The importance of salutogenic psychoeducation in mental health disorders – the role of nursing staff

INTRODUCTION

Psychoeducation is a concept defined differently depending on the area of its use. Its classic approach can be treated as a stimulation of the development of an individual and a form of psychological help focused on prevention. It is an important therapeutic element for people with mental disorders and patients with chronic diseases, e.g. diabetes, oncological diseases, or cardiovascular diseases [1]. The continuous development of the patient’s potential or the acquisition of new key competences by the patient means not only obtaining information in the field of medicine and health care, but also learning to recognize one’s own needs and emotions. Naming the experienced feelings and their correct hierarchy is the basis for alleviating stress [2].
One of the most important concepts in the approach to health is the theory of salutogenesis (Latin salus – health, Greek genesis – origin), created by Aaron Antonovsky. In his theory, the sociologist rejected the pathogenetic approach to the issues of health and disease, focusing on elements conducive to health, thus introducing a new concept of the health–disease continuum. According to the researcher, between ideal health and a fatal disease there is a whole spectrum of states, depending on where a person currently lies on the continuum [3, 4]. The salutogenetic theory seeks the source of health, its author is based on the psychological concepts of stress and coping by Richard Lazarus and Suzan Folkman. The idea of an individual’s relationship with the environment is a transaction subject to cognitive evaluation of each situation important for its well-being. Health is defined as an important human resource that should be strengthened, and a balance should be sought between environmental conditions and individual predispositions [5, 6].
The aim of the study was to demonstrate, based on the latest literature, the role of psychoeducation in mental disorders and the role of nursing staff. A review of the literature contained in Polish and foreign peer-reviewed scientific journals was made.

REVIEW METHODS

To implement the topic of the work, the literature on psychoeducation in mental health disorders was analysed. The article presents both original papers and other review publications covering the subject of broadly understood psychoeducation, health education, and health promotion. Electronic databases (PubMed, Google Scholar, EBSCO) and phrases in Polish and English were mainly used for the search: Psychoeducation and Mental health disorders, and the total number of records received in response to key phrase searches was 320,796 items. The review included 30 full-text publications in Polish and English with publication dates from 1996 to 2021. The most important substantive criterion for inclusion of selected literature items in the presented review was the subject of the work. Articles in which the issues raised differed significantly from the review’s issues or were only a side or supplementary aspect were excluded.

DESCRIPTION OF THE STATE OF KNOWLEDGE

MENTAL HEALTH

The definition of mental health proposed by the World Health Organization (WHO) is based on the broadly under-stood well-being of an individual who is able to adapt to changing environmental conditions, is able to actively partici-pate in social life, and work effectively [7]. Despite the large amount of empirical material and various theoretical reports, there is no uniformity and consistency in defining it. The concept of health distinguishes the biological, mental, and social spheres, and some researchers have extended them to the spiritual dimension.
Health in human life is currently analysed as a resource subject to constant objective and subjective assessment [8]. The mental area of health consists of mental health related to cognitive processes, and emotional health is related to expressing and experiencing emotions. The social dimension of mental health is characterized by the ability to establish and maintain proper relationships in the environment of human life [9, 10].

BASIC THEORETICAL ASSUMPTIONS OF SALUTOGENESIS

The concept of salutogenesis, similarly to Hans Selye’s theory of stress, was created as a result of observation and analysis of empirical research results [11]. Contrary to the current pathogenic model, this theory enhances the preservation of health, not just the treatment of an existing disease.
Antonovsky assumes that the normal state of human existence is a dynamic state of unstable equilibrium. The individual is constantly exposed to various stimuli (stressors), to which they can react appropriately in order to maintain a dynamic balance of life processes [12]. Stressors are a widespread phenomenon and play a significant role in human life processes, and the level of health is largely determined by the ability to reduce negentropy [13].
In the salutogenic approach, the process approach to health allows one to determine its levels. The left pole (health-ease – HE) defines the full state of mental, physical, and social health, and the right pole (dis-ease – DE) is synonymous with a serious disease that threatens life and health in all its spheres. The assessment of the effects of the health process takes into account indicators similar to those used in medicine [14]. Health care professionals and/or the patient can assess the level of health using appropriate scales, specifying the following:
• pain,
• life activity of the individual,
• existing risk of disease,
• implications for health care, etc. [15].

THE IMPORTANCE OF PSYCHOEDUCATION IN MENTAL DISORDERS

People suffering from mental illnesses are considered dangerous, unpredictable, and aggressive, which intensifies the creation of social distance [16]. Most Poles claim that mental illnesses are embarrassing diseases that are hidden from the environment, almost every third person notices indifference towards the sick, and every fifth person notices aversion [17].
The main goal of psychoeducation is to teach the patient or their relatives the skills to control the disease. This contributes significantly to reducing the risk of its recurrence or hospitalization and improves the quality of life [18]. The concept of modern health psychoeducation requires the cooperation of various health professionals, taking into account the aspects of transculturalism [19].
Psychoeducation by shaping correct health behaviours and searching for individual ways of dealing with difficult situations has a fundamental impact on self-improvement and self-knowledge. The whole range of psychoeducational tasks strengthens positive thinking, faith, and hope, and allows various deficits to be overcome [20]. An important role in the process of psychoeducation and rehabilitation of people with mental disorders is played by the nursing staff, who have constant contact with the patient and their family. By observing the patient, they correctly determines their real problems, taking on the role of a health educator. Individualization of psychoeducation and meticulous profiling of relevant content contribute to the development of a patient’s conscious decision to change their current unhealthy habits [21, 22].
The main goals of psychoeducational interventions in mental health disorders carried out by nursing staff and other health care professionals include the following:
• increasing problem solving skills,
• strengthening crisis intervention skills,
• minimizing stigma,
• modifying attitudes and beliefs about the disease,
• training in everyday challenges,
• emotional support.

IMPACT OF THE SARS-COV-2 VIRUS PANDEMIC ON MENTAL HEALTH

The SARS-CoV-2 virus pandemic contributes significantly to the occurrence of mental health disorders of individual individuals, as well as the entire global society [23]. With the onset of the epidemiological crisis, a significant increase in the occurrence of anxiety and depression disorders and intensification of stress was observed [24]. On 12 March 2020, the Polish Psychiatric Association and the National Consultant in the field of psychiatry issued a nationwide appeal highlighting the problem that the coronavirus pandemic would have on the mental health of the population. They recognized the need to introduce preventive measures counteracting the negative consequences of psychopathology [25].
The restrictions related to the pandemic resulted in a significant decrease in the physical activity of the population, which had a negative impact on the protection of mental and somatic health [26, 27]. An increase in mortality and the number of suicidal attempts was recorded, as well as an increase in the consumption of psychoactive substances [28]. The multitude of negative factors shows the multidimensional nature of the problem, affecting many spheres of life and changing typical behaviours such as work or remote learning.
Psychoeducation by healthcare professionals, especially the nursing staff closest to the patient, is crucial in maintaining mental health. Effective strengthening of individual resources prevents the recurrence of the disease and has a positive effect on the general well-being of the individual, increasing the level of knowledge about one’s own health.
In the era of the SARS-CoV-2 virus pandemic, the dominant mental disorder was depression [29]. When conducting psychoeducational activities for people suffering from depressive disorders, the nursing staff undertake the following activities:
• establishing and maintaining contact with the patient (being open, authentic, accepting, and empathetic),
• focusing on what the patient is experiencing,
• using therapeutic silence,
• encouraging the patient to describe their experiences,
• clarifying,
• encouraging the patient to participate in occupational and cognitive therapy,
• education about the disease,
• education about the importance of therapy,
• reduction of common medications and fears,
• building hope,
• avoiding judging the patient,
• counteracting suicide attempts,
• ensuring physical activity adapted to the patient’s abilities,
• educating the patient on the strategy of dealing with depressive delusions,
• patient education on sleep hygiene [30].

SUMMARY

Psychoeducation is one of the methods of education aimed mainly at patients with mental health disorders. It is a significant enrichment of other classic therapeutic forms used in psychiatry. It is based on group or individual classes, using active learning techniques. The positive effects of its influence contribute to better therapeutic cooperation of the patient and improve their functioning. It is a valuable tool used in the work of healthcare personnel.
Nursing as a profession includes elements of psychoeducation in its activities. It requires acceptance of the other person and their often extreme behaviours, especially those occurring in mental health disorders. The most important and valued feature of nursing is humanism, which requires the establishment of special interpersonal relationships.

Disclosure

The authors declare no conflict of interest.

References