The Application of Recreational and Leisure Activities on Schizophrenic Patients' Self Care

Masoud Fallahi, PhD.; Asghar Dadkhah, PhD. University of social welfare and Rehabilitation, Tehran

ABSTRACT Alzheimer's disease and other dementias are illnesses that affect the body physically, mentally, and emotionally. According to the Alzheimer's disease Education and Referral Center (2004), Alzheimer's disease is the most common form of dementia. As a result of these diseases, one's ability to perform everyday activities becomes greatly hindered. However, by incorporating specific recreational activities into this population's daily curriculum, the possibilities of them living more accomplished lives at this stage can increase. Recreational activities can counter-affect the symptoms of Alzheimer's disease and render positive effects to those suffering from these diseases. In a pre/post test study we recruited all chronic schizophrenic patients who could leave the psychiatric section; then the patient's psychiatrist and family filled consent forms for those participating in group recreational activities. Finally, 45 patients were assigned to the study and included a pilgrimage-recreational trip to Mashhad (East of Iran) for 10 days. Participants were obliged to take responsibility of their self-care and participate in collaborative activities as well as having a role in planning the trip and activities. Results show that group recreational activities as a rehabilitation intervention in psychiatric participants could impact on self- care skills. Keywords: Recreational; Leisure Activities; Schizophrenic patient; Iran.

INTRODUCTION

Historically human beings have sought treatment of physical and mental illnesses. Owing to this, treating physical illnesses has been successful, but in the field of mental illnesses, because of their complexity in nature and contribution of bio-psychosocial factors on one hand and negative biases and beliefs in society on the other hand, therapeutic and rehabilitation interventions and their efficacy in this group are faced with some difficulties⁽¹⁾. In mental disorders, particularly schizophrenia results in hospitalization. It is estimated that the prevalence of schizophrenia ranges from 1-1.5. Two thirds of schizophrenics need hospitalization, but in spite of need of treatment only half of them undergo treatment⁽²⁾. Individuals with mental disorders face relapses frequently. Some conditions are untreatable and result in chronic mental illnesses. In the US it is estimated that the rate of individuals with severe and progressive mental illnesses ranged from 1.7 - 2.4 millions with 350-800 hundred thousands with severe forms. In Iran the prevalence of individuals with psychosis, particularly, is similar to other countries and is about one percent in the general population. With regard to Iran general population of about sixty millions, it is speculated that about 600,000 persons need therapeutic and rehabilitation services and even hospitalization⁽⁴⁾. Also several studies have been conducted in the field of treatment and caring for mental disorders in other countries and some interventions have been implemented on schizophrenic patients. But results indicate that there is no significant difference between these interventions. Schizophrenia is a mental disorder which requires rehabilitation. Rehabilitation is very time consuming, because of the variety of symptoms and diagnostic difficulties, and faces a person with complexity. In short, their treatment of choice is divided into two options: organic (pharmacotherapy, electroconvulsive therapy etc) and non organic (individual and group psychotherapy and family therapy). Individuals with schizophrenia suffer from some disabilities in personal, social, educational and vocational dimensions, which require rehabilitation. There are several types of rehabilitation activities and each of them in turn, obviate some disabilities in clients.
While activities that are not therapeutic will not help the patient reach their full potential of reestablishing their lives⁽⁷⁾, they give some guidelines for making each activity purposeful and effective. Activities should no longer be viewed as a way to keep the patients busy but should provide a way to establish meaning in their daily lives. Each activity should accomplish a variety of outcomes and enable the patient to contribute, play, learn, feel safe, and be with others. One of the group interventions in rehabilitation psychiatric nursing of schizophrenic patients is recreational activity interventions. In this type of intervention the therapist tries to include patients in recreational activities and hobbies that promote activities of daily living and self-care skills. Recreational activities intervention, based on recent studies, have been successful with regard to externalization of feelings and other emotions such as depression and anxiety⁽⁷⁾, enhancing social skills and personal and group decision making⁽⁶⁾.
Some investigations have shown that group recreational activities promote socialization and daily performance^(7,8,9), social skills and sociability and result in enhanced physical and affective well-being, as well as improve self-care skills through taking responsibility and sharing in recreational activities. All of these skills play a role in establishing appropriate behaviour⁽¹⁰⁾. Overall, group recreational activities result in promotion of self-care skills in patients and increase their chance to remain in the society context. Group recreational activities help individuals to be successful in society. Our purpose is to examine the effect of group recreational activities as a rehabilitation method on schizophrenic patients' self-care skills and if application of group recreational activities cause enhanced self-care skills in clients?

MATERIALS AND PROCEDURES

The present study is a pre/post test study. Our purpose was to determine the effectiveness of group recreational activities on chronic schizophrenic patients' self- care skills in Razi psychiatric, educational and therapeutic center. At first, we recruited all chronic schizophrenic patients who could leave the psychiatric sector. Exclusion was comorbidity with other disorders, mental retardation. Then the patient's psychiatrist and family filled out a consent form regarding participating in group recreational activities. Finally, 45 patients were assigned to the experiment which included a pilgrimage-recreational trip to Mashhad which took about 10 days. The therapeutic team such as psychologist, psychiatric nurse, occupational therapist and social worker traveled with the team. The therapeutic and rehabilitation team undertook some duties and participants had major responsibilities in order to enhance self-directedness, promote collaboration and increase daily living skills. Participants were obliged to take responsibility of their self-care and participate in collaborative activities. All participants had an active role in planning the trip and activities such as shopping, pilgrimage, visiting, eating breakfast, lunch and dinner, caring for weaker participants etc.

Tools
To assess participants' self-care skills, we used a self-care skills scale. The self-care skills scale consists of 12 items such as washing, brushing, combing, shaving, and health care, nail cutting, clothing, appropriate use of drugs, ability to spend money appropriately. Each item has 4 options, which ranged from 0-3 points and the total score was 30. (Ability to engage in skill, 3 points; ability to engage in skill with encouragement, 2 points; ability to engage in skill but unwillingness to do so, 1 point, inability to do skill 0 point)^(11,12). and we employed this measure in Iran^(8-11).

Ethical consideration
Participants and their family filled consent forms in individual and group form. Psychiatrist and therapeutic team members justified participation in group recreational activities.

RESULTS

45 participants were selected for research of which 30 were men (66/7) and 15 participants were women (Table 1). The mean and SD of participants' age was 39/8 and 3/31 respectively. Singles consisted of 53/3 of the sample (24) and 6/7 percent were married (3), and 40 percent were divorced (18). In total 13 percent were living alone (Table 2). Self-care skill dimensions which, consisted of washing, brushing, bathing, individual health, combing, grooming, shaving, nail cutting, eating habits, clothing, drug use and ability to handle money, results show that there were significant differences between before and after, statistically in 8 items (brushing, individual health, grooming, combing, shaving, eating rituals, clothing, drug use). In 4 items such as washing, nail cutting, bathing, using money, although skills had increased they did not show any significant differences (Table 3). Overall, Table 3 shows at a glance that means of self-care skills have increased from pre (29/56) to post intervention (32/16). T student test showed significant differences of pre and post intervention (p:0.000)(Table 3).

DISCUSSION

As regards the investigation of the hypothesis of study, we can now gain more support for significant influence of group recreational activities on enhancing self-care skills. Results are consistent with other studies by Laurenhue⁽⁷⁾. Four dimensions in which there were no significant differences (however they were on the threshold), maybe due to bathing and nail cutting in Razi center conducted routinely twice a week, and because participants bring little money into the center, these skills are less encouraged.

CONCLUSSION

In general, results show that group recreational activities as a rehabilitation intervention in psychiatric participants could impact on self-care skills. Therefore designing such interventions for treating and rehabilitation of schizophrenic patients could lead to better performance in variable dimensions of self-care skills and independence.

Acknowledgment
We would like to express our special thanks to Razi center, psychiatrists, psychiatric nurse, psychologist, occupational therapists, social workers, transportation and audiovisual center and charity institute to support Razi psychiatric patients, participants and their families who help us in conducting this study.

REFERENCES

1. Fallahi khoshknab, M. 2002. The application of multi dimensional rehabilitation model on chronic schizophrenic patients' relapse. Research journal of shahid saddoghi university of yazd.
   
2. Fallahi khoshknab, M. 2003. Designing and evaluating multi dimensional rehabilitation nursing for schizophrenic patients, doctoral dissertation. Tehran . tabiat modarres university. P218.
   
3. Haber, Judith. Comprehensive psychiatric nursing.5th edition, St. Louis, mosby co. 1997. P821.
   
4. Haber, Judith. Comprehensive psychiatric nursing.5th edition, St. Louis, mosby co. 1997. P804.
   
5. Karbalaii ismaeel, hamid reza. Comparative investigation of chronic schizophrenic patients' daily living skills. Tehran. Iran medical university. 1376. P57.
   
6. Khankeh, hamid reza . the effect of self care skills education in chronic schizophrenic patients. Research design. Tehran University of social welfare and rehabilitation sciences. 1379.
   
7. Laurenhue, K. (2000). Broadening horizons: Activities with people with dementia. Alzheimer's Care Quarterly, 1(2), 38-45. Retrieved October 25, 2004 from Academic Search Premier database.
   
8. Maddah , sadat seyed bagher. The impact of self care education on self care skills in mentally retarded children. Research design. Tehran University of social welfare and rehabilitation sciences.1374.
   
9. Pratt, Carlos W; psychiatric rehabilitation. Santiago, academic press. 1999. P27.
   
10. Samadi, Rajab. Theoretical foundations of organizing mental patients. Tehran. social welfare and rehabilitation sciences. 1377, p10.
    
11. Stambo J Norma, leisure educational theory and practice, therapeutic recreational journal, Arlington ; third quarter 1999, vol. 33, iss.3. p253. from: http://gateway.proquest.com/openurl?ctx_ ver=z39/88
    
12. Menditto anthony, duston morris, Jaclyn card, therapeutic recreational journal. Arlington: fourth quarter 1997. vol33, iss,4; P275.