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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 12-15

Advancing mental health nursing practice in the Kingdom of Saudi Arabia: Rethinking nursing care for consumers with psychosis

1 School of Nursing and Midwifery, Monash University, Melbourne, Australia; Department of Community and Mental Health Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia
2 School of Nursing and Midwifery, Monash University, Melbourne, Australia

Date of Submission17-Apr-2020
Date of Decision22-Jul-2020
Date of Acceptance01-Aug-2020
Date of Web Publication09-Dec-2020

Correspondence Address:
Norah Mohammed Alyahya
3/13-15 Knox Street, Noble Park, VIC, 3174

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNSM.JNSM_35_20

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In this paper, the current mental health nursing care to recovery for consumers with psychosis in the Kingdom of Saudi Arabia (KSA) has been presented through one author's experience. This discussion showed major gaps in the practice. To advance this practice, it was important to understand the background of contemporary research about the role and work of nurses caring for consumers with psychosis and assisting with recovery. In addition, the perspectives of mental health nurses about their practice of care for psychosis globally were also provided. Finally, these global matters had been translated within the KSA context into advance mental health nursing care and recovery for psychosis in the aspects of education and practice. The emphasis on gender-focused research as an imperative need has been recommended.

Keywords: Nursing, psychosis, recovery

How to cite this article:
Alyahya NM, Munro I, Moss C. Advancing mental health nursing practice in the Kingdom of Saudi Arabia: Rethinking nursing care for consumers with psychosis. J Nat Sci Med 2021;4:12-5

How to cite this URL:
Alyahya NM, Munro I, Moss C. Advancing mental health nursing practice in the Kingdom of Saudi Arabia: Rethinking nursing care for consumers with psychosis. J Nat Sci Med [serial online] 2021 [cited 2023 Jan 28];4:12-5. Available from: https://www.jnsmonline.org/text.asp?2021/4/1/12/303904

  Introduction Top

The World Health Organization states that around 24 million people globally experience psychosis, and this tends to be a chronic and pervasive condition.[1] The Diagnostic Statistical Manual of Mental Disorders-5 states that psychosis is the most significant mental illness.[2]

All professionals working in mental health services play an important role in ensuring that consumers have a pathway to necessary support consumers with a mental illness; however, mental health nurses must often take on responsibility for providing additional support.[3] A nurse's role in caring for people with psychosis is to alleviate suffering, aid recovery, and minimize the risk of relapse.

  The Aim of the Paper Top

This paper aims to examine recovery care for people with psychosis in the Kingdom of Saudi Arabia (KSA), incorporating recovery models for psychosis into this context. There is a pressing need to reform and develop mental health practice in the KSA, especially in terms of working with consumers as they recover. This requires a close examination of contemporary mental health practice to allow the development of models that best fit KSA culture. Advancement of mental health nursing care will enhance client care and practice through research within the health-care environment and advance education in this area.

Contemporary mental health nursing care for people with psychosis: General overview

Mental health nursing in the KSA could be advanced, if Western mental health nursing literature was used to develop an understanding of consumers' experience of psychosis and recovery. However, this experience needs to be adapted to meet the needs of KSA culture. Contemporary mental health nursing within Western literature for people with psychosis focuses on two major aspects: nursing roles and interventions for psychosis; these are also accompanied by several factors to support nurses in their roles.

A nurse's role in caring for people with psychosis is to help in relieving symptoms, assist recovery, and minimize the risk of relapse.[3] These tasks are in part addressed through the development of an effective therapeutic relationship and skillful assessment of the consumer's needs, including risk identification to maximize health outcomes while also collaboratively working with family and carers.[3],[4],[5] Interventions are more important in the early phases of psychosis as nurses identify symptoms and apply ongoing assessments;[6] failure to conduct timely interventions could lead to consumers suffering longer durations of untreated psychosis, leading to an increase in anxiety and stress levels for staff trying to working with a consumer presenting with severe psychotic episodes.[3] Psychosis can also affect nurses' relationships with consumers; it has been reported that therapeutic relationships with consumers are the cornerstone of their work, especially during the recovery process, where they take on the role of empathic listeners guiding consumers to recovery.[7]

The development of support allows nurses to fulfill their roles and to grow capacity when working with consumers with psychosis effectively; nurses need support throughout this process, and this can be achieved through clinical supervision: an important process in nursing care. Intensive mental health training and peer support are significant supports that help nurses manage potential anxieties arising from working with consumers with psychosis.[3]

Engagement of consumers with psychosis within treatment

Within the first author's experience of some KSA mental health units, she has seen little engagement with treatment plans from nurses with consumers, despite such engagement being essential in mental health plan. The chronic nature of psychosis requires continuous engagement from both consumers and treatment team members, and mental health nurses playing a pivotal role in such teams.[8] Mental health nurses utilize a holistic biopsychosocial model of care, involving consumers in education to encourage to self-manage, as well as offering spiritual support. The importance of the consumer's perspective and their wishes must be emphasized in any treatment decisions.[9]

The global context of nurses working with consumers in their recovery from psychosis

A global literature overview is offered here to give an idea of the way, in which nurses conceptualize recovery and what factors they identify as helping or hindering recovery including strategies to facilitate recovery. Within KSA, the knowledge and experience of nurses working with consumers with psychosis are lacking and needs to be improved.

A sense of hope with regard to consumers' recovery and well-being offers motivation for nurses to include in their practice.[3] Kaewprom et al. claim many nurses conceptualize recovery from psychosis as a gradual change and improvements in consumer thoughts and behaviors.[10] Nurses identify facilitators of recovery, which include supportive families and communities.[3],[11],[12],[13],[14] Nurses viewed stigma toward consumers with mental illness as a significant barrier to recovery.[10]

To support and facilitate recovery with consumers, nurses targeted strategies such as presence intervention.[13] Being present with consumers facilitates recovery producing a calming environment, building relationships, and allowing bonding, providing consumers with hope for recovery. Another common strategy is working behind the scene that means working around the consumers with a little awareness of consumers. The nurses use an invisible network of contacts and discussions with colleagues or with consumers' families about how consumers were managing activities of daily living, symptom management, and medication compliance.[13]

Current mental health nursing practice for consumers with psychosis in the Kingdom of Saudi Arabia

At present, there is no research examining mental health nursing (MHN) and consumers with psychosis in the KSA, as this is in its infancy. By examining nurses' experiences of caring for consumers with mental illness identifies gaps in their understanding of mental illness. In addition, no mental health nursing research in the KSA has specifically examined psychosis and recovery, presenting a gap. Given the lack of current research, the first author has chosen to write about her personal experiences as an educator in mental health nursing as a way of identifying current practice. In addition, personal reflections based on observation and discussions with nurses about current practice within mental health nursing will be discussed.

Throughout the first author's experience training undergraduate nurses in mental health units, she has found shared issues emerging from nurses working within these units. In the KSA, there is no specialized postgraduate mental health nursing degree; the nurses who first author has met have held a mixture of diploma and bachelor's degrees in general nursing; very few have any form of specialized degree in mental health nursing. Some nurses had no advanced specialized training in mental health nursing before their exposure to consumers, raising the concern about their limited understanding of mental illness or psychosis.

Some units have nurses who are expatriates who do not speak Arabic well. This creates a communication gap with consumers, given that communication is central to therapeutic communication, such poor communication can create a tense atmosphere. More importantly, consumers feel they are not understood, and their needs are not being met.

Finally, nurses in these units do not have clinical supervision; this is absent across the country. This is a major concern, as nurses could use a trial and error method and not drawing upon evidence-based practice.

Translation of contemporary mental health nursing into the Kingdom of Saudi Arabia context

Drawing upon the first author's experiences of mental health nursing in the KSA, comparing it with contemporary mental health nursing recovery principles, there is a clear need and fit within the KSA culture.

  Advanced Education for mental Health Nursing Top

Currently, there is no postgraduate mental health nursing degree in the KSA, while there are aspects of mental illness in all undergraduate mental health courses, this is inadequate to address the needs of the mental health services and consumers; therefore, there is a need to develop a postgraduate mental health nursing course. The postgraduate course must use principles of mental health recovery to improve mental health nursing care for people with mental illness.

  Advanced Mental Health Nursing Practice Top

The KSA mental health system should develop in-service education or training for nurses working with consumers and their psychosis, developing practice guidelines to assist nurses working in mental health facilities. These guidelines should be tailored to meet the specific needs of various mental illnesses, including psychosis, and must consider incorporating religious and cultural social norms into the nurses' care. One KSA example is the concept of the evil eye, which is also seen in other cultures such as Greek and Italian rural society.[15],[16] The idea of the evil eye is conventional in Saudi society, despite being deemed eccentric by some mental health practitioners; this underpins the need to understand cultural considerations to be accounted for in any mental health nursing practice.

To decrease the problem of misunderstandings and to facilitate communication between nurses and consumers, expatriate nurses should be required to undertake Arabic courses. Another solution would be employing additional Arabic-speaking nurses in mental health units. In addition, the nurses' practice urgently requires the establishment of clinical supervision for nurses within the KSA mental health system. Collegial supervision could be sufficient to achieve proficient nursing care. There is also a pressing need for more planned decision sharing between consumers and nurses in relation to treatment plans; this is a central element of recovery.

Within the KSA context, there has been no research that has examined recovery models applied to either mental illness in general terms or psychosis more specifically. This is a gap in mental health practice that must be addressed in terms of developing a model of recovery suitable for the KSA context which can be applied within mental health units. Once a model for recovery is developed, there is a need for education programs for both consumers and carers, along with nurses and other health-care staff, so they are informed about psychosis and the various approaches that promote recovery. In the broader community, some individuals in KSA stigmatize psychosis and other mental illness, which does not assist consumers in their recovery. To combat and breakdown these barriers, flexible community education programs that incorporate media information either online or other media to give education about mental illness should be developed and delivered to the community.

  Gender-Focused Psychosis Studies Top

Understanding the impact of gender is an important recommendation for the advancement of mental health nursing practice in the KSA. Within the KSA context, Almutairi noted the need for further study into the mental health of women, as this is vital for the future of mental health services.[17] Gender-specific psychosis experience has not been explored through qualitative methods, only through quantitative research. One example was a study that found the duration of untreated psychosis in women was longer than in men in the KSA, suggesting that seeking mental health treatment is delayed for women. This may occur because a husband might believe that it is better for the family to keep his wife's illness a secret to preserve his standing in society, as this could affect the likelihood of marriage for any children.[18] This is adding up of a stigma that stops women from seeking treatment, which reported about Arab women with mental illness.[19]

Al-yahya examined the effects of psychoeducational intervention in terms of increasing women's insight into their illnesses and improving medication adherence among women with schizophrenia in the KSA.[20] Although the study reported improved insight and adherence to medication regimens in women after such interventions, it failed to examine any gender-specific issues. Studies related to women with psychosis in the KSA remain limited, and work in this area needs to be amplified.

  Conclusion Top

This paper is written as an opinion, as it is important to provide an understanding of the consumers' experience of psychosis and mental health nurses providing this care. Raising the context of psychosis in the KSA, examining the cultural perspectives and gender-based studies shows that there needs to be more consideration and exploration of this area. To date, within KSA, there is no study examining nurses working with mental health consumers and providing psychosis care, depicting a gap in psychosis and mental health nursing research in this country; therefore, to address this gap is essential. This must also address the educational needs about contemporary knowledge of mental health nursing, commencing with increasing the content of undergraduate mental health nursing and the development and offering a postgraduate degree in mental health nursing.

Financial support and sponsorship

The research reported in this publication has arisen from the PhD. candidature of the first author while at Monash University. The second and third authors are the candidate's research supervisors. The first author has received financial support for PhD. study from King Saud University, Riyadh, Saudi Arabia. The supporting organization has had no influence or requirements on the interpretation in the article, and has no right to disapprove publication of the finished manuscript.

Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Mental Health Atlas 2011. Geneva, Swizerland: World Health Organization; 2011.  Back to cited text no. 1
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, Virginia: American Psychiatric Association; 2013.  Back to cited text no. 2
Odeyemi C, Morrissey J, Donohue G. Factors affecting mental health nurses working with clients with first-episode psychosis: A qualitative study. J Psychiatr Ment Health Nurs 2018;25:423.  Back to cited text no. 3
Valencia M, Juarez F, Ortega H. Integrated treatment to achieve functional recovery for first-episode psychosis. Schizophr Res Treatment 2012;2012:9.  Back to cited text no. 4
Wiechula R, Conroy T, Kitson AL, Marshall RJ, Whitaker N, Rasmussen P. Umbrella review of the evidence: What factors influence the caring relationship between a nurse and patient? J Adv Nurs 2016;72:723-34.  Back to cited text no. 5
Keks N, Blashki G. The acutely psychotic patient- assessment and initial management. Aust Fam Phys 2006;35:90-4.  Back to cited text no. 6
Reed SI. First-episode psychosis: A literature review. Int J Ment Health Nurs 2008;17:85-91.  Back to cited text no. 7
Mahone IH, Maphis DE, Snow DE. Effective strategies for nurses empowering clients with schizophrenia: Medication use as a tool in recovery. Issues Ment Health Nurs 2016;37:372-9.  Back to cited text no. 8
Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B; CDBE2010 study group, et al. The economic cost of brain disorders in Europe. Eur J Neurol 2012;19:155-62.  Back to cited text no. 9
Kaewprom C, Curtis J, Deane FP. Factors involved in recovery from schizophrenia: A qualitative study of Thai mental health nurses. Nurs Health Sci 2011;13:323-7.  Back to cited text no. 10
Engqvist I, Fertz G, Nilsson K. Swedish registered psychiatric nurses' descriptions of presence when caring for women with post-partum psychosis: An interview study. Int J Ment Health Nurs 2010;19:313-21.  Back to cited text no. 11
Korteland TW, Koorengevel M, Poslawsky IE, Berno M. Nursing interventions for patients with postpartum psychosis hospitalized in a psychiatric mother-baby unit: A qualitative study. J Psychiatr Ment Health Nurs 2019;26:254-64.  Back to cited text no. 12
Moe C, Brinchmann B, Brinchmann BS. 'Working behind the scenes' an ethical view of mental health nursing and first-episode psychosis. Nurs Ethics 2012;20:517-27.  Back to cited text no. 13
White MR, Stein-Parbury J, Orr F, Dawson A. Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia. Int J Ment Health Nurs 2019;28:605-15.  Back to cited text no. 14
Staff MW. Merriam-Webster's Encyclopedia of World Religions. Portland: Ringgold Inc.; 2000.  Back to cited text no. 15
Maloney C. The Evil eye. In: Maloney C, editors: New York: Columbia University Press; 1976.  Back to cited text no. 16
Almutairi AF. Mental illness in Saudi Arabia: An overview. Psychol Res Behav Manag 2015;8:47.  Back to cited text no. 17
Al Fayez H, Lappin J, Murray R, Boydell J. Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia. Early Interv Psychiatry 2017;11:47-56.  Back to cited text no. 18
Al-Krenawi A, Graham JR, Al-Bedah EA, Kadri HM, Sehwail MA. Cross-national comparison of Middle Eastern university students: Help-seeking behaviors, attitudes toward helping professionals, and cultural beliefs about mental health problems. Community Ment Health J 2009;45:26-36.  Back to cited text no. 19
Al-yahya NM. Effects of psycho education intervention in improving insight and medication compliance of schizophrenic clients, Riyadh, Saudi Arabia. World J Med Sci 2014;11:289-300.  Back to cited text no. 20


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