الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Psychiatric hospital is still the main setting for the care of the mentally disturbed people, particularly in the developing countries.(1,2) Hospitalization is generally a stressful experience and can be viewed as crisis situation for patients and their family which affects their willingness and cooperation in the treatment.(1,6) As psychiatric treatment begins with the initial interview, patients and their family caregivers’ reactions and feelings about hospitalization should be investigated to secure better prognosis. (17, 22)
The aim of this study is to determine the reactions of psychotic patients and their family caregivers toward hospitalization in mental hospital.
The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria. This study was conducted in the ten wards that manage psychotic patients.
The subjects of the study consisted of two main groups namely a group of:
(a) 150 psychotic patients who were admitted to the hospital for the first time during the period of data collection.
(b 150 family care givers, one family member for each selected patient, “first or second degree relative” visiting the patient.
Two tools were used to collect data for the study:
The patient’s reaction interview schedule and the family caregivers’ reaction interview schedule developed by the researcher after review of literature.
Tools were tested for their content validity by a group of nine experts in the psychiatric medicine and nursing fields. A pilot study was carried out in order to ascertain the clarity and applicability of the study tools.
Selection of the patients was done through reviewing all sheets in each ward to detect those psychotic patients who were admitted for the first time to the hospital.
After explaining the purpose of the study, and taking consent from the patient. Each patient was interviewed individually twice; the first interview was within the first week of admission to hospital and the second interview after one month of admission to hospital. Patients’ demographic and clinical data were collected through reviewing the patients’ medical charts using the demographic and clinical data sheet.
Each caregiver was interviewed individually, wherever they were available, they were oriented briefly to the purpose of the study and were assured that all information gathered would be confidential and used only for the purpose of the study.
The followings are the main results obtained:
The studied patients mean age was 33.13 ± 10.39 years; the majority of the studied patients were males (72%).
More than half of the subjects (56%) were diagnosed as schizophrenics. The majority of the studied patients (83.3%) were seen by a private doctor.
The caregivers’ relation to the studied patients was brothers / sisters (52%) or fathers / mothers (28.7%).
Nearly three quarters of the studied subjects (73.3%) reported that they were not informed about the admission to the hospital.
Half of the studied patients (50%) stated that they were cheated by family, (24%) and were admitted either by force or police and only (20.6%) were admitted voluntary.
Patients reporting negative feelings toward their hospitalization while the majority of family caregivers (86.7%) reacted positively to their patient hospitalization.
The majority of the studied patients (96.6%) stated that fathers and /or mothers were the main caregiver.
More than one third of the studied patients (41.3%) expected that they will be stigmatized by hospitalization.
More than one third of the studied patients (34%, 29.3%) stated that they verbally, physically assaultive. This percent tended to decrease by the second interview to (18.7%, 8.7%).
Only (12%) of the studied patients perceived the medications as helpful during the first interview. This was sharply increased by the second interview to (54.7%).The highest percentage of the patients (88.7%) wanted to leave the hospital.
The majority of the studied patients (79.3%) reported that they didn’t accept another referral to the hospital later on, this percentage slightly tended to decrease by the second interview to (77.3%).
The majority of the studied patients which they were informed about hospital admission were had fearful feelings, while (32, 5%) were had sad feelings, (30%) were being anxious. (20%) felt angry (17, 5%) not feeling any thing, (7, 5%) were being surprised.
The majority of the studied caregivers (68%) reported that they were visiting psychiatrists, while (21.9%) reported that they were visiting Sheikhs / Menagemin and the rest (10%) were visiting El Maamoura hospital.
The majority of the studied caregivers (88%) stated that patient illness like any other illness and need help. While (23.3%) stated that all his behavior are incredible and strange.
The majority of the studied caregivers (83.3%) stated that admission of patient to hospital not cause any problems at home, while (16.7%) stated that admission of the patient to the hospital cause problems at home as negligence of the children caring and financial problems.
The majority of caregivers (95.4%) were concerned about other patients harming him or he may harm himself .The majority of studied caregivers (55.3%) reported that the staff showing acceptance to their patients.
The majority of the studied caregivers (96%) stated that nurse was informing them about the patient’s condition. More than half the studied subjects (52.6%) reported that his abnormal behaviors lead them to admitting their patient to hospital.
The following are the main recommendations yielded by this study:
1. The patient should be informed about the reasons for admission, treatment plan, and the estimated length of stay. This will make admission less traumatic.
2. Establishing an admission ward with a welcoming atmosphere; it can be a step on the way of improving patients’ reaction to hospitalization.
3. Patients admitted to the unit must attend a pre-admission conference in which the staff meets the patient and his / her family to discuss the reason for seeking admission, the treatment contract, and the program offered on the unit.
4. The admitting staff should meet the patients, treat them gently and humanely, give them much time to express their feelings and orient them to the hospital environment, its rules and regulations. This will help to decrease much of the patients’ anxiety and insecurity about the hospital, convey the therapeutic purpose of the hospital and facilitate patients’ adjustment.
5. Team work and periodic team conferences should be encouraged in mental hospitals .This will provide an opportunity for staff to come together, gain inside into the patients’ condition and cooperate in planning for patients care with emphasis on the staff attitude of acceptance and concern. Also team conference will help in the discussion of the staff own problems this help in decreasing much of their anxieties that are indirectly reflected on patients under their care.
6. Activity therapy (occupational and recreational therapy) should be given more attention, be including and prescribed in the treatment program. In addition to its role in re-socialization of patients, it also helps them to value their in hospital, be more expressive, and thus relieve their anxiety and render them more accepting of their hospitalization.
7. Regular meetings with family caregivers to support them, and decrease family anxiety and answer their questions. Emotional support should be offered to family caregivers to clarify and discuss feelings.
8. Family caregivers must be involved in their patients’ treatment plan, health education as regards the nature of mental illness, treatment, expected progress, goals of management, and methods of behavior management, environmental manipulation, family relationships and their impact on the patient.
9. There is a need to educate the community about mental illness to try to dispel the stigma and wrong beliefs concerning patients. So, the role of Mass Media should be reviewed in a way to improve the community perception of mental illness and decrease the stigma about it through giving appropriate knowledge about mental illness and the facilities available for treatment, and the role of the community in caring for psychiatric patients.