الفهرس 
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Abstract
Psychotic disorders are a group of serious illness that affects the mind. These illnesses alter person’s ability to think clearly, make good judgment, respond emotionally, communicate effectively, understand reality and behave appropriately. When symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life, however, even the most severe psychotic disorders usually are treatable. About 1% of the population worldwide suffers from psychotic disorders. These disorders most often first appear when a person is in his or her late teens, 20 or 30s. They tend to affect men and women equally (Fontaine, 2009).Patients who experience psychosis are often frightened by their experience, have difficulty forming close relationships, are severely disabled and tend to be alienated from society. Nurses should strive to connect with patients who are in a state of psychosis and help them toward rehabilitation and wellness (Moller, 2005).Psychiatric and mental health nursing interventions are nursing activities that promote mental health, prevent mental illness, assess dysfunction, assist clients to regain or improve their coping abilities and /or prevent further disabilities (American Nurses Associations, et al,2000 and Canadian Federation of mental health nurses,2005)Based on clinical judgment and knowledge, nursing interventions include any treatment that a nurse performs to enhance client outcomes. These interventions are direct (performed through interactions with the client) or indirect (performed away from, but on behalf of the client) (McCloskey and Bulechek, 2000)
Psychiatric and mental health nurses care for patients who have psychiatric disorders involving underlying psychoses other than schizophrenia and mood disorders. Central to understanding the problems of these patients is the concept to of psychosis, a term used to describe a state in which an individual experiences positive symptoms, also known as psychotic symptoms (hallucinations, delusions, or disorganized thoughts, speech or behavior). Other psychotic disorders are schziophreniform, schizoaffective, delusional, brief psychotic and shared psychotic disorders. Other psychotic disorders may be included by drugs or alcohol (Roberts, et al., 2008).Aim of the study
This study aims to develop, implement and evaluate the effect of a nursing intervention protocol for nurses working with psychotic patients through:
1. Assessing the knowledge of the nurses caring for psychotic patients.
2. Observe the performance of the nurses while caring for the psychotic patients and accordingly.
3. Develop, implement and evaluate protocol of nursing intervention for nurses caring for psychotic patients.
Study Hypothesis A nursing intervention protocol given to nurses caring for psychotic patients will lead to increase their knowledge and improve their performance of care.
Study Question What is the nurse’s knowledge concerning care of psychotic patients?
How is the nurses performance while interaction with psychotic patients?
Subject and methods
This study was conducted in Psychiatric Mental Health Hospital, ministry of health at Benha city.
The subject was comprised all available nurses working in Psychiatric Mental Health Hospital (N=100).
Data collection tools:
I- A questionnaire sheet: was formulated by the researcher based on the literature review and supervisor’s opinions to assess nurse’s knowledge pre and post the protocol implementation. The questionnaire consisted of questions in the form of multiple choices. It covered the following two main areas:
1. Sociodemographic characteristics of nurses working with psychotic patients which include age, marital status and year of experience in psychiatric field.
2. Knowledge about nature of psychotic disorders, treatment, nursing care, relapse and patient’s rehabilitation.
• Knowledge about nature of psychotic disorders including; the meaning, causes and symptoms of psychotic disorders included in 3 questions.
• Knowledge about nature of schizophrenia included; the meaning, causes and types of schizophrenia disorders included in 7 question.
• Knowledge about treatment; types, therapeutic effects, side effects included in 5 questions.
• Knowledge about patients nursing care included in 12 questions.
• Knowledge about relapse included; meaning, causes, signs and occurrence time included in 5 questions.
• Knowledge about patient’s rehabilitation included in 3 questions.
II- Observation check list: was designed by the researcher based on literature review and supervisor’s opinion to assess nurse’s behavior and performance toward psychotic patients.
It was done pre and post protocol implementation which comprises the following five main items. Each item consists of a number of observations to performances done by the nurse.
1. The first item was to observe nurse’s performance in dealing with the patients during the first interview (with the newly admitted patient’s). It included 7 items.
2. The second item was to observe nurse’s communication pattern with their patients. It included 19 items.
3. The third item was to observe nurse’s awareness to the good characteristics of the environment around their patient. It included 6 items.
4. The fourth item was to observe nurse’s performance in providing nursing care to their patients. It included in 16 items.
5. The fifth item was to observe nurse’s performance in dealing with patient’s family and relatives. It included 9 items.
Protocol content implementation:
• The protocol was implemented in the form of lectures and discussion.
• The total number of sessions was 16 in addition to two sessions for pre and post test.
• Suitable teaching aids prepared specially for the program were handout, posters and real objects.
• At the end of every session nurses questions was discussed to correct any misunderstanding which has been happened.
• A different teaching strategy was used in implementation the program e.g. lectures, discussion, and role play.
It was difficult to gather all nurses at one time, so the protocol was implemented two times for two groups of nurses separately.
Each group was exposed to the protocol content over two months, and then their knowledge was assessed another time after on month from finishing the protocol implementation phase.
To ensure that the nurse understand the protocol content each session was started by a summary about what was given through the previous and objectives of the new one taking in to consideration using simple language to suit all nurses.
To ensure exposure of all subjects to the same learning experience all nurses received the same protocol content using the same teaching methods, discussion and handout.
Evaluation of the nursing intervention protocol was carried out by using the same pre-protocol format.
The findings of the study can be summarized in the following:
According to socio-demographic characteristics of the nurses 60% of the nurses were males and 40% were females. As regards nurses’ age 36% were 25- year old and 24% were 30- year old. As regards marital status 36% were single and 64% of were married. As regards year of experience, more than half of the sample 52% was located in the period between 10- year of experience in psychiatric field experience.
As regarding nurse’s knowledge about psychotic patient, the current study revealed that there was a significant better improvement of all items of knowledge scores for nurse’s post program implementation than pre.
As regarding to nurse’s performance in dealing with psychotic patient the study reported that there was a significant improvement of all items of performance for nurse’s post program implementation than pre.
As regarding to correlation between nurse’s knowledge and their performance pre and post program implementation the study revealed that there was a significant positive correlation between nurse’s knowledge about psychotic patient and their performance pre and post program implementation.
As results of this study the following recommendation were formulated:
• The undergraduate diploma nurse’s curriculum should be connected closely with the practical time.
• The continuity of and concentration on the practical work in the training programs rather than the theoretical knowledge.
• Motivation system in the form of moral and material incentives should be adopted by nursing administrative department to foster and encourage the nursing personnel to participate positively in the practical training programs.
•Replication of the study on a larger prospect sample is highly recommended to achieve generalized results.