THE RONSU SCALE: UNVEILING A ROBUST TOOL FOR ASSESSING RECOVERY-ORIENTED NURSING SERVICES UTILIZATION AMONG PEOPLE WITH SCHIZOPHRENIA Jutharat Thongsalab, Jintana Yunibhand, I Gede Juanamasta Jurnal Keperawatan Soedirman, 2025 Recovery-oriented nursing services (RONS) have emerged as a significant paradigm in the treatment of schizophrenia. Nevertheless, the number of validated instruments available to assess patient utilization of these services is insufficient. This study aimed to develop and validate the Recovery-Oriented Nursing Services Utilization (RONSU) scale. A cross-sectional study was conducted to develop the scale for adults aged 18 and older who older residing in the community who have schizophrenia, between March and May 2023. Participants from six hospitals had participated in outpatient mental health nursing for at least eighteen months following discharge. The scale development followed the seven-step process outlined by DeVellis and Thorpe. An exploratory factor analysis conducted on 110 samples identified a four-factor structure, comprising the following components: social skill training, indirect nursing care management, therapeutic nurse‒patient relationships, and coping skill training. With the assistance of 231 participants and confirmatory factor analysis, the RONSU was refined to 32 items across the four dimensions. The construct's validity and reliability were confirmed, as the fit indices and composite reliability fell within acceptable bounds. The RONSU scale contributes in both scholarly and clinical spheres, enhancing the understanding and application of recovery-oriented nursing services for individuals with schizophrenia
Navigating personal recovery: Multinomial logistic regression analysis of schizophrenia outcomes in community-dwelling individuals Jutharat Thongsalab, Jintana Yunibhand, Penpaktr Uthis General Psychiatry, 2024 BackgroundSchizophrenia is a chronic mental disorder affecting individuals globally, emphasising the significance of personal recovery in mental healthcare. Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions.AimsThis study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage.MethodsA multistage sampling technique was employed, selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals. Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires—Stage of Recovery Scale, Beck Cognitive Insight Scale, Brief Resilience Scale, Family Support, Therapeutic Relationship-Patients Version and Social Support Questionnaire—along with personal data sheets. Pearson correlation and multinomial logistic regression were performed.ResultsThe predominant personal recovery stage among participants was stage 3, ‘living with disabilities’, comprising 42.4% of the participants. Key factors contributing to personal recovery, explaining approximately 38.4% of the variance, included resilience, family support, therapeutic alliance, hospitalisations since onset and recovery-oriented nursing service utilisation. Logit equations for stages 3 and 4 are as follows: stage 3 (living with disability): logit=−4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation; stage 4 (living beyond disability): logit=−11.57–0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance.ConclusionThe findings emphasise the significance of mental health nursing interventions. In conjunction with recovery-oriented nursing services, strengthening resilience, therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia.
Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review Jutharat Thongsalab, Jintana Yunibhand, Penpaktr Uthis Belitung Nursing Journal, 2023 Background: The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. Objective: This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. Design: The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Data Sources: Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Review Methods: Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Results: Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. Conclusion: This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals’ quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.
Strategies and challenges in addressing ethical issues in the hospital context: A phenomenological study of nurse team leaders Ni Made Nopita Wati, I Gede Juanamasta, Jutharat Thongsalab, Jintana Yunibhand Belitung Nursing Journal, 2023 Background: Nurse team leaders encounter considerable ethical challenges that necessitate using effective strategies to overcome them. However, there is a lack of research exploring the experiences of nurse team leaders in Indonesia who face ethical dilemmas in their professional duties. Objective: This study aimed to explore nurse team leaders’ experiences regarding strategies and challenges in dealing with ethical problems in hospital settings in Indonesia. Methods: This qualitative study employed a hermeneutic phenomenology design. Online semi-structured interviews were conducted between November 2021 and February 2022 among 14 nurse team leaders selected using a snowball sampling from seven hospitals (three public and four private hospitals). Van Manen’s approach was used for data analysis. Results: The strategies for overcoming ethical dilemmas included (i) seeking the facts, (ii) stepping back, (iii) considering support, and (iv) standing by patients. The challenges for the nurse team leaders in resolving ethical problems consisted of (i) seniority, (ii) trust issue, and (iii) lack of reflection and ethics training. Conclusion: Nurse team leaders recognize their specific roles in the midst of ethical challenges and seek strategies to deal with them. However, a negative working environment might impact ethical behavior and compromise the provision of quality care. Therefore, it is imperative for hospital management to take note of these findings and address issues related to seniority by providing regular ethics training and group reflection sessions to maintain nurses' ethical knowledge in hospital practice. Such interventions can support nurse team leaders in resolving ethical dilemmas and provide a conducive environment for ethical decision-making, ultimately improving patient outcomes.
Conceptualisation and Definition of Personal Recovery among People with Schizophrenia: Additionally Review Jutharat Thongsalab, Jintana Yunibhand, Penpaktr Uthis Open Nursing Journal, 2023 Background: Personal recovery is an essential mental health goal in schizophrenia. Personal recovery is deeply individual and cannot be uniformly characterised for each person. Therefore, the concept and definition of personal recovery in schizophrenia are still ambiguous. Objective: To clarify the definition and conceptualisation of personal recovery in schizophrenia patients Methods: The study followed Arksey and O’Malley’s framework stages. Related electronic documents were searched in ScienceDirect, Scopus, SpringerLink, and Google Scholar. Results: Ten systematic review studies were included in this paper. Recovery conceptualisation is various perspectives of people with schizophrenia regarding personal recovery as follows: “Recovery as a journey”, “Recovery as a process”, “Recovery as an outcome”, and “Recovery components.”. In addition, it was codified into an operational definition congruent with the CHIME plus D (connectedness, hope, identity, meaning in life, empowerment, and difficulty). Conclusion: Conceptualisation of personal recovery appears in line with the personal recovery process and outcomes close to each other. Therefore, instruments should be developed for measuring both recovery processes and outcomes simultaneously. Additionally, nursing intervention should be designed by aiming to promote and address CHIME plus D. Personal recovery studies in schizophrenia patients have been limited to developed countries. Therefore, in order to acquire a more thorough conceptualisation and characterisation, future research ought to take into account the characteristics, determinants, and outcomes of personal recovery among people with schizophrenia who come from developing nations and minority ethnic groups.
THE RELATIONSHIP BETWEEN PERCEIVED WORKLOAD AND ORGANIZATIONAL JUSTICE TOWARD NURSES’ INTENTION TO LEAVE THEIR PROFESSION Ratna Agustin, Aries Candra Ananditha, Yohanes Andy Rias, Jutharat Thongsalab Jurnal Keperawatan Soedirman, 2022 Perceived workload and organizational justice are significantly correlated with nurses’ intention to leave. However, limited studies have used a large sample to investigate this association. Therefore, this study aims to identify the association between perceived workload and organizational justice on nurses’ intention to leave. A cross-sectional online survey was conducted among 278 nurses by the simplified snowball sampling technique method from five hospitals in Surabaya, East Java Province, Indonesia. Adjusted odds ratios (AORs) and multiple linear regression were employed for data analysis. Perceived workload had increased intention to leave by 0.251-fold (95% CI = 0.20 to 0.31; p = <0.001). In addition, individuals with a high score of organizational justice are negatively associated with intention to leave -0.144 (95% CI = -0.19 to -0.10; p = <0.001) after the covariate variable has been adjusted. This study found a significant independent correlation between perceived workload and organizational justice toward nurses’ intention to leave. This suggests that nurses are more likely to consider leaving their jobs when they perceive a more significant workload and receive less organizational justice through policies and practices that intend to replenish resources.
