2.2 Methods
Patients in the CG were routinely managed, including enhanced safety management, life guides, health education, and sleep pattern management depending on the patients’ needs.
Based on the interventions for the CG, patients in the OG were provided with the following comprehensive psychological and behavioral interventions:
a) Social skills training
As patients with schizophrenia were stabilized after the drug treatment, nurses communicated with them to establish a nursing plan and rest system. Patients were required to dress neatly, keep themselves clean, actively and regularly carry out daily life training, such as bathing, changing of clothes, dining, making bed, washing, and rising with initiatives. They were also encouraged to participate in collective activities, by introducing themselves to others to promote self-worth and happiness. Patients were guided to greet others, go shopping and borrow things actively, participate in various entertainment activities based on their interests, such as singing, basketball, badmintons, and rope jumping, etc., or arranged to the working and entertainment room for activities such as watching TV, listening to music, playing card, dancing, practicing calligraphy, painting, and handicraft according to their interests and educational background. These activities were arranged 5 times a week, for 45–60 min each session. Based on their scores and performances, patients were rewarded spiritually or materially.
b) Enhanced health education
During the family visit at least once a week, family members were engaged in health education concerning the knowledge related to schizophrenia, so that they would understand the onset causes, course, results, family nursing methods, and social recovery methods of schizophrenia. Two health education and publicity activities were arranged every month in the forms of lectures or collective courses to correct patients’ misunderstanding on the disease so that they can return to the society earlier and faster.
c) Cognitive psychotherapy
Based on cognitive theories, patients’ irrational thinking was replaced by rational thinking, and interpersonal relationship was adjusted to increase their administration adherence and treatment confidence. As their acute symptoms were effectively controlled, primary psychiatry nurses provided enhanced psychological intervention by performing a collective psychological service once a week. Majority of patients with schizophrenia may have emotional problems, interpersonal relation frustrations, study and work problems, and conflicts. Therefore, nurses guided them to properly use the psychological defense mechanism and encouraged them to release their unhealthy emotions inside, speak out their ideas, face the facts positively, and obtain more robust defense capacity against mentation.
d) Reinforced individual psychological service
Nursing management and intervention were consolidated depending on the psychological problems of each patient. Through support, encouragement, leadership, interpretation, and cognitive behavior therapy, patients were guided to correctly understand the disease and rationally adjust their emotions. Their unreasonable faith inside was dug and replaced by rational faiths in order to improve unhealthy emotions and behaviors.
Both groups were managed and followed up for 6 months.
Observation indexes
i. Observation indices
(1) Positive and Negative Syndrome Scale (PANSS) was used to evaluate the severity of mental symptoms in both groups at pre- and post-intervention, which consisted of 16 items covering three aspects: psychopathological, positive, and negative symptoms. Each item is graded from 1 to 7, and the score is positively associated with the severity of mental symptoms. The Scale’s Cronbach’s α is 0.888 (Ghaderi et al. 2019).
(2) Social Disability Screening Schedule (SDSS) was used to evaluate SF at pre- and post-intervention. The scale consists of 10 items, graded as 0–2 each. The results are negatively associated with SF, and the scale’s Cronbach’s α is 0.715(Fowler et al. 2019).
(3) Satisfaction with Life Scale (SWLS) was used to evaluate the QOL of the two groups at pre- and post-intervention, which consisted of 12 items graded from 1 to 3, and the score is positively associated with the QOL. The Scale’s Cronbach’s α is 0.789(Hinz et al. 2018).
(4) Global Assessment Scale (GAS) was used to evaluate the general conditions of both group sat pre- and post-intervention. Its total score is 100, and the Cronbach’s α is 0.769(Ferreira et al. 2017). A higher score indicates better patient conditions.
(5) Brief Psychiatric Rating Scale (BPRS), consisting of 18 items graded between 1 and 7, was used to evaluate the psychiatric severity of the two groups at pre and post-intervention. Its total score ranges between 18 and 126, and the Cronbach’s α is 0.922 (Cao et al. 1785). Results are negatively associated with these verity of the disease.
(6) Recurrence: Both groups were followed up for 1 year and compared and analyzed for disease recurrence.
ii. Statistical method
Statistical analysis was performed using SPSS22.0. Numerical data are expressed as mean ± standard deviation, and comparison studies were carried out through independent sample t-test for normally distributed data and Mann–Whitney U-test non-normally distributed data. Paired test was used for pre-and-pro comparison in the two groups. Nominal data are expressed as (n[%]), and comparison studies were carried out through X2 test for intergroup comparison. For all statistical comparisons, significance was defined as P < 0.055.