THE DEVELOPMENT OF THE PSYCHOSOCIAL NURSING PROGRAM FOR AUTISTIC ADOLESCENTS WITH DEPRESSION

Abstract

                Objective: 1) to develop and test content validity of a psychosocial nursing program developed for autistic adolescents with depression, and 2) to investigate effects of the program.

                Methods: This research and development study was conducted using the 5-step developing and testing process (Van Meijel, Gamel, Van Swieten Duijfjes, & Grypdonck, 2004). The steps were 1) determining problem by reviewing existing care, medical record, nurses’notes, and supervision report; 2) exploring needs, contents and activities, required for the program by reviewing existing knowledge and in-depth interviewing expert registered nurses, autistic adolescents with depression experts who had expertise and experience in focus group interview among parent groups and nurses giving care for autistic adolescents; 3) designing program by based on the psychosocial intervention model developed by the Institute of Medicine of the National Academies (2015) together with the data of problems and needs analysis, and gap of practice to determine scope and contents of activities; 4) testing content validity of the program with Item-Objective Congruence by the five experts, and evaluating appropriateness of language, duration, procedure, media, feasibility, acceptance, satisfaction and obstacles toward the program by five registered nurses; and 5) testing effect of the program using a quasi-experimental study to measure depression score at baseline, immediately on program completion and 1- month follow up. Participants were 22 autistic adolescents with depression and parents. The participants were recruited following the inclusion criteria. The experimental group received the psychosocial nursing program and usual care while the control group received usual care. Data collection in the experimental group were conducted after completion of that in the control group. Outcome measures consisted of Demographic Data Questionnaire, Children’s Depression Inventory-Thai version, and Program Satisfaction Questionnaire. Data were analyzed using descriptive statistics and Repeated Measure ANOVA.

                Results: The program developed comprised six activities including therapeutic relationship, psychoeducation and parent training, mindfulness-based therapy, relaxation skill training, social skill training (communication and problem-solving skills), and parent training. It was 8-session, individual-based program for the autistic participants. The parents took part in only two sessions. The program had the highest level of acceptance and clinical feasibility in terms of format, contents, activities presentation, coherence, duration, and clarity of media. The program was also beneficial for psychosocial care, feasibility, and clinical outcome. Result from testing effect of the program on depression showed that the mean score of depression significantly decreased at immediately on program completion and 1- month follow up, as compared to baseline (p < .01). The depression mean score of the experimental group was significantly lower than that of the control group at immediately on program completion and 1- month follow up (p < .01). It also found significant relationship between the program and time period for outcome measure (p < .01).

                Conclusion: The program could decrease depression of the participants at immediately on program completion and at 1- month follow up. It will thus be an alternative for psychiatric nurses to provide direct nursing focusing on quality psychosocial nursing care based on professional standard for autistic patients.