i

A RESEARCH STUDY ON ATTITUDE OF NURSES TOWARDS

RELAPSE PREVENTION AMONG PSYCHIATRIC PATIENTS IN
FEDERAL NEUROPSYCHIATRIC HOSPITAL BARNAWA,
KADUNA

ABSTRACT

The problem of every hospital when the targeted objective is not achieved is that
there is something wring either with health care givers, the patients or the
general public. In order to improve the standard of health of the patients and
keep them progressively fit. The reason why such lapse are present here to be
sought and the remedy met in order to achieve the set objective of the hospital.

This study is based on the Attitude of nurses towards Relapse prevention among
psychiatric patients in Federal neuropsychiatric hospital Barnawa Kaduna. The
aim and objective of this study are all directed towards bringing out lasting
solutions to curtail this menace. It also intends to actively involve the
management of the hospital especially on employing new and scientific
approach to holistic patient care. The instruments used for data collection were
from interview and Questionnaire which were represented in tabular form, bar
chart, pie chart and percentages. Nurses were used for the study .the data
collected were analyzed. The result showed that many factor contribute to the
effect of relapse.

All these can be prevented through adequate Education, Family oriented

therapies, good social support, compliance and keep the follow-up appointment.

ii
 TABLE OF CONTENT

Title page - - - - - - - - - - i

Certification- - - - - - - - - ii

Dedication - - - - - - - - - iii

Acknowledgement - - - - - - - - iv

Abstract - - - - - - - - - - v

Table of Content - - - - - - - - - vi

CHAPTER ONE
1.1 Background of Study - - - - - - - 1
1.2 Statement of Problem - - - - - - - 3
1.3 Objective of the Study - - - - - - - 5
1.4 Significance of the Study - - - - - - 5
1.5 Research Questions - - - - - - - 6
1.6 Scope of the Study - - - - - - - 6
1.7 Limitation of the Study - - - - - - 7
1.8 Operational Definition of Terms - - - - - 7
CHAPTER TWO
REVIEW OF LITERATURE
2.0 Introduction - - - - - - - - 8
2.1 Conceptual Framework - - - - - - 9
2.1.1 Background of the Study - - - - - - 9
2.1.2 Concept of Attitude - - - - - - - 11
2.1.3 Causes of Relapse - - - - - - - 13

iii
2.1.4 Phases of Psychiatric Illness - - - - - 15
2.1.5 Types of Relapse - - - - - - - 17
2.1.6 Prevention of Relapse among Psychiatric Patients - - 19
2.2 Theoretical Framework - - - - - - 27
2.2.1 Cognitive Behavioral Chain - - - - - - 27
2.2.2 Problem of Immediate Gratification (P.I.G) - - - 27
2.2.3 Abstinence Violation effect (A.V.E) - - - - 28
2.3 Conclusion - - - - - - - - - 28
CHAPTER THREE
METHODOLOGY
3.0 Introduction - - - - - - - - 29
3.1 Research Design - - - - - - - 29
3.2 Research Setting - - - - - - - 29
3.3 Target Population - - - - - - - 31
3.4 Sampling Techniques - - - - - - - 31
3.5 Instrument For Data Collection - - - - - 31
3.6 Validity and Reliability of Instrument - - - - 32
3.7 Method of Data Collection - - - - - - 32
3.8 Method of Data Analysis - - - - - - 32
3.9 Ethical Consideration - - - - - - - 32
CHAPTER FOUR
4.0 Introduction - - - - - - - - 33
4.1 Data Presentation - - - - - - - 33
4.2 Answering Research Questions - - - - - 47
4.3 Data Analysis - - - - - - - - 49
4.4 Conclusion - - - - - - - - 53

iv
CHAPTER FIVE

5.0 Introduction - - - - - - - - 54

5.1 Discussion of Findings - - - - - - 54

5.2 Relationship with other Studies/Literature Review - 56

5.3 Implication for Nursing - - - - - - 58

5.4 Summary - - - - - - - - - 58

5.5 Conclusion - - - - - - - - - 59

5.6 Recommendations - - - - - - - 60

References - - - - - - - - - - 63

Appendix - - - - - - - - - - 64

v
LIST OF TABLES

vi
 CHAPTER ONE

1.1 Background of Study

Psychiatric illness has fascinated and confounded healers, scientist and

philosopher for centuries, it symptoms have been attributed to possession

by demons considered to be punishment by the gods for the evil done or

accepted as evidence of the inhumanity of its sufferers victims. Thus

explanation resulted in enduring stigma for those whose were diagnosed

with such disorders. Even today, much of the sigma persist although it has

less to do with demonic possession than with society’s unwillingness to

shoulder the tremendous cost associated with mental illness.

Relapse is one of the most severe problem of mental health care givers. It

is common in about 1.3% of the already treated cases of mental illness or

more than two million people (U.S. Department of Health and Human

Services [USDHHS] 1999). Its economic cost is envious. Direct cost of

relapse treatment expenses of most psychiatric illness were estimated

2.5% of the total treatment of first hand mental illness care budget in 1998

(American Psychiatric Association [APA] 2000).

The last year for which these data were available (USDHHS, 1999). In

1997, this accountant for $23.6 billion of mental health care dollar spent.
 The indirect cost such as lost of wages, premature death and incarceration

were estimated to be $46 billion in the first half of 1998 (APA, 2000).

Further unemployment among permanent disability is 10% (APA 1998).

The cost relapse in terms of individuals and family suffering are probably

inestimable.

Despite the current trend in modern treatment, there is still an alarming

rate of relapse and the reoccurrence of psychiatric illness globally.

Individual who ought to be productive and responsible in life are wasting

away on daily basis.

Today patients are required to stay for a short period of time in the

hospital admission and discharge to home environment to help reduce

dependency on the hospital care and reducing relapse. Also this helps to

reduce stigmatization and prevent complications (Feyinsayo, A. 2009).

This study will attempt an overview of Nurse and also to show how

proper utilization of psychiatric Nursing service will go a long way in

reducing and eradicating the ever growing cases of relapse among

psychiatric patients in Federal Neuropsychiatric Hospital Barnawa,

Kaduna.

1.2 Statement of Problem

The frequency of patients having readmission into the hospital over the

last few years has become a problem. This has made the achievement of

good control of patients’ symptoms and cure impossible.

Nursing Staff and the Hospital has suffered frustration seeing the

readmission of patients, whom were recently discharged home after being

stabilized on admission. Some patient relapse as soon as they are

discharged home. Other on trials discharge relapse while other still

relapse while on admission. Various factors ranging from financial

problems, lack of adequate staff have contributed to the relapse of

patients.

Some patients have about a day or two days journey distance to the

hospital resulting in poor monitoring and accessibility to the mental health

services. Other factors also include stigmatization and dependency on care

giver. All these have contributed in the frequency of relapse experienced

in the care of these groups of patient leading to the social disability.

Hence, resulting in the following:

a) Low manpower

b) Untold hardship

c) Financial constraints
 d) Societal nuisance

If not properly handled and solutions found, the economy may suffer and

the society will be at a loss apart from the untold hardship. This is what

motivated the researcher to investigate the cause, give suggestions,

remedy the situation and also reduce the high rate of relapse.

1.3 Objective of the Study

1. To evaluate the relationship between the educational background of

the Nurses and their attitude towards prevention of relapse.

2. To ascertain he relationship between the status of the Nurse and her

ability to prevent relapse among psychiatric patients.

3. To determine the relationship between the experience of the Nurse

and their ability to identify symptoms of relapse.

4. To find out whether poverty can predispose psychiatric patient to

relapse.

5. To determine the relationship between drug compliance among

psychiatric patient and relapse prevention.

1.4 Significance of the Study

The significance of this study is to help Nurses develop a positive attitude

towards the care to the psychiatric patient thereby reducing the incidence

of relapse.

1.5 Research Questions

1. What is the relationship between the educational background of the

Nurse and their attitude toward relapse prevention?

2. What is the ability of the Nurse towards Relapse prevention among

psychiatric patients?

3. What is the experience of the Nurse toward identifying symptoms

of relapse?

4. Can poverty predispose psychiatric patients to relapse?

5. Can drug compliance prevent relapse among psychiatric patient?

1.6 Scope of the Study

The scope of this study is restricted to Federal Neuropsychiatric Hospital

Barnawa Kaduna which is one of the tertiary healthcare institutions

owned by the federal Government of Nigeria.

1.7 Limitation of the Study

Financial Constraint as there is no adequate Funds.

The limitations of this study were due to lack of time due to the limited

time within which the study had to be carried out.

1.8 Operational Definition of Terms

1. Attitude: The way you think and feel about something.

2. Disability: Any restriction or lack of ability to perform an activity

in the manner or within the range considered normal for a human
being.
3. Management: The process of treatment or control of disease or
disorders or the care of patient who suffer them.
4. Nurse: A person whose job is to care for people who are ill.

5. Psychiatric Nursing: This is a branch of medicine that deals with

the prevention, treatments, diagnosis, cause of mental illness.
6. Prevention: To keep away from happening or arising of stop from
occurring.
7. Psychiatric Patient: Person who suffers from mental illness which
could be minor or major.
8. Rehabilitation: Restore to effectiveness or normal life by training

especially after illness.

9. Relapse: The return of disease after an interval of convalescence.

CHAPTER TWO

REVIEW OF LITERATURE
2.0 Introduction

This chapter deals with the review of relation literature and is based on

Attitude of Nurse toward Relapse Prevention among psychiatric patients

in Federal Neuropsychiatric hospital Barnawa and in this chapter also it

covers:

1. Conceptual Framework

 Background of the Study

 Concept of Attitude

 Causes of Relapse

 Phases of Psychiatric Illness

 Types of Relapse

 Prevention of Relapse among Psychiatric Patients

2. Theoretical Framework

 Cognitive Behavioral Framework

 Problems of Immediate Gratification

 Abstinence Violation Effect

3. Conclusion

2.1 Conceptual Framework

2.1.1 Background of the Study

Psychiatric illness comprises of various disorder with some common

features. These common features include disturbances in thinking and

occupation with self and inner fantasies. The person with a psychiatric

disorder may live in a private world. A world inhabited by voices that

condemns or accuses the person vile acts and by vision of frightening.

The person may be totally withdrawn from external environment and may

be preoccupied with an internal fantasy life.

Mary Ann Boyd (2001) defined relapse as a return of the illness symptom

which are severe enough tot disrupt daily activities or require unscheduled

in patient or outpatient intervention.

Herz (1999) outlined five phases, relapse for psychosis, these are:

1. Over Extension: In this phase, patients feel estranged from self and

the environment. He/She no longer understands himself

(depersonification).

2. Boredom and Apathy: Patients become easily tired and withdrawn,

there is a bit of clouding of consciousness here.

3. Disinhibition: There is return of consciousness, patients has

paranoid idea, accuses others etc.

4. Disorganization: Patients becomes chaotic sees, hears and believes

in all manner of things.

5. Resolution: He no longer question beliefs but act on them.

According to Barbara Schoen Johnson (2000), Non-compliance with

medications, indulging in alcohol and drug abuses are commonly related

to the frequency of rehospitalizations. Clients education about the

importance of the following medication regimes and abstaining from

alcohol and other substances have been shown to lengthen the time

between hospitalization.

Denzin (1996) described four stages of relapse as it affect drug. They are:

1. The person engages in perssimissive thinking, feeling that it is

alright to quiet old haunts.

2. Engaging in substance use in a situation where one feels compelled

to use it.

3. Realizing the need for help and getting it.

Sadock and Sadock (2003) suggest that the term of chronic mental illness,

which historically has been associated with long hospitalizations that

resulted in loss of social skills and increased dependency. These

 individuals may never have experienced hospitalization but they still do

not possess adequate skill to live productive lives with the society.

In 1955, the joint commission on mental health and illness was

established by congress to identify the nations mental health needs and to

make recommendations for improvement in psychiatric care.

2.1.2 Concept of Attitude

Attitude is a positive or negative evaluation of people, objects, event,

activities, ideas or just about anything in the environment. Attitude is also

defined as psychological tendency expressed by evaluating a particular

entity with the same degree of favour or disfavor (Eagle and Chaiten,

2012). Attitude can also be said to be an expression of favour or disfavour

towards a person, place, thing or event (the attitude object). Prominent

Psychologist Gordon Allpoit (2012) further said that the distinctive and

indispensable concept in contemporary social psychology is attitude.

The concept of attitude do not adequately distinguish between attitude and

factual beliefs on the one hand or between attitude and preference on the

other hand. To hold an attitude is to ascribe an objective moral property to

the attitude objective, however, the concept of such properties rests on

incoherent theory of relations as constitutive of their term and the belief in

 them has also pseudo-cognitive content. Moralism or th1e maintaining of

attitude is a special technique for distinguishing and promoting interest.

Attitude serves as rationalizations for concealed or unconscious impulses

and the themselves defensive by further rationalization.

Attitude formation occurs through classical conditioning, operant

conditioning and modeling as it occur to Nurse who is psychologically,

socially, culturally bound to his to her community, family and the society

they live, this will invariably affect the way they care for their patients.

According to Mary Ann Boyd (2001) defined relapse as a return of the

illness symptom which are severe enough to disrupt daily activities or

required unscheduled in patient or outpatient intervention.

2.1.3 Causes of Relapse

 Patient may not be getting enough rest;

 The patient may not be taking their medications properly as

prescribed;

 The patients may be under more stress than usual;

 They may have started another drug form a different health

problem which may interfere with the existing drugs;

  In some cases availability of drug in the case of drug abuse can

predispose a patient to relapse;

 Social influence is a cause due to pressure exerted by peers who

influence or force their friends to abuse drugs so as to demonstrate

status or superiority;

 Lack of follow-up care-in most cases patient get relapsed due to

lack of follow-up care to keep to their appo0itnment for review and

constant check-up;

 Lack of support from relations/significant others: In some cases,

patient do not get enough care, concern and encouragement from

their relations/significant others and so they tend to lose confidence

in themselves and these can lead to relapse;

 Lack of drug compliance – is one of the major cause of relapse as

most patients get tired of taking their medications as at when due;

 Existing disease conditions – some infection like HIV/AIDS tend to

complicate psychiatric condition as the body immune system is

being destroyed in the process of such disease condition.

2.1.4 Phases of Psychiatric Illness

The natural progression of psychiatric illness is usually described as

deteriorating over time. There is usually external plateau in the symptoms.

Only in some cases has it has been suggested that improvement might

occur. In reality, no one knows what the course of psychiatric illness

would be if patients were able to adhere to a treatment regime throughout

their lives.

Only recently have their medications been relatively effective with

manageable side effects. At this point, it is understood that the symptoms

of psychiatric illness combine in various numbers and degree they differ

from each other and the experience for a single individual may be

different from episode to episode, the typical course of the illness appears

to have phases.

i) Phase I: Initial Diagnosis and Early Psychiatric Illness

Here, the behavior may be both confusing and frightening to the patient

and family. Often the changes are subtle. However, at some point, the

changes in thoughts and behavior become so disruptive or bizarre that

they can no longer be overlooked.

They might include episode of staying up all night for several nights.

Incoherent conservations, aggressive act against self and others, as the

symptom progress, the patient is less and less able to care for basic needs

such as eating, sleeping and bathing. Usually, the person may not be able

to function at school or a job resulting in dependency on family and

friends. Because delusions and hallucinations seem so real, the individual

is generally unable to recognize the need for treatment. Usually

Hospitalization or some type of intensive outpatient treatment must be

initiated by family and friends.

ii) Phase II (Adaptation)

After the initial diagnosis of psychiatric illness and the successful

initiation of treatment, the patient enters a period in which symptoms may

be less acute and require less drastic measures to control. This however, is

not a period of quiescence and the symptoms actually become worse

(Brere et al, 2006).

iii) Phase III (Relapse)

Relapse is a return of the illness symptom which are severe enough to

disrupt daily activities or require unscheduled inpatient or outpatient

intervention (Murphy and Moller, 2002).

Relapse is not inevitable however, it occurs with sufficient regularity to

be a major concern in the treatment of psychiatric illness.

 Reported relapse rates vary from 25% to 90% and relapse affects both

those who are being treated and those who are not. The lower relapse rate,

is for the most part, among groups who are following a treatment regimen.

2.1.5 Types of Relapse

1. Primary Relapse
This type of relapse occurs while the patient is in the hospital

receiving treatment.

2. Secondary Relapse
In this type of relapse, the patient is discharged home but gradually

relapses as a result of some stressor around the environment.

3. Tertiary Relapse

This is where a patient breaks down after being discharged home

and accepted in the community where he belongs and eventually

resumes his/her normal life and responsibilities and is settled for

some time but suddenly or gradually relapses due to some

conditions around him/her.

4. Partial Relapse

This is type relapse where the patient breaks down in measure and

not completely and is still able to manage himself or herself to a

certain extent.
 5. Total Relapse

This is when the patient totally disintegrates mentally, socially and

physically to an extent that she/she cannot cope or manage

him/herself and is completely dependent on others for total care for

activities of daily living and psychological support to meet his

needs and medical intervention.

2.1.6 Prevention of Relapse among Psychiatric Patients

i. Health Education:

It is very crucial and a part of a Nurse’s or Doctor’s responsibility

to properly health education the patients on the rules guiding

hospital care both as in and outpatients.

It is very vital for the patients to keep to appointment dates as it

enhances continuity of care and allows for assessment especially of

eminent signs of relapse. The patient is also instructed on drug

compliance taking the drugs as at when due and to report any

hypersensitivity to drugs.

Proper information is given especially about his condition, to give

the patient insight to his condition and to alert him of factors that

can precipitate a relapse.

 If patients conditions are related to self imposed stressor such as

overwork, unduly complicated social relationships, the patient

should be encouraged to change to a lifestyle less likely to lead to

further episode of illness.

An alcoholic who works in a brewery might be asked to change

occupation

ii. Also efforts should be made to detect early signs of relapse in

patients in order to issue prompt and adequate treatment, usually

done in the outpatients units and wards in general. It is also

important to have in mind that efforts should be made to discharge

the patients home as soon as he is well enough because prolonged

hospitalization precipitates relapse. Relatives should be encourage

to visit client regularly to make the patients have a sense of

belonging and not to loose touch with the family.

iii. While on admission, patients are given holistic and individualistic

care. The Nurses and other health care givers should establish a

good rapport with the patient creating a very conducive and

therapeutic environment for recovery and prevention of relapse.

The social worker is informed to keep in touch with relations of

 patients and to inform them when bills are due to be paid in the

hospitals. That will enhance the care given to patients.

There must be sufficient drugs and not only sufficient, the drugs

must be proved and useful and effective in the treatment of the

condition. Other amenities in the ward must be in place to keep the

patient occupied and minds off the problem.

Examples of such are television or other indoor games.

iv. Family Oriented Therapies

Family oriented therapies are useful and helpful in treating

psychiatric condition because most times, patients are often

discharged in an only partially remitted state in parole.

Families to which a patient returns can often benefit from a brief

but intensive course of family therapy. The therapy should focus

and the immediate solution and should include identifying and

avoiding potentially troublesome situations (stressors).

Problems from within the family must also be resolved

immediately.
 After the immediate post discharge period, the recovery period, the

recovery process, its length and its rate are important subjects to

cover in family therapy.

Above all, patients family must accept him back as a member and

learn to help him reintegrate back into the family. The family must

help the family to avoid disability and redundancy.

v. Relapse Prevention Therapy (RPT)

This therapy is mostly used for drug dependents patients. It is a

therapy that relies on cognitive and behavioural techniques in

addition to hospitalization on outpatients basis to achieve the goal

of abstinence.

The psychological intervention usually involves individuals, group

and family modalities. It also focuses on the future and on changes

in the family activities. They may help the patient stay off the drug.

This approach can be used on a one patient basis.

vi. Milieu Therapies and Rehabilitation

The general impression from experimental studies is that vigorous

aggressive outpatients after care programmes after discharge from

the hospital combined with drug treatments are effective in

maintaining patients in the community and wading off

deterioration. Rehabilitation therefore starts from admission when

the patient develop in sight.

For either case, daycares are alternative to hospital care. The

evidence for inpatient activity programme is more circumscribed

and less impressive. Their main usefulness may come from possible

prevention of institutionalization and the secondary de-socializing

and deteriorative effects of a barren environment and form better

discharge.

Employment planning and their effects on primary psychology may

be relatively small. In some chronic cases, push and intrusive

interventions have been found to aggravate symptoms. Therefore,

these programmes should be regulated and critically evaluated.

Readmission rates are as high for chronic patients who have

participated intensively in hospital experimental programmes as

they are for control patients who have been involved in less

innovative programmes. Evaluation of such programmes leaves

little doubt that they are useful in preventing relapse, suggesting

that treatment and support in the society precisely where the patient
 needs help in adjusting in the appropriate direction or the future

work with chronic patients.

vii. Respite Care

It is a treatment approach designed to decrease the rate of relapse or

exacerbation of psychiatric symptoms and to afford families relief

from their care given responsibilities.

Respite care programmes (Greise, Honcho and King, 1999),

provide mini hospitalization for a few days every 6 – 8 weeks to

reinforce patient’s growth and to intervene in the early stages of

relapse. Evidence suggests that overall time in the hospital can be

reduced with respite care.

viii. Follow up Care

This is essential for preventing relapse. The Patient and Nurse need

to be aware that recovery has began when an inpatient or outpatient

programme is complete. The few months immediately following

completion of a treatment programme are dangerous for the patient.

This is when relapse is not uncommon. The Nurse should confirm

that arrangements for care and outpatient counseling are made

before discharge. There should be good following up care by the psychiatric

 social workers to serve as a link between the relations of patient and the

hospital..

viii. Mass Education

The awareness of mental illness should be made public through

public enlightenment regular seminars, radio programmes on the

causes, prevention and on misconception about mental illness.

ix. Government Involvement

The government should active role in the care of the mentally ill.

They should subsidize the cost of drugs for the patient in order to

ensure that all patient no matter their social status should be able to

afford their drugs. The government can also through foreign aid

import drugs and distribute to various psychiatric units where they

are given free to less privileged patients. All government hospitals

must have provision for psychiatric units render psychiatric

services at the grass root level. There should also be provision of

employment opportunities for patient soon after discharge in order

to make them useful and a contributing member of the society. To

the frequency of re – hospitalizations client education about the

importance of the following medication regimes and abstaining

 from alcohol and other substances have been shown to lengthen the

time between hospitalizations.

2.2 Theoretical Framework

2.2.1 Cognitive Behavioral Chain

Pither (1990) looked at relapse process as a of the length sequences of the

thought and action. The behavioural chain generally consists of four

distinct stages.

First there is life style, personality or situational event which firms the

background to the addictive behavior.

 The individual becomes dysphonic (experience negative mood

state) as a result of The stressor and consequently enter a high risk
situation.
 The person lapses by thinking or fantasizing about the behaviour.
 The person relapses and commits the undesired actions. This theory
explained that relapse occurs in stages
2.2.2 Problem of Immediate Gratification (P.I.G)

Once the person is the high risk situation ten their anticipation of the

pleasurable and positive effect of the addictive behaviour create a

situation of cognitive dissonance with their desire to avoid the negative

 consequences. This is called problem of immediate gratification and

facilitate the chances of lapse occurring. This theory described that when

there is a problem with immediate gratification relapse can occur

(G.ALAN MARLATT 2004).

2.2.3 Abstinence Violation effect (A.V.E)

Failure to deal adaptively with the high risk situation lead to decrease self

efficacy relapse and the abstinence violation effect, essential awareness

that the person commitment to abstinence has been violated depending on

how the abstinence violation effect is manually managed, a relapse may or

may not occur. This theory explain that high risk situation leads to

decrease self efficacy relapse (Katie Witkiewitze 2004).

2.3 Conclusion

In conclusion, this chapter deals with the conceptual framework and

theoretical framework. It was reviewed that Barbara Scheon Johnson

found out that non – compliance with medications is commonly related to

the frequency of rehospitalization.

The trend in psychiatric care is studying from that of in – patient

hospitalization to a focus of out patient care. This trend is needed due to it
cost effectiveness in providing care to the masses (town send 2006).
CHAPTER THREE
 METHODOLOGY

3.0 Introduction

This chapter deals with the method the researcher use to carry out the

research study. It gives a detailed data and description of research design,

setting, target population, sampling technique, instrument for data

collection, validity of instrument, method of collecting data, data analysis

and ethical consideration.

3.1 Research Design

Description survey method of research was adopted for this study .the

prospective method of data collection was used which involved the

administration of structural questionnaire to the respondent.

3.2 Research Setting

The area of study is federal Neuropsychiatry Hospital Barnawa Kaduna

which is located in the Southern part of Kaduna state. The hospital is one

of the tertiary health care institutions owned by the federal government of

Nigeria; it stated its service in 1975 as a state hospital until 1996 when the

federal government took over its affairs.

Kaduna is located latitude 100 and 150 of the equator and between

longitude 00 and 100 of Green Which Meridian. Major river (River

 Kaduna) transverse the town. It arises from the high land in the plateau

area and flows southwards into the Niger river.

Kaduna State has 23 local government areas which include Kaduna South

local government area of which federal neuropsychiatry hospital Barnawa

Kaduna is located. It has (2) district. Federal neuropsychiatry hospital has

a total number of 369 staff, 104 health worker s, from various discipline

of which 115 are Nurses. They all work together as a team under the

leadership of the medical director who manage the affairs of the hospital

and he is being assisted by the head of the clinical service, director of

administration and assistant director of nursing service (ADNS). Patient

with mental psychological related problem are being attended to in the

hospital. The hospital provides in and out patient service of either minor

or major emergency psychiatric cases.

3.3 Target Population

The target population was drawn from the staff of the hospital whereby

nurses were used as the target population.

3.4 Sampling Techniques

Random sampling was used to determine the population in which

maximum number of nurses.

3.5 Instrument For Data Collection

The method used by the research in of three major research tools. They

are personal observation by the researcher, verbal interview and

questionnaire method. Questionnaire in this study is regarded as the most

vital tool of adequate and correct information.

A total of 25 questions in both section A and B.

3.6 Validity and Reliability of Instrument

The questionnaire were scrutinized by my supervisor to ensure there are

in line with the stated objective ad research question the test – retest

method was used to ensure the reliability of the instrument used.

3.7 Method of Data Collection

Twenty five (25) question were formulated from the research question in

form of a questionnaires in which respondent are expected to tick

appropriate.

3.8 Method of Data Analysis

 The responses from the respondent were collected according and analyzed

using percentage, table and bar chart.

3.9 Ethical Consideration

Confidentiality was strictly maintained regarding all information and

participation was voluntary. It was carefully chosen to be able to extract

useful information from respondent.

 CHAPTER FOUR

4.0 Introduction

These chapters deal with the presentation of data and the analysis of data

collection from the questionnaire to 100 respondents and were analyzed

separately using simple percentage table and bar charts.

4.1 Data Presentation

Section A: (Personal Data)
Table I: Respondents by Sex
Sex Respondent Percentage
Male 40 40%
Female 60 60%
Total 100 100%

The data in table 1 shows that 40 respondents are Male while 60

respondents are Female. This shows that most of the respondents were

Female.

Table II: Respondent by Age

Age Respondent Percentage
20 – 30 20 20%
31 – 40 30 30%
41 – 50 40 40%
51 – above 10 10%
Total 100 100%
The data in Table II shows that 20% of the respondents were 20 – 30

years, 30% are within the ages of 31 – 40 years of age, 40 are within the

ages of 41 – 50 years while 10% were within the ages of 51 years and
above. It shows that most of the respondents were between the age of 41 –

50 years.

Table III: Respondents by Marital Status

Marital Status Respondent Percentage
Single 15 15%
Married 77 77%
Divorced 5 5%
Widow/Widower 3 3%
Total 100 100%

Table III indicate that 15% of the respondents are single, 77% are married

and 5% are divorced while 3% are widows and widowers.

Table IV: Respondents by Religion

Religion Respondents Percentage
Christians 70 70%
Muslims 30 30%
Others 0 0%
Total 100 100%
This table shows that 70% of the respondent were Christian and 30% were

Muslims with no respondent in any other form of religion. Majority were

Christians.

Table V: Respondent by Professional Rank

Professional Rank Respondent Percentage

PNS 20 20%
CNS 10 10%
SNS 15 15%
NS 55 55%
 Total 100 100%

Table V indicates that respondent form Principal Nursing Sister (PNS)

were 20%, Chief Nursing Sister (CNS) were 10%, Senior Nursing Sister

were 15%, 55% were Nursing Sisters most of the respondents were

Nursing Sister (NS).

Section B (Knowledge Inventory)

1. Educational background of the Nurse can affect their attitude

towards relapse prevention?

100
90
80
Key
70
60 Agree 80%
50
40 Disagree 20%
20
10

A B

The chart indicates that 80% respondent agreed that educational

background of the nurse can affect their attitude towards relapse

prevention while 20% disagree.

2. The Nurse attitudes have a significant role in the prevention of
elapse.

100

90 Key
Agree 80%
80
Disagree 20%
70

60

50

40

20

10

A B
3. Psycho education prevent relapse among psychiatric patient.

100

90 Key
Agree 100%
80
Disagree 0%
70

60

50

40

20
4. The status of Nurse helps in the prevention of relapse among
psychiatric
10 patient.
0 A
B
 100

90
Key
80 Agree 40%

70 Disagree 60%

60

50
100
90
8040
Key
70
6020 Agree 40%
50
4010 Disagree 60%
20
10
A B
5. The Nurse has the ability to identify a relapse patient?

100

90 Key
Agree 100%
80
Disagree 0%
70
A B
60

50

40

20

10
6. How often does patient come for follow-up?
0
A B
 2 Months
10%

4 Weeks
10%

Not regularly
80%

The chart indicates that 80% of the respondents indicate Not

regularly, 10% says 4 weeks while the others indicates 10% for 2

months.

This shows that 80% of the respondent chose C.

7. You think relapse among psychiatric patients can be prevented?

100

90 Key
Agree 100%
80
Disagree 0%
70

60

50

40

20

10

0
A B
8. Poverty predispose psychiatric patient to relapse.
100

90
Key
80 Agree 90%
70
Disagree 10%
60

50

40

20

10

A B
9.
10. Poverty affect patient care in the hospital
 100

90 Key
Agree 100%
80
Disagree 0%
70

60

50

40

20

10

0 A B

11. Financial constraints of family affect patient transportation to the

hospital?
100

90 Key
Agree 92%
80
100 Disagree 8%
70
90
60
80
50
70
40
60
20
50
12. Do10you think rehabilitation can reduce the incidence of relapse?
40
0
A B
20
Key
10

0
 Agree 100%

Disagree 0%

A B

13. How effective are the drugs used in psychiatric condition?

Effective
10%

100 Very Effective

90%
90

80

70

60
This piece chart indicate that 90% of the respondent chose B (very
effective) while 10% choose A. This shows that most respondents
50
chose B.
40
14. Do patient still break down while on routine medication?
20

10

0
 Key
Agree 80%

Disagree 20%

A B

15. Patient non tolerance to the drug affect their effectiveness?

100 Agree Key 97%

90 Disagree 3%

80

70

60

50

40

20
16. Adherence to drug regimen prevent relapse
10
A B
Response
0 Respondent Percentage
Agree 100 100%
Disagree 0 0%
Total 100 100%
17. Patient are well educated on the importance of keeping
appointment

Response Respondent Percentage

Agree 70 70%
Disagree 30 30%
Total 100 100%

The table shows that 70% of the respondents agreed that patients

are well educated on the importance of keeping to appointment

while 30% disagreed.

18. The hospital has formulated policies on the prevention of relapse

among psychiatric patients

Response Respondent Percentage

Agree 0 0%
Disagree 100 100%
Total 100 100%
The table shows that 100% of the respondents agreed that hospital

has not formulated policies on prevention of relapse among

psychiatric patient.

19. How can relapse prevention be effective in Federal

Neuropsychiatric hospital Barnawa Kaduna?

Response Respondent Percentage

Referral to cases from 10 10%
community to the hospital
 By employing the right 80 80%
professional
By provision of enough 10 10%
facilities
All of the above - -
Total 100 100%

The table shows that 80% of the respondents choose B while 10%

of the respondents chose A and also 10% of respondent choose C.

20. Misconception contribute to the relapse of psychiatric patient?

Response Respondent Percentage

Agree 98 98%
Disagree 2 2%
Total 100 100%

The table shows that 98% of the respondents agreed that

misconception can contribute to relapse while 2% disagreed.

21. The government subsidize drugs given to psychiatric patients?

Response Respondent Percentage

Agree 0 0%
Disagree 100 100%
Total 100 100%
 The table shows that 100% of the respondent B Disagree that

government does not subsidize drugs given to psychiatric patients.

4.2 Answering Research Questions

1. Research question one which seek to find the relationship between

the educational background of the nurse are altitude toward relapse

prevention was answered by figure 1,2,3 respectively . figure 1

show that 80%of respondents agreed that educational background

of the nurse can affect their attitude toward relapse prevention,

figure 2 also shows that 90% of the respondents below that the

Nurse altitude have a significant role in the prevention of relapse,

figure 3 show 100% of the respondent agree that psycho education

prevent relapse among psychotic patient

2. Research question two which seeks to know the ability of the Nurse

toward relapse prevention among psychiatric patient was answered

by figure 5 shows that 60% of the respondent agreed that the nurse

towards relapse prevention among psychiatric patient

3. Research question three seek to know the experience of the nurse

towards identify symptoms of relapse was answered by figure 7. it

 shows that 100% of the respondent agreed that the experience of

the nurse towards identifying symptoms of relapse

4. Research question four, which seek to know if poverty can

predispose psychiatric patience to relapse. Figure8,9 respectively.

Figure 8 shows tat 90% of respondent believed that poverty can

predispose psychiatric patient to relapse. Figure 9 also shows that

100% of the respondent agreed that poverty can affect patient care

in the hospital.

5. Research Question five which seek to know if drug compliance

prevent relapse among psychiatric patient was answered by figure

12,13,14,15. figure 12 show that 90% of the respondent agreed that

drugs used in psychiatric condition are effective. Figure 13 shows

that 80% of respondents disagreed that patient don’t break down

while on routine medication. Figure 14 shows that 97% of

respondent agreed that non tolerance of drugs effect the drug

effectiveness. Figure 15 shows that 100% of the respondent shows

that adherence to drug regimen prevent relapse.

4.3 Data Analysis

Section B (Knowledge Inventory)
Figure I
This figure indicate that 80% of the respondent said that educational

background of the nurse can affect their attitude toward relapse while 20% of

the respondent said it does not. Because of the type of special training given to

the psychiatric nurses than other nurses.

Figure II

This show that 95% of the respondent said that nurse attitude have a significant

role in the prevention of relapse while 5% respondent said does not. This shows

that the Nurse has a positive attitude toward the care of the patient.

Figure III

100% of the respondent agreed that the nurse has the ability to identify a

relapsed patient because of the nature of their training.

Figure IV

This shows that 60% of the respondents believe that the status of the Nurse help

in relapse prevention. Because of the nature of their training and experience.

Figure V

100% of the respondent agreed that the Nurse has the ability to identify a

relapsed patient because of the nature of their training.

Figure VI

This shows that 80% of the respondent indicate patient does not regularly come

for follow – up 10% respondent indicate patient come 4 weeks while the other
10% agreed 2 month. Base on this finding, patient do not come for follow up

regularly which is a major factor that leads to relapse.

Figure VII

100% of the respondents agreed that relapse can be prevented among

psychiatric patient? Due to drug compliance, constant follow-up and adherence

to medical advice.

Figure VIII

This shows that 90% of the respondents agreed that poverty can predispose

psychiatric patient to relapse since they don’t have the money to maintain the

treatment.

Figure IX
100% of the respondents agreed that poverty affect patient care in the hospital

since they don’t have the money to maintain treatment.

Figure X

92% of respondent agreed financial constraint of family affects patient

transportation the hospital while 2% disagreed.

Figure XI

It shows that 100% of the respondent below rehabilitation can reduce the

incidence of relapse.

Figure XII
100% of the respondent indicates that the drugs used in psychiatric

condition are very effective.

Figure XIII

It shows that 80% of the respondent disagreed that patient breakdown

while on routine medication while 20% indicates that patient do. This

prove that patient in the treatment were not likely to breakdown.

Figure XIV

97% of the respondents agree that non tolerance to the drug affect their

effectiveness while 3% of the respondent disagree

Figure XV

100% of the respondent agreed that adherence to drug regimen prevent

relapse.

Figure XVI

The table shows that 70% of the respondent agreed that patient are well

education on the importance of keeping to appointment while 30%

disagreed.

Figure XVII
 The table shows that 100% of the respondent agreed that hospital has not

formulated police on prevention of relapse among psychiatric patient

Figure XVIII

The table shows that 80% of the respondent agreed that relapse prevention

be effective in federal neuropsychiatic educates referral of case from

community to the hospital while the other 10% of the respondents

indicates by provision of enough facilities.

Figure XIX

98% of the respondent agree the misconception can contribute to the

relapse of psychiatric patient while 2% disagrees.

Figure XX

100% of the respondent disagrees the government does not subsidize

drugs given to psychiatric patients.

4.4 Conclusion

The data shows that altitude of the nurses toward relapse prevention

among psychiatric patient is effective. Data was gathered through the use

of questionnaire and were presented in tabular form percentages and in

Bar chart. The research question was answered accordingly.

 CHAPTER FIVE

5.0 Introduction

This chapter summarizes the discussion of finding, show the relationship

of the research to other studies and the implication to Nursing. It also

summarize the whole chapter showing the conclusion and

recommendations. The study is based on the study conducted in Federal

Neuropsychiatry Hospital Barnawa, Kaduna.

5.1 Discussion of Findings

The research carried out showed that Attitude of Nures towards relapse

prevention among psychiatric patients in Federal Neuropsychiatry

Hospital Barnawa Kaduna can play a greater role in reducing the cases of

relapse among psychiatric patient. The finding revealed that there is high

rate of relapse among psychiatric patient which is common cause of

concern to patients, their relations and the general public as a whole. This

fact has proven by this research work.

The finding also revealed that relapse affect both the receiving treatment

in the hospital and patients after discharge, it was also observed that the

majority of the respondent consented that relapse rate should be reduced.

Section A which carries the personal data of the respondent shows that
female respondents were the majority which shows the dominance of

female respondents in Federal Neuropsychiatry hospital Kaduna. This is

shown in Table 1,Table 2 shows that majority of the respondent. Age

range from 41-50years of age which shows that this age group is fill of

experience in life and were useful in the compilation of the data. Section

B respondent in chart 1 agreed that the educational background of the

nurse can affect their attitude towards relapse prevention. Chart 2 also

indicate that 80% of the Nurses attitude have significant role to play in

relapse prevention.

Chart 3,4,5 shows how psycho education ,status of the Nurse and her

ability can prevent relapse among psychiatric patient. chart 6 and 7 shows

that majority of the respondent agreed that relapse among psychiatric

patient can be prevented. Chart 8,9,10 agreed that poverty predisposes and

affect the care of patient since they don’t have money for to maintain the

care. Chart 11 shows that majority of the respondent agreed that

rehabilitation can reduce the rate of relapse.

Chart 12,13,14,15, also agreed that drugs used in psychiatric are effective

and patient don’t breakdown while on routine medication. Table 16,17

agreed that patient are well educated on the importance of keeping

appointment while Table 17-20 shows that majority of the respondent

 agreed that the hospital has not formulated policies on prevention of

relapse among psychiatric patient, Relapse prevention can be effective in

the hospital. Misconception contributes to the relapse of psychiatric

patient and also the Government does not subsidize drugs given to

psychiatric patients.

5.2 Relationship with other Studies/Literature Review

This study incorporates with 0ther studies such as related illness

symptoms can be severe enough to disrupt daily activities or require

unscheduled in patient or outpatient intervention (Murphy and Moller

2002).

Non-compliance with medication, lack of proper follow-up and keeping

appointments also are the major factors that contributes to relapse among

psychiatric patients.(Barbara Scheon Johnson 2000).Also this study has

investigated and found out that if the general public bring relapsed

psychiatric patients promptly to the hospital and the patients attended to

promptly that relapse rate will be greatly reduced (Denzin 1996).

Feyinsayo A.(2009), today patients are required to stay for short period

possible of time in the hospital admission and discharge to home

environment to help reduce dependency on the hospital care thereby

 reducing relapse. Also this helps to reduce stigmatization and prevents

complication. Nursing care at the tertiary level of prevention can be

administered on individual or group basis and in a variety of setting such

as inpatient hospitalization.

5.3 Implication for Nursing

The nurse should advise patient on the importance of compliance and

follow-up for continuity of care. The relatives should be encouraged to

show love to the patients and they should be told the importance of

incorporating the patients back into the family and community.

The patients should be advised to keep self occupied and stay away from

the company that may influence them negatively especially if the relapse

was as a result of drug abuse. Family therapy should be advised in order

to prevent relapse because when the family is involve in the care of the

patient, it reduce the rate to zero level.

The nurse should encourage rehabilitation from admission to discharge.

This enables the patient to be engaged and productive in life and also help

in the prevention of relapse.

5.4 Summary

The research study was carried out in response to the increasing relapse

cases of psychiatric disorders in our society and also the attitude of

nurses towards preventing relapse among psychiatric patient. Chapter one

deals with introduction of the topic, objective of the study significance of

the study, statement of the problem research question, scope, limitation

and operational terms were used in this research. Chapter two and three

looks at the view of others in relation to the topic of the research while

chapter three dealt with the methodology of the research .chapter three

and four also dealt with research design and method used. The population

which is 100 samples and its also involved the analysis the data acquired

in respect to the research questions.

5.5 Conclusion

In the course of the study, it was discovered that there are five(5) types of

relapse namely primary, secondary, tertiary, partial and total relapse all of

which have devastating effect on patients. It was shown in the study that

the families and the hospital should be fully involved in the care of the

patient in order to prevent relapse. It was also discovered that with

frequent relapse rate the might be thrown out of jobs, be divorced.

 Attitude of nurses towards relapse prevention plays a vital role in

preventing relapse to occur. "prevention they say is better than cure "in

line with this statement relapse like any other condition is preventable.

Alongside drug therapy, avoidance of stressful situations and good family

support systems are good preventive measures. Drug compliance also

tremendously assists in the stability of the patient mental state. To this

extent, the patient is health educated on the need to comply with drugs.

With proper management and care, the possible complication that may

result from frequent relapse, can be reduce as much as possible.

5.6 Recommendations

1. Nurse and other healthcare giver should enlighten the public on the

causes and preventive methods of mental illness. This will help

them know what to do and when to act when they come into contact

with relapsed patient/patients with mental illness.

2. The nurse should at every level of contact with patients relative

should health educate them on the importance of active

participation in the care of psychiatric patients taught the need of

visiting psychiatric hospitals.

3. Long hospitalization of patients should also be avoided in order not

 to make patient lose contact with home environment, community,

friends and colleagues as this also trigger relapse.

4. The government should formulate a policy to subsidize for drugs

given to psychiatric patient as the prices of the drugs are on the

increase and some of the patient are unable to buy them.

5. The national mental health act should receive reviewed and proper

implementation by the government agencies involved.

6. Nurses should be send for training so as to be up to date and

empowerment of more man power should be made.

7. The occupational therapy departments should be well equipped

with modernized equipments necessary for the rehabilitation of

patients where some of them can learn new trades to practice when

discharged from the hospital.

Recommendation for Further Studies

The research urges the general public particularly the health sector to

embark on more study in order to reduce the rate of relapse among

psychiatric patients.
 REFERENCES

Ademola, A. (2002). Basic Psychiatric Nursing, 2nd Edition. Nigeria: Manisha

Printing Press, Ibadan.

Boyd, M.N. (2001).Psychiatric Nursing: Contemporary Practice. 2nd edition,

Lippincott.

Burgess, A.W. (1997). Psychiatric Nursing Promoting Mental Illness, 3rd

Edition. USA: Cappleton and Large Standford, Connecticut.

Kaplan & Saddock (2005). Synopsis of Psychiatric Behavioral Science,

Chemical Psychiatry. 9th edition, USA: Lippincott William and Wilkin,

New York.

Townsend, M.C. (2006). Psychiatric Mental Nursing, 5th edition. Philadelphia:

F.A. Davis Company.

www.currentnursing.com

www.google/theoriesofattitude.com
 QUESTIONNAIRE

Dear Sir/Madam,

Am a final year student of School of Post Basic Nursing of Federal

Neuropsychiatric Hospital Barnawa Kaduna, carrying out a research on Attitude

of Nurses towards Relapse among Psychiatric Patients in Psychiatric Hospital

Barnawa, Kaduna.

I would like to ask you some few questions please. Feel free to answer the

questions as your response will be highly confidential.

Instruction

No name is needed please.

Tick the box you think is appropriate and fill in the blank space.

Section A: Personal Data

1. Sex:
(a) Male (b) Female
2. Age:
(a) 20 – 30 (b) 31 – 40 (c) 41 – 50 (d) 51 and above
3. Marital Status:
(a) Single(b) Married (c) Divorced (d) Widow/Widower

4. Religion:
 (a) Christian (b) Muslim (c) Others
5. Professional Rank:
(a) CNS (b) PNS (c) SNS (d) NS

SECTION B (KNOWLEDGE/INVENTORY

1. Educational background of the Nurse can affect their attitude towards

relapse prevention
(a) Agree (b) Disagree
2. The Nurse attitude have a significant role in the prevention of Relapse
(a) Agree (b) Disagree
3. Psychoeducation prevent relapse among psychiatric patients
(a) Agree (b) Disagree
4. The status of the Nurse help in the prevention of relapse among
psychiatric patient
(a) Agree (b) Disagree
5. The Nurse has the ability to identify a relapse patient
(a) Agree (b) Disagree
6. How often does patient come for follow up?
(a) 4 Weeks (b) 2 Months (c) Not regularly (d) Do not attend clinic
7. You think Relapse can be prevented?
(a) Agree (b) Disagree

8. Poverty predispose psychiatric patient to relapse?

(a) Agree (b) Disagree
9. Poverty affect patient care in the hospital
(a) Agree (b) Disagree
10. Financial constraint of family affect patient transportation to the hospital
(a) Agree (b) Disagree
11. Rehabilitation can reduce the incidence
(a) Agree (b) Disagree
12. How effective are the drugs use in psychiatric conditions?
(a) Effective (b) Very effective ( c) Moderately Effective
(d) Not effective
13. Patient will break down while on routine medication
(a) Agree (b) Disagree
14. Patient non tolerance to the drug affect their effectiveness
(a) Agree (b) Disagree
15. Adherence to drug regimen prevent relapse
(a) Agree (b) Disagree
16. Patients are well educated on the importance of keeping appointment?
(a) Agree (b) Disagree
17. The hospital has formulated policies on the prevention of relapse among
psychiatric patients
(a) Agree (b) Disagree

18. How can relapse prevent be effective in Federal Neuropsychiatric

Hospital Barnawa Kaduna?
(a) Referral of cases from community to hospital
(b) By employing the right professional
(c) By provision of enough facilities
(d) All of the above
19. Misconception contribute to the Relapse of psychiatric patient
(a) Agree (b) Disagree
20. The government subsidize drugs given to psychiatric patients
(a) Agree (b) Disagree