الفهرس 
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Abstract
experience problems in their daily-living performance.Positive and negative symptoms have been part of characteristics of schizophrenia that are absent in normal individuals, which include a distinctive fundamental distortion of thoughts and perception (positive symptoms) and loss of normal function and behavior (negative symptoms) (Charlson et al., 2019).
Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide characterized by distortions in thinking, perception, emotions, language, sense of self and behavior.Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (fixed, false, beliefs) and associated with considerable disability and may affect educational and occupational performance (Vos et al ., 2020).
Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder.The term negative symptoms describe a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal , emotional expression.The negative symptom include: blunted affect, a logia (reduction in quantity of words spoken), a volition (reduced goal-directed activity due to decreased motivation), a sociality and anhedonia (reduced experience of pleasure) and positive symptoms reflect an excess or distortion of normal function (e.g.delusions, hallucinations and disorganized behavior) (Galderisi et al., 2018).
Activities of daily living are the basic skills for schizophrenic patients that are needed to live independently and that support meaningful, productive roles.The negative symptoms and cognitive dysfunction seen in schizophrenia may lead to deterioration in the life skills of the patient. The assessment of current life skills of the patient and subsequent intervention becomes necessary for comprehensive rehabilitation;self-care is a common unmet need for people with psychiatric disorders as the psychiatric care mostly involves addressing the acute symptoms with little emphasis on rehabilitation (Samuel et al., 2018).
The aim of the study
This study aimed to evaluate the effect of psycho-educational program on activity of daily living among schizophrenic patients.
Research hypothesis:-
Psycho- educational program will have a positive effect on activity of daily living among schizophrenic patients.
Research Design:-
A quasi-experimental design (pre and post-test) was used to achieve the aim of the study.
Research Setting:-
The study was conducted at the Mental Health and Addiction Hospital at Benha city. The hospital is affiliated to the General Secretariat of Mental Health.The hospital consists of two parts:the first part is composed of six outpatient clinics,including two psychiatric clinics, addiction clinic, children’s clinic, epilepsy clinic and geriatric clinic.The second part is composed of six inpatient departments, including, addiction treatment unit with twenty beds and eighteen nursing staff members to attend for and five psychiatric departments with a capacity of two hundred beds.The psychiatric departments are divided into four male departments and one female department.
Sample size:
Convenience sample 40 of chronic hospitalized schizophrenic patients in psychiatric and mental health hospitals at Benha
The sample will be selected according to following criteria:
• Hospitalized chronic schizophrenic patients.
• Both sex males and females.
• Oriented and able to cooperate.
Tools of data collection:
The tools used for the study consist of:
Tool one: A semi structured interview sheet that, which include two parts;-
Part one: Socio-demographic sheet including personal data of the patients as name, age, sex, marital status, level of education, occupation before hospitalization and income
Part two:Clinical data including onset of disease, number of hospital admissions, symptoms that led to hospitalization, type of treatment and the presence of chronic diseases
Tool two, Observational checklist which include two parts:-
Part one:Observational checklist to assess signs and symptoms of schizophrenic hospitalized patients which include, facial expression,eye contact,body posture and movement.
Part two:Observational checklist to assess the schizophrenic patients activities of daily living ,developed by the researcher which include, personal hygiene ,manner of eating and mobility(58) items grouped into eight dispositional characteristics [General appearance(7 items),personal hygiene: showering (3 items), level of dependency during showering (3 items), Grooming (4 items), Toileting (4 items), Manner of eating (7items),Sleeping duration and pattern: Sleeping houres (3 items) Sleeping nature (6items), Cooperation with other (4 items), Interaction with other patient (4 items), Time leisure (2 items), while watching TV(5 items) and Hobbies(6 items)].
The main finding of the present study reached to the following conclusion:
More than one third of the schizophrenic patients aged between 40 to less than 50 years old
Three quarters were males
More than half were married
Less than two thirds were working before hospitalization and more than half of them had insufficient income.
Half of the schizophrenic patients’ caregiver were their wives
Three quarters of schizophrenic patients get the disease since more than two years.
Less than half hospitalized three times or more.
One fourth of them get the treatment in a form of drugs.
More than one third suffering from hypertension
Less than half of the schizophrenic patients were apathy
Three quarters had distracted eye contact
More than one third of them had unusual posture.
Less than half of the schizophrenic patients had inappropriate movement
More than one third of them had pressure of speech
More than half of them were partially oriented.
One fourth the schizophrenic patients had illogical thinking
Slightly more than one third had illusion
Less than half of the schizophrenic patients had inappropriate mood
more than one third of them had an attempt to harm self and others
Half unclean and unsuitable clothes pre the psycho-educational program implementation which decreased to slightly more than one fourth post the psycho-educational program implementation
There were statistically significant differences found in all items related the schizophrenic patients’ general appearance pre and post the psycho-educational program implementation.
Statistically relations:
Relation between schizophrenic patients’ total activities of daily living score and their socio-demographic characteristics pre and post the psycho-educational program implementation .The result found that, there are highly statistically significant differences between the schizophrenic patients’ total activities of daily living score and their socio-demographic characteristics pre and post the psycho-educational program implementation at(P<0.01).
Relation between schizophrenic patients’ total activities of daily living score and their clinical data pre and post the psycho-educational program implementation. The result found that, there were highly statistically significant differences found between the schizophrenic patients’ total activities of daily living score and their clinical data pre and post the psycho-educational program implementation at (P<0.01).
Correlation between schizophrenic patients’ total activities of daily living score and their socio-demographic characteristics pre and post the psycho-educational program implementation. The result found that, there were highly statistically significant positive correlation differences found between the schizophrenic patients’ total activities of daily living score and there socio-demographic characteristics pre and post the psycho-educational program implementation.
Correlation between schizophrenic patients’ total activities of daily living score and their clinical data pre and post the psycho-educational program implementation.The result found that, there were highly statistically significant positive correlations found between the schizophrenic patients’ total activities of daily living score and their clinical data between pre and post the psycho-educational program implementation at (P <0.01).
Based on the result of the present study one conclude that:
Psycho-educational program had a positive effect on activity of daily living among schizophrenic patients.There was a highly statistically significant differences related to total activities of daily living score of schizophrenic patients between pre and post of psycho-educational program implementation.
As a result of this study,the following recommendations were formulated:
Recommendations for education:
-Conducting training program to encourage nursing managers to support nurses to implement group activities among psychiatric patients and provide them with the necessary resources.
-Training program for nurses to help and accomplish the expected patient care outcome.
Recommendations for community:
-Training the patients to use activities of daily living to deal with psychiatric illness to live in a normal way in society.
-Programs should be designed by psychiatric hospital through health care provider for increasing awareness of patients about their illness and medication adherence to decrease the relapse rate and frequent hospitalization.
Recommendations for research:
-Raise nursing staff awareness about the importance of activities of daily living for schizophrenic patients,through mass media, posters, psychiatric patient videos and illustrated booklets.