Community Mental Health Nursing

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Prevalence of Impaired Glucose Regulation (IGR) among Schizophrenic Clients in Northern West-Bank
(2012) Salah Ali Dalal; Prof. Waleed Sweileh; Dr. Iyad Al-Ali
Background and Objectives: To investigate the prevalence of pre-diabetes mellitus ( Pre DM ) and diabetes mellitus ( DM ) in clients with schizophrenia who use antipsychotic drugs and compare it with those published in the general population. Methodology: A cross- sectional study carried out in 4 governmental primary psychiatric healthcare centers in northern West-Bank (Nablus, Jenin, Qalqilia, Tulkarm). Fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) were tested. Both the World Health Organization (WHO) and American Diabetes association (ADA) criteria for definition of pre-DM and DM were used in the study. Dysglycemia was defined as FBG> 110 mg/dl. Result: The total number of samples is 250 clients . Based on WHO criteria, 27 clients (10.8%) were diabetic and 34 (13.6%) clients were pre-diabetic. The prevalence of pre-DM was significantly higher than that reported in the Palestinian general population. However, prevalence of DM was not significantly differently from that in the general population in Palestine. Regression analysis showed that advancing age and abnormal waist circumference were significant factors associated with dysglycemia in clients with schizophrenia. Conclusion: This study confirmed the high prevalence of dysglycemia among patients diagnosed with schizophrenia, supporting the need for enhanced monitoring for diabetes in this population. It is likely that the presence of primary risk factors is more important in the development of dysglycemia in patients with schizophrenia than exposure to antipsychotic drug.
The Experience of Mothers and Teachers of Attention Deficit / Hyperactivity Disorder Children, and Their Management Practices for the Behaviors of the Child A Descriptive Phenomenological Study
(2012) Lubna Harazni; Dr. AidahAbu Elsoud Alkaissi
Abstract Introduction: ADHD (attention deficit hyperactivity disorder)is a childhood disorder affecting children worldwide and has a major burden on the child, family and other caregivers. Aim: The aim of this study is to investigate and describe the experience of the adults that interact on a daily basis with school-aged children with Attention Deficit Hyperactivity Disorder, which are mothers and teachers. This study aims also to understand management practices that are used by mothers and teachers to deal with the most prominent signs of ADHD, which are hyperactivity, impulsivity, and inattention in order to formulate a care plan. Design :The study used a qualitative descriptive phenomenological method to explore the experiences of primary caregivers of ADHD children to capture as much as possible the way in which the phenomenon is experienced. Data collection: Face to face, in-depth, semi-structured interviews were conducted with participants – the mothers and teachers of ADHD children. The interview guide allowed mothers and teachers to express their experiences with the ADHD child. Sample:Purposive sampling was used; four children diagnosed with ADHD were chosen. The sample was 4 mothers and 12 teachers (3 teachers for each child). Setting: Interviews were conducted in schools and homes of children with ADHD. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). Results: Three major themes emerged from the mothers’ interviews and ten sub-themes; (1) the burden of caring (academic track burden, activities of daily living burden, psychological and emotional burden);(2)inadequate support(lack of support from spouses and relatives, lack of support from schools, lack of support from community);(3)disturbances of the child's behavior (hyper activity, inattention, impulsivity, hostility). Five major themes also emerged from the teachers interviews and thirteen sub-themes; (1) lack of information (about the nature of the disease,about student health and follow-up, about the ideal method for dealing with child); (2)child´s behaviors disruptive (inability to follow class rules, inattention and impulsivity, using verbal and physical abuse);(3) the lack of resources (lack of time, lack of materials and experts); (4) lack of support (lack of Ministry of Education support and school team, lack of parental support); (5) the burden of having the child in the class (burden of managing the safety of the child, burden to calm the child and the other students, emotional burden). Conclusion : The findings of the study demonstrate the importance of understanding the experience of the mothers and teachers of ADHD children. It reflected the difficulties and issues of dealing and caring with ADHD children. There were clear defects in the knowledge, understanding, services provided for the children, and available support for the care givers. Improving services in terms of family and school care should be a major concern. The recommendations made on the basis of the results of this study can be used as a guide to improve the delivery of care services for people who have children with ADHD. Key words: ADHD, experience, descriptive phenomenology Definition of Concepts: - ADHD (attention deficit hyperactivity disorder):is a chronic behavioral disorder with three major symptoms including hyperactivity, impulsivity and inattention. It mostly starts in childhood, and is associated with impairment in the functioning of the child in school and at home, in social settings and at work.
Prevalence of Impaired Glucose Regulation (IGR) among Schizophrenic Clients in Northern West-Bank
(2012) Salah Ali Dalal; Prof. Waleed Sweileh; Dr. Iyad Al-ail
Background and Objectives: To investigate the prevalence of pre-diabetes mellitus ( Pre DM ) and diabetes mellitus ( DM ) in clients with schizophrenia who use antipsychotic drugs and compare it with those published in the general population. Methodology: A cross- sectional study carried out in 4 governmental primary psychiatric healthcare centers in northern West-Bank (Nablus, Jenin, Qalqilia, Tulkarm). Fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) were tested. Both the World Health Organization (WHO) and American Diabetes association (ADA) criteria for definition of pre-DM and DM were used in the study. Dysglycemia was defined as FBG> 110 mg/dl. Result: The total number of samples is 250 clients . Based on WHO criteria, 27 clients (10.8%) were diabetic and 34 (13.6%) clients were pre-diabetic. The prevalence of pre-DM was significantly higher than that reported in the Palestinian general population. However, prevalence of DM was not significantly differently from that in the general population in Palestine. Regression analysis showed that advancing age and abnormal waist circumference were significant factors associated with dysglycemia in clients with schizophrenia. Conclusion: This study confirmed the high prevalence of dysglycemia among patients diagnosed with schizophrenia, supporting the need for enhanced monitoring for diabetes in this population. It is likely that the presence of primary risk factors is more important in the development of dysglycemia in patients with schizophrenia than exposure to antipsychotic drug.
Prescription Pattern of Antipsychotics in Patients with Schizophrenia in North West-Bank
(2012) Jehad M. Bani Odeh; Prof. Waleed Sweileh; Dr. Ansam Sawalha
Background: Antipsychotic prescription patterns are fundamentally different across countries and even regions due to variations in factors including health care policies, availability and cost of drugs, psychiatric training, and preferred treatment modalities. Objectives: The objectives of this study were to evaluate the prescribing pattern of antipsychotic drugs and its conformance to international treatment guidelines among patients attending governmental primary healthcare clinics. Furthermore, predictors of antipsychotic prescribing pattern are investigated. Methods: A cross sectional study at 4 governmental primary psychiatric healthcare centers in northern West-Bank, Palestine was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. Descriptive and statistics analysis was conducted using Statistical Package for Social Sciences SPSS 19. Results: A total of 250 patients were included in the analysis. Mean age of (mean ± SD) the patients was 41.5 ± 10.3 years. A total of 406 antipsychotic agents were used; 348 (85.7%) were form first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n = 126). There was no significant difference in positive (P=0.3), negative (P=0.06) and psychopathology (P=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Regression analysis showed that use of depot, use of anticholinergic agents and use high CPZeq doses were significantly associated with antipsychotic combination. Discussions and Conclusions: This study indicated that antipsychotic prescribing was not in conformance with international guidelines. Antipsychotic combination was common and has no clinical benefits or economic drawbacks.
Prevalence of Dyslipidemia among Schizophrenic Clients in Northern West Bank
(2012) Sami "Moh’d Shaker" Saleh Al-Abwini; Dr. Iyad Ali; Prof. Waleed Sweileh
Individuals with major mental disorders lose 25 or more years of life expectancy, with coronary heart disease (CHD) as the leading cause of death. Dyslipidemia is a common health problem worldwide, and defined by the presence of one or more than one abnormal serum lipid concentration, and schizophrenic clients are at higher risk of dyslipidemia and at higher risk of dying from cardiovascular diseases. AIM: The aim of the study is to determine the prevalence of dyslipidemia among schizophrenic clients who are attending governmental psychiatric clinics in northern West Bank of Palestine. METHOD: Data was analyzed from a cross-sectional study that included a Convenience sampling of 251 schizophrenic clients attending governmental psychiatric clinics in northern West Bank of Palestine (Jenin, Tulkaram, Nablus and Qalqilia), Aged 16 years and older. According to the NCEP ATP III criteria, High total cholesterol (TC) was defined as TC ≥200 mg/dl and hypertriglyceridemia as serum triglyceride level ≥150 mg/dl. Low high-density lipoprotein cholesterol (HDL-C) was defined as serum HDL-C <40 mg/dl. High low-density lipoprotein cholesterol (LDL-C) was defined as serum LDL-C ≥130 mg/dl. RESULTS: The analysis shows an of a total of 251 subjects, 43.4% had high TC level, 33.8% had high LDL-C, 41.4% had low HDL-C, 48.2% had high triglyceride levels, and 66.5% had at least one abnormal lipid level. The prevalence of dyslipidemia in schizophrenic clients was significantly higher than from general population in other country. The prevalence of dyslipidemia in male more than female in all plasma lipids, with significant relationship in low HDL-C (p/0.02). The prevalence of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and abnormally low HDL-C, were higher in all age groups.BMI was associated with high triglycerides, and there was significant relationships between high total cholesterol and smoker. CONCLUSION AND RECOMMENDATION: This study confirmed the high prevalence of dyslipidemia among clients diagnosed with schizophrenia, which necessitates appropriate the institution of community-based intervention strategy for prevention, detection and treatment of dyslipidemia.
Psychological Distress Among Infertile Women Attending Razan Center In West Bank In Palestine: Quantitative Study
(2013) Layali Katwsa; Dr. Belal Mahamoud Rahhal
Aim of the Study: This study focuses on infertility and its impacts on Palestinian women mental health status. It was comes to assess psychological distress quantitatively in women suffering from infertility living in the West Bank in Palestine. Method: A descriptive design was used to investigate the impacts of infertility on Palestinian women’s mental health status and to investigate the most prevalent psychological problems among infertile women. The Symptom Checklist-90-R, a standardized instrument for the measurement of current psychological symptom status, was administered on Eighty eight women diagnosed with infertility and to improve the validity of our study, local control group was added; this group consisted of 100 women who attend family planning clinic, women between the ages of 18 and 42 years were taken as a convenience sample. All these respondents filled the Derogatis SCL.90-R (a self report measure of mental health symptomatology) by themselves. Data analysis: The SCL-90-R was analyzed using Statistical Package for Social Sciences (SPSS) version 16 ;the calculations of means, standard deviations, the ratio percentiles, a Kruskall-Wallis Tests carried on analyze the collected data by Derogatis's SCL.90-R. RESULTS: Analyses of the SCL-90-R indicated that participants in the study group differed in their psychological symptom status when compared with controls. Infertile women in the current study have more psychological distress as represented through the 3 indices and 9 symptom dimensions of the SCL-90-R, than fertile women , the results showed there were a statistical significant differences among the two groups of participants in relation to GSI; PSDI ; paranoid idea ;obsessive-compulsive; interpersonal sensitivity; depression symptoms ; anxiety symptoms ; and phobic anxiety . The results of the study demonstrated , that the duration of infertility , causes of infertility ,age and place of residence did not show any significant effect on mental health of infertile women . Other independent variables were found to be significant under some circumstances, such as employment and scientific qualifications. Summary: This was the first study in Palestine that explored mental health status of the infertile women. In addition, the present study could be the first study of its kind in the Arab countries as far as the literature showed, which investigated the psychological distress among infertile women by using the Symptom Checklist-90-R, a standardized instrument for the measurement of current psychological symptom status. When compared with controls, female partners of infertile couples experienced elevated levels of psychological distress, despite the negative feelings that were reported by many respondents; very few had ever consulted a mental health professional or sought counseling. Special consideration should be given to the emotional needs and psychological distress of infertile Palestinian women. The Psychological aspects of infertility should be given more attention, and be considered in all stages of treatment and medical interventions to decrease the psychological suffering of the infertile couples and to prevent developing of any psychological distress.
Family Burden among Caregivers of Mentally Ill Patients in Nablus District
(2013) Haneen To’meh; Dr. Mariam Al-Tell
Aim: The aim of this study was to assess family burden of caregivers of mentally ill patients and find out whether there is any relation between the perceived burden of caregivers of patients with mental illness and independent variables such as age, sex, education, economic status, and type of mental illness in Nablus District. Methodology: Descriptive, cross sectional design was used to achieve the aim of the study. Convenient sampling method was used to select the subject during the period from November 2012 – January 2013; it was distributed using quota method; 50 patients for each one of the following diagnosis: schizophrenia, mood disorder, and mental retardation, who were attending psychiatric outpatient clinics in Nablus district. The Zarit burden interview and the objective burden section from the Montgomery Borgatta caregiver burden scale were used to assess the burden. Result: The mean of subjective burden was mild to moderate (28.84), while objective was low (17.93). Also, the mean of psychological, social, and economic burden was low, and physical burden was low to moderate. The results showed that burden scores were significantly correlated with gender, educational level, and economic status. No significant differences were found between participants according to their age and type of mental illness. Conclusion: Higher subjective burden scores were correlated to being female, low educational level, and low economic status. While higher objective burden scores were correlated to being male, high educational level, and high economic status. Taking care of mentally ill patients affects the family negatively, so psychiatric nursing intervention should be focused on the need of the caregivers and an emphasis placed on community care for mentally ill patients as well as family intervention.
Marriage Experience among Schizophrenic Clients: Qualitative Narrative Study
(2013) Wissam Obaied; Dr. Adnan Sarhan
Introduction Marriage is considered a normal developing relation between humans. This study examined the effects of marriage among schizophrenic clients, and if we must need to encourage their marriage or not . Aim : The aim of this study is to explore the effectsof marriage on single and married schizophrenic clients. Every relationship has its ups and downs, but what does "in sickness and in health" mean if one partner has schizophrenia? While severity of the illness is a factor, relationships can survive if each partner gets the right support (Connie, 2000). Design : This study is a qualitative narrative study .We tried to answer questions related to the marital status of schizophrenic clients. Data collection . Sample : About 80 schizophrenic clients . half of them are married for at least since three years and suffering from schizophrenia for a period which is not less than six months or more . The other half included single clients suffering from schizophrenia for at least six months or more. Setting : Interviews were conducted in three mental health centers in ( Nablus –Jenin and Tul-Karem ) were included in the current study . Data Analysis : The respondents were interviewed in the mental health centers after consenting to share in this study. The interviews were started with 12 close ended questions; about their demographic data such as; age, sex, occupation and other questions. The second part of the interview was composed of 12 direct face to face narrative questions with the married respondents, and 5 questions with the single ones. Narrative interviews were conducted (Narrative interview is a form of qualitative research that takes story as either its raw data or its product). The note was written during the interviews, after taking permission from the participants, and then deep analyses of the clients’ interviews were done. Results Seven main themes were emerged from the study: 1- The effect of marriage on the Recovery Process of Schizophrenic Clients .Most of the clients encourage marriage , both married and single clients ,they believe that marriage has appositive effects on their lives ,the need of admission and the number of suicide attempt was decreased , and single clients believe the same, but due to economic factors they cannot marry . 2- The effect of gender of the client on the recovery process of him / her and on his marriage .We can say that the male have more chance to marry , and the male client have more responsibility and more stress related to these responsibility . 3 - The effect of age of the client on the recovery process of him and on his marriage .We can say that the old client less stress and more adjustment with the disease . 4-The Effect of Stigma on Marriage and Recovery Process of Schizophrenic Clients .The stigma prevent the client from having many of their rights unfortunately , such as marriage and work . 5 - The effect of having children on the recovery process of schizophrenic clients. They said that their lives became better after marriage, and they said that , their children consider as the most reason of their happiness . 6 - The big effect of the schizophrenic client's family on planning his life, and the client also said that they are at control of their family members , and they are dependent a lot on them , and they cannot marry without their help and their agreement . 7 -The big effect of the schizophrenic client's community on planning his life and marriage .the stigma against the clients in the community have negative effect in the subject of clients marriage unfortunately .The psychiatrist some time did not encourage their marriage . Conclusion The client has the right like other persons to marry and have children, but before marriage, he must have a work or a job, and the partner must know about his / her condition from the beginning. In general, marriage has positive effect on the client’s recovery process, but the other partner faces many problems related to the disease, and must be very patient and has good understanding of his partner. Key words : Schizophrenia – Marriage – Single –Recovery process – Divorce .
Estimation Ten-Year Risk of Coronary Heart Disease in Patients with Schizophrenia
(2013) Saqer M. Al-qoroum; Prof. Waleed Sweileh Supervisor; Dr. Samah Al- Jabi
Background: Studies indicated that patients with schizophrenia have shorter life span than that of general population. Objective: To estimate ten-year risk of coronary heart disease (CHD) in patients with schizophrenia. Methods: A cross-sectional study was carried out in four governmental primary psychiatric health care centers in northern West-Bank (Nablus, Jenin, Qalqilia, and Tulkarem). 112 patients diagnosed with schizophrenia were recruited for the study. A convenience, non-probability sampling method was used. Ten-year risk of CHD was calculated using Framingham risk scoring formula which includes the following variables: age, gender, smoking status, high-density lipoprotein- cholesterol, systolic blood pressure and history of anti-hypertensive drugs hypertension. Risk of CHD was categorized based on total scores into the followings: Ideal (<5%), low (5-9%), intermediate (10-20%) and high (>20%). Descriptive and analytical statistics was conducted using Statistical Package for Social Sciences (SPSS) version 20. Results: The mean age of the participants was 43 ± 10.85 years. The majority were males (76; 67%). There was no significant difference between males and females in age (P=0.72), duration of psychiatric illness (P=0.085), systolic blood pressure (P=0.75), diastolic blood pressure (P=0.7) and total cholesterol level (P=0.17). The mean ± standard deviation (SD) ten-year CHD risk score was 5.6 ± 5.8 (median (inter quartile range (Q1 – Q3)): 3 (1 – 9)). The mean ± SD ten-year CHD risk score for females was 1.5 ± 1.58 (median (Q1 – Q3): 0.75 (0.5 – 2)) while that for males was 7.5 ± 6 (median (Q1-Q3): 6 (2–13)). Based on Framingham risk scores, there were 87 (77.7%) patients in low risk, 22 (19.6%) patients in intermediate risk and 3 (2.7%) patients in high risk. Univariate analysis showed that there were significant differences between low <10% risk score and intermediate/high risk ≥ 10% risk score categories with respect to age distribution (P<0.05), gender (P<0.05), smoking (P<0.05), total cholesterol (P<0.05), diastolic blood pressure (P<0.05) and duration of psychiatric illness (P=0.03). However, there was no significant difference between the low <10% and intermediate/high ≥10% categories in terms of systolic blood pressure, waist circumference and HDL-C levels. Multivariate analysis on male patients showed that age [O.R=1.524, 95% CI (1.213-1.914)] and diastolic BP [O.R=1.207, 95% CI (1.045-1.393)] were significant factors associated with intermediate/high ≥ 10% CHD risk. Conclusions: One fifth of schizophrenia patients had a CHD risk ≥ 10%. Efforts to decrease CHD risks among patients with schizophrenia should be directed mainly toward diastolic BP as modifiable risk factor. Key words: Schizophrenia, Framingham Risk Score, CHD, Palestine
Stress and Coping Mechanism among Nurses in Palestinian Hospitals, A pilot study
(2013) Ahamd Ismail Sleman Umro; Prof. Waleed M. Sweileh; Dr. Samah Al-Jabi
Background: A survey of literature revealed that although a great deal of research has been carried out about stress and coping mechanisms internationally, little has been written about stress and coping mechanisms among nurses in Palestine. Objective: The objectives of this study were to identify the possible causes and frequency of stress experienced by Palestinian nurses working in governmental and non-governmental hospitals, and to assess the most common ways of coping mechanisms. Methods: A cross-sectional descriptive study was conducted. Nursing Stress Scale (NSS) and three subscales of Ways of Coping Checklist (WCC) were used to assess stress and coping mechanisms among Palestinian nurses. Results: Data revealed that nurses were stressed. According to NSS, the greatest perceived sources of stress appeared to be “workload” (mean=2.93) followed by “conflict with other nurses” (mean=2.63) and “emotional issues related to death and dying” (mean= 2.56). Nurses in non-governmental hospitals have significantly higher “conflict with other nurses” stress than those in governmental hospitals: 2.77 versus 2.55; (p=<0.01). Nurses with longer years of service have significantly higher “Uncertainty concerning treatment” stress than nurses with shorter years of service: 2.41 versus 2.2; (p=0.01). According to the ways of coping mechanism, nurses seemed to be resorting more to “confronting coping” (mean=2.41) while “escape avoidance” was the least coping strategy employed (mean=2. 04). Male nurses seem to resort significantly more to “confronting coping” than female nurses: 2.49 versus 2.29; (p=0.02). Nurses with long years of service seem to resort significantly more to “Distancing” than nurses with shorter years of service: 2.3 versus 2.17; (p=0.03). Conclusion: Stress among nurses is serious. Providing more nursing staff and decreasing non-nursing jobs might help to decrease nursing stress, according to coping mechanisms nurses seem to employ confronting coping strategy and this is not a healthy style some time, providing more coping strategy by mental health nurses via programs in the hospital will help nurses to choose the best coping strategy for each one.
Association between Autism and Iron Deficiency in Autistic Children in the Northern West Bank
(2013) Sajed Faisal Al Ali; Dr. Aidah Abu Elsoud Alkaissi; Dr. Sabrina Russo
Background: Iron has an important role in cognitive, behavioral, and motor development. A high prevalence of iron deficiency (ID) has been reported in people with autism. Children with autism are at risk for ID and this condition may increase the severity of psychomotor and behavioral problems, some of which already inherently exist in these children. Aim: The aim of this study is to investigate the association between autism and iron deficiency in autistic children in the northern West Bank and to identify food selectivity and compare indices of food selectivity among children with autism, children with mental disorders and typically developing children (normal children). Participant and Methods: 90 children with an age range of 3 to 13 years participated in a case control study distributed into study group and two control groups. Thirty children diagnosed with autism according to DSM-IV and ICD-10criteria served as a study group, 30 children with mental disorders other than autism served as a control group, and 30 typically developing children taken from the public functioned as a second control group. The three groups were matched for age, gender and geographical area. Serum ferritin, hemoglobin, hematocrit, mean corpuscular volume, and red cell distribution width values were measured and analyzed with food habit survey and demographic data. Results: ID was detected in 20% (N = 6/30) of autistic children based on Serum ferritin level (SF< 10µ/l), compared with 0% for the two control groups (p= 0.0001). Anemia was defined as hemoglobin <110g/l for children under the age of 6 years and hemoglobin <120g/l for children between 6 and 13 years of age .When analysis done for HGB to these six children (children who have low serum ferritin); it was found that 66.6% (4/6) of the children two were pre-school male children (HGB is less than 110g/1), and the other two were one male and one female of school children (HGB is less than 120g/l) have iron deficiency anemia, and the iron deficiency anemia was 13.3% (4\30) for all autistic group. The results indicated that these differences were for males. It was found also that the frequency of low iron intake in these children was associated with feeding difficulties and food selectivity; there was a significant difference between children in the autistic group who chose foods with a red color as a favorite 23% (7/30) compared to the other two control groups: 0%, respectively (p= 0.0001). The results demonstrated also a significant difference in the frequency of snacks per day (≥ 4) in autistic children 40% (12/30) compared to both mental disorder 16.7 % (n = 5/30) (p = 0.006) and typically developing children 6.7% (n = 2/30) groups (p = 0.001). Conclusion: Results of this study indicated that there is an association between autism, iron deficiency and anemia. Low levels of serum ferritin in autistic children might be a sign of iron deficiency and an early precursor of iron deficiency anemia. These findings suggest that food selectivity is more common in children with autism than in typically developing children. These findings suggest that ferritin levels should be measured in children with autism as a part of routine investigation. Keywords: Child, Autism, Mental disorder, typically developing children, Iron deficiency, Iron deficiency anemia, Ferritin.
Psychosocial Impact of Stigma on Schizophrenic Clients and their Family Members
(2013) Nida Jawabreh; Dr. Adnan Sarhan
Introduction: Stigma acts as a barrier for schizophrenic clients and their family members. In fact, it prevents clients and family members from getting the help they need. To date, there are limited studies regarding the impact of stigma on the social life of the schizophrenic clients and their family members in Palestine. This study aims to investigate the extent of stigma on schizophrenic clients and their families, and to investigate the effect of stigma on the interviewees in accordance with their demographic variables. Methods: By following a descriptive non-experimental design, mainly by using face to face structured interviews and a questionnaire methodology for quantitative part of the study, and narrative interviews for qualitative part. This study sample consists of 150 schizophrenic clients and 150 of their family members from the Northern cities of Nablus, Jenin and Tulkarm of the West Bank, Palestine. Results: The quantitative results show that the most prevalent stigma among schizophrenia clients was moderate with a degree of 48% and the least prevalence was severe with a degree of 2%. There is no significant correlation between the extent of stigma and: education, and gender, but in relation with age and educational status we found that there is a significant correlation. Also the prevalence of stigma among family members was found to be a round medium and low level with a degree of 21.3%, 40.6% respectively. Which revealed a normal distribution of family impact of stigma and come to the lower impact than their patients. The qualitative results show that the impact of stigma centralized on: inadequate support, burden of caring, and knowledge deficit. Conclusion: The study concluded that schizophrenic clients and their family members experience stigma in their life and this negatively affected their quality of life in different aspects. The findings show that caring for a client with schizophrenia is stressful for the family members so there is need for financial and social support and training programs for the family members.
Blood Profile of Schizophrenic Clients in Northern Palestine
(2013) Hisham zaher zhran; Dr. Iyad Ali; Dr. Adham Abu Taha
Background: People with schizophrenia die prematurely because antipsychotic medications and patients’ lifestyle, contribute to excess morbidity and mortality in these patients. Hematological side effects of antipsychotic drugs such as leucopenia, neutropenia, agarnulocytosis, leukocytosis, thrombocytopenia, thrombocythaemia and anemia occur infrequently but remain a potential cause of serious toxicity and people with schizophrenia make poor dietary choices. Complete blood count is one of the measures to investigate these morbidities and mortalities. Objectives: The objective of this study was to investigate the blood profile and general characteristics in a group of schizophrenic patients in Northern West-Bank, Palestine. Methods: A cross sectional study was conducted between August 2011 and February 2012 at the governmental primary psychiatric health care centers in Northern West-Bank, Palestine. Two hundred and fifty patients were selected by convenience sampling method. A complete blood count (CBC) was performed on blood samples collected from the selected patients to investigate the white and red blood cells, as well as platelet count. Results: The number of schizophrenic patients having anemia in our study was 63 (25.2%). Regression analysis showed that gender was significant factor associated with the prevalence of anemia in schizophrenic patients, the prevalence of female patients they have anemia more than male patients. The majority of patients had normal white blood cells and platelets counts. Conclusion and recommendation: Anemia was found among 25.2% of study population in schizophrenic patients as result of poor nutritional status, unhealthy life style of these patients, and antipsychotic drugs. It is recommended that mental health providers deliver patients with an appropriate community-based intervention strategy for prevention, detection and treatment of anemia. Furthermore, the low educational achievement among participants makes education a potentially important area for interventions targeted at this group. Lastly, the job skills of patients should be improved.
Nurses’ Attitudes and Practices towards Inpatient Aggression in Dr. Kamal Mental Health Hospital
(2014) Hussein Al- Awawdeh; Dr. AidahAlkaissi; Dr. Sabrina Russo
Background: Inpatient aggression can occur for many reasons and there are many factors that contribute to this occurrence such as patient factors, staff factors and environmental factors. There are strategies to prevent and manage aggression. Aims: The aims of this study are to explore nurse's practices and attitudes of inpatient psychiatric aggression to identify the way the nurses handle aggression by patients and exploring the effects of patients, staff and environmental factors on the occurrence of aggression. Participants and methods: The study was conducted at Dr. Kamal Adwan Psychiatric Hospital in Bethlehem. All nursing staff in the mental health hospital who had worked for at least one year at the time of the study were recruited (67 nurses). The participants ranged in age from 20-50 years with a mean age of (35.1) (±SD = ±7.8) and included 30 females and 37 males. A questionnaire was used which has three scales: Attitude Toward Aggression Scale (ATAS), Management Of Aggression and Violence Scale (MAVAS) and Demographic Scale. Results: Nurses were inclined to perceive patient aggression as destructive, violent, intrusive and functional reactions. They were less inclined to view aggression as protective, communicative or acceptable normal reactions. Female nurses in this study were more likely to view aggression as having an intrusive role whereas, on the contrary, male nurses were more likely to view aggression as having a communicative role and they believed that the aggression could be managed in general. Longer professional experience was significantly associated with a higher frequency of the management of aggression in general. Nurses from the admission ward (male and female) were in less agreement with the Protective and Communicative Attitudes scales than the nurses from the other inpatient wards. On the other hand, nurses from admission ward (particularly female) and recovery ward (male and female) had a higher rate of violent and offensive reaction to aggression than nurses from the other wards. The nurses from the chronic female ward had a higher intrusive scale than nurses from the other wards. The highest level of the scientific grade group is a Master of Mental Health with a high level mean regarding the attitudes to the acceptable normal reaction scale, violent reaction scale, functional reaction scale, offensive scale, communicative scale, destructive scale, external causative factors scale, situational/interactional causative factors scale, Management: general, and Management: use of medication. The nurses agree that there are internal, external and interactional factors to inpatient aggression. Nurses believe that patients may be aggressive because of the environment of the psychiatric hospital. Nurses believe that aggression develops because staff do not listen to the patients, there is poor interaction between staff and patients and other people make patients aggressive. Nurses believe in the use of medications, restraint and seclusion widely , on the contrary, they believe in the use of non-physical methods like negotiation and expression of anger. Conclusion: This study demonstrate that there are different attitudes of nurses toward patient aggression in psychiatric inpatient settings. This study found that aggression is negatively viewed by Palestinian psychiatric nurses. These attitudes are reflective of the opinions of lay persons in our society. There is a need for training programs to reorient the opinions of nurses in relation to inpatient aggression. These programs should contribute to improved patient care and reduction in the frequency of aggressive acts within inpatient units. Key words: Aggression; mental health nurses; ATAS; MAVAS
Prevalence of Depression among Diabetic Patients
(2014) Hanady M.Abu Hadeed; Prof. Waleed Sweileh; Dr. Samah Al- Jabi
Background: Diabetes mellitus is a common chronic metabolic disorder, and is among of the main causes of death in Palestine. Palestinians are continuously living under stressful economic and military conditions which make them psychologically vulnerable. The purpose of this study was to investigate the prevalence of depression among type II diabetic patients and to examine the relationship between depression and socio-demographic factors, clinical factors, and glycemic control. Methods: This was a cross-sectional clinical study at Al-Makhfiah primary healthcare center, Nablus, Palestine. Two hundred and ninety-four patients were surveyed, and Beck Depression Inventory (BDI-II) scale was used to assess the presence of depressive symptoms among them. Moreover, patients' records were reviewed to collect the socio-demographic characteristics of patients (age, gender, marital status, level of education, smoking status, body mass index (BMI)); and other information related to diabetes mellitus disease (duration of diabetes, glycemic control using the glycated hemoglobin (HbA1C) test, use of insulin); and presence of additional illnesses. In addition, medication adherence of the patients included was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Results: Out of 294 patients included, 164 (55.8%) patients were females and 216 (73.5%) were < 65 years old. One hundred and twenty patients (40.2%) scored ≥ 16 on BDI-II scale. Univaraite statistical analysis showed a significant association between high BDI-II score (≥ 16) and female gender, low educational level, having no current job, having multiple additional illnesses, low medication adherence and obesity (BMI ≥ 30kg/m2). On the other hand, no significant association was found between BDI-II score and glycemic control using (HbA1C), duration of diabetes, and the other socio-demographic factors. Multivatriate analysis showed that low educational level, having no current job, having multiple additional illnesses and low medication adherence were significantly associated with high BDI-II (≥ 16) scores. Conclusion: In the current study, the prevalence of depression was higher than that reported in other countries. Although 40% of the assessed patients were considered as potential cases of depression, none of them were being treated with anti-depressants. Psychosocial evaluation should be recommended as a routine clinical assessment of diabetic patients at primary healthcare clinics to improve their quality of life and reduce adverse outcomes. Key words: Diabetes mellitus, Depression, Palestine.
Depressive Symptoms Among Palestinian Deaf Adults
(2014) Ibrahim Fakhri Ibrahim Aqtam; Dr. Adnan Sarhan
The aim of the Study: The study aims to assess the prevalence of depressive symptoms among Palestinian deaf adults. Method: A quantitative cross-sectional design was adopted to answer the research question for the study. The framework is based on factors derived from previous studies on the Patient Health Questionnaire PHQ-9 (Robert & Spitzer et al, 2001). The subject population was composed of 217 adults from three representative West Bank Palestinian cities. Participants ranged in age from 15 to 65 years divided as males (n=136) and females (n=81). All participants attend special deaf centers and use the Palestinian Sign Language (PSL). Results and Data Analysis: The data analyzed using Statistical Package for Social Sciences (SPSS). We used mean, standard deviation, and multivariate logistic regression. According to the multivariate analysis results of the study showed, (OR=2. 0) (95% CI, 1.2-3.4) minimal depression, (OR= 1.7) (95% CI, 1.2-2.3) mild depression, (OR=1. 4) (95% CI, 1.1-1.9) moderate depression, and (OR=0. 9) (95% CI, 0.7-1.2) severe depression. Conclusion: The concluded result of our study is that more than half of the respondents suffer from depression at varying levels, which is considered significant conclusion. Tendency for depression might be a common health problem among deaf adults attending primary health maintenance installations. Further research on socio-demographic characteristics and the force of depression on their health status is required. Keywords: Depression, Prevalence, Cross sectional, Deaf, Palestinian.
Palestinian Women Attempted Suicide, Risks beyond the Experience A Descriptive Phenomenological Study
(2014) Einas Abu Safa; Dr. Aidah Alkaissi; Dr. Sabrina Russo
Introduction: suicide is a major public health problem all over the world. It described as “intentional, self-destructive, and self-inflicted acts. Aim: The aim of this study is to explore the risks beyond the experience of attempting suicide among a group of Palestinian women. Design: The study used a qualitative descriptive phenomenological method to explore the experiences of Palestinian women attempted suicide, to capture as much as possible the way in which the phenomenon is experienced, and the risks lays beyond the experience. Data collection: Face to face, in-depth, semi-structured interviews were conducted with participants – the women who previously attempted suicide. Sample: Purposive sampling was used; 20 women attempted suicide at least once. Setting: Interviews were conducted in a private place agreed for with the women. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). Results: From the interviews, Five themes and eighteen sub-themes emerged: violence (Sexual violence, domestic violence, collective violence, witnessing abuse, and child maltreatment); Losses (loss of parents, loss of cultural identity, loss of relation, and loss of security) ; psychological risk factors (Low self efficacy, Low Self esteem, Negative Self image, and Maladaptive coping mechanism); and Socio cultural factors (poverty, stigma, and dysfunctional family); Lack of support system (Non professional, and professional). Conclusion and Recommendation: The findings of the study demonstrate the importance of understanding the experience of the women attempted suicide, the risk beyond their experience, and the phenomena of suicide within the Palestinian community. It reflect the need for national prevention programs which include the implementation of national programs for mental health, recognizing the rights of females, tackling illiteracy among both males and females, prohibiting forced child marriage, providing economic and social support especially for young females, and promoting Islamic values rather than traditional customs. Key words: Attempted suicide, experience, risk, descriptive phenomenology. Definitions of Concepts: - Violence: is the intentional use of physical force or power, threatened or actual, against a person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. This definition associate intentionality with the committing of the act itself, irrespective of the outcome it produces (WHO, 2005). - Sexual violence: any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work(WHO, 2005). - Rape: Physically forced or otherwise coerced penetration even if slight – of the vulva or anus, using a penis, other body parts or an object(WHO, 2005). - Domestic violence: refers to a behavior by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, and psychological abuse and controlling behaviors (WHO, 2005). - Physical abuse: is an act of another party involving contact intended to cause feelings of physical pain, injury, or other physical suffering or bodily harm (WHO, 2005).
Stressors and Coping Strategies amongst Hemodialysis Patients in North of West Bank
(2015) Dina Tahseen Nimer Issa; Dr. Mariam AL-Tel; Dr. .Jamal Qaddumi
Aim: the aim of the study was to assess the stressors and coping strategies used among hemodilysis patients (HD). To find out whether there is any relation between these stressors; coping strategies used andpatient characteristics in North of West Bank. Methodology: A quantitative, cross-sectional, descriptive analytical study was carried out to achieve the aim of the study during the period between Januarys to March 2014. Data collection were took place at three governmental hospitals and one private hospital, on 120 HD patients of total 379, using the Hemodialysis Stress Scale (HSS) and Jalowiec Coping Scale(JCS). Result: The finding showed that the HD patients were mildly to moderately stressed according to HSS, the greatest perceived sources of stress appeared to be "physiological stressors" (mean=2.655) but the item with the highest percentage was "limitation on time and place for vacation" (84.2%) which belong to psychological stress subscale, and the item stress with the least percentage was "dependency on nurses and technicians"(45%). According to the ways of coping mechanisms, HD patients seemed to be resorting more to "optimistic coping" (mean=3.086) followed by "supportant coping" (mean=2.970) while "emotive coping" was the least coping strategy used (mean=2.125), the coping item with the highest percentage for using and helpfulness of using was "Prayed or put your trust in God" (94.8%) for using and (95.6%) for helpfulness of using. There were significant differences between the psychological stressors and duration of treatment and a significant difference between the stressors and coping strategy used, in addition to a significant difference between the coping strategies and helpfulness of coping. Conclusion: Maintaining the level of stressors in individuals with ESRD at minimum and using a proper coping mechanism are the key factors. Investment in this area of knowledge was justified for their contribution to improving the quality of life, minimizing potential complications of this disease, survival of these people and decrease cost. In addition future researches should be directed at detecting the predisposing factors that lead the HD patients to be variant in experiencing the intensity of stress and coping strategies used.
Prevalence and Severity of Depression among Mothers of Disabled Children in Palestine
(2015) Nemer Ahamd Nemer Hamamreh; ; Dr. Aidah Alkaissi; Dr. Sabrina Russo
Introduction: Mothers of children with disabilities often experience greater stress and emotional demands than other mothers do. Mothers of children with disabilities showed also more psychological distress than other member in their families, as they are the primary caregivers for their children. Childhood disability often imposes a social and emotional burden for children and their families. Aim: The aim of the study is to assess the prevalence and severity of depression among mothers of disabled children in the north of the West Bank in order to establish baseline data and suggest recommendations to policy makers and professional workers. Subject and Methods: A descriptive, analytical kind (cross sectional) study. About 200 mothers were included in the study divided in two groups, including 100 mothers of children with disabilities (age range, 2-16years) as a study group, and 100 mothers of normally developing children (age range, 2-16 years) as a control group. There were 47% girls and 53% boys in the children of the control group and there were 38% girls and 62% boys in the children of the study group . These children have different diagnoses with a 10% down syndrome, 18% hearing disabilities, 7 % physical disability, 11% speech disorders, 18% autism, 14% mental retardation, 12% cerebral palsy and 10 % other disorder The mothers’ average ages in the study group and control group were 32.6 (SD±6.3) and 31(SD± 5.7) years, respectively. A demographic information form and Beck Depression Inventory were administered to mothers of these children who met the inclusion criteria. The assessments were performed during children´s treatment in rehabilitation centers. Result: The prevalence of depression was higher among mothers caring for disabled children than mothers of non-disabled children in the control group. Fifty four percent of mothers of disabled children had a mild to severe level of depression and 18% of the them suffered from moderate to severe depression as derived from Beck Inventory score. When we compare between the study and control groups, the study reveals that there are many factors that increase the prevalence of depression among mothers in the study group compared to control group which include: child’s age <10 years, mother’s age <40 years, middle and low income, and un-employment.
The Experience of Palestinian Children Facing Traumatic Events The Case of a Village under Military Occupation: A Descriptive Phenomenological Study
(2016) Farid Abu Liel; Dr. Sabrina Russo
Introduction: The objective of this research is to provide an overview of the effects of war and living in a conflict zone on children; to capture their lived experience facing traumatic events and to explore the phenomenological experience of those children who live in a village nearby an Israeli settlement and separation wall, under a daily struggle against the Israeli occupation. The research seeks to understand the effect of trauma on children who live in a violent environment in order to understand the impact of such traumatic events on them, and to explore their feelings and thoughts. Aim: The aim of this study is to investigate and describe the experience of Palestinian children facing daily traumatic events. It is also our concern to understand how these children are psychologically affected by their experience. Military occupation poses a challenge for the mental health of children in Palestine, and it is influenced by a set of complex and interactive individual, social, cultural, and economic factors. Lack of studies in such issues makes it difficult to understand the phenomena in relation to the special cultural and social aspects in Palestine. Understanding these factors is critical in provision of effective and culturally appropriate care. We will employ a qualitative approach in order to create a rich and deep understanding of this important issue. Design: The design used is a qualitative phenomenological descriptive design. This design is used to study and to explore the lived experience of the Palestinian children who face traumatic events by describing the aspect of this experience and by focusing on what exists. Sample: Purposive sampling was used; 15 children who lived in a Palestinian village under military occupation and experiencing settler attacks. Setting: Interviews were conducted in a private room in the respondent’s house. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). Results: Three major themes emerged from the children’s interviews and ten sub-themes; (1) Exposure to Traumatic Events (Life threatening, witnessing violence, direct violence, deprivation of freedom, lack of safety and fear); (2) Normalization (1Role playing the traumatic events, Underestimation of danger); (3) Resilience (self-efficacy, 2Awareness and belonging, and trust in adults). Conclusion: The findings of the study demonstrate the importance of understanding the experience of the Palestinian children facing traumatic events. It reflects how these children face the traumatic events regarding the military and settler actions in their village, how they react to these events, and the degree to which they are affected. The children normalized the events through role playing the trauma and acting out violence and underestimation of danger, but then demonstrated resiliency that allowed them to increase their courage to continue. Key words: Phenomenology, trauma, children, war

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