1 Chonnam Journal of Nursing Sciences Vol. 1 December, 1996 The Effects of Therape ut ic Recreat ion Prog rams on Psychiat ric Pat ients ' Depres s ion and Human Re lat ionship Kim, Sang Sook Lee, Chung Sook Dept. of Nursing, Chonnam University Medical School > Abstract < The recent t rends in the t reatment of psychiatric patients have shown more interests in the development and the evaluation of psychiat ric rehabilitation programs along with pharmacotherapy and psychotherapy, with its ultimate purpose of patients' going back to the community. It is considered quite meaningful for a psychiat ric nurse to develop and carry out therapeutic recreation programs under the situation where practical rehabilitation programs are under- developed. This study is to evaluate the efficiency of systematic and therapeutic recreation programs on psychiat ric patients' depression and human relationship so as to suggest evidences which could be applied in a clinical situation. The subjects of this study were 12 psychiat ric in patients and day care patients of J Psychiat ric Cent re in Kwangju City during the period of August 19, 1996 to September 7, 1996, for whom 10 therapeutic recreation programs have been applied three times a week for three weeks, and then their effects on patients depression and human relationships were reviewed. The inst ruments of the study were therapeutic recreation programs developed by the researcher; depression scale which was standardized of Beck's Depression - 1 -
Inventory by Han, Hong Moo, et al.(1986); Relationship Change Scale of Schlein and Guerney translated by Moon, Seon Mo(1980) and slight ly modified by Cheon, Suk Kyun(1994). A questionaire on therapeutic recreation was dist ributed in order to evaluate therapeutic recreation programs. The data was analysed by Wilcoxon Signed Ranks Tests, and answers of each question was numbered. The results of this study were summarized as follows ; 1. The scores of depression in posttest were significant ly lower than before receiving programs from a statistical point of view(z=- 2.510, p=.012). 2. The scores of human relationship in posttest were significant ly higher than before receiving programs from a statistical point of view(z=- 2.118, p=.034). 3. Among those programs developed by the researcher, preference was shown in the order of sing, motion song and physical activities. In order to provide therapeutic recreation programs in groups for psychiat ric patients, it is thought to be more effective to apply in a gradual way taken fully into consideration of individual's or group's psychopathic conditions, needs, recreation experiences purpose and values of the program etc. In conclusion, there were positive results in patients' depression and human relationship by practicing therapeutic recreation programs. Accordingly, therapeutic recreation programs could be approached on a practical and clinical level in psychiat ric nursing with substantial evidences.. 1.,,. 1988 100 2.16, 3.01 5 (, 1994). (, 1992). (, 1995).,,,., (Lehman, Ward & Linn, 1982)., - 2 -
(, 1990)..,,, (Burgess & Lazare, 1976).. (, 1995)..,,,. (1993),,,,,,,,., (,,,, 1992)., 1996 12,.,.,. 2.,. 3.. 1.. 2. - 3 -
. 4. 1),, (, 1995).,,,,,. 2) 10 (ICD- 10: International Classification of Disease and Health Problems 10th Edition, 1992), J. 3),,,,, (Beck, 1967). Beck(1967) Depression Inventory(BDI) (1986). 4),,, (, 1993). Schlein, Guerney Relationship Change Scale(RCS) (1980) (1994).. 1., (King, 1975;, 1992). (depression) Bleuler(1950) (Lazarus, 1976).,.,, (, 1992). 80% (Kaplan, Sadock & Grebb, 1994),. (Dines & Cribb, 1993)., - 4 -
,, -, (, 1995;, 1993;, 1991;, 1988;, 1983). 2. (, 1995)..,,,,.(, 1984)., (, 1987)., (, 1991;, 1983).,, (Serban, 1979).., (, 1984). Yalom(1985),., (, 1996;, 1994;, 1994;, 1992)., (, 1995).. 3. (Therapeutic Recreation) 1) 1950. (Hospital Recreation), (Medical Recreation), (Recreational Therapy), (Recreation for the ill and handicapped) (O'Morrow, 1976). - 5 -
.,,,,,,,,,,,, (, 1995).. NTRS(National Therapeutic Recreation Society, 1989).,.,.,.,.,. Peplau. Hildegard E. Peplau(1952) (Chinn, Huether & Jacobs, 1983). 2). (assessment), (planning), (implementation), (evaluation),,,,,,.,. (Austin & Crawford, 1991). Peterson Gunn(1972) (Leisure Ability Approach). 1981.. (client- oriented approach),.. (program focus on single area of purpose),,, (Peterson & Gunn, 1984). - 6 -
, (Treatment). (Leisure Education),. (Recreation Participation) (O'Morrow, 1976)..,., (, 1994)) 3),,,, (Meyer, 1973). 19 1990 (Corrigan, Liberman & Wong, 1993). Corrigan (1993),. (1992) 4 1 1 12,,,,,. (1992),,,,,.. (Buettner, 1994). (, 1990;, 1994). (, 1995; Regan, Banks, & Beran, 1993)., Nursing Home Group Home (Lusk, 1990; Malik, - 7 -
1989), (Peterson & Gunn, 1984).,.. 1. (one- group pretestposttest design).. 1. (10 ) 2. 1996 8 19 9 7 K J,,. 1) 2) 16 65 3) 4) 5) 6). 14, 1, 1 12...,.,. 10-8 -
. 3.,,,. 1) (client - oriented approach) (Peterson & Gunn, 1984).,,,.. J. (music),. (dance). (physical activities), (social activities),., (nature & outdoor recreation activites),. (drama) (gesture game). 3 1 2,,. 3 4, 3 10 1. 2) Beck(1967) Depression Inventory(BDI) (1986). 21 (0 ) (3 ) 4 0 63. Cronbach's Alpha Cronbach's Alpha.85. 3) Schlein, Guerney Relationship Change Scale(RCS) (1980) (1994). 25 5 Likert, - 9 -
,,,,,, 7.. (1994) 135, Cronbach's Alpha.88. Cronbach 's Alpha.85. 4. 14,, 6. 4 1 5 1,.,.,.,. 1, < 2>. (1) -, (10 ). (2) -,,, 2 3 (40-45 ). (3) -, Sing Along T ea Time (5-10 ). (, 1996;, 1996). (1). (2). (3). (4). (5),. (6) (we consciousness). (7). (8). (9). (10),. - 10 -
2. 1 1.,,,,.. 2. 3. 1, 2 4. Sing Along & Motion Song 5. 6. 7. Recreation Dance - 8. T ea Time 2 1. 2. 3. Sing Along & Game Song 4. 5. (T - M Play) 6. Folk Dance - 7. Sing Along & 3 1. & 2. 3., 4.. 5. 6. T ea Time 4 1. KIMS 2. Game Song 3. (T opic Play) 4. (Gesture Game) 5. (Puzzle) 6. Sing Along & 5 1. 3 2. Sing Along & 3. - 4. 5. 6.!(Contest) 7. Sing Along &,,, -,,,, - 11 -
6 7 1.,, 2. - - 3. 1) ( ) 2) ( ) 3) ( ) 4) ( ) 4. Disco Time 5. Sing Along 8 1.,, 2. & Game Song 3. - 4. 5. 6. Sing Along 9, 10 1. 1, 2,, 2.. 3. Sing Along. 4. - 5. 6. Folk Dance - Good Night Waltz 7. Sing Along & 8. 5. SPSS/PC+., (Wilcoxon Signed Ranks Tests).. - 12 -
6. 1). 2).. 1. 12 5, 7, 21 36, 28. 4, 1, 3, 4, 1 11. 9 2, 10 3, 7.. 10 1, 1. 11, 1, 5.75 < 3>. 2. 1) 1. 20.1 13.8 (Z = - 2.510, p =.012) < 4, 5>. 2) 2. 66.9 73.2 (Z = - 2.118, p =.034)< 4, 5>. 3. (N=12) 1 36 11 2 34 12 3 21 2 4 26 9 5 21 2 6 28 5 7 30 10 8 22 2 9 27 10 10 28 2 11 34 4 12 29 3-13 -
4., 1 28 22-6 74 79 5 2 21 15-6 62 67 5 3 10 5-5 70 78 8 4 14 2-12 65 91 26 5 16 22 6 64 49-15 6 28 15-13 73 69-4 7 22 15-7 53 55 2 8 16 11-5 85 101 16 9 12 10-2 69 74 5 10 23 1-22 73 81 8 11 18 16-2 54 71 17 12 33 31-2 61 63 2 5., Wilcoxon signed ranks test Z p 10-33 20.1 7.05 1-31 13.8 8.75-2.510.012* 53-85 66.9 9.03 55-101 73.2 14.43-2.118.034* * p<.05 3.,. 5 7, 4 8. 6, 6., 12 11, 12. 2 3 4, 4 5 2., 11, 12. - 14 -
12. 11 1. 3 1 3, 2 2, 3 1 16, 15, 11, 10, 7, 5, 4.. 1. (, 1996;, 1995)., (, 1996;, 1995;, 1994;, 1993;, 1992;, 1988;, 1987). (1993),,,,,,.,,. (Z=- 2.510, p=.012).,,,, (p<.05) (1993), (p<.02; p<.01; p<.1) Russoniello(1992)., (, 1992). (Z=- 2.118, p=.034) - 15 -
. (, 1993). (Yalom, 1985),. (1995),.,, (presence) (Gardner, 1992),. 2.,,,.,, 12 (Yalom, 1985), (1993) 2, 6 12. 3 4, 3 10,,., 2 (, 1993), 2 3, 4 5 33.4%,.., 7, 8 5 10 (Yalom, 1985). 12 14, - 16 -
.,. (1993)..,..,..,.,,. (functional assessment methods) Corrigan (1993).,. (1981), (1992),.. (1993) (100%). 1996 12, - 17 -
,, (, 1996)., (, 1995)..,. 1996 8 19 1996 9 7, K J 12 3 4, 3 10,.,.,,.,.. 1., (Z = - 2.510, p =.012). 2., (Z = - 2.118, p =.034). 3.,,,,.,...,,.,,.,, - 18 -
.,.,,., (1983)..,,.,, (1995).., 34 (6), 1805-1815.,,,, (1992).., 31(4), 62-75. (1994)... (1996).. :, 333-380., (1996).. :.,, (1993). Overview of biopsychosocial Rehabilitation in Korea., 2, 1-13. (1994).., 21-68 (1980).., 19, 195-204. (1995)... (1991). -.. (1996).., 25-31. (1983).., 22 (1981)... (1992)... (1988)... (1994)... (1996).., 20-21 (1993).. :.,,, (1995),., 34 (6), 1816-1821. (1995).., 3-42., (1990). - 19 -
. :, 50-75. (1988)... (1993). Therapeutic Recreation Program.. (1996)... (1993). :,. :, 289., (1992).., 31(3), 512-521. (1994)..., (1984).. :, 382-389., (1992).., 31(1), 106-112. (1990)..., (1995).. :.,,,,, (1986). Beck Depression Inventory., 25(3), 487-502 (1995)... (1993)... (1987).., 19, 55-71. (1987)... Austin, D. R., & Crawford, M. E.(1991). Therapeutic Recreation: An Introduction. Prentice Hall, Inc., New Jersey: Englewood Cliffs, 53-70. Beck, A. T.(1967). Depression: Clinical, Experimental and T heoretical Aspects. New York: Harper & Row Publichers, Inc. Buettner, L. L.(1994). Therapeutic recreation as an intervention for persons dementia and agitation: An efficacy study. The Pennsylvania State University, Degree: MS. Burgess, A. W., & Lazare, A.(1976). Psychiatric Nursing in the Hospital and the community. New Jersey: Prentice Hall. Carter, M. J., Van Andel, G. E., & Robb, G. M.(1985). Therapeutic Recreation: A practical approach. Times Morror/ Mosby College Publishing. Chinn, P. L., Huether, S. E., & Jacobs, M. K.(1983). Theory and Nursing: A systematic approach. St. Louis: T he C. V. Mosby Company, 181-184. Corrigan, P. W., Liberman, R. P., & Wong, S. E.(1993). Recreational Therapy and Behavior Management on Inpatient Units: Is Recreational Therapy Therapeutic? The Journal of N ervous and M ental D isease, 181(10), 644-646. - 20 -
Frye, V., & Peters, M.(1972). Therapeutic Recreation: Its T heory, Philosophy and Practice. Harrisburg, Pa., Stackpole Books, 40 Kaplan, H. I., Sadock, B. J., & Grebb, J. A.(1994). Synopsis of psychiatry: behavioral sciences clinical psychiatry. 7th ed., published by Williams & Wilkins. A Waverly Company, 803-811. King, L. J.(1975). The depressive syndrome: A follow- up study of 130 Professionals Working Oversea. A m erican Journal of Psy chiatry, 132, 639-640. Kraus, R. G.(1977). Recreation T oday. California: Goodyear Publishing Company. Lazarus, R. S.(1976). Pattern of adjustment. New York: McGraw- Hill. Lehman, A., Ward, N. C., & Linn, L. S.(1982). Chronic Mental Patients: the quality of life issue. A merican Journal of Psy chiatry, 13 9, 1271-1276. Lusk, P.(1990). Who's knocking now? New clients for nursing homes. Journal of Gerontological N ursing, 16(6), 8-11. Meyer, L. E.(1973). Recreation and Mentally Ill in Recreation and Special Populations, Boston: Holbrool Press, Inc. Mullen, D. A.(1970). Recreation in Nursing Homes. National Recreation and Park Association Management Aids Series 88, 7. NTRS(1989). About Therapeutic Recreation: A Scriptographic booklet. NRPA Publications, 17-19. O'Morrow, G. S.(1976). Therapeutic Recreation: A Helping Profession. Virginia, Reston: Publishing Company, Inc., 113-132, 178-202. Peterson, C. A., & Gunn, S. L.(1984). Therapeutic Recreation Program Design: principles and procedures. 2nd ed., Englewood Cliffs, New Jersey: Prentice- Hall, Inc., 11-52. Regan, K. J., Banks, G. K., & Beran, R. G.(1993). Therapeutic recreation programmes for children with epilepsy. Seiz ure, 2 (3), 195-200. Ross, J. E.(1993). Young adults with recent spinal cord injuries: transition from rehabilitation hospital to community living. University of Illinois at Urbana- Champaign, Degree: PHD. Russoniello, C. V.(1992). An exploratory study of physiological and psychological changes in alcoholic patients after recreation therapy treatments (physiological changes). Gonzaga University, Degree: EDD. Serban, G.(1979). Mental status, functioning and stress in chronic schizophrenic patients in community care. A merican Journal of Psy chiatry. 136, 948-953 WHO(1992). (1994). ICD- 10 -. :. Yalom, I. D.(1985)., (1993).. :. - 21 -