schizophrenia-Quality of Life Questionnaire (SQoL-18)(appendix-II):

Schizophrenia Quality of Life Questionnaire (S-QoL18) developed by
(Boyer et al., 2010). The S-QoL 18 is the short version of a 41-item French self-
administered multidimensional QoL questionnaire concerning the present
circumstances and designed for patients with schizophrenia. That assesses the
patient’s view of his or her current QoL. It is made of 18 items describing 8
dimensions: psychological well-being (PsW), self-esteem (SE), family
relationships (RFa), relationships with friends (RFr), resilience (RE), physical
well-being (PhW), autonomy (AU), and sentimental life (SL), as well as a total
score (Index). The subscales present satisfactory Cronbach’s alpha (Caqueo-
Urízar, Boyer, Boucekine & Auquier, 2014). Each item is rated on a 5-point scale
from 1= “Much less than I’d prefer” to 5= “More than I’d prefer” it is in first 15
item but the last three item 16, 17, 18 item (negative sentences) from 5= “Much
less than I’d prefer” to 1= “More than I’d prefer”.

The total score ranged from 18 to 90 with a higher score indicating a better
quality of life. This tool demonstrated a good psychometric characteristic with
adequate reliability Cronbach’s alpha is .72–.84 in European countries (Boyer et
al., 2010) and .82 when translated into Arabic.

Tool III: Learned Helplessness Scale (LHS) (Appendix-III):

Learned Helplessness Scale was developed by (Quinless & Nelson, 1988). A
Likert-type scale with a 4-point range from 1 to 4 is used to assess the 20 questions
on an LHS, which is a self-report questionnaire. A high number indicates that
people are feeling more helplessness than those with lower scores, which range
from 20 to 80. Cronbach's alpha for this scale was.89-.90 when it was utilized with
persons who had mental illnesses (Kim & Suh, 2005), while the Arabic equivalent
of Cronbach's alpha is .84
Scoring system of LHS is:
1. Mild helplessness from 20 to 40,
2. Moderate helplessness from 40 to 60,
3. High helplessness from 60 to 80.

Tool IV: Rogers Empowerment scale (RES) (Appendix-IV):

Rogers, Chamberlin, and Ellison (1997) developed the Empowerment Scale

to assess personal empowerment among people who use mental health care. With
response options ranging from (1) "strongly agree" to (4) "strongly disagree," it has
items on a four-point scale. The statements are either positive or negative. Self-
esteem (9 item), Power-Powerlessness (8 items), Community Activism and
Autonomy (6 items), Optimism and Control over the Future (4 items), and
Righteous Anger (4 items) are the five characteristics that the 31-item scale
measures. Three items were each represented in 2 subscales. The overall
empowerment score has a Cronbach's alpha reliability of.82 and subscale
reliabilities for optimism and self-esteem range from.45 to.82. According to
Huang, Zhao, Sergent, and Neuhengen (2014), higher scores on the various
measures reflect a better degree of empowerment, but the Arabic translation's
Cronbach's alpha reliability is .80.
Tool V: Recovery Assessment Scale- Domains and Stage (RAS-DS)
(Appendix-V):

Recovery Assessment Scale- Domains and Stage (RAS-DS) was developed

by the (Corrigan, Salzer, Ralph, Sangster & Keck, 2004). It measures the recovery
of mental health by self-report. The 38 pieces are grouped into four recovery
domains. The following domains:
1. Functional recovery, which consists of six elements and is branded
"Doing things I value" (1-6). Doing activities that are significant to
you personally is prioritized.
2. Individual recovery ("Looking forwards") there are 18 items in this
domain (7-24) in this area, the client's desire to improve is the major
focus.
3. Clinical improvement ('mastering my illness') there are 7 elements in
this domain (25-31). The focus of this area is on gaining control over
and managing symptoms, as well as minimizing their negative effects
on daily life.
4. Social recovery. This domain's "Connecting and Belonging"
subdomain has 7 items (32-38).The client's perceived sense of
belonging is the focus of this domain.

Each item gets a 4-point rating. 1 is "untrue," 2 is "bit true," 3 is "mostly

true," and 4 is "fully true." This instrument is accessible in fourteen languages
included English (original) and Arabic. The RAS-reliability DS's was examined,
and the Cronbach's alpha value was .96.
 Scoring system of scale's score is between 38 and 152. A higher score
suggested a more positive subjective recovery experience for the patient.
Scoring system of RAS-DS:
► Low subjective recovery experience 38 – 76.
► Moderate subjective recovery experience 77 – 115.
► High subjective recovery experience 116 - 152.

Tool VI: Positive and Negative Syndrome Scale (PANSS) (Appendix-VI):

In 1992, Multi Health Systems, Inc. released this version of PANSS, which
was developed by Kay, Fiszbein, and Opler (1987). It seeks to evaluate the positive
and negative symptoms as well as the overall psychopathology related to
schizophrenia. The PANSS has three sections, the first of which assesses positive
symptoms, which are comprised of seven symptoms: delusions, conceptual
disorganizations, hallucinatory behavior, excitement, grandiosity, suspiciousness,
and hostility.

The assessment of negative symptoms is covered in the second section.

There are seven symptoms covered: blunted affect, emotional withdrawal, poor
rapport, passive/apathetic social withdrawal, difficulty with abstract thought, lack
of spontaneity and flow of conversation, as well as stereotyped thinking.

The third section also included 16 symptoms for assessing general

psychopathology, including anxiety, guilt feelings, somatic concerns, tension,
mannerism, depression, motor retardation, uncooperativeness, unusual thought
processes, disorientation, poor attention, lack of judgments and insight, disturbance
of volition, poor impulse control, preoccupation, and actively avoiding social
situations.
 Each PANSS item is given a rating on a 7-point scale, and each rating is
supported with a thorough description and specific anchoring standards for each of
the seven rating factors. When determining a rating, it is first important to
determine whether the item is indeed there, according to its definition. The severity
of any item is assessed on a scale from 2 to 7, with score (1) reflecting the absence
of that item, giving a patient with no symptoms a total score of 30 points. The
score (2) indicates that a symptom's intensity is modest or debatable, whereas the
number (7) suggests the extreme, i.e., the manifestations significantly impair most
or all important life functions.
Scoring system:

The PANSS scores for each component were determined by adding the
ratings for all of the component elements. Therefore, the possible ranges for the
subscales measuring positive and negative symptoms are each 7 to 49; however,
the subscale measuring general psychopathology has ranges of 16 to 112.
The positive and negative scales are scored according to the following categories:
 Mild (7 to 21)
 Moderate (21 to 35)
 Severe (35 to 49).
The general psychological scale is broken into three categories:
 Mild (16–48),
 Moderate (48–80),
 Severe (80–112).
The Cronbach's alpha value (Internal consistency) and criterion-related
validity were 0.77 (positive scale) and 0.77 (negative scale) and 0.52 with the
Clinical Global Impression scale (Kay, Opler & Lindenmayer, 1988).
 Method
Administrative steps

An approval from the Research Ethical Committee of the Faculty of Nursing

at Mansoura University was obtained with regard the study and the used tools and
official permission was obtained from the General Director of psychiatric
department at Mansoura University Hospital after clarifying the purpose of the
study, setting the time for beginning and explaining the process of the study as well
as to gain their cooperation and support during data collection.

Ethical Consideration

1. Informed oral consent was obtained from the schizophrenic patients before
conducting the study after clarifying the aim of the study and assuring them
about the confidentiality of the information.

2. Anonymity, confidentiality and privacy of the schizophrenic patients were

assured.

3. Voluntary participation and rights to refuse to participate in the study was

emphasized to the subjects.

4. The right to participate and to withdraw from the study was emphasized to
the participants.

5. All tools of data collection were coded to avoid declaration of any personal
information of sample information.
The tools' preparation:

1. Tool I Patient assessment sheet (socio-demographic characteristics and

clinical data) was developed by the researcher.

2. Tool II (S-QoL-18), III (LHS), and IV (ES) were translated into the Arabic
language by the researcher.

3. The translated tools (II, III, and IV) were tested for content validity by five
experts in the field of psychiatric nursing and English language. They were
accepted as valid. Arabic translation was also double checked and corrected.

4. Reliabilities of tools (II, III, IV) was done on 20 patients of schizophrenic

patients to test the internal consistency of different items of each scale by
using a test-retest method with a time period of two weeks in between each
one of them, to investigate the stability of the tools over time. The
Cronbach’s alpha value (internal consistency) of tool II (S-QoL-18) was .82,
and of the tool III (LHS) was .84, and of the tool IV (RES) was .80.

5. Pilot study was carried out during the month of September 2020 one month
before the data collection. Patients of the pilot study were excluded from the
main sample of the study.

6. Data collection was conducted during the period from January 2021 to
January 2022. Data was collected sequentially from inpatient and outpatient
clinics of Psychiatric Department at Mansoura University Hospitals.
Program Development:

The program was developed by the researcher after reviewing the relevant
literature. It aimed at enhancing helplessness, recovery and quality of life among
patients with schizophrenia.

Three phases (Assessment, Intervention, and Evaluation phase) of the

program's implementation were used:-
1. Assessment Phase:
 The researcher met with the participants, introduced herself, and explained
to them the aim of the study to obtain their consent to participate in the
study, gain their cooperation and confidence.
 The subject was interviewed individually before applying the planned
program to collect the baseline data using all study tools.
 The researcher started to fill-out the questionnaire from the participants
through individual interviewing until reached the total number. The
researcher read and explained each item to the participants and recorded
their responses to each item. This interview took about 25 to 30 minutes.
 The objective of the program was to educate patients and provide them the
tools they needed to manage their symptoms, cope with illness, and receive
treatment. Another crucial distinction is that patient’s empowerment can
extend outside of the clinical setting and into regular life (development of
self-esteem and coping skill). Empowering patients can enable them to take
more responsibility for managing their illness and engage in self-
management activities. The program also teaches these patients how to
communicate effectively and assertively. Encourage the participants to how
make decision and solving the problem. Moreover this intervention to
enhance self-care to improve their QOL and recovery.
2. The intervention phase:
 The program was carried out at the in-patient psychiatric department.
 The program was implemented for the studied schizophrenic patients; they
were divided into (10) groups, six participants in each group. Each group
attended 12 sessions (3 session / week). The researcher implemented the
program for each group in scheduled hours and days. To guarantee that each
group member receives the same learning opportunities and information.
The same instructional strategies, conversations or discussion and handouts
were used to deliver the same subject.
 The intervention was implemented through various teaching methods as
short lectures, group discussions, brain storming, demonstration re-
demonstration, and role-play. The teaching media included power-point
presentations, and a handbook.
 The researcher was started each session by welcomed the patients of each
group, summary about what was given through the previous session and the
objectives of the new one to make sure that participants recognize the
program content, discussing of the prior homework from the last session and
how to achieve the purpose of each session, taking into consideration the use
of simple language to suit the educational level of participants. Motivation
and reinforcement techniques as praise and recognition were used during the
session to enhance participation and learning and also enhance the self-
esteem.
 After each session, provide a small incentive to everyone who followed the
program's rules.
 The researcher collected data over a period of 12 months, starting on first of
January 2021 to January 2022.
3. Evaluation phase:
Evaluate participants after immediately and one month after Empowerment
Intervention by using the tools (tool II (SQOL-18), III (LHS), IV (ES), V (RAS-
DS), and VI (PANSS)).

The session's content of intervention includes:

"Orientation phase" and “Warming up"
Title: Building relationships and learning more about people.
Objective: develop a sense of trust and a therapeutic bond with the participants.
Session content:
 The researcher concentrates on enabling introduction and orienting patients
to the goal and structure of the group, with an emphasis on developing
rapport.
 The researcher met the participants in a quiet room for the first session, gave
them a warm welcome, let them take their seats, and introduced herself to
each participant in turn.
 This protocol establishes the ground rules for each group as well as the
intervention’s instructions. Additionally, the intervention’s ethical
considerations and patient consent were ensured to the patients.
 The study's scope and objectives were described by the researcher.
 Participants were given instructions on how to fill out the instruments as part
of the pre-assessment process.

“The second session”

Title: Knowledge about the nature of schizophrenia.
Objective: Inform patients who are suffering from schizophrenia about their
condition.
Session content:
 The definition of schizophrenia.
 Outlining the symptoms and indicators of schizophrenia.
 Talking about the causes of schizophrenia.
 Educating people with schizophrenia on the reality and myths surrounding
the disease.
“The third session”

Title: Knowledge about Treatment of Schizophrenia.

Objective: Provide the participants to information about treatment and it’s

important.

Session content:

 Introduce the participants to three main components of treatment for

schizophrenia (drugs, electro-convulsive therapy, and psychological
therapy).
 Helping the participants to know different types of the antipsychotics drugs
(typical and atypical antipsychotics).
 Identify the participants to importance of medication and role of drugs to
reduce of relapse.
 Discussing the participants to importance of medication adherence.
 Helping the participants When do you need to visit a doctor urgently?

“The fourth session”

Title: Side effects and Complication of antipsychotics.

Objective: provide the participants to information about side effects and
complication of antipsychotics and how deal with each of them.

Session content:

 Introduce the participants to side effects of antipsychotics (typical and

atypical).
 Helping the participants to how deal with these side effects.
 Introduce the participants to identify the complication of antipsychotics.

“The fifth session”

Titles: Communication Skills.

Objective: Participants will use communication skills to maintain productive

relationships with others.

Session content:

 Defining of communication.
 Identify Non-verbal communication instructions.
 Express positive emotions and Express negative feelings.
 Submit a positive request.
 Illustrate how to be active listener.

“The sixth session”

Title: Assertive Communication.

Objective: Applying assertive communication skills by participants.

Session content:

 Help patient to understand the difference between assertive, passive and

aggressive communication.
 Identify the advantage of assertive communication.
 List importance of assertive communication.
 How can you be an assertive person?

“The seventh session”

Title: Self-care strategies.

Objective: Identify the participants of self-care strategies for schizophrenia.

Session content: People with schizophrenia should adopt the following healthy
behaviors to enhance their quality of life:

 Quit smoking.
 Maintain personal hygiene.
 Maintain a healthy weight.
 Be active.
 Get enough sleep and Stay away from stress.

“The eighth session”

Title: Anxiety and Relaxation technique.

Objective: Identify the patients about anxiety and apply of relaxation technique to
reduce anxiety.
Session content:

 Define of anxiety and symptoms of anxiety.

 Discussing about ways to relax to deal with anxiety.
 Identify ways to be relaxed.
 Applying of relaxation technique (deep breathing, meditation) to reduce
stress and anxiety.

“The ninth session”

Title: Building self-esteem.

Objective: Increase the participants to self-esteem and self confidence

Session content:

 Define the participants to the self-esteem.

 Discuss with participants to How building self-esteem.
 Helping the participants to build your positive thinking to increase your self-
confidence and self-esteem.

“The tenth session”

Title: Anger Management.

Objective: Helping the participants to ability to control on anger.

Session content:

 Define to participants of anger.

 Introduce the participants to Damages and disadvantages caused by anger.
 Understanding the participants to Tantrums: There are six stages of anger.
  Discuss with participants how control on anger (anger management).
 Identify the participants to Ways to calm down immediately after the anger
attack.

“The eleventh session”

Title: Problem Solving and Decision Making.

Objective: Identify steps of problem solving technique.

Session content:

 Define the problem.

 How to deal with any problem.
 How to take decision.
 List solves problem steps.

“The twelve session”

Title: The last and Termination of the session.

Objective: intervention evaluation and termination.

Session content:

 A summary and comments on the prior sessions' content.

 Expressing their emotions, thoughts, and comments on the intervention.
 The administration of the study materials was carried out (post-test) using:

o Immediately after the end of the program. Evaluation of the program

for the study group was done to assess the effectiveness of the
 program on the study group using tool II, tool III, tool IV, tool V, and
tool VI.

o After one month from implementation of the program, reevaluation of

the study group was done using the study tools.

Full Arabic description of the Intervention is included in appendix (VII).

Statistical Analysis: 

Software called Statistical Package for the Social Sciences (SPSS) was used
to enter and evaluate the data (version 22).

Number and percentage were used to represent the qualitative factors. To

compare between several groupings of categorical variables, the chi-square (X2)
test was applied. Using the Pearson coefficient, two ordinarily quantitative
variables were correlated.

Some variable compressed in the result to specific statistical analysis.

Level of Significance:

 The 5% level is the set threshold of significance for all statistical tests
(p-value).
 When the likelihood of mistakes is less than 5% (p is less than 0.05), the
result is significance; when it is greater than 5%, the result is non-
significant (p is more than 0.05).
 When the likelihood of inaccuracy is smaller than 0.1%, it is highly
significant (p is less than 0.001).
 The significance of the results increases when the p-value is low.
Limitation of this study:

This study was done in a large period of time due to the beginning of the
spread of the Corona virus epidemic in 2020, the strict protective measures in all
health institutions, there was a difficult in completion data collection for different
periods.
 Results

The results of this study are presented in the following sequence:

Part I: Socio-demographic characteristics and clinical data of the studied patients

(Tables 1:4).

Part II: Relationships between pre assessment, immediately and after one month
of intervention according to studied variables (Table 5:12)

Part III: Correlation between studied variables in pre-assessment, post

immediately and after one month (Table 13:15).
Part I: Socio-demographic characteristics and clinical data of the studied
patients (Tables, 1 – 4).
Table (1) Frequency Distribution of studied sample according to Socio-
demographic characteristics (N 60):
Socio-demographic characteristics N (60) %(100)
Age
18 > 30 years 18 30.0%
30 > 45 years 34 56.7%
45 to less than 60 years 8 13.3%
Mean ± SD = 34.36 ± 9.15
Gender
Male 55 91.7%
Female 5 8.3%
Educational level
Illiterate 7 11.6%
Read &Write /Primary/Preparatory School 13 21.7%
Secondary and Technical school 29 48.4%
University / Post graduate 11 18.3%
Marital status
Single 39 65.0%
Married 10 16.7%
Divorced & Separated 11 18.3%
Occupation
Not working 20 33.3%
Working 40 66.7%
If working
House wife 4 10.0%
Technical Worker 25 62.5%
Employee 8 20.0%
Student 3 7.5%
Place of residence
Urban 29 48.3%
Rural 31 51.7%
Income satisfaction
Insufficient 44 73.3%
Sufficient 16 26.7%
Source of income
From occupation 36 60.0%
Retirement 13 21.7%
By family 11 18.3%
Total 60 100%
Test: General Linear Model
 Table (1) shows that age of the studied patients range from 18- 60 years
with mean ± SD of (34.36 ± 9.15). More than half of sample (56.7%) was among
age group of 30 to 45 years. The majority of the study samples were male (91.7%).
According to level of education one third of the studied samples (33.3%) were
illiterate or read and write. Regarding to marital status (65.0%) was single. one
third of studied sample (33.3%) weren’t working. According to the residence more
than half of the studied sample was from rural (51.7%). Concerning satisfactory of
income nearly three quarter of the studied sample (73.3%) had insufficient income.
.
Table (2): Frequency Distribution of the studied samples according to social
condition (N 60):
Social condition N (60) 100 %
Numbers of Family members
Less than 4 members 18 30.0%
4 members 14 23.3%
More than 4 members 28 46.7%
Birth order
The Younger 18 30.0%
The Middle 22 36.7%
The Older 20 33.3%
Living with whom (Cohabitation)
Alone 9 15.0%
Parents 39 65.0%
Wife/ Husband and Children 10 16.7%
Brothers/sisters 2 3.3%
Take care for you
No one 11 18.3%
Parents 34 56.7%
Wife/ Husband and Son 10 16.7%
Brothers/sisters 5 8.3%
Support system
No one 26 43.3%
Parents 24 40.0%
Wife/ Husband and Children 3 5.0%
Brothers/ Sisters/ Relatives 7 11.7%
Social Interaction
Social Initiation interaction
No 52 86.7%
Yes 8 13.3%
Maintenance interaction
No 17 28.3%
Yes 43 71.7%
Total 60 100%
Test: General Linear Model
 Table (2) illustrates that nearly half of the studied sample (46.7%) reported
that family members were more than four members. According to birth order more
than one third (36.7%) of patients were the middle in the family. Nearly two thirds
(65.0%) of the patients lived with their parents while (15%) living alone. More
than half (56.7%) of patients reported that they receive care form their parents.
Nearly half of studied sample (43.3%) of patients hasn’t emotional support from
anyone. Majority of studied sample (86.7%) no social initiation, but near three
quarter (71.7%) maintain the relationship with others.
Table (3): Frequency Distribution of studied sample according to Physical
condition (N 60):
Physical Condition N (60) 100%
Eating habit
Refuse eating 2 3.3%
Anorexia 10 16.7%
Eat and ask more 3 5.0%
Eat alone 42 70.0%
Eat with help 3 5.0%
Sleeping hour
Less than 4 hours 24 40.0%
4:6 hour 16 26.7%
More than 6 hour 20 33.3%
Insomnia
No 13 21.7%
Yes 47 78.3%
If yes:
Early Insomnia 8 17.02
Interrupted Sleep 8 %
Late Insomnia 31 17.02
%
65.96
%
Personal Hygiene
Neglect it 7 11.7%
Need help 29 48.3%
Make personal hygiene alone 24 40.0%
Physical illness
No 58 96.7%
Yes 2 3.3%
Total 60 100%
Test: General Linear Model
Table (3) shows that (20 %) of studied sample had anorexia or refuse eating.
Two third of the studied sample (66.7%) was sleeping less than 6 hour in the day.
Also (78.3%) reported sleep disturbance, (17.02%, 17.02%, 65.96%) early
insomnia, interrupted sleep and late insomnia, respectively. According to personal
hygiene, near two third (60.0%) of the studied sample were neglect personal
hygiene or need help to make it. Regarding physical illness, the most of studied
samples (96.7%) weren’t complained any physical illness.
Table (4): Frequency Distribution of the studied sample according to clinical
data (N 60):
Clinical data N(60) 100%
Diagnosis
Schizophrenia 60 100%
Family history
No 19 31.7%
Yes 41 68.3%
Presence of Hallucination
No 7 11.7%
Yes 53 88.3%
If yes type of hallucination
Auditory 31 58.5%
Visual 3 5.7%
Auditory and visual 19 35.8%
Presence of Delusion
No 8 13.3%
Yes 52 86.7%
If yes type of delusion
Grandeur 7 13.5%
Persecution 29 55.8%
Grandeur and persecution 5 9.6%
Persecution and reference 11 21.1%
Duration of the disease
1 < 5 years 21 35.0%
5 < 10 years 26 43.3%
10 years and more 13 21.7%
Onset of Age at 1st attack/ 1st diagnosed
Less than 18 year 12 20.0%
From 18 : 30 year 35 58.3%
More than 30 year 13 21.7%
Mode of Admission
Involuntary 41 68.3%
Voluntary 19 31.7%
Duration of treatment
Less than 2 years 12 20.0%
1 < 4 year 18 30.0%
4 and more 30 50.0%
Adherence to medication
No 12 20.0%
 Cause of non-adherence:
Expensive of treatment 2 16.7%
Side effect of medication 5 41.6%
Lack of insight 2 16.7%
Lack of insight and Side effect. 3 25%
0
If Yes (N=48) 48 80.0%
Yes regularly 16 33.3%
Yes interrupted 32 66.7%

If Yes (N=48) 19 39.5%

Taken medication alone 29 60.5%
Taken medication with someone help
Smoking
No 14 23.4%
Yes 46 76.6%
If yes number of cigarate:
Less than one box 16 34.78%
1 : 3 box 23 50.0%
More than 3 box 7 15.22%
Total 60 100%
Test: General Linear Model
Table (4) shows that more than two third (68.3%) had family history.
Majority of the studied sample (88.3%) had hallucination more than half of the
studied sample (58.5%) had auditory hallucination. Majority of the patients
(86.7%) had delusion, more than half of the studied sample (55.8%) delusion of
persecution. Onset of the first attack of schizophrenia more than half of the studied
sample (58.3%) occurred from 18: 30 years old ago. According to admission of
hospital more than two third of the studied sample were admission by involuntary
way. According to duration of treatment half of studied samples (50.0%) were take
medication more than four years. According to the medication adherence, (20.0%)
of the studied samples no adherence to medication and more than two third of
studied samples (41.6%) no adherence related to side effect of medication.
According to smoking more than three quarter of studied sample were smokers.
Part II: Relationships between pre assessment, immediately and after one
 month according to studied variables

Table (5) Total Scores of Schizophrenia Quality of Life (SQOL-18) between

pre assessment, immediately and after one month (n=60):
Pre- Immediately After
assessment one Test
month
Mean ± SD Mean ± SD Mean ± SD F P

Total score of 44.58 ± 6.78 49.88 ± 6.55 52.71 ± 6.58 141.647 .000
schizophrenia quality
of life
Dimension of
schizophrenia quality
of life scale.
 Self-esteem 5.23 ± 1.58 7.13 ± 1.22 8.64 ± 1.11 131.548 .000
dimension
 resilience 7.90 ± 1.95 9.56 ± 1.89 10.81 ± 1.63 82.030 .000
dimension
 Autonomy 5.08 ± 1.83 5.88 ± 1.60 6.33 ± 1.44 26.875 .000
dimension
 Physical wellbeing 5.05 ± 1.65 6.20 ± 1.32 6.80 ± 1.16 54.840 .000
dimension
 Family relationship 5.05 ± 2.44 5.56 ± 2.36 5.86 ± 2.40 14.265 .000
dimension
 Friend relationship 3.1 ± 1.25 3.31 ± 1.26 3.45 ± 1.33 3.086 .053
dimension
 Sentimental life 3.21 ± 1.87 4.08 ± 2.00 4.63 ± 2.04 30.159 .000
dimension
 Psychological 9.91 ± 3.12 8.13 ± 2.81 6.66 ± 2.52 104.042 .000
wellbeing
dimension
Test: General Linear Model

Table (5) Demonstrates the total score of schizophrenia quality of life is

(44.58 ± 6.78) pre intervention and increase to (49.88 ± 6.55) immediately post
intervention and reach to (52.71 ± 6.58) after one month of intervention and with
statistical significance P= (.000). Also dimension of schizophrenia quality of life
affected by intervention, mean score of self-esteem dimension pre intervention
(5.23 ± 1.58) and increase (7.13 ± 1.22) immediately after intervention but after
one month mean score reach to (8.64±1.11) and with statistical significance P
(.000).
The total score of resilience pre intervention (7.90 ± 1.95) increase the mean
score immediately post (9.56 ± 1.89) and increase (10.81±1.63) after one month,
with statistical significance P= (.000). And the mean score of autonomy dimension
pre intervention is (5.08 ± 1.83), increase the mean score of autonomy immediately
post (5.88 ± 1.60), also increase to (6.33 ± 1.44) after one month, with statistical
significance P (.000). Total score of Physical well-being pre intervention (5.05 ±
1.65), but increase the total score (6.20 ± 1.32) immediately post and slightly
increase to (6.80 ± 1.16) after one month, with statistical significance P= (.000).
Psychological well-being total score pre intervention is (9.91 ± 3.12) and decrease
the mean score (8.13 ± 2.81) immediately post intervention and decrease mean
score (6.66 ± 2.52) after one month with statistical significance P= (.000). All
dimensions of schizophrenia quality of life are affected by empowerment
intervention.

Table (6): Total Score of scoring system of Learned Helplessness scale (LHS)
 between pre-assessment, immediately and after one month (n=60):

Scoring system of Pre-assessment Immediately After one Test

LHS
month
N % N % N % X2 P
Mild 0 0 3 5.0% 25 41.7%
(20 : < 40)
Moderate 50 83.3% 56 93.3% 35 58.3% 49.52 .000**
(40 : < 60)
Severe 10 16.7% 1 1.7% 0 0.0%
(60 : 80)
X2: chi square
Table (6) illustrates the significance of empowerment intervention on
learned helplessness scale with p value (.000).

Table (7): Total Score of Learned Helplessness scale (LHS) between pre-
assessment, immediately and after one month (n=60):

Pre-assessment Immediately After one month Test

Mean ± SD Mean ± SD Mean ± SD F P
Total of learned
helplessness 52.61± 4.66 46.35 ± 3.76 42.48 ± 4.15 143.950 .000**
Test: General Linear Model

Table (7) Demonstrates significance on mean score of learned helplessness

pre intervention (52.61± 4.66), decrease sense of helplessness immediately post
intervention (46.35 ± 3.76) and also decrease in after one month from intervention
with mean score (42.48 ± 4.15), with show significance (.000).

Table (8) Total Score of Recovery Assessment Scale- Domains and Stage
 (RAS-DS) between Pre-assessment, post- assessment (immediately and after
one month) (n=60):

Scoring system of Recovery Pre- immediately After one Test

Assessment Scale (RAS-DS) assessment month
N % N % N % X2 P
Low subjective experience of 45 75% 6 10% 2 3.3%
recovery (38:76)
Moderate subjective experience 15 25% 54 90% 33 55.0%
of recovery (77:115) 90.83 .000**
High subjective experience of 0 0.0% 0 0.0% 25 41.7%
recovery (116:152)
Total 60 100% 60 100% 60 100%
X2: chi-square

Table (8) describes the significance of empowerment intervention on

recovery assessment with P value (.000).

Table (9) Total score of Recovery Assessment Scale-DS (RAS-DS) between

 pre-assessment, immediately and after one month (n: 60)

Pre- Immediately After one

assessment month Test
Mean ± SD Mean ± SD Mean ± SD F P

Total of recovery 70.07 ±11.62 90.25 ± 12.95 97.33 ± 12.85 165.821 .000**
assessment scale
Total Function recovery 13.25 ± 2.82 16.06 ± 2.73 17.55 ± 2.55 160.439 .000**

Total Personal recovery 36.98 ± 7.14 47.08 ± 6.90 50.11 ± 6.68 118.661 .000**

Total Clinical recovery 8.53 ± 1.85 14.06 ± 2.46 15.56 ± 2.67 153.695 .000**

Total Social recovery 11.30 ± 2.81 13.03 ± 2.74 14.10 ± 2.85 49.793 .000**

Test: General Linear Model

Table (9) Demonstrates the total score of recovery assessment scale of studied
patients pre assessment (70.07 ± 11.62) but immediately post (90.25 ± 12.95) and
(97.33 ± 12.85) after one month with statistical significance P= (.000). Total score
of functional recovery dimension of studied patients pre assessment were (13.25 ±
2.82) but immediately post (16.06 ± 2.73) and (17.55 ± 2.55) after one month with
statistical significance P= (.000). The total score of personal recovery dimension
of studied patient’s pre assessment were (36.98 ± 7.14) but immediately post
(47.08 ± 6.90) and after one month (50.11 ± 6.68) with statistical significance with
P= (.000). The mean score of clinical recovery dimension pre assessment (8.53 ±
1.85) but immediately post (14.06 ± 2.46) and after one month were (15.56 ± 2.67)
with statistical significance with P= (.000). The total score of social recovery
dimension of studied patients were (11.30 ± 2.81) pre assessment but after one
month (14.10 ± 2.85) with statistical significance with P= (.000).
Table (10) Total score of Empowerment Scale between pre-assessment,
 immediately and after one month (n=60):

Pre- Immediately After one

assessment month Test
Mean ± SD Mean ± SD Mean ± SD F P
Total of 70.68 ± 4.5 64.55 ±4.38 60.40 ± 4.23 143.536 .000**
empowerment
Dimension of
empowerment scale.
 Self esteem 20.46 ±2.12 17.44 ±2.09 16.08 ± 1.85 124.431 .000**
 Power- 17.55 ±2.26 17.46 ±2.34 17.06 ± 2.22 2.629 .081
powerlessness
 community activism 13.81 ±1.89 12.48 ±1.67 11.63 ± 1.64 45.743 .000**
and autonomy
 optimism and 9.40 ± .924 8.28 ± .825 7.68 ± .98 64.532 .000**
control of future
 righteous anger 9.45 ± 1.18 8.88 ± 1.10 7.93 ± 1.20 34.897 .000**
General Linear Model
Table (10) Demonstrates the total score of empowerment pre intervention
(70.68 ± 4.5), immediately post intervention with total score (64.55 ± 4.38) and the
total score after one month (60.40 ± 4.23), with statistical significance with
P= (.000). Self-esteem mean score pre intervention (20.46 ± 2.12), immediately
post (17.44 ± 2.09) and (16.08 ± 1.85) after one month, with statistical significance
with P= (.000).
Total score of Power- powerlessness dimension (17.55 ± 2.26) pre
intervention but total score immediately (17.46 ± 2.34) and (17.06 ± 2.22) after one
month with show significance. Total score of Righteous anger pre intervention
(9.45 ± 1.18), immediately (8.88 ± 1.10) and after one month (7.93 ± 1.20), with
statistical significance with P= (.000).

Table (11) Total score of Positive and Negative symptoms scale (PANSS)
 between pre-assessment, immediately and after one month (n=60):
Pre- Immediately After one Test
assessment month
Mean ± SD Mean ± SD Mean ± SD F P

Total score 76.42 ± 12.16 64.81±10.80 54.31 ± 9.04 317.842 .000**

of PANSS
General linear Model
Table (11) shows the significance of empowerment intervention on positive
and negative symptoms with P= (.000).

Table (12) Total Score of scoring system of positive and negative symptoms
 scale (PANSS) between pre assessment, immediately and after one month
(n=60):

Pre- After one Test

Scoring System of
assessment immediately month
PANSS
N % N % N % X2 P
Positive symptoms:
 Mild (7 < 21) 11 18.3% 35 58.3% 55 91.7%
 Moderate (21< 35) 47 78.3% 25 41.7% 5 8.3%
 Severe (35< 49) 2 3.3% 0 0.0% 0 0.0%
Negative symptoms:
 Mild (7 < 21) 46 76.7% 53 88.3% 60 100% 71.186 .000**
 Moderate (21< 35) 14 23.3% 7 11.7% 0 0.0%
 Severe (35< 49) 0 0.0% 0 0.0% 0 0.0%
General symptoms:
 Mild (16 < 48) 56 93.3% 59 98.3% 60 100%
 Moderate (48< 80) 4 6.7% 1 1.7% 0 0.0%
 Severe (80< 112) 0 0.0% 0 0.0% 0 0.0%
Total 60 100% 60 100% 60 100%
X2: chi-square
Table (12) describes the significance of empowerment intervention on
positive and negative symptoms with P value (.000).

Part III: Correlation between studied patients scores on different study

 variable

Table (13) Correlation between studied patients scores on different study

variables pre assessment:

Total SQOL Total Learned Total Recovery Total Total PANSS

helplessness assessment Empowerment
r Sig r Sig R Sig r Sig r Sig

Total SQOL -.430-** .001 .674** .000 .160 .223 -.171- .191

Total Learned -.430-** .001 -.473-** .000 .111 .399 .178 .173
helplessness
Recovery .674** .000 -.473-** .000 .269* .037 -.340-** .008
assessment
Total .160 .223 .111 .399 .269* .037 -.248- .056
Empowerment
Total PANSS -.171- .191 .178 .173 -.340-** .008 -.248- .056

*. Correlation is significant at the 0.05 level (2-tailed). *

**. Correlation is significant at the 0.01 level (2-tailed). *
r= Pearson’s Correlation Coefficient
Table (13) shows the correlation between studied samples total mean score
of studied variables pre assessment. There is a highly significant negative
correlation between, Schizophrenia quality of life and learned helplessness
(p=-.430- with significance .001), Recovery assessment and learned helplessness
(p=.-.473- with significance .000), Positive and negative symptoms and recovery
assessment (p=-.340- with significance .008). There is a highly significant positive
correlation between SQOL and recovery assessment the (p= .674 with
significance .000). There is a positive correlation between empowerment and
recovery assessment (p= .269 with significance .037).

Table (14) Correlation between studied patient’s scores on different study

post immediately:
 SQOL Learned Recovery Empowermen PANSS
helplessness assessment t
R Sig r Sig R Sig r Sig R Sig

SQOL -.449-** .000 .696** .000 .273* .035 -.393-** .002

Learned -.449-** .000 -.583-** .000 -.198- .130 .352** .006

helplessness
Recovery .696** .000 -.583-** .000 .312** .015 -.564-** .000
assessment
Empowerment .273* .035 -.198- .130 .312** .015 -.235- .071

PANSS -.393-** .002 .352** .006 -.564-** .000 -.235- .071

*. Correlation is significant at the 0.05 level (2-tailed).

**. Correlation is significant at the 0.01 level (2-tailed).
r= Pearson’s Correlation Coefficient
Table (14) shows the correlation between studied samples total mean score
of studied variables immediately after program. There is a significant negative
correlation between, Learned helplessness and Schizophrenia quality of life
(p= -.449- with significance .000), Learned helplessness and recovery assessment
(P=-.583- with significance .000), PANSS and SQOL (P=-.393- with
significance .002) and PANSS and recovery assessment (P=-.564- with
significance .000).

There is a significant positive correlation between, SQOL and recovery

assessment (p= .696 with significance .000), Empowerment and recovery
assessment (P= .312 with significance .015) and PANSS and learned helplessness
(P= .352 with significance .006). There is positive correlation between SQOL and
empowerment (P=.273 with significance .035).
 Table (15) Correlation between studied patient’s scores on different study
after one month of intervention:

SQOL Learned Recovery Empowerment PANSS

helplessness assessment
R Sig r Sig R Sig r Sig r Sig

SQOL -.378-** .003 .618** .000 .241 .064 -.384-** .002

Learned -.378-** .003 -.650-** .000 -.259-* .046 .476** .000

helplessness
Recovery .618** .000 -.650-** .000 .331** .010 -.558-** .000
assessment
Empowerment .241 .064 -.259-* .046 .331** .010 -.083 .531

PANSS -.384-** .002 .476** .000 -.558-** .000 -.083 .531

*. Correlation is significant at the 0.05 level (2-tailed). *

**. Correlation is significant at the 0.01 level (2-tailed). *
r= Pearson’s Correlation Coefficient
Table (15) shows the correlation between studied samples total mean score
of studied variables one month after program. There is a significant negative
correlation between, Learned helplessness and Schizophrenia quality of life
(p=-.378- with significance .003), Learned helplessness and recovery assessment
(P=-.650- with significance .000), PANSS and SQOL (P=-.384- with
significance .002) and PANSS and recovery assessment (P=-.558- with
significance .000).

There is a significant positive correlation between, SQOL and recovery

assessment (p= .618 with significance .000), Empowerment and recovery
assessment (P= .331 with significance .010) and PANSS and learned helplessness
(P= .476 with significance .000). There is negative correlation between
empowerment and learned helplessness (P=-.259-with significance .046).

Discussion
Schizophrenia is a complex chronic mental illness characterized by
delusions, hallucination, or confusion in speech and behavior. Cognitive
impairment has been shown to affect global functions, leading to employment
difficulties and social withdrawal, which consequently influence their quality of
life and recovery and also affect the degree of recovery and necessitate long-term
continuous care (Lee et al., 2021).

The objective of the present study was to assess the effect of an

empowerment intervention on patients with schizophrenia on helplessness,
recovery, and quality of life.

In the present study the characteristics of studied patients revealed that more
than half of the total sample was at the age group between 30-45 years. This
outcome was in line with a report by Hamed, El-Bilsha, El-Atroni, and El Gilany
(2014) who stated that more than half of patients were between the ages of 30 and
50, and also agreement with Forma, Green, Kim, and Teigland (2020).

Majority of the patients in the present study were males. This result may be
due to their families with female patients not seeking help as a result of
stigmatization and may be related to the symptoms of schizophrenia stronger in
male than female so the male patient need hospitalization. This result was in
harmony with a study in Egypt by Mahmoud & Zaki (2015). This result also was
consistent with a study by Altun, Karakaş, Olçun, Polat (2018). On the other hand,
this result was not consistent with a study in Egypt by Ghanem, Gadallah, Meky,
Mourad & Kholy (2009). Also, Osuji & Onu (2019) reported that females were
more than males.
Only 11.6% of the analyzed sample had no formal education, while 48.4%
had some form of a diploma, secondary schooling, and technical training. This may
be because more than half of patients came from rural areas where higher
education receives less attention. Additionally, nearly half of their households have
more than four members, and the majority of them earn little income. An Egyptian
research that showed 14% of schizophrenia patients were illiterate and 40% had
secondary education corroborated this finding (Mahmoud, Berma, & Gabal, 2017).
Additionally, this outcome was consistent with an Egyptian research by Dewedar,
Harfush, and Gemeay (2018), which found that 9.2% of patients were illiterate and
44.2% of patients had just a secondary education.

According to the current study, 65% of participants were single with regard
to marital status. This outcome is attributed to (86.7%) the majority of patients age
group less than 45 years and this age of marriage and so being a patient with a
mental illness delaying the marriage related to the stigma of being a patient in a
mental health facility and due to more than half of the study sample living in a
rural region where everyone knows each other generated fear of stigma. This result
was congruent with a study with Altamura, Buoli, Pozzoli (2014) that showed that
majority of schizophrenic patients were not married. In contrast Shin, Fei, Yi,
Ruslan & Sharkawi (2020) in Malaysia contradicted that majority of patients with
schizophrenia were married.

Based on the findings of the current study, two thirds (66.7%) of the studied
samples were working. This finding may be the result of poor income and a need
for money to survive; patients in the present research made up 62.5% of their
income from work but working as farmers, drivers, and market vendors when
symptoms abated and absent. This result wasn’t agreeing with a study in Egypt by
Soliman, Mahdy & Fouad (2018) who stated that half of schizophrenic patients
were unemployed. In addition to another Egyptian study in Tanta by Harfush &
Gemeay (2017) revealed that more than half of schizophrenic patients were
unemployed.

More than half (51.7%) of the participants in the current research were from
rural areas, according to the study's findings. This finding may be construed as
indicating that rural areas frequently seek out elders for Traditional therapy, put off
obtaining psychiatric care, and have an adverse impact on mental health and due to
delay the psychiatric treatment caused chronicity of illness and need
hospitalization. This result was congruent with a study in Egypt by El-Monshed &
Amr (2020) who found that more than half of schizophrenic patients were from
rural area. In addition, this result was associated with Dutesco et al. (2018) who
mentioned that majority of patients with schizophrenia was from rural area. In
contrast to this result, Desalegn, Girma, & Abdeta (2020) in Southwest Ethiopia
contradicted that more than half of schizophrenic patients were from urban.

Only 15% of the participants were living alone, while 65% of the studied
sample was living with their parents. This may be explained by the fact that nearly
three-quarters of patients (73.3%) reported having insufficient money and that
more than half of patients (65%) were single. It may also be explained by the fact
that our parents are the people who look out for us and care for us the most. More
over half (56.7%) of the studied samples were parents who provided care to their
patients. Guedes de Pinho, Pereira, and Chaves (2018) observed that more than
half of patients lived with their families, which was consistent with this outcome.
Additionally, this outcome was supported by a research conducted in Egypt by
Mohammed & Ghaith (2019). In addition, this result was consistent with Henry &
Jombo (2015) who reported that majority of the sample were residing with their
family members.

This study found that about more than half (60%) of the studied sample
either disregarded personal hygiene or completed it with help. This outcome can be
as a result of the negative symptoms and busy all time because positive symptoms
as hallucination or delusion. According to an Egyptian research by El-Bilsha
(2019), more than half of schizophrenia patients disregard personal hygiene, and
this outcome was consistent with that finding.

The current study found that one-fourth of the patients had eating troubles,
such as refusal eating, anorexia, and eating with help, according to eating patterns.
This outcome could be attributed to the fact that approximately 55.8% of the
sample had delusion of persecution a false belief that food is poisoned. This result
was consistent with Al-maghraby, El-Bilsha, and El-Hadidy (2020), who reported
that more over one-third of the schizophrenia patients refused to eat.

The present study found that two third (66.7%) of the studied sample
experienced sleep disturbances, with fewer than 6 hours of sleep being the average.
This outcome might be the consequence of psychotic symptoms, which can
produce dread and worries that impair regular sleep patterns at night and perhaps
arise from hospitalization. This finding was in line with that of (Al-maghraby, El-
Bilsha, and El-Hadidy, 2020), who found that more than one third of schizophrenia
patients had sleeplessness. In the current study, 78.3% of participants report having
insomnia, whether it is early, late, or interrupted. These findings support Reeve,
Sheaves, and Freeman's (2019) finding that 50% of psychosis patients have
insomnia.
According to the current study, more than two thirds of patients had a
confirmed family history of mental illness. This outcome is a result of the
influence of hereditary and genetics factors, which are frequently a predisposing
factor for mental illness. This outcome was in line with that of (Kiwan et al.,
2020).

The majority of the studied sample (96.7%) had not physical illness, this
finding related to 86.7% of the studied sample less than 45 years old. These
findings agree with Al-maghraby, El-Bilsha, and El-Hadidy (2020).

According to this study's findings on the age onset or started of

schizophrenia, more than half (58.3%) of studied samples were between the ages
of 18 and 30. This outcome is due to the epidemiology of schizophrenia, which the
(WHO, 2018) indicated may begin between the ages of 16 and 30. And this finding
supported the result of the study that one third (33.3%) of the studied sample not
working.

According to duration of the disease, more than one third (43.3%) of the
studied samples were from 5 to 10 years, this result due to chronicity of the
schizophrenia and also related to 20% of the studied sample non-adherence to
medication and two third (66.7%)of the studied sample was interrupted to give the
treatment. This result supported by El-Bilsha (2019).

The present study revealed that, when it came to form of admission, more
than two thirds of patients were forcibly admitted to mental hospitals. This
outcome can be the result of ignorance of the condition and stigma-related anxiety.
This finding was in agreement with an Egyptian research by Ibrahim, Callaghan,
Mahgoub, El-Bilsha, and Michail (2015), which found that more than two thirds of
patients with mental illness were admitted involuntarily.

According to this study's findings, the majority of the sample often had
auditory hallucinations and persecution delusions. This outcome might be the
consequence of non-adherence to medication, which can lead to the worsening of
positive symptoms like hallucinations and delusions. This outcome was consistent
with research done in Egypt by (Sayied, Ahmed, 2017).

More over three-quarters of the sample were found to be smokers, according

to this result. This outcome may be attributable to patients' usage of cigarettes as a
coping mechanism for auditory hallucinations. This finding was consistent with
that of Abd Elhay (2015) and Kiwan, et al. (2020), who found that two thirds of
individuals with schizophrenia smoke. Eticha, Teklu, Ali, Solomon & Alemayehu
(2015) found the opposite, finding that half of schizophrenia patients did not
smoke cigarettes.

From what we understand, only few studies have investigated psychiatric

ward interventions to empower patients, improve their prognoses, and to reduce the
risk of relapse. Greater understanding of one's illnessand a more positive attitude

towards medication can improve outcomes. This study used a recovery

Empowerment intervention focused at schizophrenia patients to improve recovery
and quality of life and decrease helplessness (Hasan & Musleh, 2017).
 Empowerment plays a critical role in the recovery of patient with mental
illness. Patients with schizophrenia prefer interventions that empower them and
enable them to function independently at all levels of daily life in the community.
Empowering mentally ill individuals does more than improve their lives; it also
shows a positive attitude to nurses who conduct empowerment interventions,
encouraging them to continue. Patients with schizophrenia are excessively exposed
to rejection, stigma, discrimination, feeling of helplessness and low quality of life.
So, empowerment is an essential component of the recovery process (Mostfa,

Khalil, Mohamed & Mohamed, 2022).

In the present study found lower in the quality of life among patients with
schizophrenia this result may be related to negative symptoms of schizophrenia
and the patient busy all time by positive symptoms and inability to live by normal
way and also frequent hospitalization, this finding supported by (Kennedy et al.,
2014).

After the empowerment intervention, quality of life significantly improved

in the current study, demonstrating that the patient had a greater awareness of his
or her condition and how it behaved. Moreover, research showed that active
treatment (intervention with medication) for negative symptoms, mental distress,
and resistance might enhance quality of life in people with schizophrenia. This
finding agrees with (Fujimaki, Morinobu, Yamashita, Takahashi & Yamawaki,
2012).

Additionally, the quality of life in patients with schizophrenia was

significantly impacted by empowerment. The results of this study confirm the
value empowerment intervention in improving patient’s quality of life. For
schizophrenic patients in the community, we propose that various rehabilitation
intervention and empowerment health education are required to improve QOL.
This result agrees with (Chou et al., 2012). And also agree with (Kranz, 2011) he
describe that empowerment intervention was the most important predictor of
quality of life. In addition, agreed this result with Barbic & Krupa (2007) he
described that increased empowerment has been found to result in lower levels of
depression and higher levels of subjective quality of life and significant
relationship between schizophrenic patients score of their empowerment and
quality of life. Another study found that changes in the Empowerment are
positively correlated with subjective quality of life (Hansson & Björkman, 2005).

Regarding the different domains of quality of life like self-esteem,

resilience, family relationships, friend relationships, sentimental life, autonomy,
physical wellbeing, and psychological wellbeing all significantly improved both
immediately after the empowerment intervention and one month later. This result
may be attributable to participants' increased awareness of their medical conditions
and the value of taking their medications. Additionally, empowerment altered how
participants in this study perceived their illness, motivated them to exert more
control over unfavorable circumstances and handle individual ’s perceptions better,
which may have contributed to their improved well-being and quality of life (i.e.,
feeling less stressed and more energetic). This outcome supports with (Hasan &
Musleh, 2017).

Patients with schizophrenia who exhibit increasing feelings of learned

helplessness this result may be due to subjected to frequent hospitalization, which
could be damaging and restrict their ability to realize their life goals additionally,
they might internalize their prejudices and be more tolerant of them, which can
result in feelings of guilt and isolation (Hasan & Musleh, 2017).

Moreover, Patients in the pre assessment have moderate to severe learned

helplessness but in after one month from empowerment intervention, that patients
have mild to moderate the learned helplessness. The recovery and learned
helplessness outcomes for schizophrenic patients showed a substantial
improvement. It appears that the intervention gave them the tools to manage their
illness and the fortitude to face anxiety and discrimination. Additionally, in this
study, empowerment pushed individuals to exert more control over unfavorable
circumstances and altered how they saw their illness, and may be also related to
assist them to handle the problems and make decision and take action about duties
in their life. Also may be decreasing the helplessness related to increase the self-
esteem according to session of empowerment intervention, this finding agrees with
(Warner, 2009; Hasan & Musleh, 2017).

In the same line, the study's findings therefore confirmed the null hypothesis
that intervention recipients would exhibit reduced helplessness both immediately
after the intervention and at the one-month after in terms of despair and recovery.
As a result, this would enhance quality of life, helplessness with show significance
statistical among the participants (Warner, 2009).

The present study showed that low in the recovery among schizophrenic
patients in pre-assessment, about low to moderate subjective feeling of recovery,
this result may be due to long term and chronicity of schizophrenia and also related
to frequent hospitalization and frequent relapses. And show significance statistical
improves recovery level immediately after intervention and one month after. This
result may be related to how empowered schizophrenic patients are linked to a
decrease in psychiatric symptoms, an increase in empowerment levels, and an
improvement in recovery score. It shows that helplessness counterbalances the
impact of schizophrenia knowledge on the hope, self confidence and self-esteem of
schizophrenic patients. This study agrees with (Pijnenborg, van Donkersgoed,
David & Aleman, 2013; Štrkalj Ivezić, Alfonso Sesar & Mužinić, 2017) he
reported that the meanings individuals give to their condition and the actual
therapy have an impact on how well psychological therapy and rehabilitation
treatments work.

This study verified that empowerment score is indeed an important element

for recovery among patients with schizophrenia. Mental health practices had
emphasized strategies for enhancing the empowerment of patients. However, we
believe that shifting toward relevant strategies for empowering patients is
necessary and may be more effective for patient recovery. Establishing
partnerships, emphasizing individual strengths and involving patients in decision-
making are all aspects of empowerment-oriented care. It also addresses boosting
patients' capacity for self-management and connecting them to support networks,
such as those for maintaining oneself while ill, living a full life, and maintaining
relationships with family and the broader community. Formulating required care
according to individual needs, and helping them increase social participation,
quality of life and enhance the recovery (Bag, 2020; Song & Shih, 2014).

In the present study, show the significant improvement in empowerment

score immediately and one month after empowerment intervention may be
attributable to less positive, negative, and general psychological symptoms. The
findings of this study largely corroborate those of earlier studies, demonstrating
that empowering schizophrenic patients was a significant motivator for them to
continue their drug therapy after discharge. This may therefore result in a high
level of participation in the intervention and therapy as well as a predisposition to
utilize successful coping mechanisms (such as assurance, persuasion, or asking for
assistance and support from others) to manage the symptoms and stresses
associated with schizophrenia. This result supported by (Hasan & Musleh, 2017;
Park & Sung, 2013).

In addition, show the significance of all empowerment dimensions like self-

esteem, power, optimism, and control, as well as community activism with P value
(.000) in all dimensions. This result may be due to encourage the patients in the
session of empowerment intervention the ability to actively pursue one's goals, the
capacity to make decisions that exert control over one's life, encourage participants
to deal with problems and solved it and increase the self-esteem. This result agreed
with (Sá-Fernandes, Jorge-Monteiro & Ornelas, 2018; Jorge-Monteiro & Ornelas,
2014).

In the present study, show improvement in positive and negative symptoms

immediately after empowerment intervention and one month later, May be due to
the empowerment intervention helped people understand their disorder better and
understand importance of medication with improve medication adherence, which
offered help and assistance, which is another important component. As a result,
they altered a number of "stressors" in the social environment, which may have
helped to further lessen the intensity of mental symptoms. This result supported by
(Chou et al., 2012), he reported that adversely influenced schizophrenia patients'
quality of life and slowed their rate of recovery was the intensity of their
schizophrenia symptoms. This finding also agrees with (Hasan & Musleh, 2017).
 Moreover, knowing about the condition was shown to be the most important
factor in patients' positive attitudes, which implies that adherence focused psycho-
education should be incorporated into routine patient treatment at clinics for
improved long-term outcomes. Antipsychotic medication non-adherence was
found to significantly lower patient self-esteem. Additionally, rather of using an
avoidance coping technique, the information gained from the intervention's
"empowerment" allowed them to deal with their psychiatric symptoms (Boyer et
al., 2013).

In present study, show that highly significant negative correlation between

participant’s score of their quality of life with learned helplessness and also
between learned helplessness and recovery in immediately and after one month
from empowerment intervention, this result due to improve the self-care ability and
daily living functions of the patients, such that they will be able to re-integrate into
the community and also decrease the feeling of helplessness by increase of self
esteem and positive talking about himself, so the empowerment intervention is
very important component to decrease helplessness and when decrease
helplessness caused enhance quality of life in patients with schizophrenia. This
result supported by (Hasan & Musleh, 2017) and also this result agrees with (Roth
& Crane-Ross, 2002) he reported that empowerment intervention as patients’
influence on service-related decisions had an impact on health-related outcomes of
the intervention in so far as to be more empowered in this respect increased the
likelihood of perceiving needs for care as met.

In the present study show that highly significance positive correlation

between empowerment and recovery, this result due to showed themselves to be
strongly associated, as empowerment is considered an important mediator for
mental health recovery and may be due to regaining the sense of self, the self-
management of the illness, a feeling of belonging and of rebuilding one's own life in the
community related to session of empowerment intervention , this result supported by
(Schmolke, Amering & Svettini, 2016) he reported that the Empowerment, self-
determination are essential elements of recovery processes and empowerment as the
process of gaining a sense of mastery and control over one’s own environment and
self. Moreover, the result describes also significance positive correlation between
recovery and quality of life, quality of life also important to recovery by other
meaning no recovery without enhances the quality of life. This result agrees with
(Barrett et al., 2010; Rogers, Chamberlin & Ellison, 1997).

Moreover, the result of this research finding negative correlation between

positive and negative symptoms and empowerment. This correlation can be
attributed to the presence of these symptoms, which limit a patient's access to
information and knowledge as well as their capacity for decision-making,
participation in society, and sharing of decision-making. This study agrees with
(Elsherif, Badawy & Gado, 2022) he reported that a highly negative significant
association between people with schizophrenia's negative and positive symptoms
and empowerment, so, the important of psychiatric therapy with empowerment
intervention to help decrease the positive and negative symptoms to enhance the
symptoms and the empowerment of patients, this finding supported by (Roth &
Crane-Ross, 2002). And also supported by (San et al., 2012), he reported that
incorporating such an empowerment intervention into routine therapy in
psychiatric clinics is an effective way to lessen the severe symptoms of
schizophrenia.
 In the present study, show that significance positive correlation between
quality of life and empowerment. This correlation may be related to the
empowerment is the main factor to improve the quality of life and may be related
to the participants felt more control of his or her care and may be due to
empowerment intervention indirectly influence a patient’s quality of life through
his or her participation in rehabilitation activities and encourage the patient to be
assertive and encourage him to solving the problem and learning him self care
strategies. This result supported by (Kranz, 2011) he reported the positive
correlation between empowerment scale and quality of life and the empowerment
care was the most important predictor of quality of life. This result also agrees with
(Al-HadiHasan, Callaghan & Lymn, 2017).

Moreover, the empowerment intervention helped them to feel better about

their negative self-evaluations and given them hope and assurance about their
ability to recovery. This may therefore result in a high level of participation in the
intervention and therapy as well as a predisposition to utilize successful coping
mechanisms (such as assurance, persuasion, or asking for assistance and support
from others) to manage the symptoms and stresses associated with schizophrenia.
These adjustments could have enhanced their social connections and recovery.
Clearly define, the process of accepting and empowerment alters individuals’
perceptions of and feelings about themselves as well as their tendency to set and
achieve life objectives, which in turn causes people to isolate them and experience
unhappiness and low self-esteem, so the empowerment intervention help their
participants to decrease helplessness and enhance quality of life and recovery. This
finding agreed with (Pijnenborg et al., 2013).

Additionally, the empowerment intervention's provision of factual

information regarding the disease may have contributed to this explanation, which
may have improved their understanding of the condition and assisted patients with
schizophrenia in developing coping mechanisms and changing their attitudes
toward antipsychotic medication (Hasan & Musleh, 2017). By being aware of
stressor triggers, this may lead to the creation of a low-stress situation, which may
also further reduce mental symptoms and promote recovery and feelings of
helpfulness. The findings of this study largely corroborate those of earlier studies,
demonstrating that schizophrenic patients' empowerment was a significant
motivator for them to continue their drug therapy after discharge. It may also have
a significant impact on lowering the relapse rate in the hopelessness, helplessness,
and recovery of empowerment intervention participants both immediately
following the intervention and at the one-month follow-up. As a result, it could
have diminished helplessness (Paul, Joseph & Pratap, 2020).

Empowerment intervention is empowering individuals who can take control

of their condition and their life. The conversation is driven by the ideas of recovery
and empowerment. This is in contrast to the feeling of helplessness, chronicity, and
incurability that is frequently communicated in the usual therapy that is not
founded on the principles of recovery and empowerment, whether intentionally or
subconsciously. In our opinion, a key component of an empowerment recovery
intervention and for preventing the harmful effects of discrimination on
schizophrenia recovery is encouraging identification with empowered people and
severing the link between the diagnosis of schizophrenia and its prognosis (Štrkalj
Ivezić, Alfonso Sesar & Mužinić, 2017).
 Conclusion

Based on the findings of the current study, it can be concluded that regarding
our empowerment intervention is an organized, recovery-based intervention
conducted in 12 sessions in one month, three of which were weekly. This study is
the quasi experimental study that has examined helplessness recovery
empowerment intervention, which has investigated a wide array of outcomes. This
format of delivering intervention is less demanding and accessible and more
accepted by mentally ill patients. This study shows that the Empowerment
intervention was superior in decreasing individual helplessness and increasing
personal strength and empowerment, improving recovery rate, decreasing
psychiatric symptoms and improving quality of life.
 Recommendation

Based on the results of the study, the following recommendations are suggested:

Recommendations for the mental health nurses:

 Developing workshops for training mental health nurses on the accurate

assessment of psychiatric symptoms oriented with their interrelation among

patients with schizophrenia.

 Conduct counsel to nurses and health care providers and encouraged to

participate in Empowerment intervention to update their knowledge about

mental health problems and its complication.

 Empowerment enhancement training program should be integrated in the

psychiatric hospitals ‘protocol of care in conjunction with pharmacological.

 A priority intervention to improve the helplessness and addressing

psychiatric symptoms of patients with schizophrenia is essential to improve

their level of self-empowerment and recovery.

 Patients with schizophrenia are in need of a rehabilitation model that

encourages their self-empowerment and recovery, thus, psychosocial

rehabilitation should aim towards empowerment within the framework of

 individuals ‘mental health promotion.

Recommendations for future research:

 Further research on developing programs that are needed for a better

understanding of relations between schizophrenia, empowerment and to

improve and self-empowerment levels of patients with schizophrenia.

 Implementation of research project on patient with schizophrenia to

improving their self-empowerment.

 Future research needs to examine the effects of disease course in each

patient and develop an individual-level Empowerment intervention. If

possible.

 Future study needs to obtain qualitative data from many cases and reflect on

its intervention effects.

 A further study is needed to examine the relationships between

empowerment intervention on relapse rate, self-esteem and medication

compliance.

 Conduct a study with large sample size and longer follow up to investigate

the effect of Empowerment intervention on the recovery of patients with

schizophrenia.
 Summary
Schizophrenia imposes a significant disability on people with suffering from
and very often unable to achieve life various goals. In about three-fourth of cases,
the course of schizophrenia has various phases including a remission phase which
with relapses and despite giving effective pharmacological treatments and
psychosocial interventions, less than 15% recovery rate is found. The concept of
empowerment as a process which accesses to information, knowledge and
developed skills, the ability to make decisions, developed individual strength,
participation in society and real control, hope, share decision making, community
approaches and stigma. Empowerment intervention is a core component of the
recovery framework, together with connectedness, hope and optimism about the
future identity and meaning of life. Empowerment is an appropriate treatment goal
for psychosis to enhance quality of life and helplessness. Empowerment
intervention is strengthen the individual's competence, natural helping systems and
proactive behaviors found to be effective in promoting recovery and overcoming
their illness-related disability.

Aim of the study:

The aim of this study was to assess the effect of Empowerment intervention on
helplessness, recovery and quality of life among patients with schizophrenia.

A quasi experimental research design was used in the study. The study was
conducted at the In-patient and out-patients of Psychiatric Department of
Mansoura University Hospital.
 They were chosen according to hospital reports and patient’s records, all
clients diagnosed with schizophrenia met the guidelines of the Diagnostic and
Statistical Manual of Mental Disorders, 5th Edition. With inclusion criteria:

1. Patients who are at least in the 2nd episodes.

2. Age from 18- less than 60 years old.
3. Both sexes male and female.
4. Able to communicate.

Tools for data collection:

Tool I: Patient assessment sheet (socio-demographic characteristics and

clinical data):
This tool will be developed by the researcher based on reviewing recent
related literature. It will include information about:
A. Patient's name, age, sex, level of education, marital status, residence …etc.
B. Clinical data: Which included diagnosis, onset of disease, and duration of
illness, previous number of admission to psychiatric hospital, family history,
and history of smoking?

Tool II: Schizophrenia–Quality of Life questionnaire (S-QoL-18):

Schizophrenia Quality of Life Questionnaire (S-QoL18) developed by
(Boyer et al., 2010). The S-QoL 18 is the short version of a 41-item French self-
administered multidimensional QoL questionnaire concerning the present
circumstances and designed for patients with schizophrenia. It is made of 18 items
describing 8 dimensions. That assesses the patient’s view of his or her current
QoL. The total score ranged from 18 to 90 with a higher score indicating a better
quality of life.

Tool III: Learned Helplessness Scale (LHS):

 Learned Helplessness Scale was developed by (Quinless & Nelson, 1988).
A LHS is a self-report questionnaire containing 20 items scored using a 4-point
likert-type scale from 1=‘strongly disagree’ to 4=‘strongly agrees’
Scoring system:
It is scored from 20 to 80 with a high score indicating individuals’ experiencing
higher levels of helplessness
1. From 20 t0 40 mild helplessness,
2. From 40 to 60 moderate helplessness,
3. From 60 to 80 high helplessness.

Tool IV: Rogers Empowerment scale (RES):

The Empowerment Scale was developed by Rogers, Chamberlin & Ellison
(1997) to measure personal empowerment among consumers of mental health
services. It contains items on a four-point scale with response options from (1)
“strongly agree” to (4) “strongly disagree”. Items are true or false statement. The
measure consists of 31 items representing five factors: Self-esteem, Power-
Powerlessness, Community Activism and Autonomy, Optimism and Control over
the Future, and Righteous Anger. Three items were each represented in 2
subscales.

Tool V: Recovery Assessment Scale- Domains and Stage (RAS-DS):

The Recovery Assessment Scale- Domains and Stage (RAS-DS) was
developed by (Corrigan, Salzer, Ralph, Sangster & Keck, 2004). It is a self-report
measure of mental health recovery. It includes 38 items clustered into four domains
of recovery. These domains are functional recovery, Personal recovery, Clinical
recovery, Social recovery. Each item is rated on a 4-point scale 1 = “untrue”; 2=“a
bit true”; 3=“mostly true” and 4=“completely true”. English (original) and this
instrument is accessible in fourteen languages included English (original) and
Arabic, with Cronbach’s α score is .96.
Scoring system: The total score of the scale ranges from 38 to 152. The higher
score indicated the more patient subjective experience of recovery.

 38 – 76 Low subjective experience of recovery

 77 – 115 Moderate subjective experience of recovery
 116 - 152 High subjective experience of recovery

Tool VI: Positive and Negative Syndrome Scale (PANSS):

This version of PANSS was developed by (Kay, Fiszbein & Opler, 1987)
and published by Multi Health Systems, Inc in 1992. It aims to assess positive
symptoms, negative symptoms and general psychopathology associated with
schizophrenia. PANSS is composed of three parts, the first part for the assessment
of positive symptoms, which include seven symptoms. The second part is
concerned with the assessment of negative symptoms. Lastly, the third part
comprised 16 symptoms for the assessment of general psychopathology.

Each item on the PANSS is rated on a 7 point rating scale and is

accompanied by complete definition as well as detailed anchoring criteria for all
seven rating points. In assigning rating considers first whether the item is at all
present, as judged by its definition. Score (1) reflects the absence of that item,
resulting in a total score of 30 points for a patient with no symptoms, the severity
of any item is rated on a scale from 2 to 7. The score (2) denotes that the severity
of a symptom rated minimal or questionable, whereas the score (7) refers to the
extreme, i.e. the manifestations dramatically interfere in the most or all major life
functioning.

Scoring system:
The PANSS scores for each component were determined by adding the
ratings for all of the component elements. Therefore, the possible ranges for the
subscales measuring positive and negative symptoms are each 7 to 49; however,
the subscale measuring general psychopathology has ranges of 16 to 112.
The positive and negative scales are scored according to the following
categories:
 Mild (7 to 21)
 Moderate (21 to 35)
 Severe (35 to 49).
Both positive and negative symptoms were covered by this.
The general psychological scale is broken into three categories:
 Mild (16–48),
 Moderate (48–80),
 Severe (80–112).

Preparation of study tool

The socio-demographic characteristics questionnaire (tool I) was developed

by the researcher. Translation of tool (II, III, and IV) into Arabic language was
done. Ajury composed of 5 modifications were done accordingly. The jury
examined as well the content validity, and revealed that the tool is valid.
Pilot study
Before embarking on the actual study, a pilot study was carried out on 20
patients to ensure the clarity, applicability and feasibility of the study tools.

As far the actual study, the actual study was conducted during a period from
the first of January 2021 to the January 2022. It went through three phases:

1-Assessment Phase
 Ethical approval was obtained from the Research Ethics Committee of
Faculty of Nursing, Mansoura University.
 Official permission was obtained from the Head of Psychiatric Department.
 The patient’s privacy was respected and protected. Patients were informed
that data confidentiality was assured and maintained.
 The researcher met with the participants, introduced herself, and explained
to them the aim of the study to obtain their consent to participate in the
study, gain their cooperation and confidence.
 The subject was interviewed individually before applying the planned
program to collect the baseline data using all study tools.
 The researcher started to fill-out the questionnaire from the participants
through individual interviewing until reached the total number. The
researcher read and explained each item to the participants and recorded
their responses to each item. This interview took about 25 to 30 minutes.
 The objective of the program was to helping patients become more
knowledgeable and allowing them to take control over their symptoms,
dealing with disease and treatment. Another important nuance is that patient
empowerment can go beyond the healthcare context, and also enter the
realm of everyday life (development of self-esteem and coping skills).
 Empowering patients can enable them to take more responsibility for
managing their health and encourage self-management activities.
The program also provides these patients good communication and assertive
communication, solving the problem and decision making to enhance their
QOL and recovery. Also, learn them about anxiety and how deal with the
stress by learning them the relaxation technique.

2-The intervention phase

 The program was carried out at the in-patient psychiatric department.
 The program was implemented for the studied schizophrenic patients; they
were divided into (10) groups, 6 participants in each group. Each group
attended 12 sessions (3 session / week). The researcher implemented the
program for each group in scheduled times and days. To ensure exposure of
all participants in the groups to the same content and learning experiences.
The same content was provided using the same teaching methods,
discussions and handouts.
 The program was implemented through various teaching methods as short
lectures, group discussions, brain storming, demonstration re-
demonstration, and role-play. The teaching media included power-point
presentations, and a handbook.
 The researcher was started each session by welcomed the patients of each
group, summary about what was given through the previous session and the
objectives of the new one to make sure that participants recognize the
program content, discussing of the prior homework from the last session
and how to achieve the purpose of each session, taking into consideration
the use of simple language to suit the educational level of participants.
 Motivation and reinforcement techniques as praise and recognition were
used during the session to enhance participation and learning.
 Give simple reward for everyone who abided by the rules of the program
after every session.
 The researcher was conducted the data collection during a period of 7
months, started from the January 2021 to the January 2022.

3-Evaluation phase

 Immediately and after one month evaluate for participants by tools (tool II
(S-QOL-18), tool III (LHS), tool IV (ES), tool V (RAS-DS) and tool VI
(PANSS)).
 Data were analyzed using SPSS (statistical package for social science)
software version 22.

The following are the main results yielded by the study:

 Part I: socio-demographic characteristics of studied participants:
Concerning the socio-demographic characteristics of the sample, more than
half of sample (56.7%) was among age group of 30 to 45 years. The majority of
the study samples were male (91.7%). According to level of education one third of
the study sample illiterate or read and write. Regarding to marital status (65.0%)
was single. Two third of studied patients (66.7%) were working. According to the
residence the half of the study sample was from rural (51.7%). Concerning
satisfactory of income nearly three quarter of the studied sample (73.3%) had
insufficient income.

 Part II: Effect of Empowerment intervention on studied variables:

It was found that the highest mean score of immediately and after one month
of Empowerment intervention on schizophrenia quality of life, Learned
Helplessness, recovery assessment, empowerment, and PANSS, with a statistical
significant difference.

 Part III: Correlation between studied patients scores on different

study variable:
1. Immediately after Empowerment Intervention:

There is a significant negative correlation between: Learned helplessness

and Schizophrenia quality of life (p= -.449- with significance .000), Learned
helplessness and recovery assessment (P=-.583- with significance .000), PANSS
and SQOL (P=-.393- with significance .002) and PANSS and recovery assessment
(P=-.564- with significance .000).

There is a significant positive correlation between: SQOL and recovery

assessment (p= .696 with significance .000), Empowerment and recovery
assessment (P= .312 with significance .015), PANSS and learned helplessness
(P= .352 with significance .006).

2. After one month of Empowerment intervention:

There is a significant negative correlation between: Learned helplessness

and Schizophrenia quality of life (p= -.378-with significance .003), Learned
helplessness and recovery assessment (P=-.650- with significance .000), PANSS
and SQOL (P=-.384- with significance .002) and PANSS and recovery assessment
(P=-.558- with significance .000).

There is a significant positive correlation between: SQOL and recovery assessment

(p= .618 with significance .000), Empowerment and recovery assessment (P= .331
with significance .010) and PANSS and learned helplessness (P= .476 with
significance .000).

Conclusion:

Based on the findings of the present study, this study revealed that the
empowerment intervention was superior in decreasing individual helplessness,
improving recovery rate, decreasing psychiatric symptoms and improving quality
of life. This study has also demonstrated that intervention content and method of
its delivery was acceptable and can be easily carried out by psychiatric outpatient
clinics. The study revealed the possibility of including empowerment interventions
as a part of an inclusive psychosocial intervention. Also, this study indicated that
the empowering intervention was an effective intervention when integrated with
treatment as usual.

Recommendation:

Based on the results of the study, the following recommendations are

suggested:

Recommendations for the mental health nurses:

 Developing workshops for training mental health nurses on the accurate
assessment of psychiatric symptoms oriented with their interrelation among
patients with schizophrenia.
 Conduct counsel to nurses and health care providers and encouraged to
participate in Empowerment intervention to update their knowledge about
mental health problems and its complication.
 Empowerment enhancement training program should be integrated in the
 psychiatric hospitals ‘protocol of care in conjunction with pharmacological.
 A priority intervention to improve the helplessness and addressing
psychiatric symptoms of patients with schizophrenia is essential to improve
their level of self-empowerment and recovery.

Recommendations for future research:

 Further research on developing programs that are needed for a better
understanding of relations between schizophrenia, empowerment and to
improve and self-empowerment levels of patients with schizophrenia.
 Implementation of research project on patient with schizophrenia to
improving their self-empowerment.
 Future research needs to examine the effects of disease course in each
patient and develop an individual-level Empowerment intervention. If
possible.
 Future study needs to obtain qualitative data from many cases and reflect on
its intervention effects.
 A further study is needed to examine the relationships between
empowerment intervention on relapse rate, self-esteem and medication
compliance.
 Conduct a study with large sample size and longer follow up to investigate
the effect of Empowerment intervention on the recovery of patients with
schizophrenia.
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 ‫)‪Appendix (I‬‬
‫استمارة البيانات الشخصية و المرضية‬
‫كود المريض‬
‫)‬ ‫(‬ ‫‪ :30 -2‬اقل من ‪ 45‬سنه‬ ‫)‬ ‫(‬ ‫السن‪ : 18 -1 :‬اقل من ‪ 30‬سنه‬ ‫‪-1‬‬
‫)‬ ‫‪ -3‬اكثر من ‪ 45‬سنه (‬
‫)‬ ‫(‬ ‫‪ -2‬أنثى‬ ‫)‬ ‫(‬ ‫‪ -1‬ذكر‬ ‫الجنس‪:‬‬ ‫‪-2‬‬
‫)‬ ‫(‬ ‫‪ .1‬يقرأ و يكتب‬ ‫)‬ ‫(‬ ‫‪ .0‬أمي‬ ‫مستوى التعليم‪:‬‬ ‫‪-3‬‬
‫)‬ ‫(‬ ‫‪ . 3‬تعليم إعدادى‬ ‫)‬ ‫(‬ ‫‪ .2‬تعليم ابتدائى‬
‫)‬ ‫(‬ ‫‪ -5‬جامعى‬ ‫)‬ ‫(‬ ‫‪ .4‬تعليم ثانوى‬
‫)‬ ‫(‬ ‫‪ .6‬دراسات عليا‬
‫)‬ ‫(‬ ‫‪ -1‬متزوج‬ ‫)‬ ‫(‬ ‫‪ -0‬أعزب‬ ‫‪ -4‬الحالة االجتماعية‪:‬‬
‫)‬ ‫(‬ ‫‪ -3‬أرمل‬ ‫)‬ ‫(‬ ‫‪ -2‬مطلق‬
‫)‬ ‫(‬ ‫‪ -4‬منفصل‬
‫)‬ ‫(‬ ‫‪ - 0‬ال يعمل‬ ‫‪ -5‬الوظيفة‬
‫) ‪...........................................‬‬ ‫(‬ ‫‪ -1‬يعمل‬
‫)‬ ‫(‬ ‫‪ -2‬ريف‬ ‫)‬ ‫(‬ ‫‪ -1‬مدينة‪±‬‬ ‫‪ -6‬مكان االقامه ‪:‬‬
‫‪-7‬مصدر الدخل‪..........................................................................................:‬‬
‫)‬ ‫(‬ ‫‪ -1‬يكفى‬ ‫)‬ ‫(‬ ‫‪ -8‬الدخل‪ -0 :‬ال يكفى‬
‫)‬ ‫‪ -3‬اكثر من ‪ 4‬افراد (‬ ‫‪ )4( -2‬افراد ( )‬ ‫‪ -9‬عدد أفراد األسرة‪ -1:‬اقل من ‪ 4‬افراد ( )‬
‫‪ -10‬الترتيب بين أفراد األسرة‪.......................................................................:‬‬
‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫(‬ ‫‪ -.‬ال‬ ‫‪ -11‬هل يوجد مرض نفسي في األسره‬
‫‪ -12‬تعيش مع من ؟ ‪..................................................................................‬‬
‫‪ -13‬من الذى يعتنى بك ؟ ‪.............................................................................‬‬
‫‪ -14‬من الذى يقدم الدعم المعنوى لك ؟ ‪............................................................‬‬
‫‪ -15‬التشخيص‪.......................................................................................:‬‬
‫‪ -16‬بداية المرض‪.....................................................................................:‬‬
 ‫‪ -17‬السن عند بدايه المرض‪........................................................................ :‬‬
‫)‬ ‫(‬ ‫‪ -1‬اراديا‬ ‫)‬ ‫(‬ ‫‪ -0‬ال اراديا‬ ‫‪ - 18‬طريقه الدخول للمستشفى‪:‬‬
‫‪ -19‬عدد مرات الدخول لمستشفى النفسية ‪.................................................................:‬‬
‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫(‬ ‫‪ -0‬ال‬ ‫‪ -20‬التدخين‪±:‬‬
‫كم سيجارة‪ /‬يوم ؟‪ - .......................‬أشياء أخرى؟‪.............................‬‬
‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫(‬ ‫‪ -0‬ال‬ ‫‪ -21‬هل يعانى من مرض جسماني‪:‬‬
‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫(‬ ‫‪ – ٠‬ال‬ ‫‪ -22‬ھل اخذت عالج من قبل ‪.:‬‬

‫)‬ ‫(‬ ‫‪ -2‬سنتين ‪ :‬اقل من اربع سنين‬ ‫)‬ ‫‪ -23‬مدة العالج ‪ -1 :‬أقل من سنتين (‬
‫)‬ ‫(‬ ‫‪ -3‬اكثر من اربع سنين‬
‫)‬ ‫‪ -0‬ال (‬ ‫‪ -24‬المواظبه على العالج ‪:‬‬
‫)‬ ‫(‬ ‫‪ -2‬نعم بانقطاع‬ ‫)‬ ‫(‬ ‫‪ -1‬نعم بانتظام‬

‫)‬ ‫(‬ ‫بمساعده احد‬ ‫)‬ ‫(‬ ‫بمفرده‬ ‫‪ -25‬يأخذ العالج‪:‬‬

‫فى حاله (ال) على مواظبه العالج ما االسباب على‬
‫ذلك‪................................................................................................................................................. :‬‬
‫‪........................................................................................................................................................‬‬
‫‪........................................................................................................................................................‬‬
‫‪........................................................................................................................................................‬‬
‫النوع‪............... :‬‬ ‫)‬ ‫‪ -1‬نعم (‬ ‫)‬ ‫(‬ ‫‪ -0‬ال‬ ‫‪ -25 .......‬هل تعانى من هالوس‪:‬‬
‫النوع‪.............. :‬‬ ‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫(‬ ‫‪ -0‬ال‬ ‫‪ -26‬هل لديك ضالالت ‪ /‬اوهام‬
‫)‬ ‫(‬ ‫‪ -0‬مهمله ( ال يقوم بها)‬ ‫‪ -27‬النضافه الشخصيه ‪:‬‬
‫)‬ ‫(‬ ‫‪ -2‬بمساعده احد‬ ‫)‬ ‫‪ -1‬بمفرده (‬

‫)‬ ‫(‬ ‫‪ -1‬فقدان الشهيه‬ ‫)‬ ‫(‬ ‫‪ -0‬رفض األكل‬ ‫‪ -28‬االكل ‪:‬‬
‫)‬ ‫(‬ ‫‪ -3‬يأكل بمفرده‬ ‫)‬ ‫(‬ ‫‪ -2‬يأكل ويطلب المزيد‬
‫)‬ ‫(‬ ‫‪ -4‬يأكل بمساعده‬

‫عدد ساعات النوم‪............................................ :‬‬ ‫‪ -29‬النوم ‪:‬‬

‫)‬ ‫(‬ ‫‪ .0‬لديك صعوبه فى الدخول فى النوم‬
‫)‬ ‫(‬ ‫‪ .1‬لديك صعوبه فى االستمرار فى النوم‬
 ‫)‬ ‫(‬ ‫‪ .2‬تستيقظ باكرا ومتعرفشى تنام تانى‬

‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫(‬ ‫‪-0‬ال‬ ‫‪ -1‬تبدأ الكالم مع اآلخرين‪:‬‬ ‫‪ -30‬التفاعل االجتماعى ‪:‬‬
‫)‬ ‫(‬ ‫‪ -1‬نعم‬ ‫)‬ ‫‪ -2‬تحفظ على العالقات مع اآلخرين‪-0:‬ال (‬

‫)‪Appendix (II‬‬
‫)‪Schizophrenia Quality of Life-18 (SQoL-18‬‬
‫مقياس جوده الحياه للفصام‬
‫أكثر مما‬ ‫كما كنت‬ ‫أقل بقليل مما‬ ‫أقل مما‬ ‫أقل بكثير مما‬
‫كنت أفضل‬ ‫افضل‬ ‫كنت أفضل‬ ‫كنت أفضل‬ ‫كنت أفضل‬
‫(‪)5‬‬ ‫(‪)4‬‬ ‫(‪)3‬‬ ‫(‪)2‬‬ ‫(‪)1‬‬
‫الثقه بالنفس‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا واثق في الحياة‪.‬‬ ‫‪.1‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫راض عن نفسي‪.‬‬
‫ٍ‬ ‫أشعر بمزاج جيد‪ .‬أنا‬ ‫‪.2‬‬

‫المرونه‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أكافح من أجل النجاح في حياتى‪.‬‬ ‫‪.3‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أستطيع التخطيط لمستقبلي المهني أو الشخصي‪.‬‬ ‫‪.4‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أبذل الجهود للعمل‪.‬‬ ‫‪.5‬‬
‫الحكم الذاتى‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أشعر بحرية في اتخاذ القرارات‪.‬‬ ‫‪.6‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اشعر بحريه فى العمل والتصرف‪.‬‬ ‫‪.7‬‬

‫الرفاه الجسدي (سالمه الجسد)‬

‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا في حالة بدنية‪ ±‬جيده‪.‬‬ ‫‪.8‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا مليئ بالطاقة‪.‬‬ ‫‪.9‬‬

‫العالقه األسريه‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لقد ساعدتني ودعمتني عائلتي‪.‬‬ ‫‪.10‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫عائلتي تهتم بى‪.‬‬ ‫‪.11‬‬

‫عالقه االصدقاء‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لقد ساعدني ودعمني أصدقائي أو أقاربي‪.‬‬ ‫‪.12‬‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى أصدقاء‪.‬‬ ‫‪.13‬‬
‫الحياه العاطفيه‬
‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا راض بحياتى العاطفيه‪.‬‬ ‫‪.14‬‬

‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا قادر على تحقيق مشاريعى العائليه والعاطفيه‪.‬‬ ‫‪.15‬‬
 ‫الرفاهيه والسالمه النفسيه‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫‪5‬‬ ‫لدي صعوبة في التركيز‪،‬والتفكيربشكل مستقيم‬ ‫‪.16‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫‪5‬‬ ‫أشعر بالعزله عن العالم الخارجي‬ ‫‪.17‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫‪5‬‬ ‫ال أستطيع التعبير عن مشاعري‬ ‫‪.18‬‬
‫المجموع الكلى‪:‬‬
‫)‪Appendix (III‬‬
‫غير موافق‬ ‫غير موافق‬ ‫موافق‬ ‫موافق تماما‬
‫تماما‬
‫(‪)1‬‬ ‫(‪)2‬‬ ‫(‪)3‬‬ ‫(‪)4‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫أيا كان المجهود المبذول فى العمل‪ ،‬أشعر أننى ال أتحكم فى النتائج‪.‬‬ ‫‪.1‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫بسبب فشلي اشعر بعجزى وعدم قدرتى في حل المشكالت‪.‬‬ ‫‪.2‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫ال أجد حلوالً للمشاكل الصعبة‪.‬‬ ‫‪.3‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫ال أضع نفسي في المواقف عندما اكون غير قادر على التنبؤ بنتائجها‪.‬‬ ‫‪.4‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫عندما احقق مهمه ما بنجاح فذلك غالبا الننى محظوظ‪.‬‬ ‫‪.5‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫ليس لدي القدرة على حل معظم مشاكل الحياة‪.‬‬ ‫‪.6‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫عندما ال أنجح في مهمة ما‪ ،‬ال أحاول القيام بأي مهام مماثلة لشعوري اننى سوف‬ ‫‪.7‬‬
‫افشل فيها ايضا‪.‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫عندما ال تتم الشيء بنفس الطريقه التى خططت لها اعرف انها بسبب انه ليس لدى‬ ‫‪.8‬‬
‫القدره اساسا‪.‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫يتمتع األشخاص اآلخرون بالسيطرة على نجاحهم و ‪ /‬أو فشلهم أكثر مني‬ ‫‪.9‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫ال أحاول فى مهمة جديدة إذا فشلت في القيام بمهام مماثلة في الماضي‪.‬‬ ‫‪.10‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫عندما اؤدى أداء سيئا‪ ،‬فإن هذا يرجع إلى عدم قدرتي على األداء بشكل أفضل‪.‬‬ ‫‪.11‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫ال أقبل مهمة ال أعتقد أنني سأنجح فيها‪.‬‬ ‫‪.12‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫أشعر أن لدي القليل من السيطرة على نتائج عملي‪.‬‬ ‫‪.13‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫أنا غير ناجح في معظم المهام التي أحاول تنفيذها‪.‬‬ ‫‪.14‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫أشعر أن أي شخص اخر يمكن أن يؤدى أفضل مني في معظم المهام‪.‬‬ ‫‪.15‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫أنا غير قادر على الوصول إلى أهدافي في الحياة‪.‬‬ ‫‪.16‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫عندما ال أنجح في مهمة ما‪ ،‬أجد نفسى القي اللوم على غبائي كسبب فى هذا‪.‬‬ ‫‪.17‬‬
‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫مهما حاولت جاهدا ال تاتى االشياء ابدا بالطريقه التى اريدها‪.‬‬ ‫‪.18‬‬

‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫أشعر أن نجاحاتى هى انعكاس للفرصه وليس لقدرتي‪.‬‬ ‫‪.19‬‬
 ‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬ ‫‪4‬‬ ‫يبدو ان سلوكى ال يؤثر‪.‬‬ ‫‪.20‬‬

‫مقياس العجز المكتسب )‪Learned Helplessness Scale (LHS‬‬

‫المجموع الكلى‪:‬‬

‫)‪Appendix (IV‬‬
‫‪Empowerment Scale‬‬
‫مقياس التمكين‬

‫غير موافق‬ ‫غير‬ ‫موافق‬ ‫موافق بشده‬

‫بشده‬ ‫موافق‬
‫)‪(4‬‬ ‫)‪(3‬‬ ‫)‪(2‬‬ ‫)‪(1‬‬
‫تقدير الذات ‪ -‬الكفاءة الذاتية‬ ‫‪‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫عمو ًما أحقق ما قمت بالتخطيط له‪.‬‬ ‫‪.1‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى اتجاه إيجابي نحو ذاتي‪.‬‬ ‫‪.2‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫عندما أضع خطه‪ ،‬بكون غالبا متأكد من قدرتى على تحقيقها‪.‬‬ ‫‪.3‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫عادة ما يكون لدى الثقة فى القرارات التي اتخذها‪.‬‬ ‫‪.4‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫غالبا ما أكون قادرا على التغلب على المصاعب التي تواجهنى‪.‬‬ ‫‪.5‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أشعر بأنني شخص ذو قيمه‪ ،‬على األقل بالمساواه مع اآلخرين‪.‬‬ ‫‪.6‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أرى نفسي أننى انسان قادر‪.‬‬ ‫‪.7‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا قادرعلى عمل األشياء مثل اغلبيه الناس االخرين‪.‬‬ ‫‪.8‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أشعر أنني لدي عدد من الصفات الجيدة‪.‬‬ ‫‪.9‬‬

‫القدره والعجز‬ ‫‪‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أشعر بالعجز معظم الوقت‪.‬‬ ‫‪.10‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪.11‬أن تسبب ازعاج لن يكسبك شيء‪.‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫ال يمكنك ان تواجه الحاكم ‪ /‬االداره‪.‬‬ ‫‪.12‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اشترك برأى مع الجماعه عندما ال أكون متأكد من شيء ما‪.‬‬ ‫‪.13‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫الخبراء هم أفضل من يقررون ما يجب على الناس فعله‪.‬‬ ‫‪.14‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أغلبيه األشياء السيئه ( المصائب) في حياتى نتيجه سوء الحظ‪.‬‬ ‫‪.15‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫عادة ‪ ،‬أشعر بالوحدة‪.‬‬ ‫‪.16‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫ليس للناس الحق في الغضب لمجرد أنهم ال يحبون الشيء‪.‬‬ ‫‪.17‬‬

‫نشاط المجتمع واالستقالل الذاتي‬ ‫‪‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫الناس لديهم الحق لتقرير المصير والتخاذ قراراتهم حتى لو كانوا‬ ‫‪.18‬‬
‫سيئين‪.‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫يجب على الناس ان يعيشوا حياتهم كما يريدون ويشاوؤن‪.‬‬ ‫‪.19‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫عمل الناس معا يمكن ان يؤثر على مجتمعاتهم‪.‬‬ ‫‪.20‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫يكون للناس قوه أكثر اذا عملوا كمجموعه‪.‬‬ ‫‪.21‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫العمل مع االخرين في المجتمع ممكن ان يساعد في تغيير األشياء‬ ‫‪.22‬‬
‫لألفضل‪.‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫غالبًا ما تحل المشكالت باتخاذ اجراءات‬ ‫‪.23‬‬

‫التفاؤل والتحكم على المستقبل‬ ‫‪‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫يلتزم الناس فقط بما يعتقدون انه ممكن‪.‬‬ ‫‪.24‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أستطيع ان احدد بدرجه كبيره ماذا سوف يحدث فى حياتى‪.‬‬ ‫‪.25‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أنا متفائل بشكل عام بشأن المستقبل‪.‬‬ ‫‪.26‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫غالبًا ما تحل المشكالت باتخاذ اجراءات‪.‬‬ ‫‪.27‬‬

‫الغضب القويم الصحيح‬ ‫‪‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫الشعور بالغضب تجاه شيء ما هو غالبا الخطوه األولى نحو‬ ‫‪.28‬‬
‫تغييره‪.‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫ليس للناس الحق في الغضب لمجرد أنهم ال يحبون الشيء‪.‬‬ ‫‪.29‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫الشعور بالغضب من شيء ما ال يمكن ان يساعدك‪.‬‬ ‫‪.30‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪.31‬أن تسبب ازعاج لن يكسبك شيء‪.‬‬

‫المجموع الكلي‪:‬‬
 ‫)‪Appendix (V‬‬
‫)‪Recovery Assessment Scale- Domains and Stage (RAS-DS‬‬
‫مقياس تقييم الشفاء – المراحل والمجاالت‬
‫صحيح كليا‬ ‫صحيح غالبا‬ ‫صحيح قليال‬ ‫غير صحيح‬
‫(‪)4‬‬ ‫(‪)3‬‬ ‫(‪)2‬‬ ‫(‪)1‬‬
‫القيام بأشياء اقدرها‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫من المهم الحصول على بعض المرح‪.‬‬ ‫‪.1‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫من المهم ممارسه عادات صحيه جيده‪.‬‬ ‫‪.2‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أقوم بفعل اشياء ذات معنى بالنسبه لي‪.‬‬ ‫‪.3‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أواصل الحصول على هوايات او اهتمامات جديده‬ ‫‪.4‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أقوم بفعل أشياء قيمه ومساعده االخرين‪.‬‬ ‫‪.5‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أقوم بفعل أشياء تجعلنى اشعر بسعاده‪.‬‬ ‫‪.6‬‬

‫التطلع للمستقبل‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أستطيع التعامل مع الوضع اذا شعرت بالمرض ثانيه‪.‬‬ ‫‪.7‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫استطيع ان اساعد نفسى لكى اتحسن‪.‬‬ ‫‪.8‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدي الرغبه بالنجاح‪.‬‬ ‫‪.9‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى اهداف فى الحياه اريد ان احققها‪.‬‬ ‫‪.10‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اعتقد انى استطيع الوصول الى اهدافى الشخصيه‪.‬‬ ‫‪.11‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫استطيع التعامل مع ما يحدث فى حياتى‪.‬‬ ‫‪.12‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫احب نفسى واحترمها‪.‬‬ ‫‪.13‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى هدف فى حياتى‪.‬‬ ‫‪.14‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اذا عرفنى الناس حقا فسيحبوننى‪.‬‬ ‫‪.15‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اذا واصلت المحاوله فسأستمر فى التحسن‪.‬‬ ‫‪.16‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى فكره عما اريد ان اكون فى المستقبل‪.‬‬ ‫‪.17‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫هناك شيء جيد سيحصل فى النهايه‪.‬‬ ‫‪.18‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫انا اكثر شخص مسؤول فى تحسن حالتى‪.‬‬ ‫‪.19‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اشعر باالمل حول مستقبلى‪.‬‬ ‫‪.20‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اعرف متى اطلب المساعده‪.‬‬ ‫‪.21‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اطلب المساعده عندما احتاجها‪.‬‬ ‫‪.22‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اعرف ما هو الشيء الذي يساعدنى على التحسن‪.‬‬ ‫‪.23‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫استطيع اتعلم من اخطائى‪.‬‬ ‫‪.24‬‬

‫السيطره على مرضى‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫أستطيع ان اتعرف على العالمات المبكره للشعور بالمرض‪.‬‬ ‫‪.25‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى خطه خاصه لكى ابقى او اصبح بصحه جيده‪.‬‬ ‫‪.26‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫هناك اشياء استطيع القيام بها تساعدنى على التعامل مع‬ ‫‪.27‬‬
‫االعراض غير المرغوب فيها‪.‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اعرف ان هناك خدمات الصحه النفسيه لمساعدتى‪.‬‬ ‫‪.28‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫على الرغم من ان االعراض ممكن ان تصبح اسوأ لكننى‬ ‫‪.29‬‬
‫أعرف كيف استطيع التعامل معها‪.‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫تأثير االعراض المرضيه على حياتى يتضائل شيئا فشيئا‪.‬‬ ‫‪.30‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫فى كل مره اواجه فيها اعراض المرض تكون مدتها اقل من‬ ‫‪.31‬‬
‫المره السابقه‪.‬‬

‫التواصل واالنتماء‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫هناك اشخاص استطيع االعتماد عليهم‪.‬‬ ‫‪.32‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫حتى عندما ال اؤمن بنفسى فان االخرين يثقون بى‪.‬‬ ‫‪.33‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫من المهم الحصول على عدد متنوع من االصدقاء‪.‬‬ ‫‪.34‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى اصدقاء عانوا من االمراض النفسيه ايضا‪.‬‬ ‫‪.35‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫لدى اصدقاء ليس لديهم امراض نفسيه‪.‬‬ ‫‪.36‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫على‪.‬‬

‫لدى اصدقاء يستطيعون االعتماد ْ‬ ‫‪.37‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫اشعر بالرضى تجاه وضعى العائلى‪.‬‬ ‫‪.38‬‬

‫المجموع الكلي‪:‬‬
 Appendix (VI)
Positive and Negative Symptoms Scale (PANSS) Rating Form

Positive Symptoms:

Absent Minimal Mild Moderate Moderate Severe Extreme

(1) (2) (3) (4) severe (5) (6) (7)
P1 Delusion 1 2 3 4 5 6 7

P2 Conceptual 1 2 3 4 5 6 7
disorganization
P3 Hallucinatory 1 2 3 4 5 6 7
behavior
P4 Excitement 1 2 3 4 5 6 7

P5 Grandiosity 1 2 3 4 5 6 7

P6 Suspiciousness / 1 2 3 4 5 6 7
Persecution
P7 Hostility 1 2 3 4 5 6 7
Total score of positive symptoms:

Negative Symptoms:
Absent Minimal Mild Moderate Moderate Severe Extreme
(2) (2) (3) (4) severe(5) (6) (7)
N1 Blunted affect 1 2 3 4 5 6 7

N2 Emotional 1 2 3 4 5 6 7
withdrawal
N3 Poor rapport 1 2 3 4 5 6 7

N4 Passive / apathetic 1 2 3 4 5 6 7
social withdrawal
N5 Difficulty in 1 2 3 4 5 6 7
abstract thinking
N6 Lack of spontaneity 1 2 3 4 5 6 7
& flow of conversation
N7 Stereotyped 1 2 3 4 5 6 7
thinking
Total score of negative symptoms:
 General Psychopathology Symptoms

Absent Minimal Mild Moderate Moderate Severe Extreme

(3) (2) (3) (4) severe (5) (6) (7)
G1 Somatic concern 1 2 3 4 5 6 7

G2 Anxiety 1 2 3 4 5 6 7

G3 Guilt feeling 1 2 3 4 5 6 7

G4 Tension 1 2 3 4 5 6 7

G5 Mannerisms & 1 2 3 4 5 6 7
Posturing
G6 Depression 1 2 3 4 5 6 7

G7 Motor retardation 1 2 3 4 5 6 7

G8Uncooperativeness 1 2 3 4 5 6 7

G9 Unusual thought 1 2 3 4 5 6 7
content
G10 Disorientation 1 2 3 4 5 6 7

G11 Poor attention 1 2 3 4 5 6 7

G12Lack of judgment 1 2 3 4 5 6 7
&Insight
G13 Disturbance of 1 2 3 4 5 6 7
volition
G14 Poor impulse 1 2 3 4 5 6 7
control
G15 Preoccupation 1 2 3 4 5 6 7

G16 Active Social 1 2 3 4 5 6 7

Avoidance

Total score of General Psychopathology Symptoms:

Total score of PANSS:

 Appendix (VII)
Empowerment program

General objectives:

At the end of this program, the patients will be able to acquire the necessary
knowledge that are essentials for understanding the nature of the illness and
treatment in order to be more skillfully and efficiently capable of dealing with
their illness. The program also, provides these patients with a number of healthy
coping strategies that enhance their helplessness, quality of life (QOL) and
recovery.

Specific objectives:

At the end of this program, the patients will be able to:

 Define schizophrenia and List the etiologies and symptoms of

schizophrenia.
 Identify importance of medication and its side effects.
 Identify assertive communication and communication skills.
 Apply coping strategies that enhance their self -esteem and quality of life.
 Apply relaxation technique and anger management.
 Understanding solving problem and decision making.

Content of the program:

The content of the program include will be implemented in twelve session
 ‫الملخص العربي‬

‫يتس‪±‬بب الفص‪±‬ام في اعاق‪±‬ه كب‪±‬يره ويجع‪±‬ل مرض‪±‬ي‪ ±‬الفص‪±‬ام غ‪±‬ير ق‪±‬ادرين‪ ±‬على تحقي‪±‬ق اه‪±‬داف الحي‪±‬اه‬
‫المختلفه‪ .‬حوالى ثالثه ارباع الح‪±±‬االت يع‪±±‬انون من مراح‪±±‬ل متنوع‪±±‬ه من مراح‪±±‬ل الفص‪±±‬ام ويش‪±±‬مل االنتكاس‪±±‬ات‬
‫ومرحله عوده اعراض المرض بالرغم من تقديم عالج دوائي فعال وتدخالت نفسيه اجتماعيه ويوجد اقل من‬
‫‪ % 15‬من حدوث شفاء‪ .‬مفهوم التمكين كعملية تصل إلى المعلومات والمعرفة والمهارات‪ ±‬المتطورة والق‪±±‬درة‬
‫على اتخاذ القرارات وتطوير القوة الفردية والمشاركة في المجتمع والس‪±±‬يطرة الحقيقي‪±±‬ة واألم‪±±‬ل وتب‪±±‬ادل ص‪±±‬نع‬
‫القرار والنهج المجتمعية ووصمة الع‪±‬ار‪ .‬يع‪±‬د ت‪±‬دخل التمكين عنص‪±‬رًا أساس‪±‬يًا في إط‪±‬ار التع‪±‬افي‪ ±‬والش‪±‬فاء‪ ،‬إلى‬
‫ج‪±‬انب التراب‪±‬ط واألم‪±‬ل والتف‪±‬اؤل بش‪±‬أن المس‪±‬تقبل ومع‪±‬نى الحي‪±‬اة‪ .‬التمكين ه‪±‬و ه‪±‬دف عالجي مناس‪±‬ب للفص‪±‬ام‬
‫لتحسين نوعية الحياة والعجز‪ .‬التدخل التمكيني هو تقوية كفاءة الفرد وأنظمة المساعدة الطبيعية التي ثبت أنه‪±±‬ا‬
‫فعالة في تعزيز التعافي‪ ±‬والتغلب على اإلعاقة المرتبطة بالمرض‪.‬‬
‫هدف الرساله‪:‬‬
‫تهدف هذه الدراسة الى تقييم تأثير تدخل التمكين على العجز والشفاء وجوده الحياة بين مرضى الفصام‪.‬‬
‫تم استخدام‪ ±‬تصميم بحث تجريبي في الدراسة‪ .‬أجريت الدراس‪±±‬ة في العي‪±±‬ادات الداخلي‪±±‬ة والخارجي‪±‬ة بقس‪±±‬م الطب‬
‫النفسي بمستشفى‪ ±‬جامعة المنصورة‪.‬‬
‫تم اختيار المرضى‪ ±‬وفقًا لسجالت المرضى‪ ±‬بالمستشفي‪ ،‬وقد استوفى‪ ±‬جمي‪±±‬ع المش‪±±‬تركين فى البرن‪±±‬امج ال‪±±‬ذين تم‬
‫تشخيص إصابتهم‪ ±‬بالفصام إرشادات الدليل التشخيصي‪ ±‬واإلحصائي‪ ±‬لالضطرابات‪ ±‬العقلية ‪ ،‬اإلصدار الخامس‬
‫المرضى الذين يعانونون على األقل من النوبه الثانية‪.‬‬ ‫‪.1‬‬
‫العمر من ‪ - 18‬اقل من ‪ 60‬سنة‪.‬‬ ‫‪.2‬‬
‫كال الجنسين ذكورا‪ ±‬وإناثا‪.‬‬ ‫‪.3‬‬
‫قادر على التواصل‪.‬‬ ‫‪.4‬‬

‫أدوات جمع البیانات‬

‫األداة األولى‪:‬‬
‫الخصائص االجتماعیة والدیموغرافیة‪ :‬تشمل الخصائص االجتماعیة والدیموغرافیة للمرض‪±±‬ى مث‪±±‬ل‬
‫العمر والجنس والحالة االجتماعیة والتعلیم والمھنة واإلقامة والدخل‪.‬‬
‫بیانات إكلینیكیة مثل عمرالمريض عند ظھور المرض‪ ،‬ومدة الم‪±±‬رض ‪ ،‬وع‪±±‬دد م‪±±‬رات ال‪±±‬دخول إلى‬
‫مستشفى األمراض النفسیة ‪ ،‬والتاریخ العائلي لألمراض النفسیة ‪ ،‬واألدویة النفسیة السابقة‪.‬‬

‫األداه الثانيه‪ :‬استبيان جودة الحياة لمرض الفصام‬

‫هو اإلصدار‪ ±‬المختصر من ‪ 41‬عنصرًا استبيانًا‪ ±‬فرنسيًا‪ ±‬متعدد األبعاد يتم إجراؤه ذاتيًا في جوده الحي‪±±‬اه‬
‫يتعلق بالظروف‪ ±‬الحالية ومصمم لمرضى‪ ±‬الفص‪±±‬ام‪ .‬يتك‪±±‬ون من ‪ 18‬عنص‪±‬رًا تص‪±‬ف‪ 8 ±‬أبع‪±±‬اد‪ .‬يق‪±±‬وم ذل‪±±‬ك بتق‪±±‬ييم‬
‫وجهة نظر المريض حول جوده الحياه الحالية‪ .‬تراوحت النتيجة اإلجمالية من ‪ 18‬إلى ‪ 90‬مع كل درجة أعلى‬
‫تشير إلى جوده حياة أفضل‪.‬‬

‫األداه الثالثه‪ :‬مقياس العجز المكتسب‬

‫تم تطوير‪ ±‬مقياس العجز المكتسب بواسطة استبيان تقري‪±±‬ر ذاتي يحت‪±±‬وي على ‪ 20‬عنص‪±‬رًا تم تس‪±±‬جيلها‪±‬‬
‫باستخدام مقياس من ‪ 4‬نقاط من ‪" = 1‬ال أوافق بشدة" إلى ‪" = 4‬أوافق‪ ±‬بشدة"‬
‫يتم تس‪±‬جيله من ‪ 20‬إلى ‪ 80‬بدرج‪±‬ة عالي‪±‬ة تش‪±‬ير إلى أن األف‪±‬راد‪ ±‬يع‪±‬انون من مس‪±‬تويات أعلى من‬
‫العجز‬
‫من ‪ 20‬إلى ‪ 40‬عجز خفيف ‪،‬‬ ‫‪.1‬‬
‫من ‪ 40‬إلى ‪ 60‬حالة من العجز المعتدل‪.‬‬ ‫‪.2‬‬
‫من ‪ 60‬إلى ‪ 80‬درجة عالية من العجز‪.‬‬ ‫‪.3‬‬

‫األداة الرابعة‪ :‬مقياس روجرز للتمكين‪:‬‬

‫هو يقيس التمكين الشخصي بين مستهلكي‪ ±‬خدمات الصحة العقلية‪ .‬يحتوي المقياس علي أربع نقاط مع‬
‫خيارات استجابة من (‪" )1‬أوافق‪ ±‬بشدة" إلى (‪" )4‬ال أوافق‪ ±‬بشدة"‪ .‬العناصر عبارة صحيحة أو خاطئة‪ .‬يتكون‬
‫المقياس من ‪ 28‬عنص ًرا تمثل خمسة عوامل‪ :‬احترام الذات ‪ ،‬وعجز القوة ‪ ،‬والنشاط‪ ±‬المجتمعي واالس‪±±‬تقاللية ‪،‬‬
‫والتفاؤل والسيطرة على المستقبل ‪ ،‬والغضب الصالح‪ .‬تم تمثيل ثالثة عناصر لكل منها في مقياسين فرعيين‪.‬‬

‫االداه الخامسه‪ :‬مقياس تقييم التعافي والشفاء‪:‬‬

‫إن‪±‬ه مقي‪±‬اس تقري‪±‬ر ذاتي الس‪±‬تعادة الص‪±‬حة العقلي‪±‬ة‪ .‬يتض‪±‬من ‪ 38‬عنص‪±‬رًا مجمع‪±‬ة في أربع‪±‬ة مج‪±‬االت‬
‫للتعافي والشفاء‪ .‬هذه المجاالت هي االنتعاش الوظيفي ‪ ،‬والتعافي‪ ±‬الشخص‪±‬ي‪ ، ±‬والتع‪±±‬افي‪ ±‬المرض‪±‬ي ‪ ،‬والتع‪±±‬افي‬
‫االجتم‪±±‬اعي‪ .‬يتم تص‪±±‬نيف‪ ±‬ك‪±±‬ل عنص‪±±‬ر على مقي‪±±‬اس مك‪±±‬ون من ‪ 4‬نق‪±±‬اط ‪" = 1‬غ‪±±‬ير ص‪±±‬حيح" ؛ ‪" = 2‬ص‪±±‬حيح‬
‫قليالً" ؛ ‪" = 3‬صحيح في الغالب" و ‪" = 4‬صحيح تما ًما"‪ .‬نظام التسجيل‪ :‬تتراوح الدرجة اإلجمالي‪±±‬ة للمقي‪±±‬اس‬
‫من ‪ 38‬إلى ‪ .152‬تشير الدرجة األعلى إلى زيادة خبرة المريض الذاتية في التعافي‪±.‬‬
‫► ‪ 76 - 38‬تعافي وشفاء منخفض‬
‫► ‪ 115 - 77‬تعافي وشفاء متوسط‬
‫► ‪ 152 - 116‬تعافي وشفاء مرتفع‬

‫األداة السادسه‪ :‬مقياس المتالزمة اإليجابية والسلبية‪:‬‬

‫يه‪±±‬دف إلى تق‪±±‬ييم األع‪±±‬راض اإليجابي‪±±‬ة واألع‪±±‬راض الس‪±±‬لبية واالع‪±±‬راض المرض‪±±‬يه العام‪±±‬ه المرتبط‪±±‬ه‬
‫بالفصام‪ .‬يتكون من ثالثة أج‪±±‬زاء ‪ ،‬الج‪±±‬زء األول لتق‪±±‬ييم األع‪±±‬راض اإليجابي‪±±‬ة ‪ ،‬وال‪±±‬تي تش‪±±‬مل س‪±±‬بعة أع‪±±‬راض‪.‬‬
‫عرض‪±‬ا لتق‪±‬ييم الم‪±±‬رض‬
‫ً‬ ‫الجزء الثاني يختص بتقييم األعراض الس‪±‬لبية‪ .‬أخ‪±‬يرًا ‪ ،‬يتك‪±±‬ون الج‪±‬زء الث‪±±‬الث من ‪16‬‬
‫العام‪.‬‬
‫يتم تص‪±‬نيف‪ ±‬ك‪±‬ل عنص‪±‬ر في مقي‪±‬اس المتالزم‪±‬ه االيجابي‪±‬ه والس‪±‬لبيه على مقي‪±‬اس تص‪±‬نيف‪ ±‬من ‪ 7‬نق‪±‬اط‬
‫ويكون مصحوبًا بتعريف‪ ±‬كامل باإلضافة إلى معايير تثبيت مفصلة لجمي‪±‬ع نق‪±‬اط التص‪±‬نيف‪ ±‬الس‪±‬بع‪ .‬عن‪±‬د تع‪±‬يين‬
‫التص‪±±‬نيف‪ ، ±‬يتم النظ‪±±‬ر أوالً في م‪±±‬ا إذا ك‪±±‬ان العنص‪±±‬ر موج‪±±‬ودًا على اإلطالق ‪ ،‬كم‪±±‬ا يتم الحكم علي‪±±‬ه من خالل‬
‫تعريفه‪ .‬تعكس الدرجة (‪ )1‬عدم وجود هذا العرض‪ ،‬مما يؤدي‪ ±‬إلى مجموع نقاط ‪ 30‬لمريض بدون أعراض ‪،‬‬
‫ويتم تصنيف ش‪±±‬دة أي عنص‪±±‬ر على مقي‪±±‬اس من ‪ 2‬إلى ‪ .7‬تش‪±±‬ير الدرج‪±±‬ة (‪ )2‬إلى أن الخط‪±±‬ورة من األع‪±±‬راض‬
‫المصنفة على أنها قليله ‪ ،‬في حين أن الدرجة (‪ )7‬تشير إلى الحد األقص‪±±‬ى ‪ ،‬أي أن االع‪±±‬راض تت‪±±‬داخل بش‪±±‬كل‬
‫كبير في معظم أو كل وظائف‪ ±‬الحياة الرئيسية‪.‬‬

‫إعداد أداة الدراسة‬

‫تم تطوير‪ ±‬استبيان الخصائص االجتماعية والديموغرافية من قبل الب‪±±‬احث‪ .‬تمت ترجم‪±±‬ة األداة (الث‪±±‬اني‬
‫والثالث والرابع) إلى اللغة العربية‪ .‬فحصت هيئة المترجمين صالحية المحتوى ‪ ،‬وكشفت أن األداة صالحة‪.‬‬

‫دراسة تجريبيه‬
‫قب‪±±‬ل الش‪±±‬روع‪ ±‬في الدراس‪±±‬ة الفعلي‪±±‬ة ‪ ،‬تم إج‪±±‬راء دراس‪±±‬ة تجريبي‪±±‬ة على ‪ 20‬م‪±±‬ريض بالفص‪±±‬ام لض‪±±‬مان‬
‫وضوح أدوات الدراسة وقابليتها للتطبيق‪ ±‬وإمكانية تطبيقها‪.‬‬
‫أما بالنسبة للدراسة الفعلية ‪ ،‬فقد أجريت الدراسة الفعلية خالل الفترة من األول من (يناير) ‪ 2021‬إلى‬
‫(يناير) ‪ 2022‬وكانت ‪ 60‬مريض فصام ومرّت بثالث مراحل‪:‬‬

‫مرحله التقييم‬

‫الموافقة األخالقية من لجنة أخالقيات البحث بكلية التمريض جامعة المنصورة‪.‬‬ ‫‪.1‬‬
‫تم الحصول على إذن رسمي من رئيس قسم الطب النفسي‪.‬‬ ‫‪.2‬‬
‫احترام وحماية خصوصية الم‪±±‬ريض‪ .‬تم إبالغ المرض‪±‬ى‪ ±‬أن‪±‬ه تم ض‪±±‬مان س‪±±‬رية البيان‪±±‬ات والحف‪±±‬اظ‬ ‫‪.3‬‬
‫عليها‪.‬‬
‫التقت الباحثة بالمشاركين وقدمت نفسها وشرحت لهم الهدف من الدراسة للحصول على موافقتهم‬ ‫‪.4‬‬
‫على المشاركة في الدراسة وكسب تعاونهم وثقتهم‪.‬‬
‫تمت مقابل‪±±‬ة الموض‪±±‬وع‪ ±‬بش‪±±‬كل ف‪±±‬ردي‪ ±‬قب‪±±‬ل تط‪±±‬بيق‪ ±‬البرن‪±±‬امج المخط‪±±‬ط لجم‪±±‬ع البيان‪±±‬ات األساس‪±±‬ية‬ ‫‪.5‬‬
‫باستخدام جميع أدوات الدراسة‪.‬‬
‫بدأت الباحثة في تعبئة االستمارة من المشاركين من خالل المق‪±±‬ابالت الفردي‪±±‬ة ح‪±±‬تى الوص‪±±‬ول إلى‬ ‫‪.6‬‬
‫العدد اإلجمالي‪ .‬قام الب‪±±‬احث بق‪±±‬راءة وش‪±±‬رح ك‪±±‬ل بن‪±±‬د للمش‪±±‬اركين وتس‪±±‬جيل ردودهم‪ ±‬على ك‪±±‬ل بن‪±±‬د‪.‬‬
‫استغرقت هذه المقابلة حوالي ‪ 25‬إلى ‪ 30‬دقيقة‪.‬‬
‫كان الهدف من البرنامج هو مساعدة المرضى‪ ±‬على أن يصبحوا‪ ±‬أكثر دراية بالس‪±±‬ماح لهم ب‪±±‬التحكم‬ ‫‪.7‬‬
‫في أعراضهم‪ ±‬والتعامل مع المرض والعالج‪ .‬وايضا ان تمكين الم‪±±‬ريض يمكن أن يتج‪±±‬اوز‪ ±‬س‪±±‬ياق‬
‫الرعاية الصحية ‪ ،‬ويدخل أيضًا إلى مجال الحياة اليومية (تنمية احترام‪ ±‬ال‪±‬ذات ومه‪±±‬ارات الت‪±‬أقلم)‪.‬‬
‫يمكن أن يم ّكنهم‪ ±‬تمكين المرضى من تحمل المزيد من المسؤولية إلدارة صحتهم وتش‪±±‬جيع أنش‪±±‬طة‬
‫اإلدارة الذاتية وان يكونوا‪ ±‬قادرين على اتخاذ قراراتهم‪ ±‬في العالج الخاص بهم‪.‬‬
‫أيض‪±‬ا ت‪±‬دريبًا‪ ±‬على المه‪±‬ارات االجتماعي‪±‬ة له‪±±‬ؤالء المرض‪±‬ى مث‪±±‬ل التواص‪±±‬ل الجي‪±‬د‬
‫يوفر البرن‪±±‬امج ً‬ ‫‪.8‬‬
‫والتواصل الحازم لتعزيز‪ ±‬جوده الحياه والتعافي والشفاء‪.‬‬

‫مرحلة التدخل‬
‫تم تنفيذ البرنامج في قسم الطب النفسي الداخلي والخارجي‪±.‬‬
‫تم تنفي‪±±‬ذ البرن‪±±‬امج لمرض‪±‬ى‪ ±‬الفص‪±±‬ام الخاض‪±±‬عين للدراس‪±±‬ة‪ .‬تم تقس‪±±‬يمهم إلى (‪ )10‬مجموع‪±±‬ات ‪6 ،‬‬ ‫‪‬‬
‫مشاركين في كل مجموعة‪ .‬حضرت كل مجموعة ‪ 12‬جلسة (‪ 3‬جلسات ‪ /‬أسبوع)‪ .‬نفذت الباحث‪±±‬ة‬
‫البرن‪±±‬امج لك‪±±‬ل مجموع‪±±‬ة في األوق‪±±‬ات‪ ±‬واألي‪±±‬ام المح‪±±‬ددة‪ .‬لض‪±±‬مان تع‪±±‬رض جمي‪±±‬ع المش‪±±‬اركين في‬
‫المجموع‪±±‬ات لنفس المحت‪±±‬وى‪ ±‬وخ‪±±‬برات التعلم‪ .‬تم توف‪±±‬ير‪ ±‬نفس المحت‪±±‬وى باس‪±±‬تخدام نفس ط‪±±‬رق‪±‬‬
‫التدريس والمناقشات‪ ±‬والنشرات‪.‬‬
‫تم تنفي‪±±‬ذ البرن‪±±‬امج من خالل ط‪±±‬رق ت‪±±‬دريس مختلف‪±±‬ة مث‪±±‬ل المحاض‪±±‬رات القص‪±±‬يرة ‪ ،‬والمناقش‪±±‬ات‬ ‫‪‬‬
‫الجماعية ‪ ،‬والعصف‪ ±‬ال‪±‬ذهني ‪ ،‬وإع‪±‬ادة الع‪±‬رض التوض‪±‬يحي ‪ ،‬ولعب األدوار‪ .‬تض‪±‬منت الوس‪±‬ائط‬
‫التعليمية عروض باور‪ ±‬بوينت وكتيب‪.‬‬
‫بدأ الباحث كل جلس‪±‬ة ب‪±±‬الترحيب بمرض‪±‬ى‪ ±‬ك‪±‬ل مجموع‪±±‬ة ‪ ،‬وملخص لم‪±±‬ا تم تقديم‪±±‬ه خالل الجلس‪±±‬ة‬ ‫‪‬‬
‫الس‪±±‬ابقة وأه‪±±‬داف الجلس‪±±‬ة الجدي‪±±‬دة للتأك‪±±‬د من أن المش‪±±‬اركين يتعرف‪±±‬ون على محت‪±±‬وى البرن‪±±‬امج ‪،‬‬
‫ومناقشة الواجب المنزلي السابق من الجلس‪±±‬ة الس‪±±‬ابقة وكيفي‪±±‬ة تحقي‪±±‬ق الغ‪±±‬رض من ك‪±±‬ل جلس‪±±‬ة م‪±±‬ع‬
‫مراعاة استخدام لغة بسيطة تتناسب مع المستوى‪ ±‬التعليمي للمشاركين‪ .‬تم استخدام تقنيات التحف‪±±‬يز‬
‫والتعزيز‪ ±‬مثل الثناء والتقدير خالل الجلسة لتعزيز المشاركة والتعلم‪.‬‬
‫أعط مكافأة بسيطة لكل من التزم بقواعد البرنامج بعد كل جلسة‪.‬‬ ‫‪‬‬
‫أجرى الباحث جمع البيانات خالل فترة اثني عشر ش‪±±‬هرا ب‪±±‬دأت من األول من ين‪±±‬اير ‪ 2021‬ح‪±±‬تى‬ ‫‪‬‬
‫يناير ‪2022‬‬

‫مرحلة التقييم‬
‫التقييم الفوري وايضا‪ ±‬بعد شهر واحد للمشاركين من خالل األدوات (األداة الثانية واألداة الثالث‪±±‬ة‬ ‫‪‬‬
‫واألداة الرابعة واألداة الخامسة واألداة السادسة)‪.‬‬
‫تم تحليل البيانات باستخدام‪ ±‬برنامج (الحزمة اإلحصائية للعلوم االجتماعية) اإلصدار ‪.22‬‬ ‫‪‬‬

‫النتائج‪:‬‬

‫الجزء األول‪ :‬الخصائص االجتماعية والديموغرافية للمشاركين في الدراسة‪:‬‬

‫فيما يتعل‪±±‬ق بالخص‪±±‬ائص االجتماعي‪±±‬ة والديموغرافي‪±±‬ة للعين‪±±‬ة ‪ ،‬ك‪±±‬ان أك‪±±‬ثر من نص‪±±‬ف العين‪±±‬ة (‪)٪56.7‬‬
‫ض‪±±‬من الفئ‪±±‬ة العمري‪±±‬ة من ‪ 30‬إلى ‪ 45‬س‪±±‬نة‪ .‬ك‪±±‬انت غالبي‪±±‬ة عين‪±±‬ات الدراس‪±±‬ة من ال‪±±‬ذكور (‪ .)٪91.7‬وبحس‪±±‬ب‬
‫المستوى التعليمي ‪ ،‬كانت تلت العينه غير متعلمين أو يق‪±±‬روؤن ويكتب‪±±‬ون‪ ±‬وتعليم ابت‪±±‬دائي‪ .‬فيم‪±±‬ا يتعل‪±±‬ق بالحال‪±±‬ة‬
‫االجتماعية (‪ )٪65‬كانوا غير متزوجين‪ .‬كان ثل‪±±‬ثى المرض‪±‬ى‪ ±‬الخاض‪±±‬عين للدراس‪±±‬ة (‪ )٪62.5‬يعمل‪±±‬ون اعم‪±±‬ال‬
‫حرفيه‪ .‬كان اكثر من نصف العينة من الريف (‪ .)٪51.7‬وفيما يتعلق بالدخل المرضي فإن ما يقرب من ثالثة‬
‫أرباع العينة المدروسة (‪ )٪73.3‬لم يكن لديهم دخل كاف‪.‬‬

‫الجزء الثاني‪ :‬أثر تدخل التمكين على المتغيرات المدروسة‪:‬‬

‫قد وجد أن متوسط‪ ±‬درجة تتزايد بعد مباشره وبعد شهر واح‪±±‬د من ت‪±±‬دخل التمكين على نوعي‪±±‬ة الحي‪±±‬اة‬
‫الفصام ‪ ،‬والعجز المكتسب ‪ ،‬وتقييم التعافي والشفاء‪ ،‬والتمكين ‪ ،‬و مقياس المتالزمه الس‪±±‬لبيه وااليجابي‪±±‬ه ‪ ،‬م‪±±‬ع‬
‫وجود فرق‪ ±‬مهم إحصائيًا‪±.‬‬

‫الجزء الثالث‪ :‬االرتباط بين درجات المرضى الخاضعين للدراسة على متغيرات الدراسة المختلفة‪:‬‬

‫‪ .1‬بعد تدخل التمكين مباشرة‪:‬‬

‫توجد عالقة سلبية ذات داللة إحصائية بين‪ :‬مقياس العجز المكتس‪±±‬ب ومقي‪±±‬اس نوعي‪±±‬ة الحي‪±±‬اة‪ ،‬وك‪±±‬ذلك‬
‫مقياس العجز المكتسب ومقياس التعافي‪( ±‬الشفاء)‪ ،‬وايضا‪ ±‬مقياس المتالزمه السلبيه وااليجابي‪±±‬ه ومقي‪±±‬اس ج‪±±‬وده‬
‫الحياه‪ ،‬واخيرا‪ ±‬مقياس المتالزمه السلبيه وااليجابيه ومقياس التعافي‪( ±‬الشفاء)‪ .‬توجد عالقة ارتباط موجب‪±±‬ة ذات‬
‫دالله احصائيه بين‪ :‬مقياس جوده الحياه ومقياس التع‪±±‬افي (الش‪±±‬فاء)‪ ،‬تق‪±±‬ييم التمكين ومقي‪±±‬اس التع‪±±‬افي (الش‪±±‬فاء)‪،‬‬
‫مقياس المتالزمه السلبيه وااليجابيه ومقياس العجز المكتسب‪ .‬وأخيرا هن‪±±‬اك عالق‪±±‬ة إيجابي‪±±‬ة بين مقي‪±±‬اس ج‪±±‬وده‬
‫الحياه ومقياس التمكين‪.‬‬

‫‪ .2‬بعد شهر واحد من تدخل التمكين‪:‬‬

‫توجد عالقة سلبية ذات داللة إحص‪±‬ائية بين مقي‪±‬اس العج‪±‬ز المكتس‪±‬ب ومقي‪±‬اس ج‪±‬وده الحي‪±‬اة ‪ ،‬وك‪±‬ذلك‬
‫مقياس العجز المكتسب ومقياس التعافي‪( ±‬الشفاء)‪ ،‬مقياس المتالزمه السلبيه وااليجابيه و مقياس ج‪±±‬وده الحي‪±±‬اه‪،‬‬
‫واخيرا مقياس المتالزمه السلبيه وااليجابيه ومقياس التع‪±±‬افي‪( ±‬الش‪±±‬فاء)‪ .‬توج‪±±‬د عالق‪±±‬ة ارتب‪±±‬اط موجب‪±±‬ة معنوي‪±±‬ة‬
‫بين‪ :‬مقياس جوده الحياه ومقياس التعافي (الشفاء)‪ ،‬وايضا‪ ±‬مقياس التمكين ومقياس التع‪±‬افي (الش‪±‬فاء) ‪ ،‬وايض‪±‬ا‬
‫مقي‪±±‬اس المتالزم‪±±‬ه الس‪±±‬لبيه وااليجابي‪±±‬ه و مقياس‪±±‬ي العج‪±±‬ز المكتس‪±±‬ب‪ .‬وهن‪±±‬اك عالق‪±±‬ة س‪±±‬لبية بين مقي‪±±‬اس التمكين‬
‫ومقياس العجز المكتسب‪.‬‬
 ‫االستنتاج‪:‬‬

‫بنا ًء على نتائج الدراسة الحالية ‪ ،‬كشفت هذه الدراسة أن تدخل التمكين ك‪±±‬ان متفوقً‪±±‬ا في تقلي‪±±‬ل العج‪±±‬ز‪،‬‬
‫أيض‪±‬ا‬
‫وتحسين معدل الشفاء والتعافي‪ ،‬وتقليل األعراض النفسية وتحسين جوده الحياة‪ .‬أظه‪±±‬رت ه‪±±‬ذه الدراس‪±±‬ة ً‬
‫أن محت‪±±‬وى‪ ±‬الت‪±±‬دخل وطريق‪±±‬ة توص‪±±‬يله ك‪±±‬ان مقب‪±±‬واًل ويمكن تنفي‪±±‬ذه بس‪±±‬هولة عن طري‪±±‬ق العي‪±±‬ادات الخارجي‪±±‬ة‬
‫لألمراض النفسية‪ .‬كشفت الدراس‪±‬ة عن إمكاني‪±‬ة تض‪±‬مين ت‪±‬دخالت التمكين كج‪±‬زء من ت‪±‬دخل نفس‪±‬ي اجتم‪±‬اعي‬
‫شامل‪ .‬كما أشارت هذه الدراسة إلى أن التدخل التمكيني كان تدخالً فعاالً عند تكامله مع العالج كالمعتاد‪±.‬‬

‫التوصيات‪:‬‬

‫بنا ًء على نتائج الدراسة يتم اقتراح التوصيات‪ ±‬التالية‪:‬‬

‫يحتاج البحث المستقبلي إلى دراسة آثار مسار الم‪±±‬رض في ك‪±±‬ل م‪±±‬ريض وتط‪±±‬وير‪ ±‬ت‪±±‬دخل التمكين على‬ ‫‪.1‬‬
‫المستوى الفردي‪ .‬اذا كان ممكنا‪.‬‬
‫هناك حاجة إلى مزيد من الدراسة لفحص العالقات بين التمكين التدخل على معدل االنتكاس واح‪±±‬ترام‬ ‫‪.2‬‬
‫الذات واالمتثال لألدوية‪.‬‬
‫إجراء دراسة بحجم عينة كب‪±‬ير ومتابع‪±±‬ة أط‪±‬ول للتحقي‪±‬ق في ت‪±‬أثير‪ ±‬ت‪±‬دخل التمكين على ش‪±‬فاء مرض‪±±‬ى‬ ‫‪.3‬‬
‫الفصام‬
 ‫الساده أعضاء لجنه الحكم والمناقشه‬

‫‪.‬عنوان الرساله‪ :‬تأثير تدخل التمكين على العجز والشفاء وجوده الحياة بين مرضي الفصام‬

‫اسم الباحثه‪ :‬هدير صابر محمد أمين العوضي‬

‫‪:‬لجنه االشراف‬
‫التوقيع‬ ‫الوظيفه‬ ‫االسم‬
‫أستاذ بقسم التمريض النفسي والصحه‬ ‫أ‪.‬د‪/‬منى أحمد البلشه‬ ‫‪1‬‬
‫النفسيه‬
‫كليه التمريض – جامعه المنصوره‬

‫مدرس بقسم التمريض النفسي والصحه‬ ‫د‪ /‬عزه ابراهيم عبد الرؤوف‬ ‫‪2‬‬
‫النفسيه‬
‫كليه التمريض – جامعه المنصوره‬

‫لجنه الحكم والمناقشه‪:‬‬

‫التوقيع‬ ‫الوظيفه‬ ‫االسم‬

‫أستاذ بقسم التمريض النفسي والصحه‬ ‫أ‪.‬د‪/‬منى أحمد البلشه‬ ‫‪1‬‬
‫النفسيه‬
‫كليه التمريض – جامعه المنصوره‬

‫أستاذ بقسم التمريض النقسى والصحه‬ ‫أ‪.‬د‪ /‬ميرفت مصطفي الجنيدى‬ ‫‪2‬‬
‫النفسيه‬
‫كليه التمريض – جامعه االسكندريه‬
‫أستاذ االمراض العصبيه والنفسيه‬ ‫أ‪.‬د‪ /‬أحمد جمال عزب‬ ‫‪3‬‬
‫كليه الطب‪ -‬جامعه المنصوره‬

‫عميد الكليه‬ ‫وكيل الكليه للدراسات العليا والبحوث‬ ‫رئيس القسم‬

 ‫الساده أعضاء لجنه االشراف‬

‫‪.‬عنوان الرساله‪ :‬تأثير تدخل التمكين على العجز والشفاء وجوده الحياة بين مرضي الفصام‬

‫اسم الباحثه‪ :‬هدير صابر محمد أمين العوضي‬

‫‪:‬لجنه االشراف‬

‫التوقيع‬ ‫الوظيفه‬ ‫االسم‬

‫أستاذ بقسم التمريض النفسي والصحه‬ ‫أ‪.‬د‪/‬منى أحمد البلشه‬ ‫‪1‬‬
‫النفسيه‬
‫كليه التمريض – جامعه المنصوره‬

‫مدرس بقسم التمريض النفسي والصحه‬ ‫د‪ /‬عزه ابراهيم عبد الرؤوف‬ ‫‪2‬‬
‫النفسيه‬
‫كليه التمريض – جامعه المنصوره‬

‫عميد الكليه‬ ‫وكيل الكليه للدراسات العليا والبحوث‬ ‫رئيس القسم‬

‫تأثير تدخل التمكين على العجز والشفاء وجوده الحياة بين مرضى الفصام‬

‫رﺳﺎﻟﺔ ﻋﻠﻤﯿﺔ‬

‫ﻣﻘﺪﻣﺔ إﻟﻲ ﻛﻠﯿﺔ اﻟﺘﻤﺮﯾﺾ ‪ -‬ﺟﺎﻣﻌﺔ اﻟﻤﻨﺼﻮرة‬

‫اﺳﺘﯿﻔﺎء ﺟﺰﺋﻲ ﻟﻠﺪراﺳﺎت اﻟﻤﻘﺮرة ﻟﻠﺤﺼﻮل ﻋﻠﻲ درﺟﺔ اﻟﻤﺎﺟﺴﺘﯿﺮ‬

‫ﻓﻲ اﻟﺘﻤﺮﯾﺾ اﻟﻨﻔﺴﻲ واﻟﺼﺤﺔ اﻟﻨﻔﺴﯿﺔ‬

‫مقدمه من‬

‫هدير صابر محمد أمين العوضي‬

‫معيد بقسم التمريض النفسي والصحه النفسيه‬

‫كليه التمريض – جامعه المنصوره‬

‫المشرفين‬
‫أ‪.‬د‪ /‬منى أحمد البلشه‬

‫أستاذ التمريض النفسي والصحه النفسيه‬

‫كليه التمريض ‪ -‬جامعه المنصوره‬

‫د‪/‬عزه ابراهيم عبد الرؤوف‬

‫مدرس بقسم التمريض النفسي والصحه النفسيه‬

‫كليه التمريض ‪ -‬جامعه المنصوره‬
2023