Decreasing Social Interaction Anxiety for Schizophrenia

Decreasing Social Interaction Anxiety for Schizophrenia CHAPTER V DISCUSSION, SUMMARY, CONCLUSION, IMPLICATIONS, LIMITATIONS AND RECOMMENDATIONS. This chapter deals with discussion, summary and conclusions drawn. It clarifies the limitations, the implications and the recommendations of the study which are given for the different areas in Nursing practice, Nursing education, Administration and Research. The primary aim of the intervention is to decrease the social interaction anxiety among patients with schizophrenia. DISCUSSION. Schizophrenia is relatively common affecting 1.1% of population in or around 65 million people worldwide. In India about 4.5 – 7.8 millions of people suffers from schizophrenia and 7 lakhs of people suffers from Schizophrenia in Tamil Nadu. The patients with Schizophrenia have been found to have pronounced deficits in the social skills. These deficiencies may reflect the primary influence of the illnesses itself.(Del prette,1999). The present study aimed to assess the effectiveness of social skills training on social interaction anxiety among the patients with schizophrenia. It was conducted at Kongunadu Mana Nala Arakkatalai ,a chronic centre at Coimbatore. The sample size was 30 patients who were diagnosed with schizophrenia. Demographic variables showed that 80 percent of the patients were under the age group of 40 – 60yrs, 53.3 percent of the patients were males, 70 percent of the patients completed their high school, 63.3 percent of the patients were married and 60 percent of the patients were from the nuclear family. Clinical variables showed that 73 percent of the patients were chronic schizophrenic patients, 50 percent of the patients were having the illness from 2 – 4yrs and 56.6 percent of the patients were admitted in the hospital for more than 2 yrs. The distribution of the subjects according to the mean pre test values of social interaction anxiety showed 47.97 and the distribution of the subjects according to the mean post test values of social interaction anxiety showed 43.57. The collected data of the present study were statistically analyzed and the results based on the objective are discussed below:- (1) To assess the social interaction anxiety before and after the social skills training among the patients with schizophrenia. The level of social interaction anxiety before the social skills training among the patients with Schizophrenia was assessed by using the SIAS scale. The scale consists of 20 questions which includes the aspects of communication, eye contact , listening, appropriate emotional response ,interaction anxiety , greeting and smiling to others. The mean pre test value of social interaction anxiety was 47.97 and the post test value was 43.57 respectively. It showed that the schizophrenic patients are having severe social interaction anxiety. From the above results the researcher came to a conclusion that the schizophrenic patients are having severe social interaction anxiety to go for effective communication which affects their day to day life. Thus by giving the social skills training; a behaviour therapy technique the patients can improve their social skills which further leads to the good communication. A study supporting the above result is as follows: Beaz . S.et al.,(2013) conducted a study to evaluate the social functioning performance (social cognition tasks) that incorporate the different levels of contextual dependence and their involvement in the real life scenarios.50 samples were included as the study participants and out of these 25 were the control subjects. The subjects were analyzed by using the pre prepared diagnostic assessment. The results showed that the both groups has the greater interaction anxiety and thus gives the poor performance in the social cognition tasks which constitutes emotional processing, empathy and social norms. The result suggests that the social skill deficits in the patients with schizophrenia will impairs their involvement in the real life situations. (2) Evaluate the effectiveness of social skills training among the patients with schizophrenia. The post-test level of social interaction anxiety was assessed after the intervention. The comparison between the social interaction anxiety of the patients before and after social skills training was statistically evaluated using paired t’ test. The mean pre-test value of social interaction anxiety was 47.97 and post test value was 43.57. The calculated paired ‘t’ value was 6.067 which is greater than the table value (1.672) and it was significant at P From the above analysis, the investigator came to the conclusion that the social skills training was an effective intervention for decreasing the social interaction anxiety of the schizophrenic patients. A study supporting the above finding is as follows : Imam.A.S,et.al.,(2004) conducted a study to determine the effect of social skills training program on social interaction anxiety of individuals with schizophrenia. For a one month program; 62 inpatients, 32 in the study group and 30 in the control group were selected as the participants and they were given 60 min training in 10 sessions for 15 days. The results indicated that social interaction anxiety had shown a tendency to gradually decrease with the lengthening of the group treatment time. The findings demonstrated that the social skills’ training is effective in reducing the interaction anxiety in individuals with schizophrenia. Similarly; as in the above described study, the present study also showed the effectiveness of social skills training programme on social interaction anxiety among schizophrenic patients. (3)Associate the social interaction anxiety with the selected demographic and clinical variables among the patients with Schizophrenia. The association of social interaction anxiety using with selected demographic and clinical variables is found out by using the chi square test and it shows that, the calculated chi square value for all demographic variables such as age , gender, education, type of family , type of schizophrenia, duration of illness, and period of stay does not have any significant association with the social interaction anxiety at P A study supporting the above result is that Hayes (1995) conducted a study on effects of social skills training on the community functioning and its impact with the chronic schizophrenic patients.63 patients met in small groups for 36 sessions of training over 4 months. The results showed that there is a significant association in community functioning with demographic status such as gender, educational status and marital status of the patients. No association was found between the age , type and duration of illness ,and period of admission. The association of social interaction anxiety with demographic variables such as age (0.842), gender (0.523), education (0.276), and type of family (0.36) were not statistically significant at P The association of social interaction anxiety with clinical variables such as the type of schizophrenia(0.589), duration of illness (0.657), period of stay (0.992) showed no significance at P The above mentioned study also supports that there was no association between the age, type and duration of illness and period of admission. And in the present study, the researcher suggests that irrespective of the age and gender; the people will have to deal with the stressful life events daily hassels which consequently affects the social decompensations which will be varying from one another and hence their perception towards the social skills might be different. And on the other side, the educational status; the participants may not have the capability to understand the social skills training it’s importance. For the other variables, type of family, type of schizophrenia, duration of illness, period of stay ; the duration and sample of the study is less. Hence this may be the reason these variables are found as no association in the present study. Similarly as the above ; in the present study there was a significant association with the social interaction anxiety and the marital status and no association was found between age, gender, education ,type of family ,type of illness and its duration and the period of stay. SUMMARY The present study was aimed to assess the effectiveness of social skills training on social interaction anxiety among the patients with schizophrenia. The objectives formulated were as follows:- To assess the social interaction anxiety before and after the social skills training among the patients with schizophrenia. Evaluate the effectiveness of social skills training among the patients with schizophrenia. Associate the social interaction anxiety with the selected demographic and clinical variables. The social skills training was the independent variable and the social interaction was the dependent variable. One group pre–test post–test quasi experimental design was used for the study. The samples include 30 schizophrenic patients. Non probability purposive sampling technique was used. The tool for the data collection consists of the demographic and clinical variables of the patients, and social interaction anxiety scale was used to assess the social interaction anxiety of the schizophrenic patients. The study was conducted at Kongunadu Mana Nala Arakkatalai, Coimbatore for a period of 6 weeks. After the pre-test, the researcher used social skills training as the intervention. The training showed a decrease in the social interaction anxiety for the patients which was assessed by the post test. As on the hypotheses and objectives, data’s were analyzed by using both descriptive and inferential statistics to find out the effectiveness of social skills training on social interaction anxiety among the patients with schizophrenia.. And it tested and proved the formulated hypothesis. MAJOR FINDINGS OF THE STUDY The pre-test and post-test values showed that there was a decrease in the social interaction anxiety among schizophrenic patients. Thus, it was an effective intervention to decrease the communication problems among schizophrenic patients. The calculated paired‘t’ test value for the social interaction anxiety among the patients with schizophrenia was 6.067. This value was greater than the table value (1.672) and‘t’ value was significant at 0.05 level. Thus this finding implies that there was a decrease in social interaction anxiety after social skills training. The association of social interaction anxiety with selected demographic and the clinical variables using chi square test shows that; among the calculated chi square values for demographic variables, marital status had a significant association at P CONCLUSION The conclusion drawn from the study is as follows:- The statistical analysis proved that, the social interaction anxiety of the patients with schizophrenia was decreased after social skills training. Thus, social skills’ training is a good intervention to improve the social skills among the patients with schizophrenia. IMPLICATIONS The present study contributes to nursing practice, nursing education, nursing administration and nursing research. The social skills training can be used to decrease the social interaction anxiety among the patients with schizophrenia. Nursing Practice The social skills’ training is an effective therapeutic technique to improve the social skills of the patients. In the nursing practice, the Psychiatric nurses as teachers or trainers can work collaboratively with their patients for behavioural modifications such as increasing socialization, improving assertiveness. The decrease in the social interaction anxiety will improve the communication pattern of the patients which in turn help them to improve their day to day life. By using this training ; nurses can overcome the social difficulties of their patients and help them achieve higher levels of psychosocial adaptation. Nursing Education. The nurse educator can encourage the staff to implement the social skills training technique for the patients in an active and more lively manner. The nurse educator can make the staff nurses , to understand about the social skills training and thus to deliver an effective and good quality of care to their patients. Nursing Administration. The nurse administrator can initiate the social skills training in psychiatric units. The nurse administrator can implement the social skills training as a group activity among the patients. Nursing Research. The nurse researcher should explore the factors that are contributing to the lack of social skills in the hospital environment among the patients with schizophrenia. More researches should be encouraged to assess the effectiveness of social skills training in all the areas of communication. LIMITATIONS The time period of the study was very short to assess the behavioural change of the patients. The study was conducted for one aspect of the social skills. The study was conducted with the limited number of samples. RECOMMENDATIONS. A comparative study can be done with the experimental and the control group. A longitudinal study can be done with large number of samples in different settings. Further research can be conducted focusing the other aspects of social skills. A comparative study can be done with the other behaviour modification techniques.